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NUR5003 > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What are mood disorders?

A

Pervasive alterations in emotions that are manifested by depression, mania or both

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2
Q

What factors are considered about a person’s mood when determining mood based disorders?

A

Congruence and appropriateness

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3
Q

What is persistent depressive disorder?

A

Presence of depressive symptoms for at least 2 years

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4
Q

How are depressive disorders diagnosed?

A
  • 5 out of the 9 criteria need to be present during the same fortnight and represent a change from previous functioning
  • Criteria 1 or 2 need to be present
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5
Q

Which two depressive symptoms need to be present in order to diagnose a depressive disorder?

A
  1. Depressed mood most of the day, nearly every day
  2. Markedly diminished interest or pleasure in all, or most activities, most of the day, nearly every day
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6
Q

What is the diagnostic criteria for hypomania in bipolar affective disorder?

A

Elevated, expansive, labile or irritable mood, abnormal/incongruent and persistent goal directed activity, lasting minimum four consecutive days and most of the day with at least 3 hypomanic symptoms:
- Grandiosity or inflated self esteem
- Decreased need for sleep (feels rested after a couple hours)
- More talkative than usual and difficult to interrupt (marked pressure of speech)
- Flight of ideas or subjective account of thoughts racing
- Easily distracted towards irrelevant stimuli
- Increase in goal directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences

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7
Q

Does hypomania impact functioning?

A

Hypomania is not severe enough to cause impairment in functioning

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8
Q

Do people experiencing hypomania typically require hospitalisation to address risks to self/others?

A

No, it is not severe enough to require hospitalisation

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9
Q

What is the difference in speech in hypomania and mania?

A

Hypomania - difficult to interrupt
Mania - cannot interrupt

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10
Q

If a person has had a manic episode in the past, can they be diagnosed with hypomania in the future?

A

No, for hypomania there must never have been a manic episode

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11
Q

What is the diagnostic criteria of mania in BPAD?

A

Elevated, expansive, labile or irritable mood, abnormal/incongruent and persistent goal directed activity, lasting minimum of one week and most of the day with at least 3 of the following:
- Grandiosity or grossly inflated self esteem
- Decreased need for sleep
- More talkative than usual and cannot be interrupted (marked pressure of speech)
- Flight of ideas or subjective account of thoughts racing
- Easily distracted towards irrelevant stimuli
- Increase in goal directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potential for painful consequences

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12
Q

Does mania cause impairment in functioning?

A

Yes

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13
Q

Does mania or hypomania require hospitalisation to address risks to self/others?

A

Mania

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14
Q

Can patients who present with mania be treated in the community?

A

No, due to risk factors and inability for family supports to safely manage them

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15
Q

What is bipolar 1?

A

Bipolar affective disorder with episodes of depression and mania

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16
Q

How long do symptoms have to appear to be considered bipolar 1?

A

Manic symptoms: at least one week
Depressive symptoms: at least 2 weeks

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17
Q

What is bipolar 2?

A

Bipolar affective disorder with episodes of depression and hypomania

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18
Q

How long do symptoms have to appear to be considered bipolar 2?

A

Hypomania: at least 4 days
Depression: at least 2 weeks

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19
Q

How fast do mood shifts occur in BPAD?

A

Mood shifts over several days or weeks (can also be months)

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20
Q

What is cyclothymia?

A

Continuous cycle of depressive and manic symptoms that are not as intense as bipolar 1 or 2, that occurs for over 2 years

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21
Q

What is rapid cycling?

A

More than 4 episodes of depression or mania within a year

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22
Q

What are mixed episodes?

A

Experiencing symptoms of both depression and mania at the same time

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23
Q

What are symptoms of low mood in BPAD?

A
  • Similar to major depressive disorder
  • Can feel helpless and discouraged
  • Lack mental and physical energy
  • Lack mental focus
  • Physical symptoms: eating or sleeping too much or too little
24
Q

