Mood Disorders

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Mood Disorders
2013-05-05 14:50:26

Mood Disorder....Major Depression/BiPolar
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  1. Neurovegetative def and signs of...
    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
  2. Which mood disorders have psychosis...and which don't?
    Major depression and Bipolar Do

    Dysthmia and cyclothymia DONT
  3. People with major depression cant...
    • problem solve
    • learn new things
    • concentrate
  4. Major depression
    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
  5. Mood
    • 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
  6. Dysthmia
    a chronically/moderately depressed mood for most of the day for at least a 2 year period
  7. Which mood disorders have mania, and which don't?
    Bipolar and cyclothymic have mania

    Major depression and dysthymia don't have mania
  8. What is a constricted or blunted affect?
    diminished range and intensity of emotion
  9. Bipolar Affective Disorder
    characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy.
  10. Whats the most common, severe and persistent mental illness?
    Bi Polar
  11. Cyclothymic Disorder
    a chronic mood disturbance of at least a 2 year duration involving numerous episodes of hypomania and moderate depression
  12. Hypomania
    a mild form of mild that it doesn't affect social or occupation functioning and they don't need hospitalization
  13. Where do cyclothymic disorder people sit on the spectrum?
    at hypomania and dysthmia
  14. dysthmia
    moderate depression
  15. Describe hypomania?
    rapid thinking and talking....lots of energy
  16. Reactive Depression
    comes from loss of something (spouse) resolves itself over time
  17. euthymia
    person with good coping skills...rides the wave
  18. ECT is especially useful for who?
    Person who is having a rapid onset bout of depression and the antidepressants aren't working or haven't kicked in yet.
  19. Describe a highly manic person
    • lack of sleep and food
    • constant motion
    • foot problems
    • outgoing
    • no judgment
    • anything in excess....drugs, sex, addictions
  20. Name MAOI's
    • Marplan
    • Emsam
    • Nardil
    • St. John Wart
    • Parnate
  21. OTC MAOI
    St. John Wart
  22. MAOI Transdermal Patch
  23. What cant you give MAOI's with?
    SSRI's and Tricyclics
  24. Name Tricyclic Anti Depressants
    • Pamelor
    • Anafranil
    • Norpramin
    • Tofranil
    • Elavil
  25. Which type of anti depressant is most lethal?
  26. Elavil can be used for 2 things....what are the and what's the dosage?
    • Depression -100mg
    • Pain-25mg
  27. Name SSRI's
    • Prozac
    • Zoloft
    • Paxil
    • Luvox
    • Celexa
    • Lexapro
  28. Which type of anti depressant is good for treatment of OCD, PTSD and eating disorders?
  29. Name the SNRI that is good for treatment of neuromuscular disorders, fibromyalgia and RA
  30. Mania
    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
  31. Does mania have psychotic features?
  32. Hypomania
    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
  33. What is the mood of a person with hypomania?
  34. S/S of Serotonin Syndrome
    • confusion/restlessness
    • lack of coordination
    • tremors/rigidity
    • hypertension
    • tachy
    • hyperthermia
    • seizure/coma/death
  35. Best intervention for mood disorders?
    medication plus therapy
  36. Bi Polar I
    when a person experiences a full syndrome of manic or mixed symptoms....possibly with depression

    • Mania + MDD
  37. Bi Polar II
    recurrent bouts of major depression with episodic occurrence of hypomania

    • hypomania + MDD
    • middle to bottom
  38. Interesting characteristics between Major Depression and Bi Polar
    Major Depression-high guilt and indifference to others

    Bi Polar-no guilt and forms attachments rapidly
  39. Gold standard drug for Bi Polar
  40. What will enhance the effectiveness of anti depressants?
    Tryptophan....and that's not good
  41. Monoamine oxydase
    • responsible for the breaking down of monoamine leading to inactivation of NTS
    • dopamine
    • norepinephrine
    • serotonin
  42. How long before a client may feel a therapeutic benefit from antidepressant therapy?
    4 weeks
  43. What is the wash out period for anti depressants?
    14 days....make sure you write start date on a paper so they know
  44. What are the cardiovascular risks for tricyclic antidepressants?
    prolonged QT wave....cardiotoxicity
  45. S/E of TCA's
    • antihistamine effects
    • anticholinergic effects
  46. What happens if you give a TCA with an MAOI?
  47. OTC that is a TCA
    St. John Warts
  48. S/E of MAOI's
    • Orthostatic hypotension
    • anorgasmia/impotence
    • insomnia
    • weight gain
    • muscle cramps
    • CNS Hyperstimulation
  49. Diet with MAOI's....result if eat the wrong thing?
    • or grapefruit juice

