Mood disorders Flashcards
What are types of mood disorders?
- Major depression
- Bipolar disorder
- Dysthymic disorder
- Cyclothymic disorder
- Seasonal affective disorder
The incidence of depression is up to three times greater in first-degree relatives of people with diagnosed depression
indications of a genetic overlap between early-onset bipolar disorder and early-onsetalcoholism
genetic theories
Serotonin, norepinephrine; possibly acetylcholine and dopamine
Neurochemical theories
Postpartum hormone alterations precipitate mood disorders such as postpartum depression and psychosis.
Neuroendocrine influences: hormones
blame the victim” and his or her family
Psychodynamic theories
defense against underlying depression
mania
Asians who are anxious or depressed are more likely to have
somatic complaints of headache, backache, or other symptoms
Latin cultures complain of
“nerves” or headaches
Middle Eastern cultures complain of
heart problems
Present everyday for 2 weeks and
person experiences a depressed mood or loss of pleasure in nearly all activities
major depressive disorder
Four of the following must be present:
changes in appetite or weight, sleep, or psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts
major depressive disorder
What are the s/s of major depressive disorder?
SAD IMAGES
Sad mood, Appetite change, Disturbed sleep, Inability to concentrate, Marked decrease in pleasurable activities (anhedonia), Apathy, (lack of interest in sex), Guilty feelings, Energy changes, Suicidal thoughts
relieve symptoms of hopelessness, inappropriate guilt, suicidal ideation, and daily mood variations
Tricyclic antidepressants
used when the client has an inadequate response to or side effects from SSRIs
Atypical antidepressants-
There is a 2- to 4-week lag period before these antidepressants reach therapeutic levels. Because of the lag period, adequate washout periods of 5 to 6 weeks are recommended between the times that (blank) is discontinued and another class of antidepressant is started.
Monoamine oxidase inhibitors (MAOIs)-
application of electrodes to the head of the client to deliver an electrical impulse to the brain; this causes a seizure
Electroconvulsive therapy (ECT)-
focuses on difficulties in relationships, such as grief reactions, role disputes, and role transitions.
interpersonal therapy
interactions-increase the frequency of the client’s positively reinforcing interactions with the environment and to decrease negative interactions
behavior therapy
treatment for depression in which a pulse generator sends intermittent electrical impulses directed toward the brain via the vagus nerve
Vagus nerve stimulation-
invasive procedure used to help manage the tremor caused by Parkinsonism and other neurologic conditions; also used to alter brain circuitry to relieve depression
Deep brain stimulation-
(TMS) noninvasive method of stimulating the brain to treat depression by delivering short pulses of energy through an electromagnetic coil placed against the scalp near the forehead
Transcranial magnetic stimulation-
What are the depression rating scales?
Self-rating scales: Zung, Beck
Clinician rating scale: Hamilton Rating Scale
a mood disorder that has its onset during darker winter months and spontaneously disappears in the spring
Seasonal affective disorder (SAD)
Prevalence: winter months only; states north of 40° to 50° of latitude
Primitive biologic response; triggered by photoperiods; melatonin
Seasonal affective disorder (SAD)
Assessment Findings: bimodal depression; cycles with the seasons
Winter: sleepy, fatigued, lethargic; irritable, unable to concentrate; suicidal; increased craving for carbohydrates; poor social interaction
Seasonal affective disorder (SAD)
What is the medical treatment for seasonal affective disorder?
Phototherapy: use of artificial light
Move to sunny location
What is the nursing management for seasonal affective disorder?
Avoid the use of eyeglasses or contact lenses that are coated to shield ultraviolet radiation because the coating interferes with light transmission to the pineal gland.
The several types of bipolar disorder all involve cycling among depressive, euthymic, and euphoric moods include?
- bipolar I
- bipolar II
- cyclothymic disorder
- mixed bipolar disorder
- rapid-cycling bipolar disorder
- ultrarapid-cycling bipolar disorder
experience severely dysfunctional moods lasting several months; depressive phases tend to be longer than manic phases
bipolar I
disorderhave severe depression alternating with hypomania.
Hypomania is a period of abnormally and persistently elevated, expansive, or irritable mood & some other milder s/s of mania.
there are no psychotic features (delusions and hallucinations)
bipolar II
people have milder mood swings, don’t meet criteria for bipolar
cyclothymic disorder
mania and depression occur simultaneously everyday for at least a week
mixed bipolar disorder
experience at least four episodes of mania and depression per year
rapid-cycling bipolar disorder
have alternating moods that may occur within a month or less
ultrarapid-cycling bipolar disorder
diagnosis of a manic episode or mania requires at least 1 week of the following unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms:
bipolar I
what are the symptoms of bipolar I?
exaggerated self-esteem
sleeplessness; pressured speech; flight of ideas
reduced ability to filter extraneous stimuli
distractibility; increased activities with increased energy
multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments
Assessment findings for bipolar I disorder?
dress can be flamboyant, layered inappropriate to season, sexually suggestive
Exaggerated self importance
Mood: euphoric, dysphoric or labile
Rapid and or loud speech, maybe pressured
Disorganized thinking, tangential or circumstantial, flight of ides
Distractible limited concentration
Medication management for bipolar disorder?
*anticonvulsants and lithium
examples of anticonvulsants
carbamazepine and valproic acid derivatives
used for Acute mania; decreases mood swings among rapid cyclers; risk for infection
Carbamazepine (Tegretol)
Enhance GABA activity; used with lithium for long-term management
Unsafe during pregnancy; side effects—GI symptoms, sedation, and ataxia
Valproic acid derivatives: Depakote
Antimanic, mood equalization; regulates activity between neurotransmitters and receptor sites
lithium
Disadvantages: ineffective for some; time lag; narrow safety range; side effects
Periodic lab tests; lithium toxicity (see table 15.8)
Maintain adequate ingestion of salts
lithium
