Alterations in Mood Flashcards
Mood Disorders
characterized by two extremes of the spectrum of feelings
mania and depression with a “normal mood” in the centre
Pathological Mood
- more intense and prolonged
- interferes with ADLs
- pervades an individual’s thinking and emotions
- there is a specific onset, course, duration and outcome
- CHANGE in the individual
Facts about suicide
- men are four times more likely to complete suicide..less likely to seek help, more lethal ways
- suicide can be disguised, ie. MVA or other accidents
Risk Factors for Suicide (women)
- women who never married
- women with many children
- ++ incidence in those in work force (harassment, sexism)
Suicide and Age
- most prevalent in young: 15-24 yo
- transition, identity, bullying
- very old: over 75..less impulsive with a plan
- elders are 10 times more likely to complete suicide, realist life assessment
- loneliness, losses, illness
At Risk Populations
- widowed or divorced and living alone
- LGBTQ
- high stress occupations
- indigenous
- completed suicide in family
Indigenous Populations and Suicide Rates
- leading cause of death for youth to 44yo adults
- Inuit youth suicide rates are 11 times the national average
- family violence, sexual abuse, incarceration, emotional distress from historical trauma
Comorbidities that ++ risk of suicide
- schizophrenia, depression, substance abuse
- 15% of people with depression commit suicide
- elderly white male with AIDS, 3 times more likely
- common within 6 mths of dx
Signs and Symptoms of feeling suicidal (warning signs)
- sudden change in mood
- sense of hopelessness and helplessness
- express wish to die
- increase substance use
- withdrawn from people and activities
- changes in sleeping patterns
- decreased appetite
- give away possessions, make preparations
Protective Factors for Suicide
- positive social support
- sense of responsibility to others (having young children, except if pp depression)
- positive coping skills
- medical and clinical support
- religious belief that suicide is wrong
- self-efficacy
Major Depressive Disorder (MDD)
- depressed mood
- cognitive, physical and behavioural symptoms that impair functioning
56% of people will experience one epi
29% will experience two epi
15.4% will experience three or more epi
Major Affective Disorder (MAD)
a. Major Depression (unipolar)
- only DEPRESSED episodes
b. Bipolar Disorder (manic depression)
- at least one MANIC episode with an epi of depression
c. Bipolar 2 Disorder
- majority of depressed epi with at least one HYPOMANIC episode
Cyclothymic Disorder
alternating episodes of depression and hypomania not severe enough to be labelled bipolar
Dysthymic Disorder
degree or severity of depression is much less, history of depressive character, chronic low mood lasting two or more years with moderate symptoms
Atypical Affective Disorder
used sparingly when symptoms are not severe enough to fit other categories of illness
Biological Model of Major Depression
alterations in the levels of CNS neurotransmitters
- dopamine
- norepinephrine
- serotonin
areas that regular appetite, sleep and emotional processes
Behavioural Model of Depression
social learning theory
continuous reciprocal interaction between cognition, behaviour and environmental influences
- stress disrupts social involvement
- reduced social positive reinforcement
- negative self evaluation
Behavioural Model of Depression
interpersonal theory
the role of environmental and familial factors
- one’s response to change and stress from early developmental experiences in family or social group
Antecedents of depression
Children - parental neglect, abuse, rejection, family disharmony, loss of parent
Adults - separation, divorce, marital problems, losses, absence of supportive social relationships
Consequences of depression
interpersonal difficulties
Cognitive Theory
Aaron Beck
- depression stems from a world view based on false beliefs about self, future and the world
- as depression becomes more severe, ability to think logically decreases immensely
CBT breaks and challenges cycle of thought distortion
Learned Helplessness
Seligman
- individuals feels they have no influence over their environment, feelings of powerlessness and helplessness
- passivity, lack of assertiveness
Risk Factors for Depression
- twice as many women
- no age limit, most commonly 20-50yo
- family hx of depression, bipolar or alcoholism
50-70% if two parents with bipolar
25% if one parent with bipolar - personality..not conclusive but trends
shy, insecure, worry a lot, internalize feelings, take things personally, not assertive, difficulty managing stress - recent life stressors
Risk Factors for Bipolar
- equal in men and women
- age, onset around 32 years old
- increasing age decreases interval between while increases length
- social class, high achievers and ambitious
- genetics, 8-18 times more likely
Symptoms of Depression
Physical
- vegetative symptoms (biological)
- physiologic functions disruptions, limbic system that regulates mood
- sleep disturbance and fatigue
- loss of or decrease appetite, anorexia
- decreased libido
Emotional/Cognitive
- sad, blue, low
- profound unhappiness, boredom, loneliness, emptiness