    Hypertensive crisis
  50. S/E of SSRI's
    • N/V/D
    • Headache
    • anxiety/agitation/akathisia
    • Insomnia
    • Sexual dysfunction
  51. Crucial patient teaching with SSRI's.
    Tell them their libido will not increase.....
  52. How do MAOI's work?
    inhibit the enzyme MAO from breaking down NTS NE, 5HT, DA increasing their amounts and mood
  53. What cant you eat with MAOI's....LIST
    • Veggies-avocados, fermented soybean
    • Fruits-bananas, figs
    • Meats/Fish-smoked, fermented or aged, sausage, bologna, salami, pepperoni
    • RED WINE
    • Chocolate
  54. What drugs interact with MAOI's?
    • Cold, sinus, asthma or allergy meds
    • Antihistamines
    • Decongestants and inhalers
    • Stimulants, diet pills
    • cough meds
  55. How do SSRI's and TCA's work?
    block reuptake of NTS by neurons
  56. How do MAOI's work?
    inhibit the enzyme that break down NTS
  57. Since OD on anti depressant meds can occur in patients with suicidal ideation, what specific precaution should be taken for these patients?
    Energy may increase before their mood, which will give them the energy to kill themselves.  Watch for sudden lifts in mood
  58. Which anti depressant medication has the highest lethality of used in an OD?
  59. Lithium
    Therapeutic level for:
     acute mania
    • acute 1.0-1.5mEq/L
    • maintenance 0.6-1.2mEq/L
  60. Signs of Lithium initial toxicity
    • ataxia
    • blurred vision
    • severe diarrhea
    • N/V
    • tinnitus
  61. Signs of increased Lithium toxicity
    • excessive output of dilute urine
    • psychomotor retardation
    • mental confusion
    • tremors
    • seizures
    • impaired consciousness
    • oliguria/anuria
    • arrhythmias
    • coma/death
  62. Severe and acute Lithium Toxicity
    • Nystagmus
    • course tremor
    • seizures
    • hyperreflexia
    • vertigo
    • somnolence
    • arrhythmis
    • hypotension
    • stupor
    • collapse respiratory depression
    • renal failure
    • coma
  63. If a person has a Lithium level of >1.5 what do you do?
    If discharging, hold it.

    If staying, continue medication and watch pt for transient sx
  64. Early warning signs of lithium toxicity and differentiate them from expected side effects.

    Toxicity-drowsy, dizzy, headache, dry mouth, thirst, GI upset, tremors, pulse irregularities, polyuria, weight gain
  65. How often are lithium blood levels tested?
    Every 3-4 days until the therapeutic level is reached, and then it is monthly.
  66. When are blood draws done for Lithium?
    in the AM prior to next dose
  67. What can occur if a client on Lithium has a high dietary salt intake?
    High salt = Low Lithium

    Low salt = High Lithium if exercise and they lose a lot of water/salt....Lithium levels with go up!!
  68. Name 3 Anti Convulsants that are used to manage Mania
    • Depakote
    • Neurontin
    • Tegretol
  69. Which Benzo is beneficial as a mood stabilizer and anticonvulsant?
  70. ECT....describe?
    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
  71. ECT is ideal for who?
    • high suicide risk pt
    • medically deteriorated
    • prego
    • elderly
    • high risk for anticholinergic S/E from meds
    • those not responding to meds
  72. What medical conditions are contraindicated for ECT
    NONE....but if you are going to be picky heart issues.  However, those can be treated pharmacologically prior to decrease likelihood or severity
  73. Explain to a client and his family what is to be expected following an ECT
    • 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
  74. Which disorder has psychotic and catatonic features?
    Major Depressive Disorder
  75. Duration of cyclothymic and dysthymic?
    2 years at least for adults and 1 for adolescents
  76. Characteristics of dysthymic disorder
    • sad/down in the dumps
    • low interest in activities
    • self critical
    • sees self as uninteresting/incapable
    • *often unreported*
  77. Diagnostic criteria for mania:
    • 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
  78. Bi Polar I vs. Bi Polar II
    I-someone who is experiencing or has experienced a full blown manic episode and possibly depression

