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W3_Mood Disorders Flashcards

Bipolar, AD, OCD

1
Q

What is bipolar disorder?

A

Bipolar disorder (manic depression) is a treatable medical illness marked by extreme changes in mood, thought, energy, and behaviour.

Bipolar disorder
a person’s mood can alternate between the “poles” mania (highs) and depression (lows).

This change in mood or “mood swing” can last for hours, days, weeks or even months

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2
Q

What are the different types of bipolar disorder?

A

**Bipolar l **Disorder
A distinct period of severe manic episode for at least a week with rapid shift of mood.

Bipolar ll Disorder
at least 1 hypomanic episode but has not had a full manic episode.

Cyclothmyia
numerous periods with manic and depressive symptoms not severe enough to meet criteria for major episodes.

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3
Q

Prevalence and course of Bipolar I and II

A

Lifetime: 0.6 to 0.8% (USA); 1.6% (Singapore)
Male to Female Ratio (1.1 : 1)

Men > manic episodes
Women > depressive episodes; > rapid cycling; > alcohol use.

Average age of onset = 20 years old

Chronic condition
15 times more likely to have complete suicide
60-70% of manic episodes occur before or after a depressive episode

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4
Q

Bipolar Mood disturbance period
Diagnostic criteria

what are the symptoms and how many?

A

During mood disturbance period
(3 or more of the following symptoms

  • Inflated self-esteem/ grandiosity
  • Decrease need of sleep
  • More talkative
  • Flight of ideas
  • Distractibility
  • Psychomotor agitation (Hypersexual)
  • High risk behavior
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5
Q

What are the treatment options for Bipolar patients?

A

Mood stabilizers

Mood stabilizers include agents that treat mania while preventing manic relapse, and agents that treat bipolar depression while preventing depressive relapse.

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6
Q

List the various categories of Mood stabilizers and adjunctive therapy

A

-Mood Stabilizer: Lithium Carbonate
Anti-convulsants/ antiepileptics
Atypical Antipsychotics

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7
Q

Mood stabilizer:
Lithium Carbonate

A

Most popular/ effective mood stabilizer

1st drug to be FDA approved for treatment of manic episodes in bipolar disorder in 1970.

Significant side effect burden, poorly tolerated in at least 1/3 of treated pts

Narrow therapeutic window (0.4 to 1.0 mmol/L)

Changes in dietary sodium intake can affect Lithium levels

Fluid volume affects lithium levels may lead to increase in side effects, progressing to lethal Li toxicity

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8
Q

Therapeutic window for Lithium Carbonate

A

(0.4 to 1.0 mmol/L)

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9
Q

What are the patient education that you will provide for patients taking Lithium Carbonate?

A
  • Do drink enough water as the drug is excreted through the urinary system
  • Changes in dietary sodium intake can affect lithium levels.
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10
Q

Name some of the anti-convulsants used to treat Bipolar

A

Valporate,
Carbamazepine,
Lamotrigine

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11
Q

Name some of the adjunctive therapy used together with anticonvulsants for patients that shows signs of ………..

A

Antipsychotics are used in adjunctive therapy with anticonvulsants.

When patients show signs of irritability or aggression then we will use olanzapine and quetiapine,

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12
Q

Name some of the adjunctive therapy used together with anticonvulsants

A

Antipsychotics such as Olanzapine, Risperidone, Quetiapine, Aripiprazole,
Ziprasidone, Clozapine

remember the anti-“P”sychotics drugs ends with ~”P”ine, Done and zole

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13
Q

What are the lab-tests to be done before starting Lithium Carbonate?

(❤️🩸🫘🍘⚖️

A
  • Full blood count (FBC) with differentials
    Leukocytosis – benign
  • Renal function test, U/E/Cr
    Renal impairment
  • Thyroid function test
    Hypothyroidism
  • ECG If > 40yrs old or existing cardiac disease
  • Cardiac malformation, neonatal hypothyroidism
  • Weight (We do not want patient to gain weight)
  • Exclude Pregnancy (contraindicated to patients who are pregnant, concerns of birth defects)
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14
Q

How frequent should we conduct Lithium monitoring for patients?

