Mood Disorders

symptoms that lead to dissociation from society as a whole.

• sleep disturbance
• decreased appetite
• lack of energy and libido
• GI upset
• mood fluctuation
• poverty of speech

Major depression and Bipolar Do

Dysthmia and cyclothymia DONT

• problem solve
• learn new things
• concentrate

depressed mood or loss of interest or pleasure in usual activities.  Person has impaired social and occupational functioning that lasts a minimum of 2 weeks

• aka affect
• a pervasive and sustained emotion that may have a major influence on a person's perception of the world.

ie depression/joy/elation/anger/anxiety

a chronically/moderately depressed mood for most of the day for at least a 2 year period

Bipolar and cyclothymic have mania

Major depression and dysthymia don't have mania

diminished range and intensity of emotion

characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy.

Bi Polar

a chronic mood disturbance of at least a 2 year duration involving numerous episodes of hypomania and moderate depression

a mild form of mania.....so mild that it doesn't affect social or occupation functioning and they don't need hospitalization

at hypomania and dysthmia

moderate depression

rapid thinking and talking....lots of energy

comes from loss of something (spouse) resolves itself over time

person with good coping skills...rides the wave

Person who is having a rapid onset bout of depression and the antidepressants aren't working or haven't kicked in yet.

• lack of sleep and food
• constant motion
• foot problems
• outgoing
• no judgment
• anything in excess....drugs, sex, addictions

• Marplan
• Emsam
• Nardil
• St. John Wart
• Parnate

St. John Wart

EMSAM

SSRI's and Tricyclics

• Pamelor
• Anafranil
• Norpramin
• Tofranil
• Elavil

TCA's

• Depression -100mg
• Pain-25mg

• Prozac
• Zoloft
• Paxil
• Luvox
• Celexa
• Lexapro

SSRI's

Cymbalta

a type of bipolar disorder in which the predominant mood is elevated, expansive or irritable with frenzied motor activity and excessive talking

** marked by 3-4 day period of little or no sleep

Yes

a mild form of mania where symptoms are excessive hyperactivity, but not severe enough to cause impairment in social or occupation functioning or require hospitalization

cheerful

• confusion/restlessness
• lack of coordination
• tremors/rigidity
• hypertension
• tachy
• hyperthermia
• seizure/coma/death

medication plus therapy

when a person experiences a full syndrome of manic or mixed symptoms....possibly with depression

• Mania + MDD
• WIDE SWINGS

recurrent bouts of major depression with episodic occurrence of hypomania

• hypomania + MDD
• middle to bottom

Major Depression-high guilt and indifference to others

Bi Polar-no guilt and forms attachments rapidly

Lithium

Tryptophan....and that's not good

• responsible for the breaking down of monoamine leading to inactivation of NTS
• dopamine
• norepinephrine
• serotonin

4 weeks

14 days....make sure you write start date on a paper so they know

prolonged QT wave....cardiotoxicity

• antihistamine effects
• anticholinergic effects

Cardiotoxicity

St. John Warts

• HYPERTENSIVE CRISIS
• Orthostatic hypotension
• anorgasmia/impotence
• insomnia
• weight gain
• muscle cramps
• CNS Hyperstimulation

• NO AGED FOODS!!
• or grapefruit juice

Hypertensive crisis

• N/V/D
• Headache
• anxiety/agitation/akathisia
• Insomnia
• Sexual dysfunction

Tell them their libido will not increase.....

inhibit the enzyme MAO from breaking down NTS NE, 5HT, DA increasing their amounts and mood

• Veggies-avocados, fermented soybean
• Fruits-bananas, figs
• Meats/Fish-smoked, fermented or aged, sausage, bologna, salami, pepperoni
• RED WINE
• Chocolate

• Cold, sinus, asthma or allergy meds
• Antihistamines
• Decongestants and inhalers
• Stimulants, diet pills
• cough meds

block reuptake of NTS by neurons

inhibit the enzyme that break down NTS

Energy may increase before their mood, which will give them the energy to kill themselves.  Watch for sudden lifts in mood

TCA-cardiotoxicity

• acute 1.0-1.5mEq/L
• maintenance 0.6-1.2mEq/L

• ataxia
• blurred vision
• severe diarrhea
• N/V
• tinnitus

• excessive output of dilute urine
• psychomotor retardation
• mental confusion
• tremors
• seizures
• impaired consciousness
• oliguria/anuria
• arrhythmias
• coma/death

• Nystagmus
• course tremor
• seizures
• hyperreflexia
• vertigo
• somnolence
• arrhythmis
• hypotension
• stupor
• collapse respiratory depression
• renal failure
• coma

If discharging, hold it.

