Emotional Responses

Chapter 19

Rochelle Roberts RN MSN

Mood

• A feeling state• An emotion

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.

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.