Chapter 17: Mood Disorders and Suicide 1

Key Terms:
1. Anergia: lack of energy
2. Anhedonia: having no pleasure or joy in life; losing any sense of pleasure from activities formerly
enjoyed
3. Electroconvulsive therapy (ECT): used to treat depression in select groups such as clients who
do not respond to antidepressants or those who experience intolerable medication side effects
at therapeutic doses
4. Euthymic: normal or level mood
5. Flight of ideas: excessive amount and rate of speech composed of fragmented or unrelated
ideas; racing, often unconnected thoughts
6. Hypertensive crisis: a life-threatening condition that can result when a client taking MAOIs
ingests tyramine-containing foods and fluids or other medications
7. Hypomania: a period of abnormally and persistently elevated, expansive, or irritable mood lasting
4 days; does not impair the ability to function and does not involve psychotic features
8. Kindling: the snowball-like effect seen when a minor seizure activity seems to build up into more
frequent and severe seizures
9. Lability emotions: emotions that are rapidly changing or fluctuating
10. Latency of response: refers to hesitation before the client responds to questions
11. Mania: a distinct period during which mood is abnormally and persistently elevated, expansive,
or irritable
12. Mood disorders: pervasive alterations in emotions that are manifested by depression or mania or
moth
13. Pressured speech: unrelenting, rapid, often loud talking without pauses
14. Psychomotor agitation: increased body movements and thoughts
15. Psychomotor retardation: overall slowed movements; a general slowing of all movements; slow
cognitive processing and slow verbal interaction
16. Rumination: repeatedly going over the same thoughts
17. Seasonal affective disorder (SAD): mood disorder with two subtypes; in one, most commonly
called winter depression or fall-onset SAD, people experience increased sleep, appetite and
carbohydrate cravings; weight gain, interpersonal conflict; irritability; and heaviness in the
extremities beginning in late autumn and abating in spring and summer; the other subtype, called
spring-onset SAD, is less common and includes symptoms of insomnia, weight loss, and poor
appetite lasting from late spring or early summer until early fall
Chapter 17: Mood Disorders and Suicide 2
18. Suicidal ideation: thinking about killing oneself
19. Suicide: the intentional act of killing oneself
20. Suicide precautions: removal of harmful items; increased supervision to prevent acts of self-harm
Learning Objectives:
1. Discuss etiologic theories of depression and bipolar disorder.
1. Biological theories:
1. Genetic theories: implicate the transmission of major depression in first-degree relatives, who are
at twice the risk for developing depression compared with the general population; first-degree
relatives of people with bipolar disorder have a 3-8% risk for developing bipolar disorder
2. Neurochemical theories: Deficits of serotonin, its precursor tryptophan, or a metabolite (5-
hydroxyindole acetic acid, or 5-HIAA) of serotonin found in the blood or cerebrospinal fluid occur
in people with depression. Norepinephrine levels may be deficient in depression and increased in
mania. Elevated glucocorticoid activity is associated with the stress response, and evidence of
increased cortisol secretion is apparent in about 40% of clients with depression. Kindling is the
process by which seizure activity in a specific area of the brain is initially stimulated.
3. Neuroendocrine influences: hormonal fluctuations; mood disturbances have been documented in
people with endocrine disorders. Elevated glucocorticoid activity is associated with the stress
response, and evidence of increased cortisol secretion is apparent in about 40% of clients with
depression.
2. Psychodynamic theories: Most of these theories seem to blame the victim and their family for their
mood disorders.
1. Most psychoanalytical theories of mania view manic episodes as a defense against underlying
depression with the id taking over the ego and acting as an undisciplined hedonistic being (child).
1. Describe the risk factors for and characteristics of mood disorders.
1. Risk factors:
1. Depression is one of the most important risk factors (page 296)

2. Suicide, and suicide attempts

3. Bipolar disorder

4. Schizophrenia, substance use disorders, antisocial and borderline personality disorders, and panic
disorders are also at increased risk for suicide and suicide attempts

2. Characteristics:
1. Changes in eating habits resulting in unplanned weight gain or loss
Chapter 17: Mood Disorders and Suicide 3
2. Hypersomnia or insomnia
3. Impaired concentration, decision making or problem solving abilities

4. Inability to cope with daily life

5. Feelings of worthlessness, hopelessness, guilt, or despair
6. Thoughts of death and/or suicide
7. Overwhelming fatigue

8. Rumination with pessimistic thinking with no hope of improvement

9. Mania

10. Pressured speech

11. Flight of ideas

12. Hypomania
2. Apply the nursing process to the care of clients and families with mood disorders.
1. Assessment
1. History: behavioral changes, previous episodes of depression, treatment, and the clients response
to treatment; family history of mood disorders, suicide, or attempted suicide
2. General appearance and motor behavior: posture, eye contact; psychomotor retardation; latency
of response; psychomotor agitation

3. Mood and affect: hopeless, helpless, down or anxious; failure at life; anhedonia; apathetic, not
caring for themselves, activities, or much of anything; sad or depressed affect, flat affect; sit alone,
staring into space, minimal interactions; withdrawn
4. Thought process and content: slowed thinking processes; may not respond verbally to questions;
tend to be negative and pessimistic in their thinking; make self-deprecating remarks, criticizing
themselves harshly and focusing only on failures or negative attributes; rumination; delusions;
suicidal thoughts
5. Sensorium and intellectual processes: orientation; general knowledge; memory; hearing voices;
hallucinations;

