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Mood Disorders Flashcards

1
Q

Pervasive alteration in mood and affect

A

Elevated
Depressed
Cycling

Impairs functioning

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2
Q

Contributing Factors: Biological

A

Hormonal dysregulation Neurotransmitter changes Neuroanatomy
Sleep neurophysiology Immunological disturbance

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3
Q

Contributing Factors: Genetic

A

Highly heritable

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4
Q

Contributing Factors: Psychosocial

A

Stress

Personality

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5
Q

Role of Stress and Mental illness

A

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

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6
Q

What is Resilience?

A

The ability to adapt well to stress

- Emotional pain & distress experienced

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7
Q

Factors that promote resilience:

A

Caring and supportive relationships
The capacity to make plans and complete a goal
Positive view of self
Communication & problem solving skills
Ability to manage strong feelings and impulses

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8
Q

Types of mood disorders

A 
Adjustment disorder with depressed mood  
Major depressive disorder
 Bipolar disorder
 - Bipolar I  
 - Bipolar II
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9
Q

What is Adjustment disorder with depressed mood ?

A

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

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10
Q

Adjustment Disorder with Depressed Mood:

Clinical Manifestations

A 
Sleep disturbances  
Feeling hopeless and sad  
Loss of self-esteem  
Irritability
Difficulty concentrating
Inability to feel pleasure (anhedonia)
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11
Q

Adjustment Disorder with Depressed Mood:

Nursing Assessment

A 
Precipitating stressor  
Patient symptoms  
Depression risk factors  Resilience factors
Current coping strategies  SAFETY
Screening tool
 ** Ex: Beck Depression Inventory
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12
Q

Adjustment Disorder with Depressed Mood:

Nursing Plan/Goal

A

Adequate sleep and rest Impulse control
Daily functioning
Self-esteem
Safety

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13
Q

Adjustment Disorder with Depressed Mood:

Nursing Interventions

A

Promote hope
Identify areas of control Encourage belief in themselves Assist in problem-solving process
Identify sources of support Encourage family functioning

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14
Q

Adjustment Disorder with Depressed Mood:

Collaborative Interventions

A

Cognitive behavioral therapy (CBT)
Family therapy
Antidepressant medication Anti-anxiety medication
Exercise

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15
Q

What is Major Depressive Disorder?

Factors?

A

Single episode or recurrent
Change in emotional state and functioning
- 14 days or longer

Average age onset mid-20s Women more affected than men
Hereditary

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16
Q

Major Depressive Disorder:

Clinical Manifestations

A

** 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

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17
Q

Major Depressive Disorder:
Lifespan considerations
Children/adolescents

A

Usually assessed within context of home / school situation
Decreased school performance
Problems with parents or teachers
Irritability

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18
Q

Major Depressive Disorder:
Lifespan considerations
Older adults

A 
Memory problems  
Social withdrawal  
Sleep disturbances
Appetite
Delusions/ hallucinations
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19
Q

Major Depressive Disorder:

Nursing Assessment

A

Symptoms of depression Difficulty completing simple tasks
Tearfulness
Somatic complaints Withdrawal/ social isolation Differentiate from grief
Co-morbidities
Suicide Assessment

20
Q

Suicide assessment includes:

A 
S.I.
- Passive vs active
- Frequency 
Plan 
 - Realistic 
 - Available means
Intent
Past attempts 
Reasons to NOT complete
21
Q

Major Depressive Disorder: Suicide Precautions

A 
Nursing suicide assessment
Documentation
Patient transport considerations
Physical environment
Observation level  
 - 1:1
 - Q 15 minute   
Restriction
 - Supervised bathroom   Contraband
22
Q

Major Depressive Disorder: Nursing Plan/Goal

A

Remaining free from self-injury
Participation in recreational activities
Knowledge that feeling better follows engaging in activities
Adherence to treatment regimen

23
Q

Major Depressive Disorder:

Nursing Interventions

A 
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
24
Q

Major Depressive Disorder:

What should be avoided?

