A nurse is reinforcing teaching with a group of adolescents regarding identifying behavioral indicators of depression. Which of the following manifestations should the nurse include? (Select all that apply.)

C This is a common and potentially life-threatening complication in individuals with anorexia nervosa who are undergoing treatment. It can lead to cardiac arrhythmias.

A. Anorexia nervosa can lead to electrolyte imbalances, including hyponatremia (low serum sodium level), due to inadequate intake of sodium and fluid restriction. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can also contribute to hyponatremia by causing the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which leads to water retention and dilutional hyponatremia. However, it is not as life-threatening as hypokalemia.

B. Anorexia nervosa can lead to electrolyte imbalances, including hyponatremia (low serum sodium level), due to inadequate intake of sodium and fluid restriction. However, it is not as life-threatening as hypokalemia.

D. Anorexia nervosa typically does not lead to hyperkalemia (high serum potassium level), as potassium is usually lost through purging behaviors or inadequate intake. Antidepressants also do not commonly cause hyperkalemia as a side effect.

A. ECT is often considered for severe major depression that has not responded to other treatments, especially when there is a risk of suicide. ECT can provide rapid relief of symptoms, which is crucial in cases where immediate intervention is needed to prevent harm to the patient.

B. While ECT is generally safe for individuals with medical conditions, including heart disease, special precautions might be needed. However, the presence of heart disease alone would not necessarily preclude ECT if the benefits outweigh the risks and if the client's cardiac status is stable.

C. Dysthymic disorder, characterized by persistent depressive symptoms that are less severe than major depression, typically does not warrant ECT. ECT is usually reserved for more severe forms of depression that significantly impair daily functioning or pose a risk to the patient's safety.

D. ECT may be contraindicated or require careful consideration in clients with brain metastasis due to potential risks related to increased intracranial pressure or neurological complications. Alternative treatments may be preferred in such cases.