- tremendous anguish
- constricted or flat affect
- decreased motivation and diminished sense of pleasure
- worse in the morning and better as the day goes on
- distortions in perceptions
- guilt, pessimism, negativism, self criticism, worthy of punishment
- time is slowed
- suicidal thoughts: fleeting, detailed plans, active or more passive like starving self
- sometimes accompanied by psychosis, delusions or hallucination
Behavioural
- slow speech, stooped posture, agitated or retarded motor activity, restless
- may attempt to look cheerful
- withdrawn from social contact
Symptoms of Mania
Physical
- endorse good feeling with increased energy and increased sexual interest and activity
- sleep disturbances, appear deteriorates, eccentric or flamboyant
Emotional/Cognitive
- happy, carefree, euphoric, labile
- expansive moods, heightened sense of pleasure with mundane tasks
- perceptual distortions: grandiosity, inflated sense of self
- sexual or religious thoughts
- poor cognition: concentration, distractible, flight of ideas
Behavioural
- hyperactive, playful, pressured speech with rhyming and punning, disinhibited
- poor impulse control: spending money, gambling, engage in senseless activity
- gregarious, ++ social contact, wear more make up
Treatments for Depression
a. antidepressants (may take up to 3 weeks)
b. exercise
c. light therapy
d. trans-magnetic stimulation
e. ECT
f. mood stabilizers
g. health promotion/self-care/preventive coping
Treatments for Bipolar
a. mood stabilizers
b. ECT
c. environmental considerations
d. health promotion and safety
e. psychotherapy
f. personal medicine
Interaction strategies (depression)
- frequent and consistent interactions
- sit
- one topic at a time
- focused questions
- concise and clear questions
- avoid finishing sentences
- active listening
Interaction strategies (mania)
- calm interactions
- listen for themes and clarify
- model slower and lower volume speech
- reduce environmental stimuli
- closed-ended questions
- brief interactions
Anxiety Disorders
a. Generalized Anxiety Disorder
b. Panic Disorder
c. Phobias
d. Obsessive Compulsive Disorder
e. Post Traumatic Stress Disorder
Generalized Anxiety Disoder
- excessive anxiety and worry occurring more days than not for at least 6 months
- difficult to control the worry
- 3 out of 6 symptoms
restlessness, easily fatigue, difficulty concentration, irritability, muscle tension, sleep disturbances - impairment
Panic Disorder
abrupt surge of intense fear or discomfort that reaches a peak within minutes
Treatment for Anxiety Disorders
a. Anxiolytics
b. anti-depressants
c. psychotherapy
d. biofeedback
e. distraction
f. self-talk
g. mindfulness
Fear
an unpleasant emotional response to a real or perceived threat
Phobia
- fear so intense that it interferes with daily functioning
- an extreme or irrational fear
- highly associated with panic attacks
Obsessive Compulsive Disorder
Obsessions are recurrent, persistent, unwanted ideas, thoughts, images or impulses that are experienced involuntarily, appear to be senseless and feel out of control
Compulsions are a need to perform a repetitive behaviour or to manage incessant thoughts by doing something to try to settle them
Interventions for OCD
a. CBT (exposure and response prevention)
b. relaxation and meditation techniques to suppress/manage
c. anti-depressants
Post Traumatic Stress Disorder
caused by a psychologically traumatic event involving actual or threatened death or serious injury to self or others
- symptoms usually begin within 3 months
Signs and Symptoms of PTSD
- re-experiencing the event or trauma, intrusive recollection
- avoidance and emotional numbing
- depression, cognitive difficulties, changes in sleeping patterns
- hypervigilance
- nightmares
- flashbacks
- panic, despair, anxiety
Interventions for PTSD
a. CBT (exposure, desensitization, recognize and manage triggers)
b. trauma-informed nursing care
c. self-soothing techniques; control, grounding
d. psychotherapy, relaxation, group therapy
- medication: anxiolytics, anti-depressants
Borderline Personality Disorder
pattern of instability in interpersonal relationships, self-image and affects, marked impulsivity
2-3% of population
many experienced traumatic events during childhood
Signs and Symptoms of BPD
- impulsive behaviour
- destructive behaviour
- large mood component (negative affect, emptiness, isolation, anger, rage)
- unstable interpersonal relationships
- self-image instability
- intense fear of abandonment
- antagonistic , “splitting”
Nursing Care for BPD
- understand the condition
- non-judgmental approach
- limit setting
- assurance that client is safe
- medication (anxiolytics, antidepressants)
- hospitalization can be detrimental because of the controls, brief duration is important
Antisocial Personality Disorder
- evidence of conduct disorder in early childhood
- antagonistic behaviour
- disinhibited behaviour
- lack of appropriate emotional response
- lack of remorse
- finds pleasure and enjoyment at the hands of others vulnerabilities
Dissociative Identity Disorder
- multiple personality disorder
- 2 or more alters with unique identity, feelings and memories
- complex disorder in response to extreme trauma
