Mental Health Nursing II NURS 2310 Unit 14 Affective Disorders

Key Terms Mood = 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 1 Discussing manifestations that identify and differentiate various affective disorders

Major Depressive Disorder (MDD) Characterized by depressed mood or loss of interest or pleasure in usual activities Impaired social/occupational functioning that has existed for at least 2 weeks w/no history of manic behavior Persistent Depressive Disorder Also known as “dysthymia” Chronically depressed mood for most of the day, more days than not, for at least 2 years; milder mood disturbance than MDD No evidence of psychotic symptoms

Premenstrual Dysphoric Disorder Depressed mood, anxiety, lability, and decreased interest in activities just prior to menses; symptoms improve upon onset Disruptive Mood Dysregulation Disorder Childhood depression; presents before age 10 Characterized by severe, recurrent temper outbursts that occur 2-3 times per week Other symptoms include hyperactivity, delinquency, psychosomatic complaints, sleeping/eating disturbances, social isolation, delusional thinking, and suicidality

Postpartum Depression Symptoms range from feeling “blue” to moderate depression to depressive psychosis “Maternity blues” = Begins within 48 hours of delivery and lasts approximately 2 weeks Moderate postpartum depression = Fatigue, irritability, sleep disturbance, loss of appetite; mother fears she will be unable to care for the baby; may last for several months Depressive 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 Disorder Individual is experiencing or has experienced at least one manic episode; may also have experienced episodes of depression Bipolar II Disorder Recurrent bouts of MDD w/episodes of hypomania; no history of a full manic episode Presents with symptoms of either depression or hypomania Major depressive episodes may include psychotic or catatonic features

Cyclothymic Disorder Recurring episodes of hypomanic symptoms and depressive symptoms that do not meet the criteria for either hypomania or MDD Intervening periods of normalcy do not exceed 2 months at a time Symptoms are severe enough to cause marked impairment in social/occupational functioning and/or to require hospitalization Mood disturbance is chronic in nature, persisting at least 2 years

Objective 2 Recalling safety interventions necessary for the depressed and the manic client

Medication management Anger management Support groups Individual psychotherapy Crisis hotline Hospitalization

Objective 3 Examining therapies appropriate for clients with an affective disorder

Individual psychotherapy Group therapy Family therapy Cognitive behavioral therapy (CBT) Psychopharmacology Electroconvulsive therapy (ECT)

Objective 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

Objective 5 Applying the nursing process to a client with an affective disorder

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

Planning – –Care plan – –Concept map Implementation – –Establish trust – –Provide for safety – –Perform risk assessment – –Administer scheduled and PRN medications Evaluation – –Mental health/psychiatric assessment tool – –Review safety plan/contract – –Assess for medication side effects