Download Guided Lecture Notes, Chapter 1

Guided Lecture Notes, Chapter 17, Mood Disorders and Suicide
Learning Objective 1. Discuss etiologic theories of depression and bipolar disorder.

Introduce the terms anergia and euthymic mood.

Provide an overview of mood disorders. (Refer to PowerPoint slides 2 and 3.)

List the categories of mood disorders: depression and bipolar disorders. (Refer to
PowerPoint slide 4.)

Describe the biologic theories associated with mood disorders: genetic and
neurochemical theories and neuroendocrine influences. (Refer to PowerPoint
slide 5.)

Discuss that evidence implicates the transmission of major depression in firstdegree relatives.

Explain that serotonin and norepinephrine are the two major biogenic amines
implicated in mood disorders. (Refer to PowerPoint slide 5.)

Explain that hormonal fluctuations may cause depression.

Discuss various psychodynamic perspectives and point out that, overall, they
seem to locate the cause within the person or his or her family. (Refer to
PowerPoint slides 6 and 7.)
Learning Objective 2. Describe the risk factors for and characteristics of mood
disorders.

Introduce the categories of major depression and bipolar disorder. (Refer to
PowerPoint slide 4.)

Distinguish between bipolar I disorder and bipolar II disorder.

Briefly discuss characteristics of related disorders such as dysthymia,
cyclothymia, substance-induced depressive or bipolar disorder, nonsuicidal selfinjury, seasonal affective disorder, premenstrual dysphoric disorder, postpartum
depression, and postpartum psychosis. (Refer to PowerPoint slide 4.)

Describe the diagnostic criteria for major depressive disorder.

Describe the diagnostic criteria for bipolar disorder.
Learning Objective 3. Apply the nursing process to the care of clients and families with
mood disorders.

For depression (Refer to Nursing Care Plan: Depression): Discuss significant
assessment findings revealed in the patient’s history and expected findings related
to general appearance and motor behavior, mood and affect, thought process and
content, sensorium and intellectual processes, and judgment and insight. Discuss
expected changes in self-concept, roles and relationships, and physiologic and
self-care status. (Refer to PowerPoint slides 14 and 15.)
o Introduce rating scales that can be used to assess and rate depression;
differentiate between self-rating scales and clinician rating scales. (Refer
to PowerPoint slide 15 and Box 17.1.)
o List nursing diagnoses commonly appropriate for the care of the patient
with major depression.
o Identify outcomes that would reflect improved functioning of the
depressed patient, emphasizing that the priority behavior is freedom from
self-injury.
o Discuss appropriate interventions by describing specific ways to provide
for safety, develop the therapeutic relationship, promote daily functioning,
use therapeutic communication, and manage medications. (Refer to
PowerPoint slide 19.)
o Discuss the effective use of SSRIs (Refer to Table 17.1), TCAs (Refer to
Table 17.2), atypical antidepressants (Refer to Table 17.3), and MAOIs
(Refer to Table 17.4). (Refer to PowerPoint slide 12.)
o Describe ECT and associated nursing care. (Refer to PowerPoint slide
13.)
o Discuss psychotherapy used for treatment of depression. (Refer to
PowerPoint slide 13.)
o Discuss the goals of combined therapy: symptom remission, psychosocial
restoration, prevention of relapse or recurrence, reduction in secondary
consequences, and increased treatment compliance.
o Review how interpersonal therapy and behavior therapy are used for
treatment.
o Discuss cognitive therapy and the correction of cognitive distortions.
(Refer to PowerPoint slide 13 and Table 17.5.)
o Briefly review treatments that are currently being tested for depression.
o Give specific interventions to manage side effects of antidepressant
medications. (Refer to Tables 17.1–17.4.)
o Illustrate questions to consider that would evaluate successful treatment
outcomes.