6. Judgment and insight: impaired judgment; cant make decisions or choices because of extreme
apathy or negative belief that it doesnt matter anyway
7. Self-concept: reduced self-esteem; guilty about not being able to function; believe that others
would be better off without them, leading to suicidal thoughts
Chapter 17: Mood Disorders and Suicide 4
8. Roles and relationships: difficulty fulfilling roles; greater the depression, the greater the difficulty;
problems going to work or school; less able to cook, clean, or care for children; avoid family and
social relationships because they feel overwhelmed, unworthy, no pleasure
9. Physiologic and self-care consideration: pronounced weight loss because of lack of appetite or
disinterest in eating; sleep disturbances, loss of interest in sexual activities; men: impotence;
constipation

10. Depression rating scales

1. Zung Self-Rating Depression scale

2. Beck Depression Inventory

3. Hamilton Rating Scale for Depression is a clinician-rated depression scale used like a clinical
interview. Clinician rates the range of the clients behaviors such as depressed mood, guilt,
suicide, and insomnia.
2. Data Analysis: analyze the assessment data to determine priorities to establish a plan of care
3. Outcomes
4. Interventions:
1. Provide for safety of the client and others

2. Institute suicide precautions if indicated

3. Begin a therapeutic relationship by spending non demanding time with the client

4. Promote completion of activities of daily living by assisting the client only as necessary
5. Establish adequate nutrition and hydration
6. Promote rest and sleep
7. Engage the client in activities

8. Encourage the client to verbalize and describe emotions

9. Work the with client to manage medications and side effects

5. Evaluation: Its essential that clients feel safe and do not experience uncontrollable urges to commit
suicide. Participation in therapy and med compliance produce more favorable outcomes for clients
with depression. Being able to identify signs of relapse and to seek treatment immediately can
significantly decrease the severity of a depressive episode
2. Provide education to clients, families, caregivers, and community members to increase knowledge
and understanding of mood disorders.
1. Education for depression:
Chapter 17: Mood Disorders and Suicide 5
1. Teach about the illness of depression
2. Identify early signs of relapse

3. Discuss the importance of support groups and assist in locating resources

4. Teach the client and family about the benefits of therapy and follow up appointments
5. Encourage participation in support groups
6. Teach the action, side effects, and special instructions regarding medications

7. Discuss methods to manage side effects of medication.

2. Education for mania:

1. Teach about bipolar illness and ways to manage the disorder.

2. Teach about medication management, including need for periodic blood work and management of
side effects

3. Lithium: teach about need for adequate salt and fluid intake
4. Teach the client and family about signs of toxicity and the need to seek medical attention
immediately
5. Educate the client and family about risk-taking behavior and how to avoid it

6. Teach about behavioral signs of relapse and how to seek treatment in early stages.
3. Identify populations at risk for suicide.

1. 72% of suicides are men

2. Clients with psychiatric disorders, especially depression, bipolar disorder, schizophrenia, substance
abuse, PTSD, and borderline personality disorder are at an increased risk for suicide.
3. Chronic medical illnesses such as cancer, HIV, AIDS, diabetes, CVAs, and head and spinal cord
injuries
4. Environmental factors: unemployment, critical life events, family hx of depression or suicide.
5. Behavioral factors: impulsivity, erratic or unexplained changes from unusual behavior and unstable
lifestyle
3. Apply the nursing process to the care of a suicidal patient.

1. Assessment
1. Previous suicide attempts (first 2 years after-highest risk period, especially first 3 months); relative
who committed suicide; warnings of suicidal intent; risky behavior, lethality assessment: does the
patient have a death plan? specific and positive answers to lethality assessment questions
increase the clients likelihood of committing suicide.
Chapter 17: Mood Disorders and Suicide 6
2. Never ignore any hint of suicidal ideation regardless of how trivial or subtle it seems and the
clients intent or emotional status. Asking clients directly about thoughts of suicide is important.

2. Intervention
1. Use an authoritative role to help the client stay safe

2. Provide a safe environment: Remove any items they can use to commit suicide, such as sharp
objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with drawstrings.
3. observe clients every 10 minutes if lethality is low. Clients with high potential lethality, one-to-one
supervision by staff is initiated. Clients are in direct sight no more than 2-3 ft away including going
to the bathroom.
4. Create a support system list: Mental health clinics, hotlines, psychiatric emergency evaluation
services, student health services, church groups, and self-help groups are part of the community
support system.
5. No-self-harm contract, contract for safety: clients agree to keep themselves safe and to notify staff
at the first impulse to harm themselves
3. Assessment for elders
1. Depression is common among elderly; marked increase when elders are medically ill
2. It is NOT expected, not a normal part of aging.

3. 14% of elders suffer with depression

4. Evaluate your feelings, beliefs, and attitudes regarding mood disorders and suicide.
1. Nurses working with clients who are depressed often empathize with them and also begin to feel sad
or agitated, or start to avoid contact with these clients to escape such feelings. Nurses should monitor
their feelings and reactions closely when dealing with clients with depression to be sure they fulfill their
responsibility to establish a therapeutic nurse-client relationship.

2. Some health-care professionals consider suicidal people to be failures, immoral, or unworthy of care.
3. The nurse must be aware of his or her own feelings and beliefs about suicide.