Mood Disorders Flashcards
Lifespan and Cultural Considerations
- life changes in OA increase risk
- prevalence no different among races
- expression of mood and culturally determined
- avoid stereotyping
Role of Stress
- stressful life events precede onset mood disorders, variable thought on degree of influence
- theory that brain’s biology changes, increases risk of subsequent episodes
- resilience important in determining impact of stress
Resilience
-ability to adapt well to stress, emotional pain and distress experienced
Factors that promote resilience
- caring and supportive relationships
- capacity to make plans and complete a goal
- positive view of self
- communication and problem solving skills
- ability to manage strong feelings and impulses
Types of Mood Disorders
- adjustment disorder with depressed mood
- major depressive disorder
- bipolar disorders
Adjustment Disorder with Depressed Mood
- change in mood and affect following a stressor
- “situational depression”
- symptoms begin within 3 months of stressor
- symptoms do not last beyond 6 months
- distress out of proportion to the stressor
- causes impairment in functioning
Clinical Manifestations of Adjustment Disorder with Depressed Mood
- sleep disturbances
- feeling hopeless and sad
- loss of self-esteem
- irritability
- difficulty concentrating
- inability to feel pleasure (anhedonia)
Nursing Assessment Adjustment Disorder with Depressed Mood
- precipitating stressor
- patient symptoms
- depression risk factors
- resilience factors
- currrent coping strategies
- safety
- screening tool (beck depression inventory for example)
Adjustment Disorder with Depressed Mood Nursing Diagnosis
- Helplessness
- Disturbed sleep pattern -Disrupted family processes
- Situational low self-esteem
- Ineffective coping
Nursing Plan/Goal for Adjustment Disorder with Depressed Mood may target…
- adequate sleep and rest
- impulse control
- daily functioning
- self-esteem
- safety
Nursing Interventions for Adjustment Disorder with Depressed Mood
- promote hope
- identify areas of control
- encourage belief in themselves
- assist in problem-solving process
- identify sources of support
- encourage family functioning
Collaborative Interventions for Adjustment Disorder with Depressed Mood
- CBT; cognitive behavioral therapy
- family therapy
- antidepressant medication
- antianxiety medication
- exercise
Major Depressive Disorder
- single episode or recurrent
- change in emotional state and functioning for 14 days or longer
- average age onset mid-20s
- women more affected than med
- hereditary
Clinical Manifestations of Major Depressive Disorder
*Significant decline in ability to function at work, school, or home
- depressed mood most of the day
- diminished interest or pleasure
- weight loss or gain
- insomnia or hypersomnia
- fatigue
- feeling worthless
- diminished concentration
- recurrent thoughts of death
Major Depressive Disorder Lifespan Considerations: Children/adolescents
- usually assessed within context of home/school situation
- decreased school performance
- problems with parents or teachers
- irritability
Major Depressive Disorder Lifespan Considerations: OA
- memory problems
- social withdrawal
- sleep disturbances
- appetite
- delusions/hallucinations
Nursing Assessment for Major Depressive Disorder
-symptoms of depression
-difficulty completing simple tasks
-tearfulness
somatic complaints
-withdrawal/social isolation
-differentiate from grief
-co-morbidities
-suicide assessment
Suicide Assessment for Major Depressive Disorder
-suicidal ideation (passive vs active, frequency)
-plan
lethality, realistic, available means, intent, past attempts, reasons NOT to complete
Major Depressive Disorder: Suicide Precautions
- nursing suicide assessment
- documentation
- patient transport considerations
- physical environment
- observation level (q15 or 1:1)
- restriction (supervised bathroom)
- contraband
Major Depressive Disorder: Nursing Diagnosis
- risk for self-directed violence
- chronic low self-esteem
- hopelessness
- social isolation
- ineffective health maintenance
Nursing Plan/Goal for Major Depressive Disorder may target…
- remaining free from self-injury
- participating in recreational activities
- knowledge that feeling better follows engaging in activities
- adherence to tx regimen
Nursing Interventions for Major Depressive Disorder
- develop therapeutic relationship
- provide distraction from self-focus
- encourage activities
- recognize accomplishments
- set limits on time spent discussing failures
- teach assertiveness
- assist in identifying strengths
- encourage patient to set goals
- explore various problem-solving strategies
- help identify resources
- avoid being overly cheerful and taking on patient’s feelings
Collaborative Interventions for Major Depressive Disorder
lab tests
- thyroid
- electrolyte
- urinalysis
- toxicology
- LFTs
- pregnancy test
Psychotherapy for Major Depressive Disorder
CBT
Non-pharm interventions for Major Depressive Disorder
- ECT
- TMS
Complementary and Alternative Interventions for Major Depressive Disorder
- exercise
- supplements
- acupuncture
- animal companionship
- music therapy
Pharmacological Interventions for Major Depressive Disorder
