Mood Disorders Flashcards
Mood Disorder def
- Mood disorders/affective disorders, are pervasive alterations in emotions that are manifested by depression, mania, or both.
- Until the mid-1950s no treatment was available to help people with serious depression or mania.
- Most common psychiatric diagnoses associated with suicide=depression; one of the most important risk factors
Mood Disorder
Etiology
Biology
- Genetic: MD-2x risk and BP- 3-8% risk in first-degree relatives
- Neurochemical:
● SErotonin:Decreased in Depression; E=Elevated=Mania
● NorEpinEphrinE: No=Depression, E=Elevated-Mania
● DopaMine: D=Down=Depression, M=Mania=”Mataas” - Neuroendocrine:
● Postpartum hormonal alterations=precipitates postpartum depression
● Elevated glucocorticoid activity=linked to depression
● 5-10% of people with depression has a thyroid dysfunction - Neuroanatomical: right-sided lesions in the limbic system, basal ganglia and thalamus= linked to development of secondary mania
Mood Disorder
Etiology
Psychodynamic Perspectives:
- Freud: looked at self-depreciation of people with depression; self-reproach to anger turned inward
- Bibring: one’s ego aspired to be ideal; if not achieved=depression
- Horney: children raised by rejecting and unloving parents=depression
- Seligman: Learned helplessness
- Psychoanalytic Theory: Manic episodes are “defenses’’ against underlying depression, with the id taking over the ego
Mood Disorder
Etiology
Cultural Considerations (In terms of manifestations):
- Children w/ depression: school phobia, failing grades
- Adolescents w/ depression: substance abuse, gangs, risky behaviors
- Adults w/ depression: substance abuse, eating disorders, gambling, workaholism
MD def
- AKA Unipolar Depression
- 2x as common to women and decreases with age;
increases with men - Single/Divorced people have the highest incidence
- 9% of people with severe depression have psychotic
features - Elderly people: also predisposed due to bereavement
overload
MD: Symptoms and Diagnosis
According to DSM-5: 5 or more of the following symptoms during 2 weeks, one of the symptoms is * - “I PASSED GC!”
Interest (diminished)
Psychomotor (agitation/retardation)
Appetite (increase/decrease)
Sleep (increase/decrease)
Suicidal Ideation
Energy (poor/low)
Depressed mood most of the day *
Guilt/Low Self-Esteem *
Concentration (Poor)
MD: Nursing Diagnosis
RISK FOR SUICIDE - priority
Low Self-Esteem
Powerlessness
Social Isolation
Disturbed Thought Process
Imbalanced Nutrition
Insomnia
Self-Care Deficit
MD: Medical Management
MAOI
Tranylcypromine (Parnate)
Phenelzine (Nardil)
Isocarboxacid (Marplan)
TCA
Protriptyline (Vivactil)
Nortriptyline (Pamelor)
Amitriptyline (Elavil)
Imipramine (Tofranil)
Clomipramine (Anafranil)
Maprotiline (Ludiomil)
Doxepin (Sinequan)
SSRI
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluovoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
(MAOI) nursing responsibilities
contraindication
s/s
mgmt
- No Tyramine Rich Foods, Coffee! = Hypertensive Crisis
“TYRAMaE”
Toyo/Tuyo
Yeast
Red Wine
Avocado/AGED FOODS!
MAlt
Eden (Cheese)
Processed, Canned, Cured Foods
S&Sx: Occipital headache, hypertension
N/V, motor agitation, sweating
Hyperpyrexia
Management: Phentolamine mesylate
(Regitine)
(TCA) nursing responsibilities
contraindication
s/s
mgmt
Blurring of vision
Urinary hesitancy
Constipation
Orthostatic hpn
Prolonged QRS Complex (widening)
Agitation
Nausea
Dizziness
Anticholinergic effects
No Sex Drive
● Contraindication: liver impairment, hx of MI, glaucoma
● Takes 6 full weeks to reach full effect
(SSRI) nursing responsibilities
s/s
mgmt
Prozac: Weight loss; may increase mild aggression
Sleepy
Stomach Upset
Sexual Dysfunction
Suicidal Thoughts
Serotonin Syndrome=Hyperreflexia, tachycardia/pnea, hpn, 41C
- Mgt: Withhold drugs!
