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D- ecrease ability to concentrate

 Pervasive alteration in emotion that are manifested E- ating disturbance (overeating/under eating)
by Depression (lost of interest in pleasure) and P- hysical signs (agitation or retardation)
Mania (exalted feeling, over activity) R- eccurent thought of death
E- xcessive feeling of unworthiness
(DSM-IV-TR) 2 CATEGORIES OF AFFECTIVE S- leep disturbance (insomnia/hypersomnia)
DISORDER S- adness/ dysphoria
E- nergy diminished
I. Depressive/Unipolar Disorder D- iminished pleasure (anhedonia)

 Persistent sad or depressed mood loss of interest on SUBTYPE of DEPRESSION

things that were once pleasurable and disturbance in I. Major Depression
sleep, appetite, energy and concentration. - presence of 5 criteria for depression,
 Increase incidence in Women than Man prime symptoms are depressed mood
Cause: and loss of interest
Medical/Biological Theory - last for at least 2 wks
- high familial genetic pattern (70% - occurs in late 20’s
identical twin, 15% siblings and 7% * with psychotic symptoms
grandparent aunts and uncle) * Melancholic type (agitated occurs after
- disregulation of NorEpinephrine and 40y/o but before 60 y/o), morning
serotonin depression
- low level of Tryptophan precursor for * Seasonal pattern (3 years pattern onset
serotonin II. Dysthymic Disorder
Psychodynamic Theory - milder than major depression
- disturbance in early mother-child - duration at least (2 yrs. For adult and 1
relationship, weak ego strong Superego yr. for children and adolescent)
Cognitive Behavioral Theory - presence of 2 or more criteria.
- reinforcement theory result of impaired - absence of Psychotic features
cognition III. DDNOS
- learned helplessness, individual belief of - last for 2 days or 2 weeks
lack of control
- cognitive triad, negative belief to NURSING DIAGNOSIS AND INPLEMENTATIONS
SELF,WORLD and FUTURE * Potential for Injury directed to Self
- assess for the signs of suicide
DIAGNOSTIC CRITERIA (9 clinical signs) - risk factor for SUICIDE
S- ex more female attempt more male commit * Self Esteem Disturbance
U- nsuccessful previous attempts - focus on the strengths and accomplishments
I- dentification with family member - teach assertive techniques
C- hronic * Social Isolation
I- llness - spend time to client
D- epression/dependent personality - then proceed to group activity
A- ge (18 -25 y/o and 40 above / Alcoholics) * Powerlessness
L- ethality of previous attempt - take as much responsibility as possible for own
self care
C- aucasians and native Americans - identify areas that she can control
L- iving alone/ No spouse or nagging spouse - verbalize areas in life that cannot control
A- cts through Gun’s and explosive next is * Altered Nutrition Less tan Body requirement
hanging and poison -high protein and carbohydrate in diet
F- inancial problems/ unemployed - increase fluid consumption
- common expressions of Suicidal individual - weight daily
Cry for help Escape - serve small frequent feeding
Heroic Manipulation
Redemption Relief of pain SSR’I
Retaliatory Reunion TCA’S
Loss of self esteem MAOI’S
- secure rooms (windows lock, break proof glass II. BIPOLAR/ MANIC DEPRESSIVE DISORDER
and mirror use plastic ware) Extreme mood swing from Mania to depression
- NO cords and sharps Cause:
- frequent observation/ unscheduled rounds Genetic 1st degree family members
- staff communication one on one Neurobiological (increase NE)
- develop therapeutic relationship Psychological (poor mother and child relationship)
- written contract SUBTYPES
- restraint as order I. BIPOLAR I
- medication as ordered - Manic episodes – persistent elevated mood for
* Dysfunctional Grieving a duration of 1 week and 3 out of the
- encourage verbalization of thoughts and following signs (grandiosity, insomnia,
feelings verbosity, flight of ideas, distractability,
- develop trusting relationship agitation and excessive involvement
- assist patient to discharge Pent –up anger into pleasurable activities )
through purge motor activity - Major Depression (alternating)
- Hypomanic – period of elevated irritable
mood lasting for 4 days, it is Less Severe and
manifesting 3 or more signs
- Depressive Disorder
- hypomanic episode dispersed with periods of
depressed mood
- No evidence of true major depression and
- alternating moods swing
- last for 2 years
* High Risk for violence directed to self and others
- redirect negative feelings into a socially
acceptable manners
- encourage brief contact with patient
- conduct suicide assessment
- seclude, restraint if necessary
- provide frequent “quiet time out”
* Impaired social Interaction
- set limit on behavior
- provide meaningful interactions
* Altered Nutrition
- increase calories, vitamin in diet, provide finger
foods and fruits
- encourage non-competitive solitary play

Antimanic (Lithium)
Mood Stabilizers (anticonvulsants)