If staying, continue medication and watch pt for transient sx

Early-N/V/D

Toxicity-drowsy, dizzy, headache, dry mouth, thirst, GI upset, tremors, pulse irregularities, polyuria, weight gain

Every 3-4 days until the therapeutic level is reached, and then it is monthly.

in the AM prior to next dose

High salt = Low Lithium

Low salt = High Lithium

So....watch if exercise and they lose a lot of water/salt....Lithium levels with go up!!

• Depakote
• Neurontin
• Tegretol

Klonopin/Clonazepam

Treats both Bi Polar and MDD

• by artificially inducing a grand mal seizure.
• given as a series of 6-12 treatments given over 3x/week

• high suicide risk pt
• medically deteriorated
• prego
• elderly
• high risk for anticholinergic S/E from meds
• those not responding to meds

NONE....but if you are going to be picky heart issues.  However, those can be treated pharmacologically prior to decrease likelihood or severity

• pt will be awake 10-15 min after procedure
• past and present memory will initially be impaired
• transient confusion and memory impairment is common for up to 6wks after
• within 6-9 months their ability to learn new material will return
• Wont remember days prior to and during treatment

Major Depressive Disorder

2 years at least for adults and 1 for adolescents

• sad/down in the dumps
• low interest in activities
• self critical
• sees self as uninteresting/incapable
• *often unreported*

• abnormally elevated mood lasting at least 1 week.
• during this period, 3 or more of the following are present:
• grandiosity
• 3-4 sleepless nights
• pressured speech
• flight of ideas
• distractibility
• increased goal oriented activity
• excessive pleasure-seeking activity
• impaired social, occupational activities
• *symptoms not related to substance abuse

I-someone who is experiencing or has experienced a full blown manic episode and possibly depression

II-recurrent major depression with episodes of hypomania

• 2 yr. period(adults) 1 yr. (kids)
• during critical period pt. not without symptoms for more than 2 months
• no major depression/mania during 1st 2 yrs
• not related to any schizo/delusional/psychotic disorder
• not related to substance abuse
• causes impaired social/occupational or other important functioning

• Cheerful
• multiple plans
• no delusions
• exalted-great worth and ability
• increased energy and motor ability
• extroverted and sociable
• lack of depth of personality (superficial)

mood-a subjective feeling/state of mind and is exhibited through feelings and emotions

affect-observable emotional expression of mood

• Females-20-25%
• Males-10-12%

• These people are more likely to be depressed:
• unmarried
• poor
• Caucasian is more prevalent
• African Americans more severe and are less likely to seek treatment

• Depression is caused by:
• increased cortisol
• reduced TSH

• Steroids
• Hormones-estrogen and progesterone

• DISTRACT the patient
• reduce environment stimulation
• set limits and reinforce them
• redirect acting out
• encourage ADL's
• encourage rest
• OFFER HIGH CALORIC FINGER FOODS

• 28% chance if one parent is bipolar
• 2-3x greater risk of both are bipolar

excess or norepi and dopamine...but deficiency of serotonin

• steroids
• anticonvulsant
• amphetamines
• anti depressants
• narcotics
• stimulants

• length of time before med begins to work
• how to deal with orthos
• how to deal with photosensitivity
• what to do for anticholinergic effects

oral hygiene

• informed consent
• NPO 8 hrs
• IV
• Atropine
• Brevitol
• airway management
• cardiac monitor
• VS

Atropine-prevent brady and control secretions

Brevitol-sedative, muscle relaxer to prevent full body response

Level and severity of depression!!!

• Risk for suicide
• complicated grieving
• Low Self esteem

• Risk for injury
• Risk for violence, self directed or other directed
• Imbalanced nutrition

• Wellbutrin
• Increase suicidal thinking

watch out for suicide attempt

Cymbalta

• drink lots of water to avoid toxicity
• monitor blood levels
• carry a card that states you are on Lithium

• Hypomania= no delusions
• Bi Polar=delusions.....grandiosity

for 6 months after the symptoms remit

• a few high energy nights where it is hard to fall asleep
• higher than usual energy levels
• racing thoughts

• low mood
• negative thought patterns
• low energy

it decreases their hyperactivity

• 24g or 1 tsp salt
• 2500-3000 mL of water