Antidote: Cyproheptadine (Perlactin)
MD: Nursing Management
- Provide safety; suicide precautions
- Beginning Therapeutic relationship: spend non-demanding time; short frequent irregular visits, therapeutic use of self
- Structure environment and time; let client plan activities
- Avoid overly being cheerful to the patient
- Give allowance for client’s psychomotor state
- Assist in ADLs only if necessary
- Offer small frequent meals
- Assign same staff member if possible
- Avoid complex sentences and directions
- No competitive games
BD: Symptoms
Stage 1: Hypomania
Cheerful, underlying
irritability
Self-exaltation, easily
distracted
Increased motor activity, extroverted and sociable
but fails to make close relationships, talk and
laugh a lot/inappropriately, weight loss, anorexia,
engagement in inappropriate behaviors
BD: Symptoms
Stage 2: Acute Mania
Euphoria
Flight of ideas, loquaciousness
Sexual interest, poor impulse control, excessive
spending, manipulative, reduced need for sleep,
hygiene gets neglected, disorganized/flamboyant
/bizarre dressing, excessive makeup and jewelry
BD: Symptoms
Stage 3: Delirious Mania
Labile
Clouding of Consciousness, Confusion, Delusion of
Grandeur/Persecution, audi/vis hallucination, incoherent
Safety is at stake, may injure others
BD: Nursing Diagnosis
Risk for Injury
Risk for Violence: Other/Self-Directed
Disturbed Thought Process
Disturbed Sensory Perception
Impaired Social Interaction
Insomnia
BD: Medical Management
LITHIUM ADMINISTRATION & THERAPY (Antimanic)
Anticonvulsants:
Carbamazepine (Tegretol): WOF Agranulocytosis, hypotension, ataxia, confusion
Valproic Acid (Depakote): WOF for jaundice, SGPT/SGOT,
bleeding, pregnancy, may cause staining of teeth
Lamotrigine (Lamictal): alternative for pregnant clients needed treatment
General Consideration: Has sedative effects
BD: Medical Management
LITHIUM ADMINISTRATION & THERAPY (Antimanic) NURSING RESPONSIBILITIES
- Effective to 75% of people with bipolar illness.
- Concurrent use with diuretics, fluoxetine, methyldopa, or NSAIDs increases lithium reabsorption by the kidney, or inhibits lithium excretion.
- Acetazolamide, aminophylline, phenothiazines, or sodium bicarbonate may increase renal excretion of lithium, reducing its effectiveness.
- The therapeutic dose (0.6 to 1.2 mEq/L)
- Causes of an increase in lithium level: decreased Na intake, fluid and electrolyte loss associated with severe sweating, dehydration, diarrhea, or diuretics
- Check Serum lithium levels every I to 2 months or whenever any behavioral change suggests an altered serum level (draw blood in AM 12 hrs after lose dose
taken) - Administer with food; adequate fluid intake - 6 to 8 glasses of water a day; avoid excessive amounts of coffee, tea, or cola or any diuretic, adequate salt intake.
- Can cross BBB; breast milk; contraindicated to pregnant wome
BD: Nursing Management
- Safety of client & those around client
- Set limits on his behaviors when needed
- Decrease environmental stimuli
- Remind client to respect distances b/n self & others
- Simple sentences; keep interactions short and frequent
- Provide finger foods, “on-the-run” & high in calories & protein
- Promote rest & sleep
- Protect client’s dignity when inappropriate behaviors occur
- Channel client’s need for movement into socially acceptable motor activities
- Physical activities such as walks, creative writing & drawing, avoid competitive games.
- Monitor I and O
