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49 Cards in this Set
- Front
- Back
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Mood disorder
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pervasive sustained emotional coloring of experience;
usually extreme changes in mood ea.mood disorder is associated with disturbed psychological, physiologic, and social functioning with many symptoms |
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Groups of symptoms for Mood disorders
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vegetative signs/problems
a. sleep problems b. appetite c. weight d. libido Cognitive features: distorted a. distorted attention b. memory c. thinking Impulse control problems a. suicide b.homicide Behavioral problems a. withdrawal b. lack of pleasure c. fatigability Somatic features a. headache b. stomachache 3. muscle tension |
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Etiology
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genetic
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Physiologic Factors
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most of the brain areas assoc. with mood disorders are in the limbic system.
reduced activity in the brain areas regulated by the neurotransmitters norepinephrine and serotonin contributes to this disorder |
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S/S: Diagnostic Criteria
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1. Major Depressive Disorder
2. Dysthymic Disorder 3. Bipolar Disorder a. I b. II c. cyclothymic disorder |
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Major Depressive Disorder
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1. over 2 wks clt has exhibited depressed mood or decreased interest or pleasure and at least 4 or the following
1. significant wgt loss 2. hypersomnia or insomnia 3. psychomotor agitation or slowness 4, fatique or energy loss 5. feelings of worthlessness or guilt 6. difficulty concentrating or indecisiveness 7. recurrent thoughts of death, either with or without suicide ideation these symptoms cause significant distress or impair social, occupational or other functioning Symptoms are not caused by substance or a gen. med condition |
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Dysthymic Disorder
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A. for at least 2 yrs, clt has depressed mood based on either subjective report or observation from others
B.-during depression has at least two of the following 1. poor appetite or overeating 2. hypersomnia or insomnia 3. fatigue or energy loss 4. feelings of hopelessness 5. difficulty concentrating or indecisiveness C. clt has never been without the above symptoms for more than 2 mths D. clt has not had major depressive disorder E. clt has never had a manic, mixed, or hypomanic episode and does not meet criteria for cyclothymic disorder F. symptoms are not caused by a substance or a gen. med. cond G. symptoms cause significant distress or impair social, occupational or other functioning |
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Bipolar I disorder: Episodes
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1. Manic episode
2. Major Depressive episode 3. Mixed Episode |
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Bipolar I Disorder
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1. clt has one or more manic or mixed episodes and one or more major depressive episodes. Episodes are not better explained by other psychiatric disorders
3. episodes are not the direct result of a substance or other medical condition |
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Manic Episode
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1. mood is abnormally and persistently elevated and expansive or irritable for at least 1 week
2. client participates excessively in pleasurable activities with a high potential for painful results 3. need for sleep is decreased 4. has inflated self-esteem or gradiosity 5. goal-oriented activity or agitation is increased 6. easily distracted, talks excessively or has racing thoughts 7. functioning in several areas is markedly impaired |
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Major Depression Episode
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a. clt has a depressed mood most of the day
b. interest in nearly all activities is markedly decreased c. significant wgt loss w/out reason d. hypersomnia or insomnia e. psychomotor agitation or slowness is present f. fatique or energy loss g. feelings of worthlessness or guilt h. difficulty concentrating or is indecisive thoughts of death are recurrent, either with or w/out suicide ideation |
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Mixed Episode
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1. meets criteria for both manic and major depressive episodes nearly every day for 1 wk or longer
2. clt requires hospitalization to prevent harm to self or others 3. displays psychotic features |
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Cyclothymic Disorder
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1. for at least 2 yrs, clt has had numerous periods with hypomanic symptoms and numerous periods of depressive symptoms but has not met criteria for major depressive disorder
2. clt has not been w/out symptoms for more than 2 mths at a time 3. clt has had no manic, mixed, or major depressive episodes during the 2 yr period 4. symptoms are not the direct result of a substance or other med. cond 5. symptoms significantly impair functioning or cause significant disease |
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Hypomanic episode from Cyclothymic disorder
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1. clt has a persistently elevated, expansive or irritable mood for at leat 4 days. This mood is clearly different from clt's usual mood
2. clt meets symptoms for a manic epi. 3. clt's function has unequivocally changed, which others have observed 4. condition is not severe enough markedly to impair social, occupational or other func. or require hosp. |
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Bipolar II disorder
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1. clt has a history of one or more major depressive epi. or has major depression now
2. clt has a hist. of one or more hypomanic epi. or has hypomania now 3. clt. has never had a manic or mixed epis. 4. symptoms cause significant distress or impair social, occupational or other functioning |
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Prevention strategies
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1. screen all clts for mood disorders
2. if a clt thinks that he or she is already experiencing symptoms, reassure the clt that the symptoms are real and that trmt can help 3. refer to organizations that provide materials about and support for those with mood disorders 4. if the clt has not yet approached a MD about s/s encourage to do so 5. if taking meds, to control existing mood disorders, stress the importance of following the med. regimen and reporting problems to MD |
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Psychotherapy
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used extensively for tmt of depression w/ pharmacologic interventions
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Cognitive-Behavior Therapy
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is a significant effective trmt for depressive disorders. can reduce subsequent relapse
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Pharmacologic Therapy
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two groups: antidepressants and mood stabilizers
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Pharmacologic Therapy
Antidepressants |
does not treat mania or hypomania
highly effective: has narrow therapeutic window so watch for overdose. 1. SSRIs 2. Other Reuptake inhibitors 3. Cyclic Antidepressants 4. MAOI's 5. Mood Stabilizers 6. Lithium |
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SSRI's
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1st line drugs for depressive disorders. s.e. GI, CNS, loss of libido, few or no anticholinergic or cardiotoxic s.e.
