Physiological causes of depression in the elderly

Depression represents the most common psychiatric disorder in the elderly. Physiological processes can often cause depressive symptoms. The psychiatric nurse provides an important role in assisting the depressed elderly client through interventions, such as talking, exercise, touch, and relaxation.

Death from auto-erotic asphyxiation in a long-term psychiatric setting

Death from auto-erotic asphyxiation is a startling phenomenon that is on the rise both in the general population and within psychiatric facilities. While these auto-erotic behaviors may lead to death, it is seldom the client's intention to do harm; rather, the intent is to heighten masturbatory sensations. After describing this phenomenon, the authors discuss implications for nursing care.

The water-intoxicated patient

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.