Mood Disorders Flashcards
What is the depression criteria?
Five or more of the following symptoms over the same 2 week period and represent a change in functioning. At least one of the symptoms is either depressed mood or loss of interest of pleasure.
Depressed mood most of the day, nearly everyday
Markedly diminished interest or pleasure
Significant weight loss (when not dieting) or gain, or decrease/ increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feeling worthless or inappropriate guilt
Lack of concentration and/ or indecisiveness
Recurrent thoughts of death or recurrent suicidal ideation
ALSO; the symptoms cause significant distress or impairment and are not attributable to substance use or medical condition
What is the Mania criteria?
Distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week (or any duration is hospitalisation is necessary) with 3 or more of the following symptoms (4 symptoms if mood is irritable)
Inflated self esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas or racing thoughts
Distractibility
Increase in goal directed activity
Excessive involvement in pleasurable activities that have high potential for painful consequences
What are the two types of Bipolar disorder?
Bipolar 1 (1 or more manic or mixed episodes)
Bipolar 2 (characterised by hypomania and a depressive episode)
What are the symptoms of Bipolar disorder?
A cycling between depression and normal mood and mania
Aetiology: again a complex relationship between genes, psychosocial factors and hormonal imbalance.
Cortisol and thyroid levels have been found to be high in mania
Circadian rhythms have been found to be very important and account for decreased need for sleep
Risks: relevant to either mood state: depression = suicide, isolation, malnutrition, finance
Mania = suicide, high consequence behaviours such as disinhibition around money and sex, malnutrition, aggression
How many years of symptoms you do need be diagnosed with ‘Persistant depressive disorder”
2 years
What is Cyclothymia?
chronic bipolar disorder with mild symptoms over 2 years
What is Perinatal and Postnastal Depression?
depressed mood, excessive anxiety, insomnia and weight changes. Has similar causes to depression including psychosocial, genes and hormonal changes.
What is Grief and mood disorders?
the difference between grief and major depressive disorder. 4 stages of normal grief: Shock and protest, preoccupation, disorganisation, resolution. Clients with major depressive disorder often are fixed in disorganisation stage and cannot move forward to resolution.
what are some nursing considerations using a combination of psychotherapy, pharmacotherapy and education?
Psychotherapeutic interventions can include; client-motivated including education around self-management techniques such as how to cope and get through when times are particularly bad.
Therapeutic use of self: Counselling/communication skills; listening with interest, reflection of content and feeling, summarising and closure
Pharmacology: antidepressants and mood stabilisers. Nurses role is about education around the medication, side effects and precautions, i.e. antidepressants can take 2-6 weeks to work.
What is Mania characterised by?
Characterised by 3 main features: persistently elevated mood (elation or irritability); increased activity and poor judgement.
What are some consequences of mania?
DSM 5 includes behaviours such as inflated self esteem or grandiosity, decreased need for sleep, more talkative, pressured speech, flight of ideas, racing thoughts, distractibility, poor attention span, increase in goal directed activity, excessive involvement in activities that have potential for painful consequences
Causes impairment in social or occupational functioning
Is not attributable to a physiological cause i.e. drugs
May experience delusions and hallucinations
High risk of dehydration, malnutrition
Appearance: can be colourful and ‘over the top’ dishevelled, malodorous
Must be present for at least a week
What is major depressive disorder?
a condition involving seriously depressed mood and other symptoms which affect all body systems and interfere significantly with a persons ability to carry out their daily living activities.
What is Dysthymic disorder?
chronically depressed mood for most of the day, more days than not, for at least two years.
What is the DSM 5 criteria for Major Depressive Episode (MDE)
Major depressive disorder is classified as a condition in which 1 or 2 and at least four of the other symptoms below are present:
-Depressed mood most of the day, nearly every day
-Marked diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (anhedonia)
-Significant weight loss when not dieting, or weight gain
-Insomnia or hypersomnia nearly every day
-Psychomotor agitation or retardation nearly every day
-Fatigue or loss of energy every day
-Feelings of worthlessness or excessive or inappropriate guilt nearly every day
-Diminished ability to think or concentrate, or indecisiveness, nearly every day
-Recurrent thoughts of death or suicidal ideation
What is the DSM 5 criteria for Dysthymia?
