Bipolar And Mania
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Bipolar And Mania

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Psychiatric and Mental Health Nursing

Psychiatric and Mental Health Nursing

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  • At least 15% of the population will suffer from a mood disorder at some time… at any one time 12-17% of the population suffers from depression ? Depression is a persistent problem that is likely to recur. Depression is more than just a sad mood “people who are depressed [may] suffer from slowed thought processes and impairments in memory that can interfere with their functioning. Women are twice as likely to suffer from depression (found to be true in 30 countries over a period of 40 years) The prevalence of depression is increasing worldwide.

Bipolar And Mania Bipolar And Mania Presentation Transcript

  • Essentials of Understanding Abnormal Behavior Mood Disorders and Suicide
  • Mood Disorders & Suicide
    • Mood Disorders: Disturbances in emotions that cause subjective discomfort, hinder a person’s ability to function, or both; depression & mania are central to these disorders
    • Depression: Emotional state characterized by intense sadness, feelings of futility & worthlessness, & withdrawal from others
    • Mania: Emotional state characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity
  • Depression and Mania
    • In the “World of Mood,” there are two poles: mania and depression.
    • Unipolar disorders: involve only depression
    • Bipolar disorders: involve both manic and depressive episodes
    • Note that there are no mood disorders involving mania alone.
  • Mood Disorders (cont’d)
    • Depression occurs ten times as frequently as mania.
    • Depression is the most common complaint of individuals seeking mental health care.
    • Epidemiologic catchment area survey:
      • 2.3% of adult males and 5% of adult females in the U.S. have a mood disorder in a one-year period.
  • Mood Disorders (cont’d)
    • Lifetime prevalence:
      • Severe depression: 5-12% of males and 10-25% of females
      • Mood disorder: 15% of males and 24% of females
    • Risk of another episode increases with each episode
      • 50% after one episode, 70% after second, 90% after third
  • Mood Disorders (cont’d)
    • Lifetime prevalence:
      • Severe depression: 5-12% of males and 10-25% of females
      • Mood disorder: 15% of males and 24% of females
    • Risk of another episode increases with each episode
      • 50% after one episode, 70% after second, 90% after third
  • The Symptoms of Depression
    • Affective: Depressed mood, dejection, excessive and prolonged mourning, worthlessness, lack of joy
    • Cognitive: Pessimism, decreased energy, disinterest, loss of motivation
      • Cognitive triad: Negative views of self, outside world, and the future
      • Avolition: lack of motivation to do things. This symptom is often responsible for the impairment of functioning that occurs with depression.
      • don’t expect to be successful so don’t try, so they are more likely to experience failures.
      • depressed individuals may be less effective at solving intellectual problems and may also have memory problems
  • The Symptoms of Depression (cont’d)
    • Behavioral: Social withdrawal, lowered work productivity, lack of personal cleanliness, slow speech
      • Psychomotor retardation: Slowing of bodily movements, expressive gestures, and spontaneous responses
        • People with this symptom have more problems with thinking and memory and take longer to recover from depression
    • Physiological: Loss of appetite/weight, constipation, sleep disturbance, disruption of menstrual cycle, aversion to sexual activity
      • depression also causes decline in the function of the immune system and depressed people produce fewer white blood cells
      • There may be agitation; high levels of random activity which does not help them achieve any particular goals-
  • The Symptoms of Depression
    • Culture influences the experience & expression of symptoms
      • Sadness/guilt (U.S. & Western European) versus somatic/bodily complaints (Asian)
      • “ Nerves” and headaches (Latino & Mediterranean)
      • Weakness, tiredness, “imbalance” (Asian)
      • Problems of the “heart” (Middle Eastern)
      • Being “heartbroken” (Hopi)
  • The Symptoms of Mania
    • Affective:
      • Elevated, expansive, irritable mood, if frustrated, may become belligerent
      • Impaired social & occupational functioning
      • Boundless energy, enthusiasm, self-assertion
    • Cognitive:
      • Flightiness, pressured thoughts, lack of focus & attention, poor judgment
  • Table 10.1: Symptoms of Depression and Mania
  • Figure 10.1 Disorders Chart: Mood Disorders Source: American Psychiatric Association (2000).
  • Figure 10.1: Disorders Chart: Mood Disorders (cont’d) Source: American Psychiatric Association (2000).
  • Depressive Disorders
    • Major depression : A disorder in which a group of symptoms, such as depressed mood, loss of interest, sleep disturbances, feelings of worthlessness, and inability to concentrate, are present for at least two weeks
  • Depressive Disorders (cont’d)
    • Dysthymic disorder : Characterized by chronic and relatively continual depressed mood that does not meet the criteria for major depression
    • persistently depressed mood, more days than not for at least 2 years (1 for kids)
