S3 M11 Mood & Affect Flashcards
Postpartum depression and baby
Effects connection between mom and baby
seen by week 6
a consistent behavior of not wanting to care for child
baby blues
hormone drop
80% of moms
after first 2-3 days
resolves by day 10
Postpartum depression can lead to
a permanent depressive disorder
Postpartum wellcheckups are important to prevent
Postpartum psychosis
Depression and being excited for tomorrow
indicator of suicide
MAOI food contradiction
Cheese
Wind/beer
Soy sauce
Pickles (tyramine)
Drastic ^ in BP
All antidepressants have the greatest risk of suicide at
2 weeks
ON TEST
DO NOT GIVE Tricyclic antidepressants with MOAIs =
Serotonin syndrome
Most common anticonvulsant meds instead of lithium
Depakote
Topamax
Extrapyramidal side effects
acute dystonia
pseudoparkinsonism?
Tardiva dyskinesia?
Akathisia?
Causes for post partum depression
Hormone imbalance - Estrogen/progesterone, thyroid/serotonin
Lifestyle - Sleep deprivation, feeling overwhelmed, loss of control
Risk factors for post partum depression
Poverty
Lack of support
Unplanned pregnancy
History of previous depression
Low self-esteem
Domestic violence
Difference between postpartum depression and baby blues
onset
KEY
Symptoms interfere with child care
occurs by 6 weeks and up to 6 months or a year
KEY is lasting longer than 2 weeks
Postpartum depression symptoms
No appetite
Sleep problems
Emotional lability
Sadness guilt inadequacy
Fatigue
Anxiety
Rejection of infant
PPD effects on mother
Can become a chronic depressive disorder.
Even if treated, ^ episodes of depression
PPD effects on father
Emotional strain
^ depression in father who are also at risk due to child birth
PPD effects on children
Emotional and behavioral problems
sleeping and eating difficulties
delayed language development
excessive crying
Postpartum psychosis occurs within _ after delivery
But can be as early as or as late as
2-3 weeks
48 hours or 6 months
Postpartum psychosis S/S
Pronounced sadness
Disorientation
Confusion
Paranoia
Hallucinations
Delusional thoughts of self-harm or harming the infant
Postpartum psychosis is an _
EMERGENCY
Needs immediate help and hospitalization
Postpartum depression prevention during pregnancy
Monitor for S/S of depression
Complete depression questioner during pregnancy and after delivery
Support groups, counseling, therapies
Antidepressant meds
Postpartum depression prevention after baby is born
Early screening for S/S
If PT has history, Dr. can recommend antidepressant treatment and psychotherapy immediately after delivery
Questions
History
Bonding
Emotional state
Comms
Past psychosis?
Is mom reluctant to care?
Mood, affect?
How does mom feel?
Questions
self care
support
exercise
diet
rest, bathe, journal, music?
fam?
5-10min
Eat healthy
Psychotherapy treatment PPD
Mental health professional
Coping, problem solving, realistic goals.
Fam can help
Antidepressant treatment for PPD
Little breast feeding side effect
Work with Dr. to weight benefits to risks
Drug classes for PPD
Most prescribed
for psychosis
Antidepressants
Antianxiety
SSRIs
Antipsychotics
SSRIs of choice
Sertraline
Paroxetine
SSRIs
Inhibits reuptake so more serotonin is available
Serotonin
Regulates
Neurotransmitter
Mood, social behavior, appetite, sleep, memory, sex
SSRI side effects
Insomnia/drowsiness
Blurred vision
Dry mouth
Joint pain
Sex problems
SUICIDAL THOUGHTS
Serotonin syndrome
To much serotonin
Life threatening
S/S of serotonin syndrome
restlessness
^ in BP and HR
Pupil dilation
Loss of coordination
Flu like (diarrhea, headache, shivering, sweating)
Severe serotonin syndrome S/S
High fever
Seizures
Irregular heartbeat
Come
SSRIs interactions
St. Johns wort - Serotonin syndrome
SSRIs take how long to work
within 2 weeks pt may become
4-6 weeks
suicidal
DO NOT stop SSRIs suddenly
Withdrawal S/S are
Flu like
Nausea dizziness, uneasiness, fatigue
Suicide
Intentional act of killing one self
Risks for suicide
Psych disorders
Certain chronic disorders
Environmental factors
Previous history
Family history
Suicidal ideation
Many PTs with depression have suicidal ideation BUT do not have the energy to carry out the plan
Hints of suicide
DO NOT IGNORE
Determine suicide potential
Is there a plan?
