Depression and Elation

T.H. Brigum
1. Firm and matter-of-fact
2. T.H.s orientation. T.H.s current hydration status. Current physical debilities or
limitations. Any homicidal/suicidal tendencies.
3. Clang associations
4. Flight of ideas
5. Milkshakes, fruits, raw vegetables, sandwiches
6. It should be given with juice, milk, or semisolid food. It can cause rapid shift
in mood from manic episode to depression. It can cause uncomfortable
extrapyramidal side effects.
7. Delusion
8. A room with a patient with dependency and intimacy issues who is being
discharged tomorrow
9. Risk for injury. Deficient fluid volume. Anxiety
10.Take T.H. to a quiet area to regain control
11.Have each patient discuss the matter individually with his/her therapist
12.Playing basketball with a staff member. Riding an exercise bike at a moderate
speed. Working with clay in recreational therapy. Taking a walk with a staff
member.
13.Walk T.H. to his room
14.Postural hypotension. Weight gain. Gynecomastia in men. Drowsiness.
15.Reasons for repeated past noncompliance with medications. How to maintain
self-esteem. How to identify and maintain things he values. Early signs of
mood changes.
Adrian Knight
1. Tell AD that you will stay with him for a few more minutes and then return in
another hour.
2. Ads food and fluid intake. Ads bladder and bowel elimination patterns. Ads
activity level.
3. Industry vs. inferiority
4. Risk for self-harm related to previous suicide attempt and unresolved grief.
5. His single lifestyle. The fact that Ad is male. The fact that Ad is unemployed.
His state of depression. The fact that Ad is 18 years old. His history of loses.
6. Removing belts, glass objects, coat hangers, razors, and other sharp items
from Ads environment. Check to be sure that Ad swallows his medications.
Monitor meal trays for missing utensils. Search gifts and other items brought
by visitors.
7. Its a burden to feel responsible for people leaving you. You deserve to be
punished? Youre feeling all alone and as if you have nothing?
8. Preparation for ECT treatments require that the patient be NPO. Written
consent is required for treatments. The patient is asleep during ECT
treatments. Memory impairment is common with ECT treatments.
9. Use of a bite block. Administration of an IV muscle relaxant. Pulse oximetry
monitoring. Blood pressure monitoring. Electrocardiogram (ECG) monitoring.
10.It sounds like you have made a firm decision and changed your mind.

11.8AM and 12 noon

12.The doctor has ordered thyroid and other tests to see if your feelings have a
physical basis.
13.Withdrawal
14.By the time of discharge, Ad will begin to grieve in a direct and open matter.
15.Assist Ad in preparing a structured activity schedule so that he knows what is
expected.
16.Countertransference
17.Kind but firm
18.Reflect to Ad that he seems to be enjoying the music and suggest that he join
the music group.
19.A promise to contact you or another staff member if he is tempted to act on
destructive impulses. Surrendering items such as sharps or pills. Participation
of family and friends in the contract.
20.Say to him Youll be leaving in a few days. How are you feeling about ending
our relationship?
21.Its hard; but, Im going to work on sharing my feelings a little bit at a time
with my new therapist.
Severe and Persistent Mental Disorders
Cassandra White
1. Hyperactivity. Hypoactivity
2. Continues with repeated cycling of depression and mania
3. Mrs. White probably has difficulty identifying and expressing her feeling.
4. I hear how sad and hopeless you are feeling. I believe we can work together
to help you.
5. It must be difficult to take medicine that makes you feel bad. Lets see if we
can figure out what might help.
6. 3600mg/day
7. Nausea. Fine hand tremors. Headaches. Fluid retention. Fatigue.
8. Gentle exercise a few times a week. Remind yourself that most side effects
diminish after several weeks of therapy. Elevate feet when sitting.
9. Twitching. Decreased alertness. Poor coordination. Blurred vision.
10.Complete blood count (CBC) with differential. Serum thyroid panel.
11.Bipolar is associated with risk for suicide. She has expressed thoughts of
despair and guilt. Substance abuse and depression are risk factors for
suicide.
12.Daily attendance at alcoholics anonymous. Participation in a staff-led support
group. Twice weekly counseling sessions with you at the clinic.
13.Mrs. White and other family members need an opportunity to discuss their
feelings.
14.Their friends are a source of support.
15.Verbalization of feelings about her family. Continued attendance at alcoholics
anonymous. Compliance with medication. Understanding of Bipolar disorder.