Treatment-resistant depression: An overview for psychiatric advanced practice nurses.

PURPOSE: Treatment-resistant depression (TRD) can require complex management. The purpose of this paper is to provide an update on the hypothesized neurobiology of depression, and to describe treatment options for patients impacted by TRD. CONCLUSIONS: Recent neurobiological findings support the use of augmenting pharmacological agents, neuromodulation techniques, and esketamine as effective in achieving remission for those with TRD. PRACTICE IMPLICATIONS: First-line interventions for depression can be safely managed by primary care providers. Psychiatric advanced practice nurses must be well versed and capable of treating more complicated cases, including TRD, that may require second- or third-line approaches.

Impact of Social Support on Symptoms of Depression and Loneliness in Survivors Bereaved by Suicide.

According to the latest statistics from the American Association of Suicidology, there were approximately 41,000 suicides in the United States, accounting for 112 suicides per day or one every 12.8minutes (Drapeau & McIntosh, 2015). Survivors bereaved by suicide often experience complicated grief and feelings of social isolation. The study was a secondary data analysis from a study which involved 44 participants over the age of 18 from Southwestern Pennsylvania. Symptoms of depression and loneliness were assessed in relation to reported social support available to participants. The findings support the notion that increased availability of support can decrease symptoms of depression.

Identifying and managing nonsuicidal self-injurious behavior in the primary care setting.

PURPOSE: To provide an overview of nonsuicidal self-injurious behavior (NSSIB) for nurse practitioners (NPs) who see patients with this complex phenomenon in primary care settings. DATA SOURCES: Selected research and clinical reviews. CONCLUSIONS: NSSIB is characterized as a low-lethality, repetitive act that can alter or cause damage to the body tissue. Among researchers and those who work directly with young people, there is a general consensus that NSSIB is increasing in prevalence. Unfortunately, NPs often view self-injuring patients negatively, likely because of a lack of knowledge as to how to help this special patient population. IMPLICATIONS FOR PRACTICE: Appropriate treatment can be initiated in the primary care setting; however, NPs must be aware of how and when to refer to specialty mental health services. Those with psychiatric comorbidities such as mood lability, anxiety, chronic emptiness or depersonalization, dysphoria, loneliness, anhedonia, or borderline personality disorder require management by mental health specialists. Patients experiencing NSSIB in response to command auditory hallucinations need immediate medical attention.

Fusion of psychiatric and medical high fidelity patient simulation scenarios: effect on nursing student knowledge, retention of knowledge, and perception.

High fidelity patient simulation (HFPS) has become an increasingly popular teaching methodology in nursing education. To date, there have not been any published studies investigating HFPS scenarios incorporating medical and psychiatric nursing content. This study utilized a quasi-experimental design to assess if HFPS improved student knowledge and retention of knowledge utilizing three parallel 30-item Elsevier HESI(TM) Custom Exams. A convenience sample of 37 senior level nursing students participated in the study. The results of the study revealed the mean HESI test scores decreased following the simulation intervention although an analysis of variance (ANOVA) determined the difference was not statistically significant (p = .297). Although this study did not reveal improved student knowledge following the HFPS experiences, the findings did provide preliminary evidence that HFPS may improve knowledge in students who are identified as "at-risk." Additionally, students responded favorably to the simulations and viewed them as a positive learning experience.