week 7: mood disorders & 3 D's Flashcards
key point when differentiating/diagnosing mood disorders
interference in clients ADLs
overall QOL
what is anhedonia?
loss of pleasure for things in your life that used to bring you pleasure
what 2 things are experienced in bipolar affective disorder
- depressed mood
- mania
cycle between the two!
what 2 things are experienced in major depressive disorder
- depressed mood
- anhedonia
Major depressive disorder: DSM 5
5 or more symptoms INCLUDING depressed mood AND/OR anhedonia
- most of the day, nearly everyday for 2 weeks or more
hx of 1 or more depressive episodes, NO hx of mania
Major depressive disorder: symptoms
+/- in appetite, 5% weight change in a month is significant
- sleep changes
- psychomotor agitation or retardation
- fatigue/energy loss
- feelings of worthlessness/guilt
- poor concentration
- recurrent suicidal ideation/past attempt
major depressive disorder: categorization of depressive episodes
mild
- symptoms present, result in minor impairment of functioning
moderate
- symptoms & impairment in between mild & severe
severe
- seriously distressing, unmanageable, large interference
major depressive disorder: subtypes (2)
peripartum onset
- perinatal (during pregnancy), postpartum (within 3-4 weeks post)
seasonal depression
- annually during fall/winter
MDD: MSE (mood/affect)
mood:
- sustained period of low mood
- sadness, hopelessness
- loss of interest
- ANHEDONIA
affect:
- flat
- constricted
- teary
MDD: pharmacological interventions
- SSRIs (pram/xetine)
- SNRIs (axine)
- TCAs (ipyline/ipramine)
- MAOIs
MDD: non-pharmacological interventions (3)
psychotherapy
- CBT, group therapy
electroconvulsive therapy (ECT)
transcranial magnetic stimulation (TMS)
what is ECT?
electrical current is passed through the brain, intentional seizure
- administer anesthetic/paralytics prior
when would ECT be used (3)?
- marked vegetative symptoms or catatonia
- treatment resistant BPD
- experiencing acute suicidality
what is TMS?
MRI strength magnetic pulses used to stimulate focal areas of the cerebral cortex
when would TMS be used?
- MDD (schizophrenia, anxiety disorders being explored)
difference between recurrent depressive disorder & depressive disorder
recurrent fluctuates between normal mood to severe depression
depressive disorder is only depression
BPD: classifications - bipolar 1 disorder
one or more manic episodes w/ depressive component
BPD: classifications - bipolar 2 disorder
periods of major depression accompanied by at least one incidence of hypomania
BPD: classifications - cyclothymic disorder
mild form of BPD where mood swings from short period of mild depression and hypomania for at least 2 years
BPD chart: bipolar 1, bipolar 2, cyclothymic (whats the range)
bipolar 1 - full range between mania and major depression
bipolar 2 - range between hypomania and major depression
cyclothymic - range between hypomania and minor depression
genetics & BPD
not guaranteed pass between parent & child (hereditary)
co-occuring disorders (4)
- psychosis
- anxiety disorders, ADHD
- substance use
- eating disorders (binge eating or bulimia)
manic/hypomanic episode: DSM 5 - description (2)
period of abnormally elevated, expansive, or irritable mood AND abnormally increased goal-directed activity or energy
manic/hypomanic episode: DSM 5 - symptoms
three or more of following symptoms
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative
- Flight of ideas
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
manic vs hypomanic episode (3)
hypomanic is just less severe
manic
- cause marked impairment in functioning
- episode not due to psychologic effects of a substance
- lasts at least 7 days
hypomanic
- cause change in functioning thats uncharacteristic
- episode not due to psychologic effects of a substance
- lasts at least 4 days
manic episode: MSE (mood/affect)
mood: mood swings, feelings of euphoria, extreme irritability
affect: labile affect, full range of emotions, exaggerated
manic episode: MSE (insight/judgement)
compromised insight into impact of behaviours & diagnosis on behavioural choices
engage in high-risk behaviours w/ lack of consideration for consequences
KEY: lack impulsive control
depressive/minor depressive episode: DSM 5
5 or more of the following symptoms
- depressed mood most of everyday
- loss of interest in almost all activities
- significant weight loss or +/- appetite
- engaging in purposeless movements (pacing around room)
- fatigue/loss of energy
- feelings of worthlessness/guilt
- decreased ability to think/concentrate
- recurrent thoughts of death, suicidal ideation w/o plan, or attempt
depressive vs minor depressive episodes: DSM 5
depressive is 5 or more of the symptoms in a 2 week period
minor depressive episode is 2-4 of the symptoms in a 2 week period
priority care issues
safety: protect patient from poor judgement/increased impulsivity & increased suicide risk
monitor electrolytes and thyroid function
- change in eating habits
assess effects of medication
pharmacological treatment 2 goal & corresponding meds
prevent mood cycling
- lithium (mood stabilizer)
treat symptomology
- antipsychotics
- anticonvulsants
- antianxiety
- antidepressants
non-pharmacological interventions
- decrease stimuli
- monitor sleep
- nutrition/hydration
- limit setting, redirect behaviour
- maintain safety
- psychotherapy
- ECT (last resort)
