Suicidal thoughts

It is important for the nurse to note the presence of suicidal thoughts. The nurse accurately documents in the patient s record and reports to the primary health care provider any statements concerning suicide and the ability of the patient to carry out any suicide intentions. The nurse performs a physical assessment, which includes obtaining blood pressure measurements on both arms with the patient in a sitting position, pulse, respiratory rate, and weight. 

Differentiating between depression and dementia can be difficult, so symptoms of depression should be documented for several weeks prior to initiating therapy for the treatment of depression with AD. Citalopram and sertraline are recommended as first-line agents because of their efficacy in placebo-controlled trials.49 Indications for the use of antidepressants include depression characterized by poor appetite, insomnia, hopelessness, anhedonia, withdrawal, suicidal thoughts, and agitation. 

The therapeutic dose of acamprosate is 666 mg orally three times daily, and it is supplied as a 333 mg tablet. It can be started at the full dose in most patients without titration. It differs from disulfiram and naltrexone in that it is excreted by the kidneys without liver metabolism. Consequently, it is contraindicated in patients with severe renal impairment (creatinine clearance less than or equal to 30 mL/minute), and dose reduction is necessary when the creatinine clearance is between 30 and 50 mL/minute. The most common side effects are gastrointestinal and include nausea and diarrhea. Rates of suicidal thoughts were also increased in patients treated for 1 year with acamprosate (2.4%) versus placebo (0.8%). If necessary the total daily dose maybe decreased by 1 to 3 tablets (333-999 mg) per day to alleviate side effects. 

Now there are a number of problems with relapse-prevention studies. One is the fact that many people who are taken off antidepressants experience withdrawal symptoms, which in severe cases can last for months. Some of these withdrawal symptoms - sadness, suicidal thoughts, crying spells, trouble concentrating, irritability, anxiety, agitation and insomnia, for example - are also symptoms of depression.12 These withdrawal symptoms could lead both patients and researchers to think that the patient has relapsed. 

Suicidal thoughts are one of the symptoms of depression. Paradoxically, one of the best-publicized dangers of SSRIs is their potential to increase the risk of suicide. This heightened risk is especially well established for children, adolescents and young adults. In their most recent analysis of the data, the FDA concluded that, when compared to placebos, SSRIs double the risk of suicidal thoughts and behaviour in depressed patients up to the age of 24/ There also seems to be an increased risk for people who are older than 24, but the interpretation of these data is still disputed.8... 

Suicidal thoughts Recurrent thoughts of death suicidal ideas attempted and actual... 

Long-term amphetamine abuse results in many damaging effects, not least of which is addiction. Chronic abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin). The paranoia can result in homicidal as well as suicidal thoughts. 

If a family member notices any of the symptoms previously mentioned in a loved one, then it may be that the loved one is depressed and should be evaluated by a mental health professional. If a loved one is expressing suicidal thoughts, or it is discovered that he or she has put his or her affairs in order (has sold or given away significant amounts of personal property, written a will, settled debts, etc.), then it would be critical to get help for that person as quickly as possible. Suicide is a major concern with people who abuse drugs, since a majority of suicides in the United States are attempted under the influence of drugs or alcohol. 

If a person is having suicidal thoughts presently, then you should assess for any plans that he or she may have for carrying out a suicidal act. One way to be attuned to clients preferred plans is to ask them about means used in past suicide attempts or parasuicidal behavior. For example, if a person tells you that he attempted suicide by swallowing a handful of pills in the past, then you can ask if that idea has reoccurred to him recendy or if a client tells you she has burned herself in the past with a cigarette, you can ask if she has been thinking about doing that recendy. You also want to look for how specific the plan is to determine its... 

I sometimes give myself permission to have knock-down-drag-out major depressive episodes, with suicidal thoughts and everything, because that s how sad I feel, or how hurt. But I would not take my life. I can t disappoint Jehovah, and I could not do that to my family or friends. I know the depression will pass. 

Of greater concern is the safety of the TCAs. Toxic levels of these medications can produce lethal cardiac arrhythmias, seizures, and suppression of breathing. An overdose of a 1-2 week supply of most TCAs is often fatal, a serious consideration when prescribing medication to depressed patients with suicidal thoughts. Children taking imipramine for treatment of ADHD have died from sudden cardiac death consequently, child psychiatrists seldom use TCAs. Likewise, patients with heart disease or seizure disorders are more likely to have dangerous complications from TCAs and should avoid them. 

The full spectrum of depressive symptoms including depressed mood, anhedonia, lack of energy, and even suicidal thoughts may strike as many as 25% of patients who experience a TBL Depression in these patients not only exacts a tremendous psychosocial toll but also interferes with their participation in physical and occupational rehabilitation. As a result, long-term functional recovery from TBl can be sorely compromised by depression. Potential treatments for post-TBl depression include conventional antidepressants and stimulants (see Table 12.1). 

In turn, conditions characterized by the term depression include affective disorders, which are frequently accompanied by a number of other disturbances including unmotivated sorrow, sleep disorders, changes in appetite, various psychomotor disturbances, loss of interest in things once pleasurable, feelings of worthlessness, and often suicidal thoughts. 

Seizures Increased intracranial pressure, convulsions, and toxic psychosis have occurred. CNS stimulation also may occur and may lead to tremor, restlessness, lightheadedness, confusion, dizziness, depression, hallucinations, and rarely, suicidal thoughts or acts. 

Atomoxetine (Strattera) [ADHD/Selective Norepinephrine Reuptake Inhioiter] WARNING Severe liver injury may rarely occur D/C w/ jaundice or TLFT, T frequency of suicidal thoughts Uses ADHD Action Selective norepinephrine reuptake inhibitor Dose Adults Children >70 kg. 40 mg X 3 d, T to 80-100 mg -s- daily-bid Feds <70 kg. 0.5 mg/kg x 3 d, then T 1.2 mg/kg daily or bid (max 1.4 mg/kg or 100 mg) Caution [C, /-] Contra ... 

NAG, w/ or w/in 2 wk of D/C an MAOI Di p Caps SE t BP, tach, wt loss, sexual dysfxn EMS Use caution w/ albuterol can t CV effects monitor for liver injury (RUQ pain, h atomegaly, jaundice) t risk of suicidal thoughts OD Reports limited but may cause xCTostomia (dry mouth), anxiety, prolonged QT interval and Szs symptomatic and supportive... 

Efavirenz is given orally at a dose of one 600-mg tablet per day. As an important part of the AIDS cocktail, efavirenz is administered with the same protease inhibitors and NRTIs as described in the nevirapine section. The half-hfe of efavirenz after a single dose is 52-76 h, and multiple doses lower the half-life to 40-55 h. Treatment with efavirenz has been associated with the development of serious psychiatric side-effects, including severe depression, suicidal thoughts, aggressive behavior, and paranoid and manic reactions. 

Abnormal bleeding, hyponatremia, seizures, hypomania, and suicidal thoughts have been reported. 

Immediately notify the physician if depression or suicidal thoughts occur... 

Suicidal thoughts or acts Absence or treatment of psychiatric disorder or stressors leading to suicidal thinking... 

Montgomery SA, Dunner DL, Dunbar GC Reduction of suicidal thoughts with paroxetine in comparison with reference antidepressants and placebo. Eur Neuropsychopharmacol 5 5-13, 1995... 

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