however can cause Serotonin Syndrome=drug/drug w/ St. John's Wort and MAIOs |
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Serotonin Syndrome
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confusion, disorientation, mania, restlessness or agitation, myoclonus, rigidty, etc.
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Other Reuptake Inhibitors
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1. Cymbalta (duloxetine)-treats depression-
duloxetine is a potent inhibitor of serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake-does not inhibit MAO, s.e. N,C,Dzznss,somnolence, insomnia, h.ache, dry mouth 2. milnacipran (Midalcipran)- is a norepinephrine serotonin reuptake inhibitor (SNRI)-different in that it affects two neurotransmitters (nonipi & seri) almost equally where usually SNRIs work mostly on serotonin. |
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Novel (Atypical) Antidepressants
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1.trazodone (Desyrel)
2.Mirtazapine (Remeron) 3. bupropion (Wellbutrin, Zyban) 4. maprotiline (Ludiomil) 5. amoxapine (Asendin) these are safer than TCAs or MAOIs- 2nd line antidepressants various s.e: usually CNS and anticholenergic type, GI upset |
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Cyclic Antidepressants
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includes
a. TCA tertiary amines (amitriptyline, clomipramine, doxepin, imipramine, trimipramine) b. TCA 2ndary amines (amoxapine, desipramine, nortriptyline, protriptyline) c. tetracyclics (maprotiline) have lots of side effects including cardiotoxic and narrow therapeutic window used only when SSRIs and novel anidep. have been ineffective block reuptake of NE & DA and block the reuptake pumps at the noradrenergic neuron NOT USED FOR AT RISK SUICIDE PTS.can be used for overdose |
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Monoamine Oxidase Inhibitors
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MAOI
a. phenelzine (Nardil) b. tranyclypromine (Parnate) may be used to treat atypical depression or if pt does not respond to other drugs but used rarely they block the activity of MAO that breaks down catecholamines (NE espec.)in the neuron. increase levels of tyramine so cannot eat foods that contain this may lead to hypertensive crisis |
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catecholamines
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The most abundant catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine
Catecholamines are hormones that are released by the adrenal glands in situations of stress such as psychological stress or low blood sugar levels. Catecholamines cause general physiological changes that prepare the body for physical activity (fight-or-flight response). Some typical effects are increases in heart rate, blood pressure, blood glucose levels, and a general reaction of the sympathetic nervous system |
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Mood Stabilizers
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1st line drugs for bipolar
more effective for mania than for depression |
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hypertensive crisis
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symptoms:
occipital headache palpitations neck stiffness or soreness N,V Sweating dilated pupils photophobia tachycardia or bradycardia chest pain orthostatic hypotension disturbed cardiac R & R |
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Lithium
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only drug with unequivocally proven prophylactic activity in bipolar disorder. 1st line drug for long-term trtmt
but inadequate for pts with rapid cycling MUST monitor lithium levels in blood 2 X's weekly normal is 0.6 to 1.2 mEq/L Lithium toxicity has a fairly narrow therapeutic window |
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Lithium toxicity
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CNS, GI, GU, ECG changes, sever hypotension,
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Anticonvulsant Medications
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a. carbamazepine
b. divalproex may be used to replace Lithium may work on the GABA system |
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Refractory Mania
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bipolar mood cycle-meds used
a. Anticonvulsants (Lamotrigine-Lamictal) for the depression in bipolar-for rapid cyclers s.e.: Stevens-Johnson syndrome & toxic epidermal necrolysis with multiorgan failure b. Atypical (novel) antipsychotics-clozapine-few motor s.e. also Olanzapine= c. Other meds=Gabapentin (Neurontin) - |
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Somatic nonpharmacologic Interventions
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ECT- Phototherapy - sleep deprivation (SD)- transcranial magnetic stimulation (TMS) and vagal nerve stimulation (VNS)
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ECT- Electroconvulsive Therapy
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a small dose of electricty to 1 or both sides of the brain to induce a seizure and alleviate depressive symptoms
relatively few long-term s.e. s.e.: memory impairment, to severe confusion NPO after midnight, make sure they void, removes dentures, & pt wears loose fitting clothes, clt gives informed consent, physical exam including spinal x-ray, post-proc; may need 02, put pt on side, reorient, |
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Phototherapy
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using artifical light therapy for 1-2 30-180 min.daily sessions. for mild to moderate s.s depression with seasonal pattern
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SD-sleep deprivation
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for depressive phase of bipolar
has strong and rapid effect on depressed mood. may suppress cholinergic activity which releases monoamine |
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TMS-transcranial magnetic stimulation
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stimulates the cerebral cortex and induces elec. currents in neurons
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VNS-Vagal nerve stimulation
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involves the relationshp of autonomic signals to limbic and cortical function
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Nursing Process:
Assessment |
1. safety 1st-increase risk of suicide and accidents (due to mania)violent acting out
2. psychological functioning 3. mental status (including affect, thought processes and intellectual processes)-judgement and insight 4. physiologic & psychomotor activity-safety-avoid eating, sleeping 5. behavioral 6. social activity |
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Nursing Process:
