mental health nursing ii nurs 2310 unit 14 affective disorders
TRANSCRIPT
Mental Health Mental Health Nursing IINursing II
NURS 2310NURS 2310
Unit 14Unit 14
Affective DisordersAffective Disorders
Key TermsKey TermsMood = A pervasive, sustained emotion
that may have a major influence on a person’s perception of the world (sadness, joy, anger)
Affect = The emotional reaction associated with an experience
Depression = An alteration in mood that is expressed by feelings of sadness, despair, and pessimism; loss of interest in usual activities; change in appetite and sleep patterns; somatic symptoms may be present
Mania = An alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking/speaking; can occur as a biological or psychological disorder, or as a response to substance use or a general medical condition
Hypomania = as per above; not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization; psychotic features are absent
Acute mania = as per above; symptomology becomes intensified to the point of requiring hospitalization
Acute mania (cont’d) = Characterized by euphoria/elation, though mood varies frequently; racing/disjointed thinking which may include psychotic features; increased sexual interest w/poor impulse control; excessive energy; may neglect grooming
Delirious mania = A severe clouding of consciousness w/accompanying confusion, disorientation, and possibly stupor; extreme mood lability; delusional thinking w/grandiosity, religiosity, or persecution; auditory and/or visual hallucinations; frenzied psychomotor activity which places individual at risk for harming self or others, exhaustion, and even death if not resolved
Objective 1Objective 1
Discussing manifestations that identify and differentiate
various affective disorders
Major Depressive Disorder (MDD)Major Depressive Disorder (MDD)Characterized by depressed mood or loss of interest or pleasure in usual activitiesImpaired social/occupational functioning that has existed for at least 2 weeks w/no history of manic behavior
Persistent Depressive DisorderPersistent Depressive DisorderAlso known as “dysthymia”Chronically depressed mood for most of the day, more days than not, for at least 2 years; milder mood disturbance than MDDNo evidence of psychotic symptoms
Premenstrual Dysphoric DisorderPremenstrual Dysphoric DisorderDepressed mood, anxiety, lability, and decreased interest in activities just prior to menses; symptoms improve upon onset
Disruptive Mood Dysregulation Disruptive Mood Dysregulation DisorderDisorder
Childhood depression; presents before age 10Characterized by severe, recurrent temper outbursts that occur 2-3 times per weekOther symptoms include hyperactivity, delinquency, psychosomatic complaints, sleeping/eating disturbances, social isolation, delusional thinking, and suicidality
Postpartum DepressionPostpartum DepressionSymptoms range from feeling “blue” to moderate depression to depressive psychosis“Maternity blues” = Begins within 48 hours of delivery and lasts approximately 2 weeksModerate postpartum depression = Fatigue, irritability, sleep disturbance, loss of appetite; mother fears she will be unable to care for the baby; may last for several monthsDepressive psychosis = depressed mood, agitation, indecision, lack of concentration, guilt; often includes lack of interest in or rejection of the baby; mother may be at risk of suicide and/or infanticide
Bipolar I DisorderBipolar I DisorderIndividual is experiencing or has experienced at least one manic episode; may also have experienced episodes of depression
Bipolar II DisorderBipolar II DisorderRecurrent bouts of MDD w/episodes of hypomania; no history of a full manic episodePresents with symptoms of either depression or hypomaniaMajor depressive episodes may include psychotic or catatonic features
Cyclothymic DisorderCyclothymic DisorderRecurring episodes of hypomanic symptoms and depressive symptoms that do not meet the criteria for either hypomania or MDDIntervening periods of normalcy do not exceed 2 months at a timeSymptoms are severe enough to cause marked impairment in social/occupational functioning and/or to require hospitalizationMood disturbance is chronic in nature, persisting at least 2 years
Objective 2Objective 2
Recalling safety interventions necessary for the depressed
and the manic client
Medication management
Anger management
Support groups
Individual psychotherapy
Crisis hotline
Hospitalization
Individual psychotherapy
Group therapy
Family therapy
Cognitive behavioral therapy (CBT)
Psychopharmacology
Electroconvulsive therapy (ECT)
Objective 4Objective 4
Reviewing the use, classifications, side effects, and nursing care related to medications for depression
and mania
Antidepressants elevate mood and alleviate other symptoms associated with moderate to severe depression– SSRIs and tricyclics increase the
concentration of norepinephrine, serotonin, and/or dopamine in the body by blocking the reuptake of these neurotransmitters
– MAOIs inhibit monoamine oxidase enzymes that inactivate norepinephrine, serotonin and/or dopamine in the body
Mood stabilizers help to suppress swings between mania and depression– Enhances reuptake of norepinephrine and
serotonin, decreasing levels in the body and resulting in decreased hyperactivity
Antidepressants– Tricyclics
Amitriptyline (Elavil)
– SSRIs Citalopram (Celexa) Fluoxetine (Prozac) Sertraline (Zoloft)
– MAOIs Phenelzine (Nardil)
– Miscellaneous Agents Bupropion (Zyban, Wellbutrin) Trazodone (Desyrel) Venlafaxine (Effexor) Duloxetine (Cymbalta)
Mood Stabilizers– Antimanics
Lithium carbonate (Eskalith, Lithobid)
– Anticonvulsants Valproic acid (Depakote) Lamotrigine (Lamictal) Topiramate (Topamax)
– Calcium Channel Blockers Verapamil (Isoptin)
– Antipsychotics Aripiprazole (Abilify) Quetiapine (Seroquel) Risperidone (Risperdal)
Side effects of antidepressants may include– Dry mouth, sedation, nausea– Decreased seizure threshold– Increased suicide potential– Discontinuation syndrome
Gradual termination reduces withdrawal symptoms
– Serotonin syndrome with SSRI use– Hypertensive crisis with MAOI use
Side effects of mood stabilizers are specific to medication class– Lithium carbonate has narrow margin of safety
Lithium toxicity can be fatal Monitor sodium intake
Assessment– Gather information about client’s mood
and level of anxiety, thoughts to harm self/others
Diagnosis– Risk for self-directed violence R/T suicidal
feelings– Risk for violence directed toward others
R/T homicidal ideation– Imbalanced nutrition, less than body
requirements R/T lack of interest in food– Disturbed sleep pattern R/T depression– Anxiety R/T panic disorder– Social isolation R/T agoraphobia