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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
Which mood disorders have psychosis...and which don't?
Major depression and Bipolar Do
Dysthmia and cyclothymia DONT
People with major depression cant...
- problem solve
- learn new things
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.
a chronically/moderately depressed mood for most of the day for at least a 2 year period
Which mood disorders have mania, and which don't?
Bipolar and cyclothymic have mania
Major depression and dysthymia don't have mania
What is a constricted or blunted affect?
diminished range and intensity of emotion
Bipolar Affective Disorder
characterized by mood swings from profound depression to extreme euphoria (mania) with intervening periods of normalcy.
Whats the most common, severe and persistent mental illness?
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
Where do cyclothymic disorder people sit on the spectrum?
at hypomania and dysthmia
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
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.
Describe a highly manic person
- lack of sleep and food
- constant motion
- foot problems
- no judgment
- anything in excess....drugs, sex, addictions
- St. John Wart
MAOI Transdermal Patch
What cant you give MAOI's with?
SSRI's and Tricyclics
Name Tricyclic Anti Depressants
Which type of anti depressant is most lethal?
Elavil can be used for 2 things....what are the and what's the dosage?
- Depression -100mg
Which type of anti depressant is good for treatment of OCD, PTSD and eating disorders?
Name the SNRI that is good for treatment of neuromuscular disorders, fibromyalgia and RA
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
Does mania have psychotic features?
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
What is the mood of a person with hypomania?
S/S of Serotonin Syndrome
- lack of coordination
Best intervention for mood disorders?
medication plus therapy
Bi Polar I
when a person experiences a full syndrome of manic or mixed symptoms....possibly with depression
Bi Polar II
recurrent bouts of major depression with episodic occurrence of hypomania
- hypomania + MDD
- middle to bottom
Interesting characteristics between Major Depression and Bi Polar
Major Depression-high guilt and indifference to others
Bi Polar-no guilt and forms attachments rapidly
Gold standard drug for Bi Polar
What will enhance the effectiveness of anti depressants?
Tryptophan....and that's not good
- responsible for the breaking down of monoamine leading to inactivation of NTS
How long before a client may feel a therapeutic benefit from antidepressant therapy?
What is the wash out period for anti depressants?
14 days....make sure you write start date on a paper so they know
What are the cardiovascular risks for tricyclic antidepressants?
prolonged QT wave....cardiotoxicity
S/E of TCA's
- antihistamine effects
- anticholinergic effects
What happens if you give a TCA with an MAOI?
OTC that is a TCA
St. John Warts
S/E of MAOI's
- HYPERTENSIVE CRISIS
- Orthostatic hypotension
- weight gain
- muscle cramps
- CNS Hyperstimulation
Diet with MAOI's....result if eat the wrong thing?
- NO AGED FOODS!!
- or grapefruit juice
S/E of SSRI's
- Sexual dysfunction
Crucial patient teaching with SSRI's.
Tell them their libido will not increase.....
How do MAOI's work?
inhibit the enzyme MAO from breaking down NTS NE, 5HT, DA increasing their amounts and mood
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
What drugs interact with MAOI's?
- Cold, sinus, asthma or allergy meds
- Decongestants and inhalers
- Stimulants, diet pills
- cough meds
How do SSRI's and TCA's work?
block reuptake of NTS by neurons
How do MAOI's work?
inhibit the enzyme that break down NTS
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
Which anti depressant medication has the highest lethality of used in an OD?
Therapeutic level for:
- acute 1.0-1.5mEq/L
- maintenance 0.6-1.2mEq/L
Signs of Lithium initial toxicity
- blurred vision
- severe diarrhea
Signs of increased Lithium toxicity
- excessive output of dilute urine
- psychomotor retardation
- mental confusion
- impaired consciousness
Severe and acute Lithium Toxicity
- course tremor
- collapse respiratory depression
- renal failure
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
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
How often are lithium blood levels tested?
Every 3-4 days until the therapeutic level is reached, and then it is monthly.
When are blood draws done for Lithium?
in the AM prior to next dose
What can occur if a client on Lithium has a high dietary salt intake?
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!!
Name 3 Anti Convulsants that are used to manage Mania
Which Benzo is beneficial as a mood stabilizer and anticonvulsant?
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
ECT is ideal for who?
- high suicide risk pt
- medically deteriorated
- high risk for anticholinergic S/E from meds
- those not responding to meds
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
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
Which disorder has psychotic and catatonic features?
Major Depressive Disorder
Duration of cyclothymic and dysthymic?
2 years at least for adults and 1 for adolescents
Characteristics of dysthymic disorder
- sad/down in the dumps
- low interest in activities
- self critical
- sees self as uninteresting/incapable
- *often unreported*
Diagnostic criteria for mania:
- abnormally elevated mood lasting at least 1 week.
- during this period, 3 or more of the following are present:
- 3-4 sleepless nights
- pressured speech
- flight of ideas
- increased goal oriented activity
- excessive pleasure-seeking activity
- impaired social, occupational activities
- *symptoms not related to substance abuse
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
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
Characteristics of hypomania
- multiple plans
- no delusions
- exalted-great worth and ability
- increased energy and motor ability
- extroverted and sociable
- lack of depth of personality (superficial)
Mood vs. affect
mood-a subjective feeling/state of mind and is exhibited through feelings and emotions
affect-observable emotional expression of mood
Incidence of mood disorders in males vs. females
Sociocultural risks for depression
- These people are more likely to be depressed:
- Caucasian is more prevalent
- African Americans more severe and are less likely to seek treatment
Hormonal causes of depression
- Depression is caused by:
- increased cortisol
- reduced TSH
Medications whose Adverse Effects cause depression
- Hormones-estrogen and progesterone
Nursing interventions for Mania
- DISTRACT the patient
- reduce environment stimulation
- set limits and reinforce them
- redirect acting out
- encourage ADL's
- encourage rest
- OFFER HIGH CALORIC FINGER FOODS
Genetics theory for Bi Polar
- 28% chance if one parent is bipolar
- 2-3x greater risk of both are bipolar
Biochemical theory for cause of mania
excess or norepi and dopamine...but deficiency of serotonin
medications that cause mania
- anti depressants
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
What is an important intervention for a person who is having anticholinergic side effects?
Pre and intra care for ECT
- informed consent
- NPO 8 hrs
- airway management
- cardiac monitor
What do atropine and Brevitol do?
Atropine-prevent brady and control secretions
Brevitol-sedative, muscle relaxer to prevent full body response
What do you assess on a patient you are about to give anti depressant?
Level and severity of depression!!!
Nanda examples for Depression
- Risk for suicide
- complicated grieving
- Low Self esteem
Nanda examples for Mania
- Risk for injury
- Risk for violence, self directed or other directed
- Imbalanced nutrition
Name and anti depressant that is good for ADHD and smoking cessation too.
- Increase suicidal thinking
If a persons energy gets better but the mood doesn't follow....
watch out for suicide attempt
What anti depressant treats neuromuscular disorders, fibromyalgia and RA?
Lithium patient teaching....
- drink lots of water to avoid toxicity
- monitor blood levels
- carry a card that states you are on Lithium
Hypomania vs. Bi Polar and delusions
- Hypomania= no delusions
- Bi Polar=delusions.....grandiosity
How long does a client with clinical depression remain on the anti depressant?
for 6 months after the symptoms remit
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
What are the early signs of relapse for patients with depression?
- low mood
- negative thought patterns
- low energy
What does Lithium do for people with Bi Polar?
it decreases their hyperactivity
What are the sodium and water intakes necessary for a person on Lithium?
- 24g or 1 tsp salt
- 2500-3000 mL of water