Concept Map:
Depressive Disorders with Suicidal Ideations
Name __________________________
Date ___________________________
Pathophysiology
Labs/Diagnositics
Characterized by sadness severe enough
to interfere with function, and often by
decreased interest or pleasure in activities.
Exact cause unknown; likely involves
heredity, changes in neurotransmitter
levels, altered neuroendocrine function,
and psychosocial factors. Women tend to
be at higher risk for depressive disorders,
however, Studies indicate that clients who
typically have completed suicides are
primarily men, as men tend to choose
more lethal forms of injury (gun, jumping
from heights, etc.) and women use less
lethal methods such as drug overdose.
Patient history
Physical assessment
Patient interview
Clinical criteria (DSM-5)
Patient Health Questionnaire-9 (PHQ-9)
CBC, electrolyte test, TSH screen
Vitamin V12 & folate levels, to rule out
physical disorders that may cause
depression
Dexamethasone Suppression Test
Growth Hormone Assessment
Polysomnographic Measurements
Screening for suicide risk assessment
Alcohol and drug screening
Clinical Manifestations
Medications
Clinical Manifestations can be either subjective or
objective
Patient can feel sad or irritable most of the day,
every day
Insomnia or hypersomnia
Excessive sadness
The verbal or written threat of suicide
Pessimism and hopelessness
Digestive problems, overeating, or appetite loss
Patient reports physical and/or social anhedonia
Psychomotor agitation or retardation
Fatigue
Feelings of Worthlessness or guilt
Recurrent thoughts of death
Physical evidence of suicide attempt
SSRIs
SNRIs
NDRIs
Novel Antidepressants
TCAs
MAOIs
Psychostimulants: dextromphetamine,
methylphenidate)
PRN medications administered for crisis, such as:
lorazepam (Ativan)
alprozolam (Xanax)
quetipine (Seroquel)
haloperidol (Haldol)
ziprasidone (Geodon)
(Non-medication therapy: Electroconvulsive therapy
ECT, support groups, psychotherapy) rTMS)
Risk Factors
Complications
Diagnosis of chronic mental disorders (major
depressive disorder, bipolar disorders,
borderline personality disorder, PTSD,
schizophrenia
Alcohol and substance abuse
History of prior suicide attempts
Family history of suicide
Economic loss
Divorce or separations
Serious illness; physical or chronic pain
Social isolation
Access to lethal means
Recent release from inpatient psychiatric
hospitalization
Death by suicide
Continued self-harm
Drug complications
Possible Harm to others
Worsened mental/physical impairment
Concept Map:
Depressive Disorders with Suicidal Ideations
Nursing Assessment
Past health history, current medications
Past surgical history
Perform neurological assessment
Patient Health Questionnaire-9
Perform screening for suicide risk
assessment
Obtain history from client and family
members
Kayley Dotson
Name __________________________
09/25/2021
Date ___________________________
Nursing Concepts
Interpersonal violence
Mood and loss
Stress and coping
Fatigue
Psychosis
Self-concept
Self-management
Adherence
Anxiety
Patient education
Nursing Outcomes
Nursing Interventions
Patient will remain free from self-harm during
hospitalization
Patient will seek help when experiencing
self-destructive impulses
Patient will verbalize 3 techniques on
developing coping skills to help handle stressful
situations
Patient will explore suicidal thoughts with staff
Patient will contract for safety with nurse every
night shift
Patient will connect suicidal thoughts to current
stressors
Patient will demonstrate compliance with any
medication or treatment plan within the next two
weeks
Initiate one-on-one monitoring at arm’s length per facility
protocol. Avoid leaving client unattended for any reason
Educate and listen to the patient about reasons why they
want to self-harm
Create a safe environment by removing potential weapons or
objects that may inflict harm (weapons, utensils, sharp
objects, belts, ties, etc.)
Encourage the client to discuss feelings, emotions, fears and
anxieties and alternative ways to cope with those feelings
Assess for signs that the client has a plan to commit suicide
Educate the patient on 3 techniques on developing coping
skills to help the patient handle stressful situations
Create a verbal or written contract, stating that patient will
not act on impulse to do self-harm
Identify situations or triggers and ineffective coping behaviors
that may result in suicidal thoughts or actions
Administer medications carefully and appropriately
Provide resource information for support groups, hotlines,
and counselors that are available 24/7
Evaluation
Maintained safe environment by removing
potential harmful objects from patients
room
Patient discussed feelings, emotions, and
anxieties and verbalized different ways to
cope with stressors
Patient signed written contract, stating
patient will not act on impulse to do
self-harm
Patient verbalized importance of
appropriately taking prescribed medications
Provided resource information for local
support groups and 24/7 hotlines in time of
crisis