Mood Disorders and Suicide Flashcards
Dysthymic (Dysthymia)
profound sense of dissatisfaction or unease, seen with depression
Mood Disorders
also referred to as affective disorders
they are pervasive alterations in emotions that manifest as depression, mania, or both
Mood Disorders: Etiology
Theories:
- genetics
- neurochemical (Monoamine): serotonin, norepinephrine, dopamine
- neuroendocrine-hormone (specifically hormone fluctuation w/ depression, correlation between hypothyroidism and depression)
- psychodynamic theories: Freud (depression is anger turned inwards)
*need to r/o hypothyroidism when someone comes in w/ new onset of depression
Mood Disorders: Cultural Considerations
Symptoms of depression in children manifest differently
-more cranky, mood might be a little different
-adolescents present as more withdrawn, changes in academic performance, substance use, more somatization (physical symptoms like migraines) - don’t verbalize as well
Mood Disorders: Related Disorders
- persistent depressive disorder
- disruptive mood dysregulation disorder
- cyclothymic disorder
- seasonal affective disorder (type of depression) MDD w/ seasonal pattern
- premenstrual dysphoric disorder
Persistent Depressive Disorder
depressed mood for most of the day for more days than not for at least 2 YEARS
symptoms don’t effect ADL’s like w/ MDD
Disruptive Mood Dysregulation Disorder
- severe recurrent temper outbursts
- the outbursts are inconsistent w/ developmental level
- occur on average three or more times per week
- mood between outbursts is irritable or angry most of the time
Premenstrual Dysphoric Disorder
For most menstrual cycles:
- marked affective lability
- marked irritability or anger
- marked depressed mood, hopelessness, self deprecating thoughts
- marked anxiety, tension, on edge
- anhedonia
- concentration
- physical symptoms (breast tenderness)
Seasonal Affective Disorder
recurrent episodes of major depressive (can be mania or hypomania) w/ seasonal onset
Tx: vitamin D, light therapy, therapy interventions, antidepressants
Major Depressive Disorder (MDD)
5 or more symptoms present over a 2-week period
at least one symptoms must be depressed mood or loss of interest or pleasure
SIGECAPS
SIGECAPS
- Sleep (loss or too much)
- Interest or enjoyment (anhedonia)
- Guilt or hopelessness
- Energy (decreased)
- Concentration (decreased)
- Appetite (increased or decreased)
- Psychomotor retardation (slow movement)
- Suicide
MDD: Clinical Course
- untreated depression can last weeks to months to years
- depression can occur as a single episode or a recurrent pattern (most experience recurrent episodes)
- mild/moderate/severe
- severe depression-psychotic symptoms (20%)
MDD: Presentation
- client may be overwhelmed with their feelings
- sleep disturbance
- seclusive to room
- may be unable to sustain long interactions
- possible change in self-care (appearance)
- possible change in self-esteem or confidence
- lack of sexual desire
- possible changes in cognitive functioning (slowed activity, ambivalence, decreased concentration)
MDD: Nursing Interventions
- # 1 priority = safety (assess for suicide)
- encourage conversations (brief interactions multiple x per day)
- promote ADLs (schedule may be provided for them)
- engage the client in activities
- medication education
- silence (allow them space, don’t need to fill silence)
- use simple concrete steps if overwhelmed
MDD: Tx
- therapy
- meds: MAOIs, SSRIs, SNRIs, TCA, Atypicals (buproprion, mirtazapine, vilazodone, trazadone)
- ECT
- newer treatments: transcranial magnetic stimulation (TSM - uses magnetic fields for tx resistant depression), Ketamine (nasal spray, IV)
*OD lethal potential w/ MAOIs, TCAs
Serotonin Syndrome
HARM
Hyperthermia
Autonomic instability
Rigidity
Myoclonus
Serotonin Discontinuation
discontinuation syndrome - feel bad if they come off meds too fast (need to taper off)
ECT
electroconvulsive therapy
- tx resistant depression
- administered as a series of tx/maintenance tx
- involves application of electrodes to the head to deliver an electrical impulse to the brain which causes seizure
- theory: the seizure causes changes to the chemical imbalance w/ depression
- recognize the historical perspectives
ECT: Nursing Considerations
- potential for temporary memory loss/confusion
- NPO after midnight
- have client void before
Catatonia
can occur w/ severe MDD
3 or more of the following:
- stupor
- catalepsy
- waxy flexibility
- mutism
- negativism
- posturing
- mannerism
- stereotypy
- agitation
- grimacing
- echolalia
- echopraxia
tx = benzos
ECT may be considered
Bipolar Disorders: Types
Bipolar I
Bipolar II
Cyclothymia
Bipolar I Disorder
3 or more symptoms for a total of one week or more
episodes of mania alternating w/ depression
Bipolar Disorder: Symptoms
DIG FAST
Distractibility Impulsivity Grandiosity Flight of ideas Activity Sleep (decreased need for it) Talkativeness (increased)
Bipolar II Disorder
hallmark sign is hypomania
hypomania is similar but not as severe as mania (doesn’t have the intensity to cause gross dysfunction)
severe episodes of depression (often when people seek tx)
Cyclothymia
more persistent but less severe version of bipolar disorder
no loss of social or occupational functioning - but symptoms cause clinically significant distress
pattern of the disorder present for two years
Features of Bipolar Disorder
- w/ psychotic features
- w/ catatonia
- rapid cycling
- first episode of mania generally in teens, 20s, or 30s
- risk for suicide
Bipolar Disorder: Presentation
may have:
- short attention span
- pressured, rapid speech
- labile mood
- provocative or risky behaviors
- poor boundaries
Bipolar Disorder: Differential Diagnosis
- BPD
- Substance induced
- Mania d/t general medical condition (steroid use)
- Anxiety
- ADHD
Bipolar Disorder: Nursing Interventions
- safety
- decreasing environmental stimuli (promote rest)
- speaking clearly w/ simple sentences
- nutrition (encourage fluids)
- redirect energy
- set limits when they cannot do so themselves (you are standing close to me, may you step back two feet, etc)
Bipolar Disorder: Tx
therapy alone is not considered sufficient w/ bipolar disorder
medications:
- anticonvulsants
- antipsychotics
- antidepressants
- Lithium
Lithium
- therapeutic range
- serum levels obtained prior to AM dose
- kidney function (renal disease contraindication)
- high response rate
- onset of action: up to 14 days
- teach clients signs of lithium toxicity (N/V, tremors, ataxia)
Acute Mania
lithium or valproic acid w/ an antipsychotic
Suicide
- intentional act of killing oneself
- suicidal ideation (SI): thinking about killing oneself
- passive vs. active
- attempted (either failed or incomplete, incomplete = person was found or recognized attempt)
- suicidal thoughts are common in mood disorders, especially depression
- self-injury
Suicide: Risk Factors
- gender (men > risk), 3x rate of women
- > 65YO
- separated or divorced
- hx of suicide attempt
- family hx of suicide
- alcohol or substance use
- access to lethal methods, such as guns
Suicide: Protective Factors
- feeling responsible for children or other family
- religious/spiritual/cultural beliefs
- overall satisfaction w/ life
- presence of social support
- effective coping skills
- access to medical care
Suicide Precautions
- increased supervision
- removal of harmful objects
