Wk 3: Mood disorders Flashcards
Define mood?
= the way a person feels, and is usually consistent with circumstances
- relates to their circumstances
- changes frequently by different levels.
Describe mood disorders? and some characteristics of them.
= a term used to describe mental illnesses where mood is disturbed (depression and/or mania) to the point that the person has difficulties functioning in various aspects of their lives.
- struggle to cope with changes in mood.
- not to be confused with inability to regulate mood (a common experience of people with personality disorders)
What are types of mood disorders?
Depressive disorder and bipolar disorder
We talk about mood disorder on a spectrum. Explain this..
Major depressive disorder sits opposed to mania with bipolar disorder in the middle that incompases both the highs and lows of both.
We talk about mood disorder on a spectrum. Explain this..
Major depressive disorder sits opposed to mania with bipolar disorder in the middle that incompases both the highs and lows of both.
Differ grief from depression and what are some of the symptoms?
Grief: natural response to loss of something or something. it is an understandable and culturally appropriate response to life events.
Symptoms
- anger
- comes in waves
- decreases over time
- improves with contact to people
- preservation of self-esteem
- able to experience some enjoyment
As per the DSM V what are the common and differing factors of their disorders?
The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed aetiology
What is the DSM 5 criteria for major depressive disorder (MDD)?
Diagnosis is made when a person experiences at least 5 of the 9 symptoms in a consistent 2 week period. (1 or 2 must be included to confirm diagnosis)
- must represent a difference from their previous functioning
- symptoms can to be attributed to another medical condition.
- Depressed mood most of the day, nearly every day. Aka: anadonia
- Markedly diminished interest or pleasure in all, or most activities, most of the day, nearly every day.
- Significant weight changes [loss or gain] when not dieting. (≥ 5% in 1/12)
- Insomnia or Hypersomnia nearly every day.
- Psychomotor agitation or retardation, nearly every day.
- Physical fatigue or loss of energy every day.
- Feelings of worthlessness, excessive or inappropriate guilt nearly every day (Can be delusional).
- Diminished ability to concentrate or give enough attention, ambivalence or indecision nearly every day.
- Recurrent thoughts of death or suicidal ideation.
* this is the same criteria as bipolar disorder
Define anadonia
= complete loss of pleasure
What is the aim of pharmacological treatment for MDD: antidepressants
= believed that they have an effect on neurotransmitters in the brain. The reduction or absence of these correlates/ in cases of depression.
What neurotransmitters do antidepressants effect?
The 3 neurotransmitters involved are;
- Serotonin
- Noradrenaline (Norepinephrine)
- Dopamine
- they affect these in different ways
Who do antidepressants help?
- chronic mild depression may be warranted with antidepressant therapy when other interventions are exhausted.
- Family history of depression & recurrent depressive episodes are more likely to warrant antidepressant therapy
- they don’t help everyone
Describe Selective serotonin reuptake inhibitors (SSRI’s), their common side effects and examples.
- most common anti-depressant
- very effective in treating depression and better side effect profile
- less toxic in overdose
- Also effective with social phobias & anxiety disorders
- Broad usage to the extent of prescription for erectile dysfunction [Fluoxetine]
Action: SSRI’s inhibit the reuptake of neurotransmitters, specifically serotonin, allowing serotonin to remain in the CNS for longer
Common side effects: Dry mouth, headache, drowsiness, dizziness, tremors, diarrhoea, constipation, loss of appetite, sexual dysfunction
- usually go away in 2 weeks
Examples: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
Describe Serotonin and Noradrenaline
Reuptake Inhibitors (SNRI’s), their common side effects and examples.
Thought to produce fewer side effects (such as weight gain), but more difficult to withdraw from.
Mode of action: Work by inhibiting the reuptake of noradrenaline and serotonin
- stop or delay substances called serotonin and norepinephrine from being reabsorbed in the brain, which leaves more of them available for the brain to use.
Common side effects: intensified dreaming, mild nausea, headache, diarrhoea, abdominal cramping, restlessness, reduced sex drive and difficulty reaching orgasm
Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
Describe Tricyclic Antidepressants (TCAs), their common side effects and examples.
Action: TCAs act on different pathways to other antidepressants, and also inhibit the reuptake of the neurotransmitters serotonin and norepinephrine, increasing the levels of these two neurotransmitters
- Generally seen as more effective in treating depression, however more potent side effects & lethal in over-dosage
- Usually administered at night due to sedative properties
- good to us for those with depression that effects their sleep
Other uses:
- amitryptyline, dothiepin & doxepin are commonly used in pain disorders given their propensity to bind to pain receptors and enhance the efficacy of analgesia
- imipramine commonly used on children with enuresis >5 years
Common side effects: blurred vision, dry mouth, constipation, weight gain or loss, low BP on standing, rash, increased HR
Examples: amitriptyline, clomipramine, imipramine
Describe Monoamine Oxidase Inhibitors
(MAOI’s), their common side effects and examples.
