A depressed patient does not converse except when addressed, and then only in monosyllables. Which response by the nurse is likely to be most helpful?
a. "Can you tell me how you're feeling today?"
b. "What would you like to talk about?"
c. "It would be helpful if you talked more.".
d. "It seems rather cold in here today.".
D
Alogia or poverty of speech is common in severe depression and other mental health disorders. Making observations about neutral topics such as the environment draws the patient into the reality around him in a nonthreatening way but places no burdensome expectations for answers on the patient. It also helps to convey interest in the patient and helps to build rapport. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialogue. Decision making is often impaired in depression, so asking the patient what he wants to talk about burdens the patient with a task (decision making) likely to frustrate him because he does not want to talk at all. Telling the patient that more talking is desirable places a burden of unrealistic expectations on the patient; this can increase feelings of guilt, frustration, or worthlessness.
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