mood disorders Flashcards
MOOD DISORDER OVERVIEW
-impairs functioning
- persuasive alteration in mood and affect
elevated
depressed
cycling
- not appropiriate
- out of proportion
- rapid/dramatic change in mood
CONTRIBUTING FACTORS
biological - hormonal dysregulation - neurotransmitter changes - neuroantonomy -sleep neurophysiology immunological disturbance
genetic
-highly heritable
psychosocial
- stress
- personality
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
-the ability to adapt well to stress
emotional pain and distress experience
- factors that promote resilience
caring and supportive relationships
the capacity to make plans and complete a goal
positive view of self
communication and problem solving skills
ability to manage strong feelings and impules
MOOD DISORDERS
- adjustment disorder with depressed mood
- major depressive disorder
- bipolar disorder
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 FOR ADJUSTMENT DISORDER
- precipitating stressor
- patient symptoms
- depression risk factors
- resilience factors
-current coping strategies - safety
-screening tool
-
NURSING DIAGNOSES ADJUSTMENT DISORDER WITH DEPRESSED MOOD
helplessness disturbed sleep pattern disrupted family processes situational low self -esteem ineffective coping
NURSING PLAN AND GOAL ADJUSTMENT DISORDER WITH DEPRESSED MOOD
adequate sleep and rest impulse control daily functioning self esteem safety
NURSING INTERVENTIONS 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 functioning
COLLABORATIVE INTERVENTIONS ADJUSTMENT DISORDER WITH DE[RESSED MOOD
cognitive behavioral therapy family therapy antidepressant medication antianxiety mediaction exercise
MAJOR DEPRESSIVE DISORDER OVERVIEW
single episode or recurrent change in emotional state and functioning average age onset mid 20's women more affected than men hereditary
CLINICAL MANIFESTATIONS MAJOR DEPRESSIVE DISORDER
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 CONSIDERATION
children/adolescents -usually assessed within context of home /school situation - decreased school performance problems with parents or teachers irritability
older adults
- memory problems
- social withdrawal
- sleep disturbances
- appetite
- delusions/ hallucinations
NURSING ASSESSMENT MAJOR DEPRESSIVE DISORDER
- symptoms of depression
- difficulty completing simple tasks
- tearfulness
- somatic complaints
- withdrawal / social isolation
- differentiate from grief
- comorbidities
- suicide assessment
SUICIDE ASSESSMENTS
suicidal ideation
- passive vs. active
- frequency
Plan
- lethality
- realistic
- available means
intent
past attempts
reasons to not complete
suicide precautions
- nursing suicide assessment
- documentation
- patient transport considerations
- physical environment
- observation level 1:1 Q15 checks
- restriction (supervised bathroom)
- contraband
NURSING DIAGNOSIS MAJOR DEPRESSIVE DISORDER
risk for self directed violence
chronic low self esteem
hopelessness social isolation
ineffective health maintenance
NURSING PLAN /GOAL MAJOR DEPRESSIVE DISORDER
remaining free from self injury
participation in recreational activities
knowledge that feeling better follows engaging in activities
adherence to treatment regimen
nursing interventions major depressive disorder
develop therapeutic relationship provide distraction from self focus encourage activities recognize accomplishments set limits on time spent discussing failures teach assertiveness
COLLABORATIVE INTERVENTIONS MAJOR DEPRESSIVE DISORDER
laboratory tests -thyroid electrolytes urinalysis toxicology liver function tests pregnancy test
ANTIDEPRESSANTS
CBT THERAPY
ECT
TMS
ALTERNATIVES -exercise -supplements - acupuncture -animal companionship music therapy
PHARMACOLOGY INTERVENTION FOR DEPRESSION
SSRIS
- increase available serotonin
- first line medication
- fluoxetine , citalopram , sertraline, escitalopram
SNRIS
- increase serotonin and norepinephrine
- venlafaxine, duloxetine
TCAS AND MAOIS
older with significant side effects
ATYPICAL ANTIPSYCHOTICS
- used with SSRI for severe depression
- apripiprazole, risperidone
COGNITIVE BEHAVIORAL THERAPY
identifies negative thoughts and behaviors
replaces disordered thought processes
mindfulness training
PSYCHOTHERAPY
most effective when combined with medication
both effective when used independently
ELECTROCONVULSIVE THERAPY
-electric current is passed through the brain to induce a seizure
- given under anesthesia
- NPO 4 hrs before
- receive muscle relaxant
- monitor EEG,EKG,oxygen saturation , vtal signs
- short term memory loss expected (usually restored)
- typically 2-3 times per week for 12 treatments
BIPOLAR DISORDERS
mood alternatives between extremes
- depression
- mania
- interspersed with neutral mood
Bipolar 1
greater than or equal to 1 manic episode and greater than 1 major depressive episode
Bipolar 2
greater than 1 major depressive episode and at least 1 hypomanic episode
MANIC EPISODE
-abnormally exspansive elevated or irritable mood
- increased goal directed activity
-most of the day every day
plus 3 or more of the following
- inflated self esteem
- decreased need for sleep
- more talkative than usual
- flight of ideas
- distractibility
- psychomotor agitation
- increased pleasurable activities
MANIC
- symptoms last at least 1 week
-mood disturbance causes
marked impairment in functioning
psychotic features
necesaritates hospitalization
HYPOMANIC
-symptoms last at least 4 days
-mood disturbances causes
change in functioning
uncharacteristic behaviors
observable by others
no hospitalization
NURSING ASSESSMENT FOR BIPOLAR DISORDER
- changes in thought processes
- inflated self esteem
- delusions
- ignoring fatigue, hunger, hygiene
- distractibility
- hallucinations
- surprising sense of well being
nursing assessment bipolar disorder
-rapid loud pressured speech
-flight of ideas
- poor judgement/impulsivity
shopping, drugs,sex
- unusual appearance
dressing inappropriately
nursing diagnosis examples
- risk for injury
- disturbed thought process
- impaired social interaction
- self care deficit
- sleep deprivation
- risk for suicide