A

Serum Lithium level monitoring:
* Sample** 5-7 days** after initiation,
* Change in dose/formulation
* Introduction of interacting medication.
* Monitor 2 weekly in acute phase until stable, 3 to 6 monthly thereafter.
* Obtain sample at least 12 hrs after last dose
* Therapeutic range: 0.4 – 1.0mmol/L

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15
Q

If we are conducting Lithium Monitoring for the patient tomorrow morning at 9am, when should be the last dose of Lithium Carbonate?

A

Last dose: 8pm today
Do not serve the morning dose at 8am and obtain sample

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16
Q

Nursing interventions for Bipolar Disorder

A

1) Establish TNPR
Non-judgemental
Active listening
Explore with patients
Encourage patient to verbalize if they have the mood to live on.

2) Milieu Management
Set boundaries
Check environment (noise levels etc.)
un-obtrusive suicide monitoring

3) Medication administration and monitoring
Side effects of the drug, after 2-3 weeks
behavioral charting
check for hoarding

4) Ensuring Patient’s Safety
(prevent single room, 1-1 monitoring, prevent patient self-lock, increased monitoring every 15mins)

**5) Caring for Patient’s ADLs **
(Hygiene & I/O Charting)

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17
Q

List the various types of Anxiety Disorders
(all the Ds)

PD is not Parkinson Disease yea

A

1) Generalised Anxiety Disorder (GAD)
- Anxiolytics only in Panic stage.
2) Social Anxiety Disorder (SAD) = Social Phobia

3) Panic Disorder w/ wo agoraphobia - Pharm
4) Simple Phobia - Psycho
5) Obsessive Compulsive Disorder (OCD) Pharm+Psycho
6) Adjustment Disorder

