- Crying
- Low  mood
- Adehdonia
- Weight loss
- Reduced hours of work
- Lack of enjoyment

- She is very overwhelmed and is struggling with completing day to day tasks.
- Poor concentration and productivity at work and home
- She is exhausted as she has had trouble sleeping
- Poor appetite has lead to weight loss
- Emotions are getting in the way of her life; decreased involvement with children; feeling guilty
- She's experiencing a loss of joy in her relationships; withdrawal from friendships and strain on relationship with partner
- Decreased libido putting added strain on relationship with partner
- Decreased self care

2. What risks is Alison presenting with and how would you assess her level of risk currently?

- Risk to self: admits to taking tablets (previous suicide attempt) and also thinks about harming herself. Displays insight; knows she can seek help. However, she admits that she has not told anyone about her attempt; lack of support if mental state deteriorates further.
- Financial insecurity from missing work

- Open ended questions 
- Active listening 
- Clarification 
- Silence 
- Empathetic 
- Non-judgemental 
- Body language 
- Focus on patient, not taking notes or anything 
- Explanation to pt at the end

2. Identify risk and protective factors for Razak’s risk of deterioration of mental state

Risk
- Young family relying on her
- No healthy way to deal with stress, no coping strategies
- Financial stress, employment
- previous suicidal thoughts

Protective
- Sister, who encouraged to reach out for help
- Access to health services
- Children
- Husband
- Family

Dave- not a great partner
Extra stressors at work
Husband leaving a couple years ago
Struggling to pay the bills
2. Protective factors
Children
Sister
Friends
Dave - "when he's in the mood"

SSRIs
- SEROTONIN SYNDROME: results when there is too much serotonin at the synapse, causing an excess in neuron activity – people who take high doses of antidepressants that caused increased amounts of serotonin or a combination of these medications are at risk of serotonin syndrome 
o SIGNS AND SYMPTOMS – headaches, altered conscious state, dilated pupils, hyperthermia, diaphoresis, tachycardia, unstable BP, nausea and vomiting, tremors, ataxia and risk of seizures 
Ataxia, diaphoresis, hyperreflexia 
o MANAGEMENT – resolves when the causative medication is ceased. 
Supportive therapy to alleviate the symptoms. 
Benzodiazepines may be given for agitation and tremors and to minimise the risk of seizures. 
ICU transfer may be necessary

- Documentation

Keep self in a dark environment from 6pm to 8am. You may use blue light blocking glasses.- helps to help the blue light from devices which disturbs sleep