    II-recurrent major depression with episodes of hypomania
  79. Diagnostic criteria for cyclothymic disorder
    • 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
  80. Characteristics of hypomania
    • Cheerful
    • multiple plans
    • no delusions
    • exalted-great worth and ability
    • increased energy and motor ability
    • extroverted and sociable
    • lack of depth of personality (superficial)
  81. Mood vs. affect
    mood-a subjective feeling/state of mind and is exhibited through feelings and emotions

    affect-observable emotional expression of mood
  82. Incidence of mood disorders in males vs. females
    • Females-20-25%
    • Males-10-12%
  83. Sociocultural risks for depression
    • 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
  84. Hormonal causes of depression
    • Depression is caused by:
    • increased cortisol
    • reduced TSH
  85. Medications whose Adverse Effects cause depression
    • Steroids
    • Hormones-estrogen and progesterone
  86. Nursing interventions for Mania
    • DISTRACT the patient
    • reduce environment stimulation
    • set limits and reinforce them
    • redirect acting out
    • encourage ADL's
    • encourage rest
  87. Genetics theory for Bi Polar
    • 28% chance if one parent is bipolar
    • 2-3x greater risk of both are bipolar
  88. Biochemical theory for cause of mania
    excess or norepi and dopamine...but deficiency of serotonin
  89. medications that cause mania
    • steroids
    • anticonvulsant
    • amphetamines
    • anti depressants
    • narcotics
    • stimulants
  90. General teaching for anti depressants
    • length of time before med begins to work
    • how to deal with orthos
    • how to deal with photosensitivity
    • what to do for anticholinergic effects
  91. What is an important intervention for a person who is having anticholinergic side effects?
    oral hygiene
  92. Pre and intra care for ECT
    • informed consent
    • NPO 8 hrs
    • IV
    • Atropine
    • Brevitol
    • airway management
    • cardiac monitor
    • VS
  93. What do atropine and Brevitol do?
    Atropine-prevent brady and control secretions

    Brevitol-sedative, muscle relaxer to prevent full body response
  94. What do you assess on a patient you are about to give anti depressant?
    Level and severity of depression!!!
  95. Nanda examples for Depression
    • Risk for suicide
    • complicated grieving
    • Low Self esteem
  96. Nanda examples for Mania
    • Risk for injury
    • Risk for violence, self directed or other directed
    • Imbalanced nutrition
  97. Name and anti depressant that is good for ADHD and smoking cessation too.

    Down side??
    • Wellbutrin
    • Increase suicidal thinking
  98. If a persons energy gets better but the mood doesn't follow....
    watch out for suicide attempt
  99. What anti depressant treats neuromuscular disorders, fibromyalgia and RA?
  100. Lithium patient teaching....
    • drink lots of water to avoid toxicity
    • monitor blood levels
    • carry a card that states you are on Lithium
  101. Hypomania vs. Bi Polar and delusions
    • Hypomania= no delusions
    • Bi Polar=delusions.....grandiosity
  102. How long does a client with clinical depression remain on the anti depressant?
    for 6 months after the symptoms remit
  103. What are the early signs of relapse for patients with a manic state?
    • a few high energy nights where it is hard to fall asleep
    • higher than usual energy levels
    • racing thoughts
  104. What are the early signs of relapse for patients with depression?
    • low mood
    • negative thought patterns
    • low energy
  105. What does Lithium do for people with Bi Polar?
    it decreases their hyperactivity
  106. What are the sodium and water intakes necessary for a person on Lithium?
    • 24g or 1 tsp salt
    • 2500-3000 mL of water