- SSRIs
- SNRIs
- TCAs and MAOIs
- Atypical antipsychotics
First line med for Major Depressive Disorder
SSRIs
- fluoxetine
- citalopram
- sertraline
- escitaolpram
**increases available serotonin
SNRIs
**increases serotonin and norepinephrine
- venlafaxine
- duloxetine
TCAs and MAOIs
-older with significant side effects
Atypical antipsychotics
- used with SSRI for severe depression
- aripiprazole
- risperidone
Duration of Medication Treatment: 1st episode/no risk factors
-6 months after symptom remission
Duration of Medication Treatment: 1st episode with risk factors or 2nd episode
1 year after symptom remission
Risk Factors for MDD
- dysthymia prior to episode
- poor recovery between episodes
- current episode > 2 years
- onset before age 20 or after 50
- family hx
- severe symptoms, psychosis, suicidality
Psychotherapy
- most effective when combined with medication
- both effective when used independently
CBT
Cognitive Behavior Therapy
- identifies negative thoughts and behaviors
- replaces disordered thought processes
- mindfulness training
ECT
Electroconvulsive Therapy
- electric current is passed through the brain to induce a sz
- given under anesthesia (NPO)
- receive muscle relaxant
- monitor EEG, EKG, O2 sat, VS
- short term memory loss expected (usually restores)
- typically 2-3 times per week for 12 tx
TMS
Transcranial Magnestic Stimulation
- magnetic field passes through skull
- causes cells in cerebral cortex to fire
- FDA approved
- target area for depression is left prefrontal cortex
- rapid onset of improved symptoms (1-2 weeks)
- as effective for depression WITHOUT psychosis as ECT
Inpatient therapeutic strategies for MDD
- many inpatient units use the Recovery Model
- healing is possible when health care team collaborates with patients
- focus on patient strengths
- identify realistic outcome criteria
- assist with developing criteria
- assist with developing measurable short term and long term goals
Important Strategies for MDD
- recognize that patients with depression often reject support and encouragement
- recognize unrealistic expectations for self and patient
- identify feelings that originate with patient
- understand role of biology and genetics in maintenance of depressed mood
Bipolar Disorders
-mood alternates between the extremes: depression, mania, interspersed with neutral mood
Bipolar 1
1 or greater manic episode and 1 or greater MDD epsiode
Bipolar 2
1 or greater MDD episode and at least 1 hypomanic episode
Manic Episode
abnormally expansive, elevated or irritable mood
-increased goal directed activity (most of day, everyday….plus 3 or greater of the following factors)
- inflated self esteem
- decreased need for sleep
- more talkative than usual
- flight of ideas
- distractibility
- psychomotor agitation
- increased pleasurable activites
Manic
symptoms last at least 1 week
-mood disturbance causes: marked impairment in functioning, necessitates hospitalization, psychotic features
Hypomanic
- symptoms last at least 4 days
- mood disturbance causes: change in functioning, uncharacteristic behavior, observable by others, NO hospitalization
Rapid Cycling
During a 12 month period:
-four or more illness episodes (mania, hypomania, or depression)
- at least 2 months between each episode OR alternating episodes (period of mania, followed by depression)
- more likely: female, earlier onset, tx resistant
Biopolar Disorder Nursing Assessment
- changes in thought processes
- inflated self esteem (delusions)
- ignoring fatigue, hunger, hygiene
- distractibility
- hallucinations
- surprising sense of well being
- rapid loud pressured speech**
- flight of ideas
- poor judgement/impulse (shopping, drugs, sex)
- unusual appearance (dress inappropriate)
Nursing Plan/Goal for Bipolar disorders may target…
- injury prevention
- focus
- making choices
- appropriate behaviors
- self-care
- sleep
Nursing interventions for patient with mania
- encourage reality-based thinking
- acknowledge belief, but share that you see it differently
- enhance socialization
- set limits
- promote improved self-care
- enhance rest and sleep
- decrease stimuli
- remain calm and relaxed
- firm and matter of fact demeanor (esp with limit setting)
- use role modeling behavior (offers reassurance)
- build trusting relationship
- promote safety
Promoting safety with bipolar disorders
- remove smoking and contraband materials
- safety checks
- create structured program with rest periods
- redirect patients who are at doorways (elopement risk)
- set and enforce limits on unsafe or inappropriate social behaviors
- prevent escalation (patient self-identifies triggers/calming strategies)
Collaborative Interventions for Bipolar disorders
- diagnostic stx
- pharmacologic: mood stabilizers
- psychotherapy
- case management
Mood Stabilizers
- antipsychotics
- lithium
- anticonvulsants
Antipsychotics
- aripiprazole
- riperidone
- olanzapine
anticonvulsants
- valproic acid
- lamotrigine
- carbamazepine
Relapse prevention for bipolar disorders
- important to involve family and patient (creating relapse strategies)
- teach patient and family about course of illness, important to adhering to medication regimen, early warning signs of relapse, community resources (NAMI)