A

Avoid:
Being overly cheerful
Taking on patient’s feelings

25
Major Depressive Disorder: | Collaborative Interventions
``` Pharmacological - Antidepressants Psychotherapy - CBT Non-pharmacological - ECT - TMS Complementary & Alternative - Exercise - Supplements - Acupuncture - Animal companionship - Music therapy ```
26
Major Depressive Disorder: Collaborative Interventions Lab tests
``` Thyroid Electrolytes Urinalysis Toxicology Liver function tests Pregnancy test ```
27
Major Depressive Disorder: | Pharmacological Interventions
SSRIs - increase available serotonin - First-line medication - fluoxetine, citalopram, sertraline, escitalopram SNRIs - increase serotonin and norepinephrine - venlafaxine, duloxetine TCAs & MAOIs - Older with significant side effects Atypical antipsychotics - Used with SSRI for severe depression - aripiprazole, risperidone
28
Major Depressive Disorder: | Risk Factors with medication tx
Dysthymia prior to the episode Onset before age 20 or after age 50 Poor recovery between episodes Family hx of depression Current episode > 2 years Severe symptoms - psychosis, suicidality
29
MDD: Psychotherapy
Most effective when combined with medication - Both effective when used independently Cognitive behavior therapy (CBT) - Identifies negative thoughts and behaviors - Replaces disordered thought processes - Mindfulness training
30
MDD: Non-pharmacological | ECT
Electroconvulsive Therapy (ECT) - Electric current is passed through the brain to induce a seizure - Given under anesthesia NPO prior to tx - Receive muscle relaxant - Monitor EEG, EKG, Oxygen saturation, vital signs - Short term memory loss expected (usually restored) - Typically 2-3 times per week for 12 treatments
31
MDD: Non-pharmacological | TMS
Transcranial Magnetic Stimulation (TMS) - 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
32
MDD: Inpatient therapeutic strategies
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 measurable short term and long term goals
33
MDD: Important strategies to remember
- Recognize that patients with depression often reject support & 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
34
What is bipolar disorder?
Mood alternates between extremes - Depression - Mania - Interspersed with neutral mood
35
What is bipolar I?
≥ 1 manic episode and ≥ 1 major depressive episode
36
What is bipolar II?
≥ 1 major depressive episode and at least 1 hypomanic episode
37
What is a manic episode?
Abnormally expansive, elevated or irritable mood
38
Manic episode includes >3 of the following:
``` Inflated self esteem Decreased need for sleep More talkative than usual Flight of ideas Distractibility Psychomotor agitation Increased pleasurable activities ```
39
Manic episode Length? Mood disturbance causes:
Symptoms last at least 1 week Mood disturbance causes: - Marked impairment in functioning - Necessitates hospitalization - Psychotic features
40
Hypomanic Length? Mood disturbance causes:
Symptoms last at least 4 days Mood disturbance causes: - Change in functioning - - Uncharacteristic behaviors - Observable by others - NO hospitalization
41
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, treatment resistant
42
Bipolar 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 judgment/impulsivity - Shopping - Drugs - Sex Unusual appearance - Dressing inappropriately ```
43
Bipolar Disorder: | Nursing Plan/Goal
``` Injury prevention Focus Making choices Appropriate behaviors Self-care Sleep ```
44
Bipolar Disorder: with Mania | Nursing Plan/Goal
``` 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 - Especially with limit-setting Use role modeling behavior - Offers reassurance Build trusting relationship Promote safety ```
45
Bipolar Disorder: | Promote Safety
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
46
Bipolar Disorder: | Collaborative Interventions
Diagnostic studies Pharmacological therapy - Mood stabilizers - Antipsychotics: aripiprazole, riperidone olanzapine - Lithium - Anticonvulsants: valproic acid, lamotrigine and carbamazepine Psychotherapy Case management - Referral to community resources, NAMI
47
Bipolar Disorder: | Relapse Prevention
Important to involve family and patient - Creating relapse prevention strategies Teach patient and family about: - Course of illness - Importance of adhering to medication regimen - Early warning signs of relapse - Community resources - NAMI

Psych Exam 1 (5 decks)

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