For bipolar disorder (Refer to Nursing Care Plan: Depression): Discuss
significant assessment findings related to mania expected in general appearance
and motor behavior, mood and affect, thought process and content, sensorium and
intellectual processes, and judgment and insight. (Refer to PowerPoint slides 22
and 23.)
o Discuss expected changes in self-concept, roles and relationships, and
physiologic status. (Refer to PowerPoint slide 23.)
o List nursing diagnoses commonly appropriate for the care of the patient
with bipolar disorder.
o Identify outcomes that would reflect improved functioning of the patient
with bipolar disorder, emphasizing that the priority behavior is freedom
from injury to self or others.
o Discuss appropriate interventions by describing specific ways to provide
for safety, meet physical needs, provide therapeutic communication,
promote appropriate behaviors, and manage medications. (Refer to
PowerPoint slide 26 and Nursing Interventions for Mania.)
o Discuss the use of lithium and anticonvulsant drugs for bipolar disorder.
(Refer to PowerPoint slide 21 and Table 17.6.)
o Discuss the importance of assessing for signs of toxicity and ensuring that
patients and their families have this information before discharge. (Refer
to Table 17.7.)
o Illustrate questions to consider that would evaluate successful treatment
outcomes.
Learning Objective 4. Provide education to clients, families, caregivers, and community
members to increase knowledge and understanding of mood disorders.

Discuss teaching necessary for the patient and family living with major
depression. (Refer to PowerPoint slide 19 and Client Family Education for
Depression.)
o Include topics such as how to manage the medications, how often the
patient needs to return for monitoring and diagnostic tests, the beginning
symptoms of relapse, the effectiveness of psychotherapy and
antidepressants in combination, and available support groups such as The
National Alliance for the Mentally Ill.

Discuss teaching necessary for the patient and family living with bipolar disorder.
(Refer to PowerPoint slide 26.)
o Include topics such as educating patients about the dangers of risky
behavior, the cause of bipolar disorder, medication management, ways to
deal with behaviors, potential problems that manic people can encounter,
adherence to the established dosage of lithium, drugs that interact with
lithium, the necessity of periodic monitoring of serum lithium levels, and
symptoms of lithium toxicity and interventions to take.
Learning Objective 5. Identify populations at risk for suicide.

Correlate depression as one of the most important risk factors for suicide, and
specify risk factors such as family strife, parental alcoholism or mental illness,
history of fighting, and access to weapons.

Define suicidal ideation. (Refer to PowerPoint slide 27.)

Emphasize that suicide involves ambivalence.

Discuss the epidemiology of suicide by gender, and identify population groups at
greatest risk. (Refer to PowerPoint slide 28.)
Learning Objective 6. Apply the nursing process to the care of a suicidal client.

Illustrate warning signs of suicidal intent, risky behaviors, and discuss areas to be
assessed in a lethality assessment. (Refer to PowerPoint slide 28 and Boxes 17.2
and 17.3.)

Identify outcomes that would reflect improved functioning of the suicidal patient,
emphasizing that the priority behavior is freedom from self-injury.

Discuss nursing interventions, emphasizing the need for safety. (Refer to
PowerPoint slide 29.)

Point out the need for the nurse to assume a more directive role than with patients
who are nonsuicidal. (Refer to PowerPoint slide 31.)

Explain the use and effectiveness of a no–self-harm contract.

Discuss ways to provide for a safe environment and create a support system.
(Refer to PowerPoint slide 31.)

Discuss therapeutic interventions when working with the family, accounting for
the possibility of guilt, anger, and sadness. (Refer to PowerPoint slide 30.)

Explore the nurse’s response to suicidal ideation or attempts.

Discuss the legal and ethical issues of assisted suicide. (Refer to PowerPoint
slide 32.)
Learning Objective 7. Evaluate your feelings, beliefs, and attitudes regarding mood
disorders and suicide.

Explore personal feelings regarding suicide, and discuss how they may affect
nursing care. (Refer to PowerPoint slide 40.)

Explore the possibility for frustration when working with patients with mood
disorders.

Discuss effective ways for nurses to cope with personal feelings, including when
faced with patients who are suicidal.