Depressed mood for most of the day during a 2-year period (1 year for children and adolescents), presence of depressed mood.
Symptoms cause clinically significant distress in social, occupational, and other important areas of functioning.
Presence of two or more of the following:
Decreased or increased appetitie
Insomnia or hypersomnia
Anergia or chronic fatigue
Anhedonia
Poor concentration or difficulty making decisions
Feelings of hopelessness and despair
What are the depression observable changes in functioning?
Behavioural changes: social and emotional withdrawal, less effective in areas of work and family relations, substance abuse
Cognitive changes: become increasingly egocentric, thoughts become negative, difficulty concentrating, indecisiveness, self-deprecating beliefs and negative ruminations, thoughts of death and suicide
Communication changes: don’t initiate conversation, latency and poverty of response
Mood changes: mood lower than usual, feelings of sadness and hopelessness, may cry a lot. The observable behaviours associated with changes in a persons mood are referred to as affect
Alterations in physical functioning: sleep disturbances, fatigue, appetite changes, sexual desire diminishes, psychomotor retardation, somatisation
How can you treat depression?
Medication
Electroconvulsive therapy
Psychological therapies
What is the DSM 5 criteria for a manic episode?
Mania is classified as an elevated, expansive or irritable mood for at least one week. There is also significant impairment in social or occupational functioning. Three or more of the following seven symptoms must be present:
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative/pressure of speech
Flight of ideas/racing thoughts
Distractibility
Increase in goal directed activity (e.g. social, work, school or sexual activity)
Excessive involvement in pleasurable activities that may have negative consequences (e.g. shopping, sexual or business activities)
(Hypomania has the same symptoms but they are only present for up to 4 days)
What are the Mania observable changes in functioning?
Behavioural changes: Increased activity, distractible and impulsive, sexually disinhibited, spending large amounts of money, starting up ill-advised business ventures
Cognitive changes: Racing thoughts, being easily distracted, increased sense of self-importance, loss of insight
Communication changes: Very talkative, speech is rapid and pressured, conversation expansive and difficult to disengage from, intolerant of criticism and become irritable and argumentative
Mood changes: Elevated or high, irritable mood, rapidly changing intense emotions (labile)
Physical symptoms of mania: Reduced need for sleep, increased energy, increased appetites
How can you treat BPAD?
Medication:
-Lithium
-Anticonvulsant medications
Psychotherapy
Self-management
Depression: key causative factors (Biopsychological model)
genes and gene- environment interaction
neurochemicals, hormones, circadian rhythms and immune system
sex difference
Bipolar disorder: key causative factors (Biopsychological model)
neurochemicals
hormone system
circadian rhythms
Define: Affect
observable mood (subjective)
Define: Mood
how the patient feels (objective)
Define: Egocentric
the patients thoughts of themselves
Define: Euthymic
typical mood range
Define: Elation
great happiness or exhilaration
Define: Dysthymic
lowered mood that is chronic
Define: labile
rapidly changing emotional state
Define: impulsivity
behavioural acts based on feelings and lack of fore thought
Define: somatisation
manifestation of psychological distress in the form of physical symptoms
Define: pressure of speech
rapid and often loud speech
Define: Anhedonia
loss of interest in usually pleasurable activities
Define: psycho-motor retardation
slowing up of usually fluid physical movement
DSM 5 criteria for a manic disorder
A- persistent and abnormal elevated expansive or irritable mood
B- increases activity, energy
1. inflected self esteem or grandiosity
2. decreased need for sleep
3. pressure of speech
4. flight of ideas or racing thoughts
5. distractibility
6. increased goal directed activity
7. excessive involvement in pleasurable activities.
C- mood disturbance causes marked impairment to social or occupational functioning
D- the episode is not due to a substance or medical condition
