Question

You are working the day shift on a medicine inpatient unit. You are discussing discharge instructions with J.B., an 86-year-old man who was admitted for mitral valve repair. His serum blood glucose had been averaging 13.8 mmol/L or higher for the past several months. During this admission, his dosage of insulin was adjusted, and he was given additional education in managing his diet. While you are giving these instructions, J.B. tells you his wife died 9 months ago. He becomes tearful when telling you about that loss and the loneliness he has been feeling. He tells you he just doesn’t feel good lately, feels sad much of the time, and hasn’t been involved in his normal activities. He has few friends left in the community, since most of them have passed away. He also tells you that he has been feeling so down the past few months that he has had thoughts about suicide

1. What information should you be asking JB regarding his thoughts of suicide?
2. Which psychiatric disorders can result in suicidal ideations or gestures?
3. Ill people often have trouble sleeping, experience a change in appetite, reduce their level of activity, and have thoughts of death. How can you tell the difference between old age with illness and depression?
4. List five of the most common signs of depression.
5. J.B. was started on an SSRI such as fluoxetine (Prozac). What special instructions should you give him regarding SSRIs?
6. What advantages does ECT hold over the other treatments for depression
7. ECT is a highly stigmatized treatment; many people are reluctant to consent to initiate treatment. What are the most common untoward effects of ECT?

Answer 1

1)

• Have you ever felt this way before in your lifetime?
• How long have you been feeling this way?
• How frequently have you had this feeling?
• How strong these feelings are?
• Have you discussed your thoughts and feeling to someone?
• Did you ever harmed yourself?

2)

• Post traumatic stress disorder
• Depression
• Bipolar disorder
• Schizophrenia
• Borderline personality disorders
• Mental illness due to substance abuse

3) old age- decreased level of activity and trouble in sleeping are seen. Thoughts of death is present , but suicidal thoughts are absent. Lack of interest in activities is not present. , limitations in activities is due to age related health issues like joint pain.

Depression- decreased level of activity and trouble in sleeping with increased suicidal thoughts. Social isolation and lack of interest in activities are present. Persistent feeling of sadness

4) signs of depression

• Persistent feeling of sadness
• Loss of interest in activities
• Changes in sleep pattern, appetite, self esteem etc..
• Lack of concentration and slowness in activities
• Anxiety ,hopelessness, mood swings and suicidal thoughts

5)

• Should avoid taking excess coffee and caffeine containing drinks
• Avoid cola and energy drinks because all these may lead to development of a serious condition called serotonin syndrome

6)

• ECT work in patients where drug and psychotherapy are ineffective
• ECT have fewer side effects compared to medication
• ECT have quick action
• Depression get resolved after one or two treatments.

7) people may experience trouble in memorizing events occoured during treatment. For most of people, these memory loss problem resolve after few months of final treatment