Mood Disorders Flashcards
Mood
The prominent, sustained, overall emotions that a person expresses and exhibits; inhibits one’s perception of the world and how one functions
Blunted
Significantly reduced intensity of emotional expression
Flat
Absent or nearly absent affective expression
Inappropriate
Discount affective expression accompanying the content of speech or ideation
Labile
Varied, rapid, and abrupt shifts in affective expression
How long before a “depressed” patient can be diagnosed with Major Depressive Disorder?
Two weeks
How long before a “depressed” patient can be diagnosed with Dysthymia disorder/Persistent Depressive Disorder?
Two years
- Doesn’t usually affect ADLs
Depression typically develops in response to:
- Loss
- Disappointment
- Failure
Depressive Moods are marked by what kind of feelings?
- Helplessness
- Hopelessness
- Worthlessness
Risk Factors for Depression
- Lack of coping abilities
- Presence of life and environmental stressors
- Current substance use or abuse
- Medical comorbidity
- Prior episode of depression
- Family history of depression
- Lack of social support
Neurotransmitters that make you “happy”
- Serotonin
- Norepinephrine
- Dopamine
Five Cardinal Signs of Depression
- Sleep disturbances
- Appetite changes
- Poor concentration
- Decreased energy
- Excessive guilt or worthlessness
Nursing Interventions for Depressive Disorders
- Assess for suicidal ideation
- Establish trust/rapport
- Encourage expression of feelings
- Provide non-threatening environment
- Provide activities client able to complete
- Promote adequate rest/nutrition
Characteristics of Dysthymic Depression
- Mild-moderate depression
- Maladaptive use of defense mechanisms
- S/Sx most days for at least 2 years
- NO mania
SSRI Drugs
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
SNRIs
- Venlafaxine
- Duloxetine
- Bupropion
Acute Phase of Psychiatric Medication Use
The primary goal of therapy for the acute phase is symptom reduction or remission. The objective is to choose the right match of medication and dosage for the patient. Careful monitoring and follow-ups are essential during this phase to assess patient response to medications, adjust the dose if necessary, identify and address side effects, and provide patient support and education
Continuation Phase of Psychiatric Medication Use
The goal of this treatment phase is to decrease the risk for relapse (a return of the current episode of depression). If a patient experiences a response to an adequate trial of medication, use of the medication generally is continued a the same dosage for at least 4-9 months after the patient returns to a clinically well state.
Maintenance Phase of Psychiatric Medication Use
For patients who are at high risk for recurrence, the optimal duration of maintenance treatment is unknown but is measured in years, and full-dose therapy is required for effective prophylaxis
Discontinuation Phase of Psychiatric Medication Use
The decision to discontinue active treatment should be based on the same factors considered in the decision to initiate maintenance treatment. These factors include the frequency and severity of past episodes, the persistence of dysthymic symptoms after recovery, the presence of comorbid disorders, and patient preference. Many patients continue taking medications for their lifetime
Tricyclic Drugs
- Amitriptyline
MAOI’s
Monoamine Oxidase Inhibitors
1. Phenelzine
S/Sx of Mania
- Elation (grandiose)
- Hyperactivity
- Agitation
- Accelerated thinking/speaking
- Abnormal and persistent
- Elevated mood (euphoria/elation)
- Expansive mood (lack of restraints in expression)
- Overvalued self-importance
- Irritable; demanding; destructive
- Use of sarcasm, profanity
- Excessive spending
- Increased libido; risk taker/poor judgement
Hypomania
- Mild form of mania
- Excessive hyperactivity, but not severe enough to cause impairment in functioning or require hospitalization
Rapid Cycling
- Extreme form of mood lability (bipolar I and II)
- Continuous cycling between mania and depression and hypomania and depression
- Essential feature of Bipolar: four or more mood episodes that meet criteria for manic, mixed hypomanic, or depressive episode during the previous 12 months
Bipolar I
Manic episode or mixed and depressive episode
Bipolar II
Major depression and hypomania
Cyclothymia
Hypomania and depressive episodes not meeting full criteria for major depressive episode
- Lasting at least 2 years
Nursing Interventions for Mania
- Provide safety
- assess suicidal/homicidal ideations
- Promote sleep/nutrition
- Decrease stimuli
- Accept client (provide social support)
- Utilize energy
- Antipsychotics
- Encourage effective expression of feelings
- Reinforce reality (DON’T focus/challenge delusions)
- Identify manipulative behaviors
Therapies for Manic Disorders
- Individual : support until able to effectively participate
- Group: focus on self-esteem, reality, and relationships
- ECT: usually for major depression
- Family therapy
- Cognitive therapy
Side Effects of ECT
- Memory loss
- Confusion
Who can not have ECT?
- Increased ICP
- Recent MI
- CVA
- Retinal detachment
- Pheochromocytoma
- Those at risk for complications of anesthesia
Antimanic Drug
Lithium carbonate
Lithium levels
- 0 - 1.5 for acute mania
0. 6 - 1.2 for maintenance
Antiepileptics
- Carbamazepine
- Valproic acid
- Divalproex sodium
- Lamotrigine
Anoxiolytics
- Clonazepam
Antipsychotics
- Olanzapine
- Haloperidol
- Risperidone
Lithium
- Needs to be combined with antipsychotics and benzodiazepines
- If you take lithium, you will need regular blood tests and monitoring of your kidney and thyroid function for drug toxicity levels