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18
Q

Fear of Height

A

Acrophobia

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19
Q

Fear of Open Space

A

Agoraphobia

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20
Q

Fear of closed space

A

Claustrophobia

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21
Q

Fear of Strangers

A

Xenophobia

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22
Q

Fear of dirt and germs

A

Mysophobia

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23
Q

Fear of water

A

Hydrophobia

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24
Q

Fear of fire

A

Pyrophobia

25
Fear of animals
Zoophobia
26
Fear of cats
Ailurophobia
27
Fear of dogs
Cynophobia
28
Prevalence & Risk factors of GAD in Singapore
**Singapore Mental Health Survey** 2016 Prevalence of GAD 1.6%; Female: Male 3.6 : 1 **Commodity:** Major Depressive Disorder (MDD), Dysthymia = (PDD) Panic Disorder & Agoraphobia Social Phobia **Risk factors: ** Older age, Chinese ethnicity Being divorced
29
What is the Level of Anxiety State: When patient presents with **selective inattention**?
Moderate Anxiety
30
What is the Level of Anxiety State: When patient is alert **presents with heightened perceptual field?**
Mild Anxiety, patient can identify a source of anxiety
31
What is the Level of Anxiety State: When patient presents with **complete self absorption, focused on specific detail only**? What happens to their **perceptual field**?
Severe anxiety Perceptual Field greatly reduced.
32
What is the Level of Anxiety State: When patient presents with **lack of focus on the environment, state of terror & emotional paralysis, panicky**? Patient in this anxiety state may also present with ....... or ........ de...... ?
Panic anxiety state. Patient may also present with hallucination or delusion.
33
What is the Level of Anxiety State: When patient presents with **severe shakiness, sleeplessness, severe withdrawal, immobility or severe hyperactivity**?
Panic anxiety state
34
What is the Level of Anxiety State: When patient presents with **confusion, sense of impending doom, tachycardia, threats and demand, feeling of drea, loud & rapid speech**?
Severe anxiety
35
What are the 4 levels of anxiety?
Mild Moderate Severe Panic
36
What is the Level of Anxiety State: When patient presents with **Voice tremors**?
Moderate anxiety
37
What is the Level of Anxiety State: When patient presents with **attention seeking behaviour**?
Mild Anxiety
38
What is the Level of Anxiety State: When patient presents with **tension-relieving behavior** such as biting nails.
Mild Anxiety
39
What is the Level of Anxiety State: When patient presents with **irritability and/or restlessness**?
MIld Anxiety
40
What is the Level of Anxiety State: When patient presents with **repetitive questioning**?
Moderate Anxiety
41
What is the Level of Anxiety State: When patient presents with **pacing, banging hands on table**?
Moderate Anxiety
42
What is the Level of Anxiety State: When patient presents with **Loud & rapid speech, hyperventilation, sense of impending doom**?
Severe anxiety
43
What is the Level of Anxiety State: Patient is able to solve problems but not at optimal capacity
Moderate anxiety
44
What is the Level of Anxiety State: Patient is able to effectively work towards a goal and examine alternatives
Mild anxiety
45
What is the Level of Anxiety State: When patient is unable to see connections between events or details
Severe anxiety
46
What is the Level of Anxiety State: When patient is unable to learn and solve problems, disorganized or irrational reasoning.
Panic stage of Anxiety
47
What are anxiety disorders?
Anxiety is a normal response to threatening situations. Anxiety is pathological when it is excessive and persistent or when it no longer serves to signal danger. Persons with anxiety use rigid, repetitive, and effective behaviors to control anxiety. Anxiety disorders interfere with personal, occupational, or social functioning.
48
Mental aspects of Anxiety Disorders.
- **Worry** - A state of unease/ uncertainty over actual or potential problems - **Fear** – A state of alarm due to an immediate threat to the individual - **Rumination** – Prolonged and compulsively focused attention on certain thoughts, often “looping” - **Preoccupation** – A state of being deeply absorbed in thought - **Catastrophising** – Imagining the worst or most terrifying outcome - **Focusing on the negative** – Remembering only the bad things that happen and leaving out the good
49
Physical aspects of Anxiety Disorders
Heart pounding Rapid breathing Chest pressure Dizziness Muscle tension Weak legs
50
Behavioural aspects of Anxiety Disorders
SEEKING REASSURANCE SEEKING HELP AVOIDANCE SICK ROLE DEPENDENCE RESTLESS PACING
51
What are the main difference in nursing management between the level of anxiety? - mild & moderate - Severe & panic
Importance of milieu therapy and the use of medications for severe & panic level of anxiety
52
Social Anxiety Disorder (SAD) is commonly known as?
Social Phobia A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny of others The individual fears that he or she will act in a way that will be humiliating or embarrassing Exposure of feared situation provokes anxiety Recognises fear as excessive or unreasonable
53
Simple Phobias
Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation Exposure to the phobic stimulus provokes anxiety Recognises fear as excessive or unreasonable avoids the phobic object or situation
54
What are the 2 essential features of OCD?
**Obsession** Recurrent and intrusive **thoughts**, feelings, idea, and sensation. **Compulsion** A conscious recurrent** behaviour** such as cleaning, counting, checking, or avoiding.
55
What are some of the Common Obsessions?
Contamination Pathological Doubt Need for symmetry Somatic Obsession Worry about discarding something important
56
Pharmacotherapy for OCD
**Tricyclics (TCAs)** - Clomipramine (Oral) **Selective Serotonin Reuptake Inhibitor (SSRI)** -Fluoxamine (Luvox) -Fluoxatine (Prozac) -Paroxetine (Paxil) - Sertraline (Zoloft) - Citalopram Tricyclics/SSRI with **Buspirone/ clonazepam** (if anxious) Tricyclics/SSRI with **antipsychotics (if delusional)**
57
Psychotherapy for OCD
Research shows that “behaviour therapy” was an effective treatment for OCD **Therapeutic Techniques** Exposure in vivo (directly facing a feared objection, situation or activity) Exposure in fantasy Response prevention (Delaying performance & ritual) **Patient Education** Managing anxiety during exposure sessions Group Therapy Cognitive Reconstructuring Record Keeping **Combined pharmacotherapy & psychotherapy**
58
Panic Attack
A discrete period of intense fear or discomfort Abrupt onset, reached a peak within 10 mins **Four or more symptoms:** * palpitations, * chest pain, * shortness of breath, choking, nausea, * abdominal distress, * sweating, trembling, dizzy, * derealisation, depersonalisation, * fear of losing control, * fear of going crazy or of dying
59
Panic Disorder
Recurrent unexpected panic attacks Persistent concern about having further attacks Worry about consequences of attack e.g. Fear of losing control, of dying, of heart attack or stroke, of becoming crazy First panic attack occurs when subjects are engaged in an ordinary aspect of life Young life-threatening age 20 – 30 Background of life threatening illness, loss of close relationship, prolonged strain Repeated visits to GP and ED May be associated with Agoraphobia Course is highly variable, waxing and waning Pharmacological treatment early in the illness often leads to complete remission 5 year study: 34% recovered, 46% minimally impaired, 20% moderate to severely impaired

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