Therapeutic Communication
Name three nontherapeutic communication techniques.
overhelping, controlling, narcissism, transference, counter transference, blurred boundaries, judging, shaming, dismissing, blocking, unavailability, inconsistency
Which type of bipolar is classified as: at least 1 episode of persistent, elevated, expansive or irritable mood (mania) and at least one clearly recognizable episode of major depression
Bipolar 1
True or False: children with depression may present with irritability instead of depressed mood.
True
This gender and age group have the highest suicide rate.
Elderly men
tyramine, fermented foods, aged foods, and certain beverages
Of the three phases of the nurse patient relationship, which phase does laying expectations, setting parameters, and starting termination of the relationship.
Orientation
A decreased need for sleep and a lot of daytime sleepiness can be clues to __________.
hypomania
Name three risk factors for depression.
History of depressive episodes (personal or family member)
History of suicide attempts (personal or family member)
Member of LGBTQ+ community
Female gender
Age 40 or younger
Postpartum period
Chronic Medical Illness
Absence of social support
Negative, stressful life events
Active alcohol or substance use
History of sexual abuse
The national suicide hotline number is:
800-273-talk
This medication reduces anxiety without immediate sedative and mildly euphoric effects of others in the same class.
Buspirone/Buspar
A patient has just received distressing news about their diagnosis. They seem withdrawn and quiet.
Discuss the importance of nonverbal communication in this context.
A mnemonic for bipolar symptoms is DIG FAST. This stands for:
Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity, Sleep needs diminish, Talkative
----Daily Double----
What theory is based on the assumption that biological predisposition with stressors equals decreased neurotransmitter receptor sites.
Stress diathesis theory
Give an example of three factors that increase an individuals risk for suicide.
Health: Comorbid mental health problems
Environmental: Access to means, prolonged stress in relationships, bullying, loss of employment, divorce, exposure to suicide either known or through media
Historical: Previous attempts, family history of suicide or adverse childhood events
Neurobiologic aspects of suicide: Strong association between suicide & low serotonin.
Noradrenergic systems: Overactivity associated with severe anxiety, agitation, and a high suicidal risk.
Hypothalamic-pituitary-adrenal (HPA) axis: Suicide victims often exhibit HPA axis abnormalities.
Genetic factors: Suicide clusters develop in some families
Societal factors: No social supports to combat negative events and severe stress.
Psychologic factors: Psychotic tendencies result in increased risk
This mood stabilizer can cause changes in hydration status.
Lithium
Explain how using open-ended questions can enhance communication with the patient.
Using open-ended questions encourages the patient to express themselves more fully, facilitating a deeper conversation and allowing the nurse to understand the patient's concerns and emotions better.
Rapid cycling consists of or more distinct episodes of alternating mania and depression in a month period. Usually indicates more severe symptoms and resistance to treatment.
4 episodes and 12 months
This treatment for depression focuses on identifying and testing negative thoughts, developing alternative thinking patterns, and rehearsing new cognitive and behavioral responses.
Cognitive behavioral health
"I will not be bothering you any more" is an example of what type of statement?
Covert
This class of medications can cause a hypertensive crisis.
MAOIs
You are caring for a bipolar who appears anxious and expresses feelings of fear and uncertainty about the future.
Describe two therapeutic communication techniques you would use to support this patient.
Active listening: This involves fully concentrating, understanding, responding, and remembering what the patient says.
Empathy: This involves recognizing the patient’s feelings and validating their emotions.
What classification of bipolar has a high risk of suicide?
Mixed bipolar
---- Daily Double ----
A single episode of symptoms exhibit what type of depression: depressed mood most of the day, markedly diminished pleasure in all or most activities, hypersomnia, feelings of worthlessness, hopelessness, helplessness or excessive, inappropriate guilt, diminished ability to concentrate, recurrent suicidal ideation without a plan.
Major Depressive Disorder
May be a single episode or recurrent
5 or more of the following symptoms present during the same two week period and include depressed mood or anhedonia
Depressed mood most of the day
Markedly diminished pleasure in all or most activities
Significant weight loss when not dieting
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or anergia – 97% of people with depression have this
Feelings of worthlessness, hopelessness, helplessness or excessive, inappropriate guilt
Diminished ability to concentrate or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation with or without a plan
What patient education would you give a parent regarding behaviors that are concerning for a potential suicide attempt.
Sudden behavioral changes include:
Giving away prized possessions
Writing farewell notes
Making out a will
Putting personal affairs in order
Failing to sleep or fall asleep for more than one night in a row (global insomnia)
Exhibiting sudden or unexpected improvement in mood after being depressed and withdrawn
Neglecting personal hygiene
The therapeutic range for Lithium is ______.
0.6 to 1.2 mEq/L
Mild toxicity: 1.5 to 2.5 mmol/L (millimoles per liter). Moderate toxicity: 2.5 to 3.5 mmol/L. Severe toxicity: Higher than 3.5 mmol/L