    • includes poor appetite or overeating, sleep disturbance, low energy level, low self-esteem, difficulties in concentration or decisions making, feelings of hopelessness
    • average duration 5 years - can last 20.
    • Symptoms are NOT less severe; they just do not occur everyday
      • Pessimism, guilt, loss of interest, poor appetite or overeating, low self-esteem, chronic fatigue, social withdrawal, concentration difficulties
  • Bipolar Disorders
    • Bipolar I disorders : The most severe form of bipolar disorder involving full blown mania which includes serious impairment of functioning and/or psychotic features.
      • Psychoses tend to be mood-congruent, meaning they fit the person’s expansive mood. A person in full-blown mania would be more likely to believe that he is Superman than to believe he is dying.
      • To qualify for a diagnosis of manic episode (bipolar disorder), symptoms must last at least a week.
  • Bipolar Disorders (cont’d)
    • Bipolar II disorders : Recurrent major depressive episodes with hypomanic episode
      • Hypomania is a less severe form of mania which is experienced as an increased in goal-directed activity and energy. A person with hypomania may go unnoticed by others and will not lose contact with reality.
  • Bipolar Disorders (cont’d)
    • Cyclothymic disorder : Chronic and relatively continual mood disorder with hypomanic episodes and depressed moods that do not meet criteria for major depressive episode
      • Symptoms present for more than 2 years, never symptom free for more than 2 months
  • Other Mood Disorders
    • Mood disorder due to general medical condition : Characterized by depressed mood and/or elevated or irritable mood as a direct result of a general medical condition
    • Substance-induced mood disorder : Prominent and persistent disturbance of mood attributable to use of a substance or cessation of substance use
  • Symptom Features and Specifiers
    • Specifiers : Describe major depressive episodes in terms of severity, presence or absence of psychotic symptoms, and remission status
      • Useful for prognosis
      • May include information such as:
        • Melancholia : Loss of pleasure, lack of reactivity to pleasurable stimuli, depression that is worse in the morning, early morning awakening, excessive guilt, weight loss
        • Catatonia : Motoric immobility, extreme agitation, negativism, or mutism
  • Symptom Features and Specifiers (cont’d)
    • Course specifiers:
      • Rapid cycling: Episodes occurred 4 or more times during the previous 12 months
      • Seasonal pattern: Moods are accentuated during certain times
        • Seasonal affective disorder (SAD): Serious depression fluctuates according to the season
      • Postpartum onset: Occurs within 4 weeks of childbirth and lasts longer than 1 month.
        • Hallmark symptom: inability to be around the baby or care for the baby.
        • Affects 8-10% of new moms.
        • 75-80% experience “post-partum blues,” lasting 3-4 days after the birth of the child.
  • The Etiology of Mood Disorders
    • Psychological or Sociocultural Approaches to Depression:
      • Psychodynamic: Focus on separation & anger
      • Behavioral: Reduced reinforcement leads to less activity; secondary gain from reinforcement of inactivity
      • Cognitive: Negative thoughts & errors in thinking
  • Psychological or Sociocultural Approaches to Depression
    • Cognitive-Learning:
      • Learned helplessness: The belief that one is helpless & unable to affect outcomes in one’s life
      • Attributional style: People who feel helpless make speculations (causal attributions) about why they are helpless
      • Depressed people operate from a primary triad of negative self-views, present experiences, and future expectations.
        • Four errors in logic typify this negative schema:
          • Arbitrary inference
          • Selected abstraction
          • Overgeneralization
          • Magnification/ minimization
    • Sociocultural:
      • Culture, social experiences, & psychosocial stressors, including stress & gender
  • Table 10.2: Explaining the Findings That Rates of Depression Are Higher Among Women Than Among Men
  • Biological Perspectives on Mood Disorders
    • The Role of Heredity:
      • Adoption studies: Incidence of mood disorders is higher among biological families than among adoptive families
      • Twin studies: Concordance rates are higher for monozygotic twins than for dizygotic twins (especially for bipolar disorders), although non-genetic factors also have an influence
  • Neurotransmitters & Mood Disorders
    • Neurotransmitters: Chemical substances that are released by axons of sending neurons & that are involved in the transmission of neural impulses to the dendrites of receiving neurons
    • Catecholamine Hypothesis
      • Neurotransmitters are broken down or chemically depleted by MAOs
      • Neurotransmitters are reabsorbed by the releasing neuron in the reuptake process
  • Figure 10.2: The Catecholamine Hypothesis: A Proposed Connection Between Neurotransmitters & Depression
  • The Treatment of Mood Disorders
    • Biomedical Treatments for Depressive Disorders:
      • Medication:
        • Tricyclic antidepressants (TCAs)
        • Heterocyclic antidepressants (HCAs)
        • Monoamine Oxidase Inhibitors (MAOIs)
        • Selective Serotonin Reuptake Inhibitors (SSRIs)
