Unit 26 Mood Disorders Flashcards
What are the two broad categories of mood disorders?
Depression
Bipolar Disorder (composed of depression + mania)
State the mood disorder continuum.
Major depression Dysthymia (mild depression) Normal mood Hypomania (great happiness and hyperactivity) Severe mania
What are transient symptoms?
Normal healthy responses to everyday disappointments
When does pathological depression occur?
Pathological depression occurs when adaptation to social and occupational issues are ineffective
What factors can contribute to Depression and Bipolar Disorder?
- Social class (lower income = higher prevalence / Bipolar more frequent in higher classes)
- Seasonality (spring and fall)
- Race and Culture (certain cultures can change how they express the mood disorders)
What are primary risk factors of Depression and Bipolar Disorder?
- Early childhood trauma
- First degree family history
- High levels of neuroticism (responding to stress poorly)
- Absence of social support
- Alcohol or substance abuse (vice-versa)
- Female gender
- Unmarried
- Negative life event
- Medical illness
- Postpartum period
What physiological predisposing factors could contribute to depression? (things that need to be addressed first!)
- Medication side-effects
- Neurological disorders (MS, Brain tumors, etc)
- Electrolyte disturbances
- Endocrine disturbances
- Nutritional deficiencies
What 2 neurotransmitters are affected by medications for depression?
- Serotonin
- Norepinephrine
If depression is suspected in a PT what neuroendocrine hormone/gland should be checked?
TSH possible abnormality, Thyroid should be checked!
What medical conditions could lead to depressive disorder?
- Inflammatory disorder
- Major surgeries
- Infections
- Cardiac issues
- Endocrine (thyroid issues)
What leads to substance/medication induced Depressive Disorder?
- CNS drugs
- Steroids
- Systemic Medications
- Alcohol/substance abuse, dependence, withdraw
Define Major Depressive Disorder.
- Depressed mood or loss of interest or pleasure in usual activities
- Impaired social and occupational functioning for 2 weeks
- No history of manic behavior (BiPolar if any episode of mania)
- Symptoms cannot be attributed to the use of substances or a general medical condition
What are seasonal features of Major Depressive Disorder?
-Episodes begin in fall or winter and remit in spring, reduced metabolic activity, anergia, hypersomnia, overeating, weight gain, carb craving.
(Try light therapy)
What is Persistent Depressive Disorder/Dysthymic Disorder?
- Sad
- No evidence of psychosis
Chronically depression mood for:
Most of the day
More days than not
For at least 2 years
What are Depressive Disorder Psychosocial Theories?
[Cognitive theory] by Aron Beck 3 distortions/negative expectations of: -Environment, -Self, -Future
[Learning]
-learned helplessness i.e. gives up
[Object Loss]
-separation from sig. other in first 6 months leads to despair and depression in response to loss
[Psychoanalytical]
-loss is internalized and directed against the ego (anger turned inward)
[Transactional Model]
-combined effects of genetic, biochemical, psychosocial influences (all of the above lead to depression)
What are some risk factors for depressive disorders in childhood?
- Genetic predisposition
- Stressful situations
- Detachment from primary caregiver, parental separation, death of parent, pet, etc.
- A move, academic failure, physical illness
(NOTE: ALL ARE LOSSES)
What are symptoms of depressive disorder in children and adolescents?
Children: psychosomatic complaints, sleeping and eating disturbances, social isolation, and suicidal thoughts or actions
Adolescent:
- Sleeping and eating disturbances
- Sexual acting out
- Substance abuse
- Inappropriately expressed anger
- Social withdraw
*look for sudden change and maladaptive behaviors
What is the focus of therapy on?
To alleviate the symptoms and strengthen coping and adaptive skills to prevent future psychological problems
Describe mood disorder in older people?
- Perceived losses contribute to
- ECT works well, but limited duration
- Bereavement overload (friends are being lost)
- Helplessness increases
- Depression is most common psychiatric disorder
What is the assessment data that can be seen in Depressive Disorders? (The ABC and P of Depression).
ABC and P
[Affective] s/s are sadness, despair, flat affect, emptiness, anxiety, anhedonia**
[Behavior] s/s crying, regression, withdrawal, psychomotor retardation (brain activities slow), catatonia, self-destructive behavior
[Cognitive] s/s difficulty getting mild disappointment, slowed thinking, blaming self/others, strong desire for suicide, confusion, obsession with worthlessness, *ruminating (thinking same thing again and again)
[Physiological] s/s tired, slowing of all bodily functions (constipation for example), eating and sleeping changes, somatic complaints
-The worse the depression the worse the symptoms
In order from most serious to least name nursing diagnosis for depressive disorders. How should nursing diagnosis be prioritized?
Risk for self-directed violence/suicide 1st priority
Altered Nutrion
Sleep pattern disturbance/self care deficit …etc, etc
Essentially think Maslow. Basic safety and needs, threatening first.
What are Depressive Disorder nursing interventions?
- Ask client re suicide
- Create safe environment
- Encourage feeling expression
- Develop trust
- Easy activities (coloring, drawling, etc.)
- Simple daily structure
- Offer simple choices
- Be accepting of client
- Teach problem solving- break problems into manageable pieces
- Client and family education
Define suicide.
Behavior, not a diagnosis or disorder
Major depression and bipolar disorder are Dx’s that could lead to suicide
What are the levels of suicidal behaviors?
Ideation: Frequent and specific thoughts of death and ways to die
Planning: Logical and well prepared suicide plan with a good likelihood of success
Gesture: Behavior or activity that is dangerous or harmful, but not potentially lethal (technically cutting could be this, or leaving notes of value)
Attempt: Clear, self-destructive actions with a good probability or expectation of lethality that did not result in death
Succesful suicide:
