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Mood Disorders Lecture 6 Mental Health Nursing-NUR 417
5/22/2018 Mental Health Nursing-NUR 417 Mood Disorders Depressive disorders Bipolar disorder
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Mood Disorders Part I Depressive disorders
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Outline-Part I-Depressive disorders
5/22/2018 Outline-Part I-Depressive disorders Introduction Epidemiology Types Etiological Implications Developmental Implications Nursing Process
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Introduction Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep,appetite, and mental processes are a common accompaniment.
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Introduction (cont.) Depression is the oldest and most frequently described psychiatric illness. Transient symptoms are normal, healthy responses to everyday disappointments in life. Pathological depression occurs when adaptation is ineffective.
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Epidemiology Gender prevalence Age
Higher in women than in men by about 2 to 1 Age Depression more common in young women than in older women Opposite is true for men Marital status: Single and divorced people more likely to experience depression than married people
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Epidemiology (cont.) Social class: There is an inverse relationship between social class and report of depressive symptoms; the opposite is true with bipolar disorder. Seasonality: Affective disorders are more prevalent in the spring and in the fall.
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Types of Depressive disorders
Major depressive disorder Dysthymic disorder Premenstrual dysphoric disorder
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Major Depressive Disorder
Loses interest or pleasure in usual activities Social and occupational functioning impaired for at least 2 weeks
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Dysthymic Disorder Sad or “down in the dumps”
No evidence of psychotic symptoms Essential feature is a chronically depressed mood for Most of the day More days than not For at least 2 years
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Premenstrual Dysphoric Disorder
Essential Features Depressed mood Anxiety Mood swings Decreased interest in activities Symptoms occur during the week prior to menses and subside shortly after onset of menstruation
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Etiological Implications-Depressive Disorders
Biological theories Genetics: Hereditary factor may be involved Biochemical influences: Deficiency of norepinephrine, serotonin, and dopamine has been implicated Possible diminished release of thyroid- stimulating hormone
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Etiological Implications-Depressive Disorders (cont.)
Physiological influences Medication side effects Neurological disorders Electrolyte disturbances Hormonal disorders Nutritional deficiencies Secondary depression related to: Cardiovascular disease Infections (e.g., hepatitis, pneumonia) Metabolic disorders (e.g., diabetes mellitus)
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Developmental Implications
Adolescence Symptoms include: Anger, aggressiveness Social withdrawal Substance abuse Restlessness; apathy
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Developmental Implications (cont.)
Postpartum Depression May last for a few weeks to several months Usually associated with hormonal changes Treatments: antidepressants and psychosocial therapies Symptoms include: Fatigue Irritability Loss of appetite Sleep disturbances Loss of libido Concern about inability to care for infant
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Nursing Process/Assessment
Transient depression Mild depression Moderate depression Severe depression Symptoms Not necessarily dysfunctional With normal grieving associated with dysthymic disorder A constant sense of hopelessness and despair Affective The “blues” Anger, anxiety, sadness Helpless, powerless Feelings of total despair, worthlessness, apathy Behavioral Certain amount of crying Tearful, regression Slow physical movement, limited verbalization Psychomotor retardation, curled-up position, no interaction with others Cognitive Some difficulty getting mind off one’s disappointment Self-blame and blaming of others Retarded thinking processes, difficulty with concentration Prevalent delusional thinking, with delusions of persecution Physiological Feeling tired Anorexia or overeating, sleep disturbances, somatic symptoms Anorexia or overeating, sleep disturbances, somatic symptoms, feeling best early in morning and worse as the day progresses Anorexia, insomnia, feels worse early in morning and somewhat better as the day progresses
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Nursing Diagnosis Risk for suicide Dysfunctional grieving
Low self-esteem Powerlessness Social isolation/Impaired social interaction Disturbed thought processes Imbalanced nutrition less than body requirements Disturbed sleep pattern Self-care deficit
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Planning The client Is able to identify aspects of self-control over life situation Is able to maintain reality orientation Is able to concentrate, reason, and solve problems
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Implementation Maintaining client safety
Promoting increase in self-esteem Encouraging client self-control and control over life situation
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Client/Family Education
Management of the illness Medication management Stress management techniques Ways to increase self-esteem Electroconvulsive therapy Support services Suicide hotline Support groups Legal/financial assistance
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Evaluation Evaluation of the effectiveness of nursing interventions is measured by fulfillment of the outcome criteria.
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Mood Disorders Part II Bipolar disorders
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Outline-Part II- Bipolar disorders
Introduction Etiological Implications Types Nursing Process
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Introduction Bipolar disorder also known as manic depression
Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy Delusions or hallucinations may or may not be part of clinical picture
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Bipolar Disorder (Mania)
Etiological implications Biological theories: Strong hereditary implications Biochemical influences: Possible excess of norepinephrine, serotonin, and/or dopamine
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Bipolar Disorder (Mania) (cont.)
Physiological influences Alterations in electrolyte transfer Brain lesions Medication side effects Steroids Amphetamines Antidepressants
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Types of Bipolar disorder
Bipolar I disorder Bipolar II disorder Cyclothymia
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Bipolar I Disorder Individual is experiencing, or has experienced, a full syndrome of manic or mixed symptoms May also have experienced episodes of depression
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Bipolar II Disorder Recurrent bouts of major depression
Episodic occurrences of hypomania Has not experienced an episode that meets the full criteria for mania or mixed symptomatology
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Nursing Process/Assessment
* Nursing Process/Assessment 5/22/2018 Symptoms may be categorized by degree of severity Stage I—Hypomania Stage II—Acute mania Stage III—Delirious mania Symptoms Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization Intensification of hypomanic symptoms; requires hospitalization A grave form of the disorder, characterized by severe clouding of consciousness and representing an intensification of the symptoms associated with acute mania Mood Cheerful Euphoria labile, from ecstasy to despair Cognition Self-exultation Fragmented, disjointed thinking; flight of ideas; hallucinations and delusions Confusion, disorientation, hallucinations, delusions Activity and behavior Increased motor activity Excessive psychomotor behavior; inexhaustible energy; goes without sleep; bizarre dress Frenzied psychomotor activity; agitated, purposeless movements; exhaustion and death can occur without intervention
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Nursing Diagnosis Risk for Injury related to:
Extreme hyperactivity Disturbed thought processes related to: Biochemical alterations in the brain Disturbed sleep pattern related to: Excessive hyperactivity and agitation
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Nursing Diagnosis (cont.)
Imbalanced Nutrition less than body requirements related to: Refusal or inability to sit still long enough to eat Disturbed sensory perception related to: Biochemical alterations in the brain and to possible sleep deprivation Impaired Social Interaction
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Planning The client Exhibits no evidence of physical injury
Has not harmed self or others Eats a well-balanced diet to prevent weight loss and maintain nutritional status Interacts appropriately with others
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Implementation Maintaining safety of client and others
Restoring client nutritional status Encouraging appropriate client interaction with others Assisting client to define and test reality Meeting client’s self-care needs
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Client/Family Education
Management of illness Medication management Support services Crisis hotline Support groups Individual psychotherapy Legal/financial assistance
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Evaluation Evaluation of the effectiveness of the nursing interventions is measured by fulfillment of the outcome criteria.
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Treatment Modalities for Mood Disorders
Psychological treatment Individual psychotherapy Group therapy Family therapy Cognitive therapy Organic Treatments
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Treatment Modalities for Mood Disorders (cont.)
Psychopharmacology For Depression * Maprotiline * Mirtazapine * Amoxapine * Serzone * Trazodone * Effexor Bupropion For mania: Lithium carbonate Anticonvulsants Verapamil Olanzapine
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Treatment Modalities for Mood Disorders (cont.)
Electroconvulsive Therapy For depression and mania Mechanism of action: increase levels of biogenic amines (norepinephrine, serotonin, and dopamine) Side effects: temporary memory loss and confusion Risks: mortality; permanent memory loss; brain damage Medications: pretreatment medication; muscle relaxant; short-acting anesthetic
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Nursing Process: Suicide Assessment
Epidemiological factors Marital status: Suicide rate for single people twice that of married people Single, divorced, and widowed people have rates four to five times greater than those who are married Gender: Women attempt suicide more often; more men succeed Age: Suicide highest in persons older than 50 years; adolescents also at high risk
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Nursing Process: Suicide Assessment (cont.)
Epidemiological factors (cont.) Socioeconomic status: People in the highest and lowest social classes have higher suicide rates than those in the middle classes. Professionals: Professional healthcare personnel and business executives are at the highest risk. Religion
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Nursing Process: Suicide Assessment (cont.)
Presenting symptoms/Medical- psychiatric diagnosis Mood disorders (major depression and bipolar disorders) are the most common disorders that precede suicide. Other disorders include Anxiety disorders Schizophrenia
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Nursing Process: Suicide Assessment (cont.)
Suicidal ideas or acts Assess: plan, previous attempts Verbal clues: Direct statements: “I want to die.” Indirect statements: “I don’t have anything to live for anymore.”
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Intervention with the Outpatient Suicidal Client
Do not leave the person alone. Schedule daily appointments. Establish trusting relationship. Antidepressant medication. Take any hint of suicide seriously. Report threats of suicide immediately.
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