Nursing roles for nursing a depressant pt

A
  1. Physical assessment
    - Comprehensive psychiatric assessment incorporating a thorough physical assessment as physical conditions can mimic or influence depression
    - Hypothyroidism can mimic and chronic pain can influence severity and frequency
    - Medical treatments can cause depression or interfere with antidepressants, such as steroids, Ab, CNS and dermal medications
    - Physical state needs to be monitored: nutrition + elimination, energy levels, sleep, attention to ADLs and grooming
    - Monitor for evidence of substance misuse and consider a withdrawal regime if using substances prior to admission
  2. Mental state examination (MSE)
    - Any MSE changes must be handed over within the team and documented
    - Abrupt changes in mood are of particular concern as patients are resourceful and can take advantage of complacency from nursing staff
  3. Nurse-pt relationship
    - Therapeutic relationship to be established and maintained
    - TIC
    - Maintain a physical presence, as pt requires observation, reassurance, opportunities to discuss their concerns, be validated and promote self-esteem
    - Depression is an illness of isolation, and ongoing contact reinforces MH nurses concerns for their welfare
    - Empathy is crucial for these pts
    - Encouragement to gradually increase independence and expand self care, using positive statements. Start with basics and try not to overwhelm
  4. Education
    - Psychoeducation: education on the condition and management is of vital importance to the patient and carers
    - Medication education
  5. Risk assessment
    - Suicide risk
    - Self-harm risk (deliberate and accidental)
    - Aggression to others (common risk for postnatal depression: infanticide)
    - Self neglect (hygiene and grooming are overt signs)
    - Substance abuse
    - Compliance
  6. Risk management
    - Identify risks
    - Enhance protective mechanisms
    - Gauge pts thoughts, intent, plan and assess history of attempts
    - Determine level of risk and make plan to address and absolve risk
    - Document the assessment, degree of risk and plan of action
25
Q

What do antidepressants do? MOA

A

Increase level or effect of serotonin, noradrenaline or dopamine

26
Q

What are antidepressants used for?

A

Depressive disorders, pain disorders, anxiety disorders and social disorders

27
Q

Side effects of antidepressants

A
  • Can potentially lead to manic episodes
  • Weight gain
  • Reduced libido
28
Q

Are antidepressants addictive?

A

No

29
Q

Which type of antidepressant is used for deliberate self harm or suicide attempts?

A

SSRIs - lower risk of increased suicidal ideation

30
Q

How long do antidepressants take to work?

A

Improvements often noted after 3 weeks but full therapeutic effect can occur after 6-8 weeks

31
Q

What are common reasons for non-compliance with antidepressants?

A
  • Side effects
  • Delayed response to medications (6-8 weeks for full effect)
32
Q

MHN roles when changing antidepressants

A
  • MSE to monitor mental state changes
  • Monitor for signs of toxicity
  • Monitor for signs of increased risk of self-harm/suicide
33
Q

Mania/hypomania nursing care

A
  1. Physical assessment
    - Hyperthyroidism can mimic mania and amphetamines + corticosteroids can induce mania
    - Attention to physical state needs monitoring: nutrition + elimination, energy levels, sleep and rest with emphasis on balance, attention to ADLs and grooming
    - Monitor for evidence of substance misuse and consider withdrawal regime
  2. Maintenance or improvement of physical health
    - Monitor ADLs and promote sleep, rest, adequate nutrition and hydration
    - Consider PRN meds to promote appropriate sleep/wake cycle
    - When hypomanic, offer finger foods and nutritional supplements as they are difficult to direct and remain seated for meals
  3. MSE
    - MSE changes must be handed over within the team and documented
    - Mood swings are common in patients with BPAD
  4. Limit setting
    - Low stimulus environment as easily distracted
    - Short and simple statements with limit setting needs to occur, and frequently
    - Manic pts can dress and behave provocatively and can regret when mood stabilises, so limits need to be put in place
    - Limit visitors and lengths of visits
    - Replace noise and group activity with drawing, painting, relaxation music and 1:1 contacts
  5. Nurse-pt relationship
    - MHN should be calm around pts
    - Attitude of MHN and ability to communicate is important. Be approachable, patient, tolerant, open, honest, non-judgemental, compassionate, consistent, kind and non-punitive
    - Maintain a physical presence as requires observation, redirection, opportunities to discuss their concerns, be validated and promote responsibility
    - Encouragement about making healthy choices about their treatment and welfare
    - Often need to be parental or authoritarian
  6. Education
    When mood stabilises
    - Provide psychoeducation on the illness, treatment and early warning signs of relapse
    - Develop a relapse plan with focus on early warning signs (EWS) of relapse and an alert system for their supports (clinical and personal)
  7. Risk assessment
    - Suicide risk
    - Self-harm risk (deliberate and accidental)
    - Aggression to others
    - Risk of harm from others
    - Self neglect
    - Compliance
    - Vulnerability
  8. Risk management
    - Identify actual and potential risks
    - Enhance protective mechanisms
    - Gauge pts thoughts, intent and plan and assess history of attempts
    - Determine level of risk and plan to address and resolve risk
    - Document assessment, degree of risk, effectiveness of interventions and plan of action
34
Q

What kind of medications are used for BPAD?