Nursing Diagnosis-see pg 604 |
1. Risk for Suicide r/t...
2. Risk for Violence r/t... 3. Ineffective Health Maintenance r/t... 4. Impaired Social Interaction r/t... 5. Disturbed Thought Processes r/t... 6. Ineffective Therapeutic Regimen Management r/t... |
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Nursing Process:
Planning |
Goals:
1. remain safe 2.self-control 3.adequate and appropriate nutrition 4. appropriate social behavior 5. logical, reality-based thought processes 6. maintin med. regimen |
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Nursing Process:
Implementation/Interventions |
Interventions:
1. protect from suicide 2. managing the potential for violence 3. maintaining physical health and personal hygiene 4. enhancing thought processes a. self-esteem issues b. anxiety and agitation 5. encouraging treatment and med. adherence |
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Nursing Process:
Implementation/Interventions Protecting the client from Suicide |
1. take away all dangerous objects from environment
2. lock bathroom door 3. develop therapeutic relationship 4. monitor when on new meds-1st 3 wks most dangerous 5. checks clt's mouth to make sure swallowed meds. so does not hoard for suicide |
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Nursing Process:
Implementation/Interventions: Managing the Potential for Violence |
1. assess
2. place on violence precautions if needed 3. assess for risky or dangerous behaviors 4. if violent: room restriction or half-hall restrictions 5. prn meds if s/s of violence 6. reduce stimuli and interaction w/ other pts in milieu 5. removes all dangerous items 6. develop behavioral plan for self-control (similar to a contract) 7. teach clt to recognize what triggers violent thoughts and behaviors 8. educate the clt about illness |
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Nursing Process:
Implementation/Interventions: Maintaining Physical Health and Personal Hygiene |
1. monitor food and fluid
2. assess weight, VS & labs 3. work w/clt and nutritionist to devise a menu 4. lithium causes dehydration-monitor fluids closely 5. balance rest with activity 6. help relax for sleep-limit bright light, stimulus, enforce a schedule for sleep 7. encourages independence in dressing, hygiene, and grooming. 8. sets schedule for personal care & posts in bathroom 9. give positive reinforcement |
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Nursing Process:
Implementation/Interventions: Enhancing Thought Processes |
1. prn meds to improve thought patterns
2. assesses the intensity of the thought disturbance until meds kick in 3. do not argue with validity of hallucinations 4. show respect and acceptance but let know that the perception is not shared 5. helps clt to focus on activities or statements 6. provides a safe, quiet environment A. self-esteem: encourage verbalization of feelings and positive behaviors-help find strengths b. Anxiety & Agitation: assess and maintain med. regimen -limit contact with others -relaxation, exercises, imagery and progressive muscle relaxation if clt can handle it |
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Nursing Process:
Implementation/Interventions: Encourage Treatment and Medication Adherence |
1. provide info about meds and needed aftercare
2. help pt keep notebook with info 3. ed. on importance to prevent relaspe & s/s of relaspe 4. explore why cannot adhere to regimen, give info to primary care provider |
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Nursing Process:
Implementation/Interventions: Evaluation |
1. reports fewer or no suicidal thoughts
2. refrains from self-harm or acting aggressively toward others 3. ingests adequate calories & fluids, maintains balance btw activity and rest, and manages self-care 4. participates in milieu activities and social interactions 5. expresses a positive sense of self-worth w/out delusions of grandeur 6. demonstrates logical thought processes 7. reports reduced anziety and agitation 8. adheres to the therapeutic regimen & discusses the importance of doing so after discharge |