      • Electroconvulsive Therapy (ECT)
  • The Treatment of Mood Disorders
    • Psychotherapy & Behavioral Treatments for Depressive Disorders:
      • Psychoanalysis: gain insight into unconscious & unresolved feelings of separation or anger
      • Behavior therapy: increase exposure to pleasurable events & to improve social skills
      • Interpersonal psychotherapy & cognitive-behavioral therapy effective for treating less severe cases
      • Combination of psychotherapy & medication may be best
  • Treatment for Bipolar Disorders
    • Same forms of psychotherapy & behavior therapy used for Unipolar Disorder are also used for Bipolar Disorder
    • Typical treatment for Bipolar involves lithium carbonate, which is 60-80% effective
    • Anticonvulsant drugs are also being used
  • Suicide
    • Suicide: The intentional, direct, & conscious taking of one’s own life
    • Suicide is not classified as a mental disorder, although the suicidal person usually has psychiatric symptoms, such as:
      • Depression
      • Alcohol dependence
      • Schizophrenia
  • Figure 10.3: Suicide
  • 10 common characteristics of suicide
    • The common purpose is to seek a solution : suicide is seen as the solution to an unsolvable problem; it is not pointless or accidental.
    • The cessation of consciousness is a common goal: consciousness represent constant psychological pain
    • The stimulus for suicide is generally intolerable psychological pain :
    • The common stressor in suicide is frustrated psychological need: feelings of frustration, failure, worthlessness, etc.
    • A common emotion in suicide is hopelessness-helplessness
  • 10 common characteristics of suicide (cont.)
    • The cognitive state is one of ambivalence : although the person may be strongly motivated to end his/her life, there is usually a strong desire to live, as well.
    • The cognitive state is one of tunnel vision : the person has great difficulty seeing the big picture and believes death is the only way out
    • The common action in suicide is escape : goal is escape from an intolerable situation
    • The common interpersonal act in suicide is communication of intention : At least 80% of suicides are precipitated by verbal or nonverbal cues of suicidal intention.
    • The common consistency is in the area of lifelong coping patterns that predispose the person to suicide
  • Study of Suicide
    • Psychological Autopsy: Systematic examination of existing information to understand & explain a person’s behavior before his/her death
    • Suicide survivors are different from those who succeed:
      • Attempter: white female housewife in 20s-30s, marital difficulties, uses barbiturates
      • Succeeder: white male, 40s or older, ill health or depression, use guns or hangs himself
  • Facts About Suicide
    • Alcohol frequently implicated
    • Men are more likely than women to kill themselves (men use firearms)
    • Common among people under age 25
    • Men 3 to 4 times as likely to be successful, women more likely to attempt suicide
    • Married people are less vulnerable
    • Socioeconomic level is not a factor
  • More Facts About Suicide
    • Over 60% of suicides are committed using firearms, 70% of attempts are from drug overdose
    • Suicide rates are lower in Catholic & Muslim countries
    • Highest rates in U.S. are for Native Americans, lowest for Asian Americans
    • More than 66% of those who commit suicide communicate their intent to do so beforehand
    • High correlation with alcohol consumption
  • Perspectives on Suicide
    • Emile Durkheim: suicide may occur because of:
      • alienation from society (egoistic suicide)
      • unbalanced relation to society (anomic suicide)
      • for the greater good (altruistic suicide)
    • Sigmund Freud: Suicide results from the existence of Thanatos, the death instinct antagonistic to the life instinct
  • Perspectives on Suicide (cont’d)
    • Biological explanations:
    • Research suggests that low levels of serotonin contribute to vulnerability to suicide.
      • Evidence suggests that patients with low levels of 5HIAA ( 5 hydroxyindoleacetic acid - a chemical produced when serotonin is broken down in the body) are more likely than others to commit suicide, more likely to use violent methods, and more likely to have a history of violence, aggression, and impulsiveness
      • Other evidence suggests impairment of serotonin receptors in the brain stem and frontal cortex of suicidal individuals.
    • Genetics: Although there appears to be a higher rate of suicide among parents and close relatives of people who commit suicide, more evidence is needed to understand this relationship.
  • Preventing Suicide
    • Assumption: Potential victims are ambivalent – they have a strong wish to die, but also a wish to live.
    • Lethality : The probability that a person will choose to end his/her life
    • Three-step process for working with a potentially suicidal person:
      • Know factors correlated with suicide
      • Determine probability for person attempting suicide
      • Implement appropriate action
  • Preventing Suicide
    • Telephone Crisis Intervention:
      • Maintain contact/establish relationship
      • Obtain necessary information
      • Evaluate suicidal potential
      • Clarify nature of stress & focal point
      • Assess strengths & resources
      • Recommend & initiate action plan