mood disorders

Question 1

Bipolar affective disorder

DSM diagnosis

Answer 1

• pt experiences mania/hypomania and depression

3 or more:

• grandiosity
• flight of ideas
• distractibility
• increase in goal orientated activity

manic: lasting 1 week most of day
hypomanic: at least 4 consecutive days

Question 2

bipolar treatments:

medications

Answer 2

• antipsychotic
• mood stabalising
• anxiolytic

Question 3

bipolar nursing considerations

Answer 3

• suicide and self harm risk
• aggression to others
• vulnerability
• neglect (sleep, food, self care)

Question 4

bipolar I vs II

Answer 4

Bipolar I: one or more manic, with major depressive
1 week, most of the day
causes impairment in function and/or hospitalisation

Bipolar II: One or more depressive and one hypomanic
at least 4 consecutive days
not severe enough to cause marked impairment in social or necessary to hospitalise

Question 5

Mood stabilisers:
Lithium carbonate
Sodium valproate 
carbamazepine
lamotrigine

Answer 5

Lithium: High side effects, toxicity.
- nausea, vomitting, weight gain, fatigue
ROUTINE BLOODS FOR TOXICITY
- NURSING CONSIDERATIONS:
- monitor water and salt intake, changes can increase lithium levels (toxicity)
- replace fluids/electroylytes lost through exercise

Sodium: well tolerated
- nausea, vomitting, weight, diarrhoea

Carba: less sedating
- drowsiness, dizziness, nausea

Lamo: Rash
- drowsiness, headache, blurred vision

Question 6

depression

DSM criteria

Answer 6

5 out of 9 symptoms present during 2 week period

• depressed mood most of day
• diminished interest or pleasure in actives
• weight changes
• insomnia
• fatugue
• worthlessness
• suicidial ideation

Question 7

anti-depressants:

Selective serotonin reuptake inhibitors (SSRIs)

Answer 7

• sertraline
• inhibit the reuptake of neurotransmitters (particularly serotonin) allowing serotonin to remain in the CNS for longer

Side effects: Dry mouth, headache, dizziness, tremors, sexual dysfunction

Question 8

anti-depressants:

Serotonin - noradrenaline reuptake inhibitors (S&NRIs)

Answer 8

• venlafaxine
• fewer side effects than SSRIs but harder to withdraw from
• inhibiting the reuptake of noradrenaline and serotonin

Side effects: intensified dreaming, nausea, headache, restlessness, difficulty reaching orgasm

Question 9

anti-depressants:

Tricyclic antidepressants (TCAs)

Answer 9

• Amitriptyline
• more effective but more potent side effects and lethal in overdose.
• administered at night due to sedative

Question 10

Mono-amine oxidase inhibitors (MAOIs)

Answer 10

• diet restrictions as can cause high BP when taken with tyramine rich foods (alcohol, aged cheese, processed meats)

Question 11

discontinuation syndrome

FINISH

Answer 11

Flue like symptoms 
Insomia
Nausea
Imbalance 
Sensory disturbances 
Hyperarousal 

(1-2 weeks)

Question 12

Nursing care of depressed person

Answer 12

• MSE
• Risk ax
• Risk mgmt
• Physical ax
• Physical state (ADLs, nutrition)

Question 13

ECT

Answer 13

• electroconvulsive therapy
• severe depression
• electric current passed through the brain to induce seizure

Question 14

Psychotherapies

• CBT
• Interpersonal therapy
• Financial counselling

Answer 14

• non invasive treatment
• CBT thoughts emotions behaviours.
  Challenges negative thoughts