A

Mood stabilisers, antidepressants and benzodiazepines

35
Q

Why are benzodiazepines sometimes used in BPAD?

A

Good for rapid control of manic symptoms as mood stabilisers are slower

36
Q

Why are antidepressants used in BPAD?

A

Used for depressive episodes

37
Q

What needs to be considered when choosing an antidepressant for BPAD?

A

SSRIs can trigger manic episodes

38
Q

What type of medication are mood stabilisers?

A

Anticonvulsants, so not recommended for patients who need ECT (not lithium carbonate so this is recommended)

39
Q

What are the side effects of lithium carbonate?

A
  • Stomach upset (affected pts advised to take with milk)
  • Irreversible renal damage from toxicity
40
Q

When and why are serum levels of lithium carbonate taken?

A

More than 12 hours post dosage.
Taken to monitor compliance of taking the medication and can monitor for toxicity

41
Q

Besides medication, what are interventions for BPAD?

A

ECT, CBT and milieu therapy

42
Q

How are involuntary patients approved for ECT?

A

Need to be approved by the mental health tribunal (MHT)

43
Q

What type of episode is ECT usually used for?

A

Depressive episodes

44
Q

What are advantages of ECT?

A
  • Works more rapidly than meds (good for pts refusing to eat and drink and for pts with intense suicidal ideation)
  • High success rate (around 80%)
  • More appropriate for treatment resistance depression and catatonic presentations of depression or schizophrenia
  • Can be used for mania/hypomania when other treatments have minimal effect
  • Regular physical and consultant psychiatrist reviews are provided, in accordance with the Mental Health Act 2014 (Vic)
45
Q

What are the adverse effects of ECT?

A
  • Poor public perception
  • Brief period of headache
  • Cognitive impairment
  • Potential for complications consistent with use of IV anaesthetic agents and ECT is considered an invasive procedure
46
Q

CBT in BPAD treatment

A
  • Applies a positive approach towards their symptoms by changing the ways they think and react/behave
  • Aim is to change ingrained habits and maladaptive approaches to constructive, healthy ones
  • Helpful after manic episodes, can help patients handle stressful situations that might otherwise lead to a manic episode
47
Q

Milieu therapy in BPAD treatment

A
  • Reduction of sensory stimulation given the disorganised thought processes of the patient
  • For depressed pts, a safe environment is essential
48
Q

What are suicide risk factors?

A
  • Prior attempts
  • History of deliberate self-harm
  • Mental illness
  • Substance misuse
  • Indigenous males
  • Incarceration
  • Social factors: poor relationships, family discord, marital separation and conflicts, legal proceedings, unemployment, finances, social welfare recipients, loss of partner, sexual abuse, trauma, isolation, sexual orientation
  • Physical state: chronic disability, chronic pain, terminal conditions
49
Q

What is para-suicide?

A

Suicide attempts or gestures without the intent to die

50
Q

What is deliberate self-harm (DSH)?

A

Any intentional damage to the body without a conscious intention to die including cutting, burning, carving, branding, head-banging, scratching, biting, bruising, abrasions, pulling skin and hair, done to alleviate emotional distress

51
Q

What question should you ask to determine suicidal thoughts?

A

Do you feel that life is worth living?

52
Q

What question should you ask to determine suicidal intent?

A

Have you felt like acting on this?

53
Q

What question should you ask to determine suicide method and plan?

A

Have you made any plans to carry this through?

54
Q

What question should you ask to determine suicide history?

A

Have you ever tried to harm or kill yourself before?

55
Q

What should you find out about previous suicide attempts?

A

Were they alone?
Did they change their mind or feel guilty?
Did they get medical treatment or care?
Did they get help? Was it effective?
What current factors are different?

56
Q

Suicide risk nursing care

A

Safety
- Remove at risk items
- Frequent observations
- Potential for 1:1 supervision
Nurse-pt relationship
- Listen effectively, be sensitive, empathetic, caring, respectful, accepting, encouraging
- Observe patients at more difficult times: determine periods of crisis and observe at those times.
- Empower pt by providing options (for some this will provoke more stress so don’t)
- Do not use admission/discharge, MHA status or seclusion as a threat in order for patient to comply with care
Planning
- Verbal contracts or “no suicide contracts”
- Encourage pt to contact you in times of crisis in the community, reinforcing the success of this action by owning the responsibility for personal safety.

NUR5003 (7 decks)

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