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Mood Disorder

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Mood Disorder

Mood Disorder

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  • 1. Mood Disorders:Depression and Suicide Depression Suicide
  • 2. Depression • Common treatable mental illness • May be unipolar (i.e. person only gets depressed) or bipolar (episodes of mania and depression cycle) • May be situational (related to events) or not • May be chronic low level (dysthymia), recurrent, or single episode
  • 3. Depression is common:
    • Among elderly
    • Among people with chronic and some acute illnesses
    • Related to grief response
  • 4. Symptoms of Depression: Mood Related
    • Dysphoria or depressed mood
    • Despairing, tearful, anhedonia
    • Low self esteem feel worthless
    • May feel excess shame, guilt
    • May have stored up angry feelings
    • Mood related symptoms may be Diurnal, varying by time of day
  • 5. Symptoms of Depression: Thought Related
    • Slow speech and thought processes
    • Poverty of ideas
    • No sense of humor, libido
    • Rumination
    • Hopeless helpless negativistic thoughts
    • Low concentration ability
  • 6. Symptoms of Depression: Behavior Noted
    • Psychomotor retardation
    • Anergia
    • Decreased function at work, decreased participation in social activity, hobby
    • Decreased attention to appearance and hygiene
    • Suicide ideas and other self destructive behavior
  • 7. Symptoms of Depression: Vegetative
    • Altered sleep-hypersomnia, insomnia
    • Often with early morning awakening and
    • difficulty falling asleep
    • Altered nutrition-eating too much or not
    • enough, not the same as the eating disorder.
    • Altered self-care-bathing, grooming, attention
    • to detail
  • 8. Adolescent manifestations of depression
    • May or many not look like the symptom pattern already noted
    • May see: behavior changes, poor school performance, illegal behavior, drug use, hypersexuality
    • Acting out is common in kids and adolescents
  • 9. Modifiers of Depression
    • Psychotic Features
    • Seasonal Affective Disorder
    • Catatonic features
    • “ melancholic features” like prominent vegetative signs
    • Postpartum depression
    • Depression and Anxiety disorders often go hand and hand.
  • 10. Psychologic theories of depression
    • Cognitive theory-persistent automatic negative thought
    • Learned helplnessness-behavioral
    • Psychoanalytic-anger turned inward
    • Grief gone awry
  • 11. Physiologic Theories of Depression
    • Decreased levels of epinephrine and serotonin result in affective disturbance
    • Neuro endocrine link-to hypothyroid, cortisol levels, more
    • Genetic Connection
  • 12. Antidepressant meds to know:
    • SSRI: Celexa, Prozac, Paxil, Zoloft
    • Novels: Wellbutrin, Effexor, Remeron
    • TCA’s: Elavil, Sinequan, Tofranil
    • MAOI: Nardil
  • 13. Points of Action of Antidepressant Medications
  • 14. Central Serotonin Syndrome
    • Hyperactivity and agitation
    • Elevated vital signs
    • Seizures, muscle rigidity
    • Irrationality, mood swings, hostility
    • Discuss Rx: Stop med, provide safe environment, block serotonin response with meds
  • 15. Treatment with ECT
    • Indications: prior good response, severe risk, non response to meds. OK cardiac status/surgery risk
    • Preop: Consent, teaching, NPO, prep
    • During: meds (3), seizure, nurse role
    • Post: Airway/breathing, fall risk, safety, reorientation, HA, when eat?
  • 16. Nursing Intervention Issues
    • Always assess suicide potential, catalogue depression symptoms thoroughly
    • Target the particular problems the individual is demonstrating
    • Be cognizant of need for patience, development of therapeutic rapport
  • 17. Suicide Demographics
    • Males succeed more than females, females attempt more often
    • Incidence increases at adolescence/young adulthood; then increases again as people move into early middle age.