Are the means available?
Are there preparations?
Location?
Time/date?
Nursing interventions for suicide
Safety
No-suicide or no-self-harm contracts
Assess support systems
Be positive and nonjudgmental
If lethality is low observe _
If lethality is high observe
Q10min
One to one
Suicidal ideation meds
Antidepressants
SSRIs
MAOIs
MOA enzymes
Monoamine oxidase
break down neurotransmitters (serotonin, norepinephrine, dopamine)
MOAIs inhibit them
Foods to avoid with MAOIs
Tyramine (preservative)
Aged cheese, fermented foods, beer, soy sauce
MAOIs and BP
orthostatic hypotension when initiating
MAOIs can lead to
Serotonin syndrome
S/S
confusion, restlessness, seating, muscle jerk movements
MAOIs side effects
Dry mouth
Nervousness dizziness
Sex problems
^BP
Difficulty urinating
Weight gain
All antidepressants take _ to work
2-4 weeks
Greatest risk of suicide with antidepressants occurs at
2 weeks
PT now has energy to commit self harm
Major depressive disorder 101
2 or more weeks of sad mood or lack of interest in life
AND
S/S of major depressive disorder
Must have at least 4
Anhedonia
Change in weight
Change in sleep
Drop in energy
Drop in concentration
Indecisiveness
Suicidal ideation
How long does major depressive disorder last
Most clear in
Few weeks to years
6 months
Cause of major depressive disorder
v in neurotransmitters
risk ^ with fam history
Major depressive disorder meds
Tricyclic antidepressants
MAOIs
SSRIs
Antipsychotics for psychotic features
Major depressive disorder therapy
Psychotherapy
Electroconvulsive therapy
Tricyclic older antidepressants
Nortriptyline
Amitriptyline
Doxepin
Tricyclic antidepressants 101
Keep neurotransmitters available to brain
Take 6 weeks to reach full effect
Also used for panic disorder, obsessive-compulsive, eating disorders
TriCyclic Antidepressant Side-effects
TCA’S
Thrombocytopenia
Cardiac - arrhythmia, MI, stroke
Anticholinergic - tachycardia, urinary retention
Seizures
Tricyclic antidepressant side effects
Dry mouth
Constipation
Weight gain
Blurred vision
Tricyclic antidepressant contraindications
Liver function
Recent MI
Tricyclic antidepressants + MAOIs
SEROTONIN SYNDROME
Tricyclic antidepressants have anticholinergic side effects
dont give to pt with
glaucoma
benign prostatic hyperplasia
urinary retention
CVD
kidney problems
lung problems
Electroconvulsive therapy 101
Placing electrodes on clients head and delivering impulse
Causes seizures
Shock resets brain chemistry
When to resort to electroconvulsive therapy
When antidepressants don’t work
Actively suicidal
Electroconvulsive therapy regiment
6 to 15 times
3x a week
To receive improvement in depression, electroconvulsive therapy should be done at least
Max benefits achieved at
6 times
12-15 times
Nursing for major depressive disorder
Get history
Safety - ASK DIRECTLY “are you suicidal”
Promote ADLs
Self care - diet sleep hydration etc
DO ONE TASK AT A TIME
Suicide and meds
Antidepressants will give pt the energy to follow through with suicide
pt may also hide meds to attempt suicide later
Therapeutic comms for suicide
Verbalization of emotion
Education - on illness and meds
Follow up on appts
PT needs to be taught to ID
Signs of relapse, get treatment immediately
Suicide risk and antidepressants
PT will have more energy to follow through
PT may believe meds don’t work because they take time to kick in
GREATEST RISK IS IN 2 WEEKS AFTER STARTING