- Monoamines include Dopamine, Noradrenaline, Adrenaline and Serotonin
- Monoamine Oxidase is an enzyme which breaks down these monoamines
Action: Preventing the enzymes action increases the levels of these monoamines
Common side effects: dry mouth, nausea, diarrhea, constipation, headache, drowniess, insomnia, dizziness
Examples: moclobemide, phenelzine, selegiline, tranycypromine
Note: use of MAOI’s requires diet restrictions because they can cause dangerously high blood pressure when taken with tyramine rich foods (e.g. Strong or aged cheeses, cured/processed meats, pickled/fermented foods, soybeans, vegemite, alcohol)
- if someone is depressed and this was one of their fav foods, a different medicine might be better
What are the common side effects of some antidepressants?
dry mouth, dizziness or lightheadedness
Are antidepressants addictive or do they chnage a person’s personality?
No
If an antidepressant needs to be changed can this be done as a straight swap?
a tapering off period is required before commencing a new medication, however cross titration is of a shorter period as the newer antidepressants require less time to ‘wash out’
What are some other things antidepressants are used for?
a variety of general and psychiatric conditions
eg.
- Fibromyalgia
- pains
- premature ejaculation
- migraines
- nocturnal enuresis
Are antidepressants beneficial for those with bipolar?
No not usually, as they can lead to manic episodes.
When do the effects of antidepressants set in? and what is the key negative effect?
- Positive effects can take two weeks and full effect can take 6-8 weeks.
- Increase risk of suicide due to increase energy to act on suicidal impulses and cognitive ability
to plan and implement plan (if suicidal thoughts are present or vulnerability to suicide)
- when someone is depressed they don’t have the energy to make and plan and act it out.
Explain serotonin syndrome. What can cause it? what are the impacts? what are some symptoms?
= a drug induces excess of serotonin
= occurs when two or more antidepressants or other seratogenic agents (pethidine, cocaine, LSD, Ecstasy, St Johns Wort) are taken concurrently causing an excess of serotonin.
Can occur as an;
- adverse reaction to a normal therapeutic dose
-after drug overdose
- drug interactions.
Impacts;
- can be potentially fatal and occurs when two or more antidepressants
Symptoms
- agitation
- confusion
- hyperthermia
- hypertension tremor
- sweating
- dilated pupils
- diarrhoea
- tremor
Mortality: rate of 2%-12%
Describe discontinuation syndrome
= Can occur when there is an interruption, reduction or discontinuation of antidepressant medication
- Occurs in approx. 20% of people who abruptly stop or have a marked reduction in taking antidepressants when they have been taking for a month (Gabriel & Sharma, 2017)
Symptoms include:
- Flu like symptoms
- Insomnia
- nausea
- Imbalance
- sensory disturbances
- Hyperarousal (Agertation/anxiety + sad and horrible)
Symptoms are usually mild and last 1-2 weeks
What are some MUSTs for nursing care of a person with depression?
- Comprehensive psychiatric assessment
- Risk assessment
- Risk management
What are risk assessment points someone might have if they have depression?
- Suicide risk
- Self harm risk
- Aggression to others (eg. Post natal depression – infanticide or where aggression is a feature)
- Self neglect
- Substance abuse
- Medication adherence
When might an MSE be conducted for someone with depression?
- maybe on a phone call every 2 days if in the community
- every shit if inpatient
- risk assessment may occur at the same time
Define infanticide
When someone kills their babys often because of post-natal depression.
What are some key points of risk management for someone with depression?
- enhance protective factors
- recovery goals
- keep the person safe
- assess their physical health as this can decline simultaneously to mental health.
- Identification of the risks (thoughts, intent, plan, history)
- Determine level of risk with a plan and work with the consumer to manage risks
- Document assessment, risk and plan of action
- Supporting/enhancing protective factors
What physical health issues can be closely linked with depression?
Assessment
- Many physical conditions mimic or influence depression
- Physical conditions such as Hypothyroidism can mimic & chronic pain syndromes can influence the severity, frequency &
intensity of depressive symptoms.
- Anxiety commonly occurs with depression and moods rarely remain static
- Certain conditions such as Cancer, Cardiovascular diseases & Diabetes Mellitus are frequently linked with depression in clients
- Some medical treatments can result in depression as a side effect or interfere with anti-depressant treatments. Some
examples; steroids, antibiotics, CNS & dermatological meds
Nursing management
- may not be eating so put on a
What are some nursing interventions for people with depression?
- risk assessment
- start food and fluid chart as they may not be eating
- MSE
- educate them on effective ways to improve sleep
- ensure the therapeutic relationship
- ongoing psychoeducational
- encourage
- the importance of exercise
- educate on not using substances
- scheduling pleasurable activities
- psychoeducation to carers
- educate on medication
- make opportunity to discuss their condition, show empathy, discuss their symptoms and care
- promote independence e.g. make the bed together
- do activities together e.g. shoot the ball
*acknowledge gains in a mature manner
*Even if the client does not engage, persist as depression is an illness of isolation & ongoing contact reinforces nursing concerns for their welfare
What are some key points of assessment to gauge physical health in someone with depression?
- Nutrition & elimination
- Energy levels
- Sleep
- ADL’s & grooming
- risk assessment
- MSE
How long can a diagnosis for bipolar?
10-20 years
- as unless you get a great history its hard to decided that they have both manic and depression often its easier to see them as one.
- Manic episodes more common as first presentation in men
- Depressive episodes more common as first presentation in women
- High incidence of treatment non-adherence
- Co-occurring substance misuse issues (self-medication)
