NUR 144 - Week 2 *MH* - Mood Disorders and Suicide Flashcards
What are the mild “version” of Depression, Mania and Bipolar
Mild depressive disorder = dysthymia
Mild Mania = Hypomania
Mild bipolar = cyclothymia
- Alternates between mania and depression for at least 2 years
How are mood disorders diagnosed?
Mood disorders are diagnosed on a spectrum from mild symptoms to severe symptoms
Mild - Might be treated on outpatient
Severe - Necessitate hospitalization to protect client from self-harm
Depression:
What is it?
Causes/Triggers
Cause:
- Loss
- Trauma
- Hormonal imbalance
- Stress
Depression:
Diagnostics
Diagnosis determined by providers using DSM-5 Criteria
- Based on expression of symptoms of mental illness on a spectrum over time
List some depressive disorders
Major depressive Disorder:
What is it?
s/s
One of more depressive episodes of at least two weeks of depressed mood
s/s:
- Depressed mood
- Anhedonia - Inability to feel pleasure
- Apathy, hopelessness
- Appetite disturbance
- Sleep disturbance
- Psychomotor disturbance
Depression:
s/s
s/s:
- Depressed mood
- Anhedonia - Inability to feel pleasure
- Apathy, hopelessness
- Appetite disturbance
- Sleep disturbance
- Psychomotor disturbance
- Recurrent thoughts of death/suicide
Depression:
Nursing care/considerations
Suicide Risk: Assess the client risk for suicide and implement appropriate safety precautions
Self-care: Monitor the client’s ability to perform ADL’s and encourage independece as much as possible
Communication: Relate therapeutically to the client who is unable or willing to communicate
What is something important to note about Tricyclic antidepressants (TCAs)?
Overdose of Tricyclic antidepressants (TCAs) can be lethal
Activation Syndrome:
What is it?
Causes:
s/s
Set of manifestations–including impulsivity and suicidal ideations–that may present after starting an antidepressant
Cause:
- Initiation of anti depressant, very often SSRI
s/s:
- Irritability, impulsivity, agitation
- Anxiety
- Aggressiveness
- Possible increased thoughts of suicide
Serotonin Syndrome:
What is it?
Causes
s/s
What is it?
High levels of serotonin
Cause:
- Overdose of serotonin meds
- Taking multiple types of antidepressants
- Drugs: LSD (lysergic acid), ectasy
- Antidepressants + St. John’s wort
s/s or Manifestations:
- Restlessness
- Sweating
- Dilated pupils
- Tachycardia, HTN
- Muscle rigidity
- Lack of muscle coordination
Antidepressant Discontinuation Syndrome:
What is ti?
Causes?
s/s
What is it?
- clinical manifestations that may occur with sudden discontinuation of the antidepressant medication which the client has been taking for more than a month
Causes:
- Abrupt discontinuation of antidepressants
s/s:
- Difficulty sleeping
- Anxiety
- Depression
- Flu like symptoms
Bipolar Disorder:
What is it?
s/s of mania?
Diagnostics
Cyclothymic - Mild cycling between hypomania and mild depressive symptoms
Bipolar I - Extremely high levels of mania; at least one episode of mania
Bipolar II - At least one hypomanic + one major depressive episode
s/s of mania:
- overactivity
- overeating, overspending
- not sleeping
- talking very quickly
Diagnostics:
- Cyclothymic disorder is diagnosed when clients alternate between mania and mild/moderate depression for at least 2 years
not as severe as the shifts seen in either bipolar I or II
Lithium Toxicity:
Range
Causes
Clinical Manifestations
Early = >1.5mEq/L
Severe = >2.5mEq/L
Causes:
- Dehydration
- Overdose
Clinical Manifestations: (from early to severe)
- Poor coordination
- Confusion
- Blurred vision
- jerky motor movement
- rapidly deteriorate, advent of comatose
- Severe respiratory complications, can be fatal
Which medication class should not be taken with St John’s wort
SSRIs
Non-Pharmacologic Treatment for mood disorders
Cognitive behavioral therapy (CBT):
- Meeting with trained therapist who helps client to change behavior by changing thinking
Electroconvulsive Therapy (ECT):
- Administered to client who may have had a treatment refractory depression
- Most used
Transcranial Magnetic Stimulation (TMS):
- Magnetic pulses to stimulate focal areas of the cerebral cortex
- Unlike ECT, no anesthesia is used
Light Therapy:
- Used for clients who experience seasonal affective disorder because of lack of sunshine
- CBT, exercise, healthy eating and self care are important
ECT:
Nursing implications
Pre- ECT:
- Benzos should be discontinued
- NPO 6-8 hours
- General anesthesia, to prevent muscle distress and fractures
Mania:
Nursing Interventions/Care
Inpatient:
- Ensure client receives high calorie finger foods
- Ensure unit is quiet at night
Outpatient:
- Encourage the client to eat high calorie foods
- Good sleep hygiene: Dark, quiet room with no distractions at night
Depression:
Interventions
Inpatient:
- Structured plan encourages them to get up, get dressed and be with other clients for group activities
- Walking, fiber and fluid - Bowel movements may be slowed
Outpatient:
- Case management to coordinate both medication management and psychotherapy
Suicide:
Short term outcomes/goals
Long term outcomes/goals
Short term:
- Absence of suicidal ideation
- ADLs
- Alteration in thought processes
- Ability to function and heal in outpatient setting
- Mood stability
Long-term
- Adherence with meds
- Lack of suicidality
- Functionality in relationships and life
Suicide:
SAD PERSONS
S - sex male
A - age <19 or >45
D - depression
P - previous attempt
E - ethanol
R - rational thinking loss
S - social supports lacking
O - organized plan
N - no partner
S - sickness (major or chronic)
Suicide:
Risk factors
- Been abused or neglected as a child
- Having been bullied
- Family hx of suicide
- Relationship problems
- Sexual violence
Mania:
s/s
-
- Overactivity
- Overeating
- Overspending
- Not sleeping
- Talking very quickly
- Racing thoughts
