Mood Disorders

Question 1

Name the Key causative factors which have been identified for depression

Answer 1

• Genes and gene-environment interactions
• Neurochemical factors, hormonal systems, circadian rhythms and the immune system
• Sex differences

Question 2

Summarise genes and gene-environment interaction with depression

Answer 2

Five psychiatric disorders (major depression, bipolar disorder, schizophrenia, autism and attention deficit disorder) share most of the same genetic pattern, which interacts with prenatal environmental factors to produce changes in the brain that lead to a general psychiatric disease vulnerability. This phenomenon is called pleiotropy and it involves one gene influencing multiple seemingly unrelated disorders

Question 3

Summarise neurochemical factors, hormonal systems, circadian rhythms and the immune system for depression

Answer 3

Major depression is not simply a consequence of low levels of serotonin or other neurotransmitters in the brain. It is likely that monoamines modulate a range of other neurobiological systems to produce major depression.

Neurotransmitter systems impact hormonal systems to produce major depression.

Important among these systems is the hypothalamic-pituitary-adrenal axis which controls the release of cortisol and thyroid hormones as well as the overall circadian rhythms (the body’s 24hr cycle of brainwave activity).

The Immune system by way of pro-inflammatory cytokines (to produce an inflammatory response) may underpin many of these mechanisms

Question 4

Summarise sex differences with depression

Answer 4

Established that women are more than twice as likely to develop depression than men and this difference occurs across cultures. The theories that have been proposed to explain this range from biological to social and psychological factors. Male and female differences in immune system responses to stress and in turn, the initiation of depression are likely to be important. Women may be more sensitive to the social environment and show greater inflammatory response occurs, they feel more social disconnection and experience a depressed mood.

Question 5

Name the key causative factors which have been identified for bipolar disorder

Answer 5

• Neurochemical factors
• Hormone systems
• Circadian rhythms

Question 6

Summarise Neurochemical factors for bipolar disorder

Answer 6

The Genetic-environmental interaction produces changes in neurochemical systems. It is argued that as decreases in monoamines (the neurotransmitters serotonin, noradrenaline and dopamine) caused depression, increases in these same monoamines caused mania. This was supported by evidence that drugs such as cocaine and amphetamines stimulate dopamine activity and mimic symptoms of mania. There are many neurotransmitter systems involved and the origin of bipolar disorder remains in the complex interplay between genetic makeup and environmental factors

Question 7

Summarise Hormone systems for bipolar

Answer 7

Cortisol and thyroid hormone levels have been found to be elevated in clients during manic episodes and even when clients are in remission from the illness. Other researchers have found differences in structural brain function (blood flow from one part of the brain to another) during elevated mood compared to periods of normal functioning.

Question 8

Summarise circadian rhythms for bipolar

Answer 8

One of the prominent features of the manic stage of bipolar disorder is lack of sleep. In particular, clients with bipolar are sensitive to disturbances in their 24-hour circadian cycles and this a prominent feature of their illness during manic and depressive episodes

Question 9

Define Affect

Answer 9

The observable mood (subjective data)

Question 10

Define Mood

Answer 10

How the person feels (objective data)

Question 11

Define Egocentric

Answer 11

The patient’s thoughts of themselves without regard to others’ thoughts and feelings

Question 12

Define Elation

Answer 12

Great happiness or exhilaration

Question 13

Define Euthymic

Answer 13

The typical mood range, living without mood disturbances

Question 14

Define dysthymic

Answer 14

Low mood occurring for 2 or more years (chronic)

Question 15

Define Labile

Answer 15

Rapidly changing emotional state

Question 16

Define impulsivity

Answer 16

The tendency of acting without thinking based on feelings that lack forethought

Question 17

Define somatisation

Answer 17

The physical expression of stress and emotions through the mind-body connection (throwing up from anxiety, having a headache due to stress)

Question 18

Define pressure of speech

Answer 18

The tendency to speak rapidly and often have loud speech (motivated by the urgency that may not be apparent to the listener and can be difficult to interpret (erratic, fast, irrelevant speech)

Question 19

Define anhedonia

Answer 19

An inability to experience pleasure from activities that were usually found enjoyable

Question 20

Define psycho-motor retardation

Answer 20

Slowing down or hampering your mental or physical activities (slow thinking or body movements)

Question 21

Name the symptoms that fall under the American Psychiatric Association criteria for Major depressive disorder

Answer 21

• Depressed mood
• Loss of interest or pleasure
• Significant weight loss when not dieting or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Indecisiveness or difficulty concentrating
• Recurrent thoughts of death

Question 22

How many symptoms over how many weeks need to be present to ‘meet’ the criteria?

Answer 22

Five or more symptoms need to be present over the same two-week period and must represent a change from previous functioning

Question 23

What are three nursing interventions which can be used with depression

Answer 23

• Preform a MSE and risk assessment on them (always start with assessment)
• Treat anger and negative thinking as symptoms of the illness, not the person targeting you
• Make positive decisions for them when they are unwilling to make the decision for themselves (time to get out of bed)

Question 24

What is the rationale for performing a mental status exam and a risk assessment?