    • Know the other high risk times
  • 18. SAD PERSONS Scale
    • S: sex –male
    • A: age –
    • D: depression
    • P: previous attempts
    • E: ETOH use
    • R: Rational thinking loss
    • S: social support lack
    • O: organized plan
    • N: no spouse
    • S: sickness
  • 19. Types of suicide attempts and health care providers resp.
    • Lethal: successful or capable of being successful
    • Non lethal: defined as a suicide attempt by attempter, but actions not likely to be sufficient to kill person
    • Self Mutilation: self destructive behavior that is not intended to kill self, just cause pain, draw blood, or punish
    • All types are at increased risk of killing self at a later point
  • 20. Suicide Assessment Clues
    • Overt statements, “I am thinking about ending it all.”
    • Covert Statements, “You’ll be better off without me.”
    • Lifting of severe depression sudden calm
    • Giving away, wills gathering means
    • Withdrawal, isolation, anxiety, depression
  • 21. Suicide Risk Assessment
    • Passive suicide ideas “God take me”
    • Active suicide ideas w/o plan
    • Active suicide ideas w/plan, no means
    • Active suicide ideas w/plan ready (look at lethality of plan, specificity, means, timing issues, command hallucinations)
  • 22. Suicide Intervention Triad: Environment, Monitoring, and Interpersonal Intervention:
  • 23. Some Interpersonal Interventions re Suicide
    • Remain calm and do not respond with hostility or avoidance
    • Take it seriously and ask specific questions, decrease isolation
    • Convey: crisis is temporary, pain can be survived, help is available, and you are not alone
  • 24. What are suicide precautions?
    • Some degree of close observation of the client (discuss particulars)
    • Keeping harmful things off the unit—sharps, poisons, things to hang with
    • Designed to provide some safety during acute period, but do not let your guard down.
  • 25. Unit 6 Mood Disorders: Bipolar Disorder
  • 26. Mania: The Opposing Pole of Bipolar Disorder
    • Some people cycle more rapidly than other; rapid cyclers more difficult to manage
    • Bipolar disorder is thought to be chronic, but very manageable
    • Often triggered by psychosocial or physical stressor
  • 27. Mania: Mood Symptoms
    • Euphoria, expansive mood
    • Unstable (labile) mood
    • Irritability, especially if limits set
    • Grandiose sense of self esteem, often covers underlying self doubt
  • 28. Mania: Cognitive Symptoms
    • Rapid pressured speech, thoughts
    • Excess humor, vulgar, hypersexual
    • Flight of Idea
    • Clang Association
    • Scattered thought, may be incoherent
    • Fault finding, manipulative
  • 29. Mania: Behavioral Symptoms
    • Hyperactivity, often prolonged, boundless energy
    • Wild spending, gambling, foolish ventures
    • Inappropriate grooming, excessive or seductive
    • Work and social relations impaired, e.g. may start a lot things, but not follow through
  • 30. Mania: Physical Symptoms
    • Decreased sleep (often the first sign of impending cycle)
    • Decreased eating, no time to eat
    • No time to go to the bathroom
  • 31. Mania: Theories of Etiology
    • Genetic
    • Complex biogenic amine disturbance
    • Social factors
  • 32. Nursing Diagnosis: Risk for Injury
  • 33. Nursing Diagnoses:
    • Disturbed thought process
    • Imbalanced nutrition
    • Disturbed sleep pattern
    • Impaired social interaction
    • Ineffective individual coping
  • 34. Nursing Care Issues
    • Safety of self and others paramount (talk about risks)
    • Avoid environmental stimulation
    • Avoid competition, and difficulty lengthy tasks
    • Large muscle activity that is safe is good
    • Address sleep/rest, limit setting, and eating
    • Hygiene help
    • Note-easy to personalize their comments.
  • 35. Lithium:
  • 36. Anticonvulsants you need to know:
    • Gabapentin (Neurontin),
    • phenytoin (Dilantin),
    • Valproic Acid
    • Klonopin and Valium (studied already)
    • Tegretol
    • Phenobarbital