Emotional Responses

1. Emotional Responses Chapter 19 Rochelle Roberts RN MSN

2. Mood • A feeling state • An emotion

3. Adaptive functions of emotions • Social communication • Physiological arousal • Subjective awareness • Psychodynamic defense

4. Adaptive emotional responses • Implies an openness and awareness of feelings • An example is an uncomplicated grief reaction

5. 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.

6. Grief • Is the subjective state that follows loss • Two types of pathological grief reactions are: • delayed grief reaction and distorted grief reaction (depression)

7. Lifetime Risk for Depression • For women 20-30% risk • For men 7-12% risk • Depression often occurs along with other medical and psychiatric illnesses

8. Bipolar Disorders • A depressive episode with previous or current manic episodes. • Mania is an elevated or irritable mood.

9. 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.

10. 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

11. 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.

12. Seasonal Affective Disorder (SAD) • Depression that comes with shortened hours of daylight in winter and fall and disappears during spring and summer.

13. Potential for suicide • 15% of severely depressed patients commit suicide • 25-50% of patients with bipolar disorder attempt suicide at least once.

14. 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

15. 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.

16. 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)

17. 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.

18. NANDA Diagnoses • Dysfunctional grieving • Hopelessness • Powerlessness • Spiritual distress • Risk for suicide • Risk for self directed violence

19. DSM-IV-TR diagnoses • Bipolar disorders • Cyclothymic disorders • Major depressive disorder • Disthymic disorder

20. Nursing outcome • Patient will be emotionally responsive and return to a pre-illness level of functioning

21. Planning care • Reduction and removal of maladaptive emotional responses • Restoration of the patient’s occupational and psychosocial functioning

22. Planning care cont. • Improvement in the patient’s quality of life • Minimization of the likelihood of relapse and recurrence

23. 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)

24. 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.

25. 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.

26. Mental Health Education cont. • Communicate that mood disorders are a medical illness, not a character defect • Recovery is the rule, not the exception • Mood disorders are treatable illnesses • Goal of intervention is not just to get better, but to get and stay completely well.