Ch. 17 Mood Disorders

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Mood

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is a sustained, emotional feeling perceived along a normal continuum of sad to happy.

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Mood disorder (affective disorder)

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-Prolonged, inappropriate feelings of sadness/depression
-Impairs the person’s ability to function and conduct routine things
-Feelings of worthlessness, guilt

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Dysthymia definition

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suffer from more chronic, ongoing symptoms of depression, which are not severe as those of MMD.

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Bipolar Disorder

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(formerly known as manic depression) is another of several mood disorders.
- characterized by distinct episodes of mania (elation, euphoria) & depression
-Is a chronic, lifelong disease; no dx test

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Cyclothymia

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-is a milder form of bipolar illness characterized by episodes of depression & hypo mania that are not severe enough to meet the criteria 4 bipolar disorder.
-Chronic, fluctuating mood disturbance

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patients w/ depression have changes in the brain...

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neurotransmitters norepinephrine, serotonin, dopamine, acetylcholine, & gamma- aminobutyric acid (GABA), but other unexpected negative life events also play a major role.

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patients experiencing depression display....

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varying degrees of emotional, physical, cognitive, & psychomotor symptoms.

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Cognitive symptoms

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such a the inability to concentrate, slowed thinking, confusion, & poor memory of recent events are particularly common in older patients w. depression.

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Psychomotor symptoms

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of depression include slowed or retarded movements, thought processes, & speech or, conversely, agitation manifesting as purposeless, restless motion.

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Symptoms of acute mania...

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-usually begin abruptly & escalate over several days.
- symptoms are a heightened mood (euphoria), quicker thoughts (fight of ideas), more and faster speech (pressured speech), increased energy, increased physical & mental activities (psychomotor excitement), decreased need 4 sleep, irritability, heightened perceptual activity, paranoia, increased sexual activity, & impulsivity.

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labile mood

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with rapid shifts toward anger & irritability.

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As the manic phase progresses...

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approximately two thirds of patients w/ bipolar disorder develop psychotic symptoms primarily paranoid or grandiose delusions, if treatment interventions have not been initiated.

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The onset of bipolar disorder....

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is usually in late adolescence or early 20s.

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Approximately 60% to 80% of patients w/ bipolar disease will begin with

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a manic episode

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Patients w/ mood disorders have a high incidence of

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attempting suicide

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factors that increase the risk of suicide include

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increasing age, being widowed, being unmarried, unemployment, living alone, substance abuse, previous psychiatric admission, & feelings of hopelessness.

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most episodes of depression last

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3 months if treated, 6 to 12 months untreated

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treatment of mood disorders include

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nonpharmacologic & pharmacologic therapy.

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acute stage

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is that period from diagnosis to initial treatment response.
- 10 to 12 weeks

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initial response

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is defined as a significant reduction in symptoms so that the person no longer fits the criteria for the illness.

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continuation phase

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able to prevent relapse & consolidate the initial response into a complete recovery (defined to be symptom- free for 6 months)
-is 4 to 9 months of combined pharmacotherapy & psychotherapy.

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Maintenance phase therapy

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is recommended 4 individuals w/ a history of 3 or more depressive episodes, chronic depression, or bipolar disorder.
- goal of the maintenance phase therapy is 2 prevent recurrences of the mood disorder.

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another form of pharmacologic treatment 4 depression & bipolar illness is

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electroconvulsive therapy (ECT)

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A course of ECT usually consist of

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6 to 12 treatments, but the # is individualized to the needs of the patient.

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the development of a clinical antidepressants response requires

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at least 2 to 4 weeks of therapy at adequate dosages.

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Major Depression Diagnostic Criteria: At least 4 symptoms must be present:

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change in appetite, sleep or weight
feelings of worthlessness or guilt
difficulty concentrating or making decisions
recurrent thoughts of death or suicidal ideation, plans or attempts.

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Major Depression Diagnostic Criteria: Must have symptoms present:

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for at least 2 weeks.

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DYSTHYMIA

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Chronically depressed mood over 2 years.
Described as sad or down in the dumps
Children present as irritable at least 1 year

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DYSTHYMIA: When depressed must have 2 or more of the following:

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Poor appetite or overeating
Insomnia or hyperinsomnia
Low energy/fatigue
Low self-esteem
Poor concentration
Feelings of hopelessness

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SSRI’s (selective serotonin reuptake inhibitors)

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-most commonly prescribed antidepressant
-They intensify the effects of serotonin to improve mood

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SNRI’s (serotonin & norepinephrine reuptake inhibitors)

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-Newer class that inhibit reuptake of serotonin & norepinephrine
-No anticholinergic or cardiac effects
-Side effects: SEROTONIN SYNDROME

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Tricyclic antidepressants

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-Still used in major depression
-Block re-uptake of serotonin, norepinephrine, dopamine
-Side effects- anticholinergic (constipation, dry mouth, decrease GI & bladder motility), hypotension, sedation
-Low therapeutic threshold; not for patient with suicidal thoughts
-Many drug interactions

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MAOI’s (monoamine oxidase inhibitors)

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Block destruction of epinephrine, norepinephrine, dopamine, and serotonin

Dietary restrictions- avoid foods high in tyramine or hypertensive crisis

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Patient Teaching

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That all antidepressants can take 4-6; 6-8 weeks for full effect
-Patients can be at a higher risk for suicide once feeling better
-Do not abruptly stop, could cause withdrawal symptoms:
Nausea, headache, visual disturbances, dizziness, tremor

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mild depression only causes

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minor functional impairment

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St. John's wort may...

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increase toxic effects of antidepressant medicines.

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NRSG DX: BIPOLAR DISORDER

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KNOWLEDGE DEFICIT

VIOLENCE, RISK FOR

SELF-CARE DEFICIT

IMBALANCED NUTRITION

RISK FOR SUICIDE

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Mania:

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-euphoria, elation, excessive emotional displays, compulsive buying, inappropriate dress, delusions
-50% have substance abuse issues
-Will be treated for depression and mania, should not be on uni-treatment

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the physiologic manifestations of depression begin to be alleviated w/in

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the first week of therapy.

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the physiologic symptoms will improve after

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2 to 4 weeks of therapy at an effective dose.

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Acute mania is initially treated w/

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lithium, valproate, or an atypical antipsychotic agent as monotherapy.

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Bipolar disorders are primarily managed w/

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mood stabilizing medications such as lithium carbonate (Lithane, Eskalith, Lithobid).

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Atypical antipsychotics can be useful in

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early treatment to promote sleep and to decrease anxiety agitation. These medications also demonstrate mood stabilizing properties.