Bipolar disorder 101
Mood disorder
Recurrent depression and mania
Mania 101
Euphoric
Grandiose
Energetic
Sleepless
Poor judgment
Rapid thoughts, actions, and speech
Depressed phase of bipolar
same as depression
2 or more weeks + 4 symptoms
Manic episode onset
sudden and rapid
over a few days
can last days to months
Psychotic manifestations with mania are more likely in
adolescents
At what age do manic episodes first occur
Teens
20s
30s
Bipolar types
Mixed
I
II
Bipolar mixed
Alternates between major depressive and manic
has periods of normal behavior
Bipolar I
Mostly manic
with at least 1 depressive episode
Bipolar II
Mostly depressive
with at least 1 manic episode
Diagnosis of a manic episode
1 week of
heightened activity grandiose/agitated mood and 3 or more S/S
Manic S/S
Exaggerated self esteem
Pressured speech
Distractibility
Sleeplessness
Flight of ideas
In manic phase, pt engages in
high risk activities involving poor judgment
spending sprees, sex with strangers, impulsive investments
Bipolar meds
Antimanics - lithium
Anticonvulsants - stabilize moods, protect cycle
Antipsychotics - for psychosis
Lithium - Mood stabilizer 101
Reduces and sometimes can stop cycling between moods
Lithium is NOT METABOLIZED, EXCRETED THROUGH URINE
Normal lithium serum range
- 5-1.0 maintenance
- 8-1.4 treatment
above 1.5 TOXIC
Lithium serum toxicity S/S
1.5-2.0
N&V
Diarrhea
Poor coordination
Drowsiness
Slurred speech
Lithium serum toxicity S/S
2-3
Ataxia - lack of muscle control, spasms, hypertonia etc
Blurred vision
Tinnitis
Pruritus
Large urine output
Incontinence bladder and bowel
Nurse interventions for lithium toxicity between 1.5-3.0
Stop med
Call Dr.
Prepare for gastric lavage
Start IVs to maintain electrolytes
Lithium serum toxicity S/S 3.0 and above
Cardia arrhythmia
Hypotension
Peripheral vascular collapse
Seizures
Drop in LOC
Nursing interventions for lithium above 3.0
All previous plus
Aminophylline, mannitol or urea to get rid of lithium
Hemodialysis to remove lithium
What to monitor when lithium is above 3.0
Monitor resp, circulatory, thyroid, and immune systems
Anticonvulsant meds used as mood stabilizers
Gabapentin
Carbamazepine
Divalproex
Topiramate
Common side effects for anticonvulsants
drowsiness
sedation
weakness/fatigue
Nursing - safety with anticonvulsants
Get up slow
monitor hypotension
Antipsychotics 101
block dopamine
reduce delusions and hallucinations
Antipsychotic meds
1st gen - thorazine
2nd gen - clozapine
3rd gen - aripiprazole
Side effects of antipsychotics
Dystonia - muscle contract repetitively, twisting movements
Pseudo parkinsonism
Tardive dyskinesia - involuntary movements of body and face
Akathisia - inability to remain still
Psychotherapy and bipolar disorder
Used during depressive or normal phase
combined with meds = reduces suicide and injury
helps client and family
Nursing in depressive state of bipolar
Same as major depression
history
safety
suicide watch
promote ADLs
promote self care - sleep, diet, exercise
Manic phase care for nursing
Use short sentences
Remind client to respect distance
High calorie finger foods
Promote rest/sleep
Decrease stimuli
Protect client dignity
Bipolar - education for fam
Teach ways to manage disorder
Med management - blood work
Teach about salt and fluid intake
Teach S/S of toxicity
Teach S/S of relapse
Salt and lithium
Maintain same level
Salt excess or depletion will affect lithium levels