Answer 24

To gather an understanding of what the client is feeling right now and understanding where the mental state is at the point in time

Question 25

What is the rationale for treating anger and negative thinking as symptoms of the illness, and not as them attacking you

Answer 25

• Depressed people are often negative and angry
• By identifying that negativity and anger are aspects of the illness, the nurse can encourage the client to move on from these issues, to express more appropriate emotions

Question 26

What is the rationale for making positive decisions for the client when they are unwilling to make the decision for themselves?

Answer 26

• Depressed people can have difficulties making even the simplest of decisions
• By using problem-solving techniques (identifying options and the advantages and disadvantages of each option, and exploring the consequences of taking these actions) the nurse can guide the client to appropriate decisions

Question 27

What are the 4 areas of the DSM-5 criteria for a manic disorder?

Answer 27

• Persistent and abnormal elated expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day
• During the period of mood disturbance and increased energy/activity (three or more) of symptoms (four if the mood is only irritable are present to a significant degree and represent a noticeable change from usual behaviour
• Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features
• The episode is not attributable to the physiological effects of a substance or to another medical condition

Question 28

What are the symptoms which are present for the Manic criteria?

Answer 28

• Inflated self-esteem or grandiosity
• Decreased need for sleep (feels rested after 3 hours of sleep)
• Flight of ideas or subjective experience that thoughts are racing
• Increase in goal-directed activity
• Distractibility (attention to easily drawn to unimportant or irrelevant external stimuli)
• Excessive involvement in activities that have a high potential for painful consequences
• Pressure of speech (more talkative than usual)

Question 29

What are three appropriate nursing interventions when working with someone experiencing an acute episode of mania?

Answer 29

• Perform an MSE, functional enquiry and risk assessment
• Speak in a calm, supportive tone
• Always respond to legitimate complaints

Question 30

What is the rationale for speaking in a calm, supportive tone?

Answer 30

• Using this tone of voice encourages the client to respond positively, not defensively
• A clear, calm tone discourages the client’s need to engage in power struggles. The tone conveys to the client that they are supported and that the events are under control

Question 31

What is the rationale for responding to legitimate complaints?

Answer 31

• Clients with mania may make many frivolous complaints

- Nurses must always respond to legitimate complaints appropriately, to diffuse irritability and develop trust

Question 32

Why do people find it difficult to talk about suicide?

Answer 32

• Sensitive subject, people may don’t want to address the issue
• Worried it will make the situation worse
• Society stereotypes
• Being in denial that their loved one is suicidal

Question 33

What should be included in a risk analysis plan?

Answer 33

• Category of risk
• Detail of historical risk information
• Health-related factors
• Planned intent
• Staff allocation
• Strengths
• Barriers
• Specific risk

Question 34

What are stable risk factors?

Answer 34

Factors which are unchangeable

Question 35

What are the stable risk factors associated with suicide risk?

Answer 35

• Age
• Gender
• Marital status
• History of previous mental disorder/illness, personality disorder, substance use disorder, previous self-harm, previous suicide attempt
• Family history of suicide
• Childhood adversity, neglect or abuse, early behavioural problems
• Employment difficulties

Question 36

What are dynamic risk factors?

Answer 36

Factors that are fluctuating or can change with intervention

Question 37

What are the dynamic risk factors associated with suicide risk?

Answer 37

• Mental state and/or risk factors (current diagnosis of personality disorder, impulsively, substance abuse, active symptoms of mental illness with a suicidal/self harm/ harm to others ideation with plan and intent)
• Isolation and poor social support
• Recent losses such as a job, bereavement, separation
• Recent suicide of a friend, family member or public figure
• Recent experience of adversity or stressful event such as admission or discharge from mental health inpatient units
• Access to means and opportunity for suicide/self-harm/harm to others
• Unauthorised leave or failure to return from leave

Question 38

What are protective factors?

Answer 38

Factors that reduce the likelihood of a negative outcome

Question 39

What are the protective factors associated with suicide risk?

Answer 39

• Positive engagement with services, therapeutic alliance evident, compliance with treatment, awareness of early warning signs, concerns about the effect of suicide on others
• Stable employment and accommodation
• Prolonged abstinence from substances
• Previous help-seeking behaviour
• Strong, dependable social supports, good relationships

Question 40

What are some questions you would ask someone you suspect or know is experiencing suicidal ideation?

Answer 40

• “You’ve told me a bit of what’s been happening”
• “Does it seem unbearable at times?”
• “Have you ever had thoughts of hurting yourself?”
• “Have you ever tried hurting yourself?”
• “Do you ever have thoughts of hurting someone else?”
• “Have you ever had to protect yourself from others?”

The reality is that it is generally a relief for the person to have someone ask in a simple direct way about their thoughts and plans