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Week 3 Lecture notes
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week 3 lecture notes emma mental health
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WEEK 3*If highlighted like this, know this for the test*
Class Objective
• Discuss issues and treatment options of Bipolar Affective Disorder,
Anxiety Disorders and Dementia
• Discuss the current issues and treatment options for children’s mental
health
Assessing for Suicide
• Ask if the person has ever had thoughts of harming themselves or of
ending their life
• If they say ‘yes’ ask about when, circumstances, do they feel this way
now
• If they have an active plan, do they have the means to accomplish it
• Is there anything that would stop them from acting on the plan?
• Can they commit to a future event?
(CAMH)
Test question: among the following, who would be the most likely to
commit suicide? * Know the risk factors and warning signs for suicide below*
best therapeutic interaction with the client
Risk Factors for Suicide
• People at a higher risk of suicide include those who:
– have a serious mental health and or addiction problem
– have had a recent major loss
– have a family history of suicide
– have made previous suicide attempts
– have a serious physical illness
– have an impulsive personality
– lack support from family or friends
– have access to weapons, medications or other lethal means of
suicide
– Older men are at especially high risk for suicide
(CAMH, RNAO BPG)
Warning Signs for Suicide: applying to a scenario
People who are feeling suicidal may:
– show a sudden change in mood or behaviour
– show a sense of hopelessness and helplessness
– express the wish to die or end their life
– increase substance use
– withdraw from people and activities that they previously enjoyed
– experience changes in sleeping patterns
– have a decreased appetite
, WEEK 3
– give away prized possessions or make preparations for their
death
(CAMH, RNAO BPG)
Protective Factors (focus more on risk factors than protective factors)
• Protective factors help to increase a person’s resilience; the ability to
recover or “bounce back” in the face of stress and adversity. These
include:
– positive social supports
– a sense of responsibility for others, such as having children in the
home (except when the person has postpartum depression or
psychosis) or having pets
– positive coping skills
– a positive relationship with a medical or mental health provider
– self-efficacy (a person’s belief in his or her ability to succeed in
specific situations)
– a religious belief that suicide is wrong.
(CAMH, RNAO BPG)
A 23 yo woman, is in the ER w /her parents. Her parents are concerned about
her well being and feels she needs to be admitted to the mental health
inpatient unit. You as her nurse assess the patient with symptoms of
depression, denies any thoughts of suicide and self harm. The patient’s
parents agree that she is not suicidal, but feel she could get suicidal if her
depression isn't treated. What would you suggest to the psychiatrist on call
when he arrives to assess the patient? (type of question on the test)
a) Recommend the patient be admitted to the inpatient unit under
a Form 1 (she does not fit the criteria for form 1)
b) Recommend a voluntary admission for the patient to get her
started on pharmacotherapy
c) Suggest Wanda be observed overnight to see if she becomes
suicidal as you think she's not telling you the truth
d) Recommend Wanda be referred to a psychiatrist at the
outpatient clinic and have Wanda started on an antidepressant
(how do we know she will be complying with the treatment?)
- Look at the history of the client (has this happened before?)
- Look at their support system
- There’s no true answer as we need to know more
Commonly Used Antidepressants
• SSRIs: Decrease serotonin blockers in the brain.
– sertraline (Zoloft)
– fluoxetine (Prozac)
, WEEK 3
– citalopram (Celexa)
– escitalopram (Lexapro)
– paroxetine (Paxil, Pexeva)
– fluvoxamine (Luvox)
– trazodone (Oleptro)
SE: fatigue, diarrhea, stomach upset, nausea, dry mouth, rash, weight
loss/gain, insomnia, headaches, low sex drive;hyponatremia
Serotonin syndrome: confusion, sweating, diarrhea, agitation, fever,
arrhythmia, seizures, LOC
- SSRI: blocks all negativity
- It takes about 4-6 weeks to feel the effects of ALL antidepressants (not
just SSRIs)
- When you start antidepressants, once it takes effect, you start to have
energy and they may commit suicide then (because they have the
energy to do so)
Commonly Used Antidepressants
• SNRI: improve serotonin and norepinephrine levels
– desvenlafaxine (Pristiq)
– duloxetine (Cymbalta)
– venlafaxine (Effexor XR)
SE: elevated BP, loss of weight, appetite, nausea, vomiting, urinary retention,
sexual dysfunction, increase in SI
Contraindication: hypertension and CAD
Commonly Used Antidepressants
• TCA: used when SSRIs and others not effective
– Amitriptyline
– Clomipramine (Anafranil)
– Desipramine (Norpramin)
– Doxepin
– Imipramine (Tofranil)
– Nortriptyline (Pamelor)
SE: constipation, dry mouth, fatigue, low BP, irregular heart rate and seizures
• Tetracyclic Antidepressant: maprotiline
- May be prescribed this because it has worked in the past
Commonly Used Antidepressants
• Atypical:
• Dopamine Reuptake Inhibitor (DRI): blocks dopamine transporter, used
in ADHD, smoking cessation, weight loss for morbid obesity, SAD
– Bupropion (Wellbutrin)
SE: increase BP, nausea, vomiting, dry mouth, sweating, sore joints, sore
throat, diarrhea, dizziness
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