Adaptive functions of emotions
• Social communication• Physiological arousal• Subjective awareness• Psychodynamic
defense
Adaptive emotional responses
• Implies an openness and awareness of feelings
• An example is an uncomplicated grief reaction
Maladaptive emotional responses
• A detachment or denial of one’s feelings
• Suppression of emotions and a delayed grief reaction are examples of a maladaptive response
• Mania and depression are other examples.
Grief
• Is the subjective state that follows loss
• Two types of pathological grief reactions are:
• delayed grief reaction and distorted grief reaction (depression)
Lifetime Risk for Depression
• For women 20-30% risk
• For men 7-12% risk• Depression often
occurs along with other medical and psychiatric illnesses
Bipolar Disorders
• A depressive episode with previous or current manic episodes.
• Mania is an elevated or irritable mood.
Depression
• Behaviors may vary.
• Key element here is change in assessing behavior
• A change in usual behavior patterns
• The most common behaviors are depressive mood, anxiety, and somatic complaints.
Risk Factors for depression
• Prior episodes of depression• Fhx• Prior suicidal attempts• Female gender• Age at onset < 40 years old• Medical comorbidity• Personal hx of sexual abuse• Substance abuse
Postpartum blues
• Are brief episodes lasting 1-4 days that occur in 50-80 % of women within 1-5 days of delivery.
• Postpartum depression occurs from 2-12 months after delivery, risk is 10-15%.
• Postpartum psychosis- low incidence, onset 2-3 days post delivery.
Seasonal Affective Disorder (SAD)
• Depression that comes with shortened hours of daylight in winter and fall and disappears during spring and summer.
Potential for suicide
• 15% of severely depressed patients commit suicide
• 25-50% of patients with bipolar disorder attempt suicide at least once.
Predisposing Factors of depression
• Genetics in the case of recurrent depression and bipolar disorder.
• Aggression turned inward theory (Freud)-anger turned inward
• Object loss theory -ruptured tie between mother and child• Personality organization theory- poor self-concept• cognitive model-related to disturbed thinking• Helplessness/hopelessness model- no control over
outcomes in life• Behavioral model- person affects environment with
reinforcement variable
Biological Model
• Mood disorders result from dysregulation in neurotransmitter systems, particularly serotonin. (5-HT)
• And from mechanisms that control hormonal balance (cortisol, GH, and prolactin) and biological rhythms.
Precipitating stressors and mood disorders
• Loss of attachment (death)
• Life events ( physical and sexual abuse)
• Role strain (gender related work& home)
• Physiological changes (meds and illnesses)
Coping Mechanisms
• Mourning and bereavement; Mourning begins with introjection-directing your feelings toward the mental image of a loved one. This serves as a buffering mechanism.
NANDA Diagnoses
• Dysfunctional grieving
• Hopelessness
• Powerlessness
• Spiritual distress
• Risk for suicide
• Risk for self directed violence
DSM-IV-TR diagnoses
• Bipolar disorders
• Cyclothymic disorders
• Major depressive disorder
• Disthymic disorder
Nursing outcome
• Patient will be emotionally responsive and return to a pre-illness level of functioning
Planning care
• Reduction and removal of maladaptive emotional responses
• Restoration of the patient’s occupational and psychosocial functioning
Planning care cont.
• Improvement in the patient’s quality of life
• Minimization of the likelihood of relapse and recurrence
3 Phases of Treatment
• Acute treatment- goal is to eliminate symptoms (6-12 weeks)
• Continuation treatment- goal is to prevent relapse ( the return of symptoms) and to promote recovery (4-9 months)
• Maintenance treatment-goal is to prevent recurrence- a new episode of illness (1 or more years)
Nursing Interventions address:
• Environmental issues- highest priority should be given to the potential for suicide.
• Nurse-patient issues-supportive companionship• Physiological treatments-(meds, ECT,sleep
deprivation, & phototherapy)• Expressing feelings-encourage expression of hope• Cognitive strategies-help patient explore their
feelings, increase positive thinking by reviewing strengths.
Nursing Interventions address:
• Behavioral changes- give reinforcement to accomplishing positive activities, occupational and recreational activities. Also encourage movement and physical exercise.
• Social skills model effective social behaviors to increase self-esteem
• Mental health education for patient and the family to increase family functioning and decrease symptomatology.
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