od Mo rs rde iso D

DOL MA. . SD OR E

MAN RN, DO, RCA ME

Mood Disorders
Pervasive alterations in emotions that are manifested by depression, mania, or both, and interfere with the persons ability to live life

Categories Major depression: 2 or more weeks of sad mood, lack of interest in life activities, Bipolar disorder (formerly called manic-depressive illness): mood cycles of mania and/or depression and normalcy

Related Disorders
Dysthymia: sadness, low energy, but not severe enough to be diagnosed as major depression disorder Cyclothymia: mood swings not severe enough to be diagnosed as bipolar disorder Substance-induced mood disorder Mood disorder due to a general medical condition

Related Disorders (contd)

Postpartum or maternity blues Postpartum depression Postpartum psychosis

Etiology Biologic theories Genetics Neurochemical theories

SEROTONIN & NOREPINEPHRINE

Neuroendocrine or hormonal fluctuations

Etiology (contd) Psychodynamic theories

Self-reproach to anger turned inward Inability to achieve personal ideals Powerless ego JACOBSON MEYER FREUD BIBRING

Manic episodes are a defense against depression Reaction to a distressing life experience Rejecting or unloving parents HORNEY BECK

Resulting from specific cognitive distortions

Cultural Considerations
Other behaviors considered age-appropriate can mask depression Somatic complaints are a major manifestation among cultures that avoid verbalizing emotions Asians who are anxious or depressed are more likely to have somatic complaints of headache, backache, or other symptoms Latin cultures complain of nerves or headaches Middle Eastern cultures complain of heart problems

Major Depressive Disorder

 Twice as common in women and more common in single or divorced people Involves 2 or more weeks of sad mood, lack of interest in life activities, and at least four other symptoms:
Changes in appetite or weight, sleep, or psychomotor activity Decreased energy Feelings of worthlessness or guilt Difficulty thinking, concentrating, or making decisions Recurrent thoughts of death or suicidal ideation, plans, or attempts

Untreated, can last 6 to 24 months; recurs in 50% to 60% of people Symptoms range from mild to severe

Treatment and Prognosis

Antidepressants SSRIs (Prozac, Zoloft, Paxil, Celexa) prescribed for mild and moderate depression TCAs (Elavil, Tofranil, Norpramin, Pamelor, Sinequan) used for moderate and severe depression Atypical antidepressants (Effexor, Wellbutrin, Serzone)
MAOIs (Marplan, Parnate, Nardil) used infrequently because interaction with tyramine causes hypertensive crisis

 Electroconvulsive therapy (ECT) is used when medications are ineffective or side effects are intolerable.
6 to 15 treatments scheduled three times a week Preparation preparation procedure of a client for ECT is similar to for any outpatient minor surgical have some short-term memory

The client will impairment

Psychotherapy in conjunction with medication is considered most effective treatment; useful therapies include behavioral, cognitive, interpersonal therapy

Application of the Nursing Process: Major Depressive Disorder

Assessment
History: the clients perception of the problem, behavioral changes, any previous episodes of depression, treatment, response to treatment, family history of mood disorders, suicide, or attempted suicide General appearance and motor behavior: slouched posture, latency of response, psychomotor retardation or agitation Mood and affect: hopeless, helpless, down, anxious, frustrated, anhedonia, apathetic; affect is sad, depressed, or flat Thought processes and content: slowed thinking processes, negative and pessimistic, ruminate, thoughts of dying or committing suicide

Application of the Nursing Process: Major Depressive Disorder (contd)

Assessment (contd)
Sensorium and intellectual processes: oriented, memory impairment, difficulty concentrating Judgment and insight: impaired judgment, insight may be intact or limited Self-concept: low self-esteem, guilty, believe that others would be better off without them Roles and relationships: difficulty fulfilling roles and responsibilities Physiologic considerations: weight loss, sleep disturbances, lose interest in sexual activities, neglect personal hygiene, constipation, dehydration

Application of the Nursing Process: Major Depressive Disorder (contd) Intervention

Providing for the clients safety and the safety of others Promoting a therapeutic relationship Promoting activities of daily living and physical care Using therapeutic communication Managing medications Providing client and family teaching

A POSE AT THE DAVAO MEDICAL CENTER PSYCHIATRIC SECTION

Bipolar Disorder

Occurs almost equally among men and women It is more common in highly educated people The mean age for a first manic episode is the early 20s

 Involves mood swings of depression (same symptoms of major depressive disorder) and mania. Major symptoms of mania include: Inflated self-esteem or grandiosity Decreased need for sleep Pressured speech Flight of ideas Distractibility Increased involvement in goaldirected activity or psychomotor agitation Excessive involvement in pleasureseeking activities with a high potential for painful consequences

Treatment and Prognosis

Medication Lithium; regular monitoring of serum lithium levels is needed Anticonvulsant drugs are used for their moodstabilizing effects: Tegretol, Depakote, Lamictal, Topamax, and Neurontin, as is Klonopin (a benzodiazepine) Psychotherapy Useful in mildly depressive or normal portion of the bipolar cycle. It is not useful during acute manic stages

Application of the Nursing Process: Bipolar Disorder Assessment

General appearance and motor behavior: psychomotor agitation; flamboyant clothing or makeup; think, move, and talk fast; pressured speech Mood and affect: euphoria, exuberant activity, grandiosity, false sense of wellbeing, angry, verbally aggressive, sarcastic, irritable

Application of the Nursing Process: Bipolar Disorder (contd) Assessment (contd)

Thought processes and content: flight of ideas, circumstantiality, tangentiality, possible grandiose delusions Sensorium and intellectual processes: oriented to person and place but rarely to time, impaired ability to concentrate, may experience hallucinations Judgment and insight: judgment poor, insight limited Self-concept: exaggerated self-esteem

Application of the Nursing Process: Bipolar Disorder (contd)

Assessment (contd)
Roles and relationships: rarely can fulfill role responsibilities, invade intimate space and personal business of others, can become hostile to others, cannot postpone or delay gratification Physiologic and self-care considerations: inattention to hygiene and grooming, hunger or fatigue

Application of the Nursing Process: Bipolar Disorder (contd) Intervention

Providing for safety of client and others Meeting physiologic needs Providing therapeutic communication Promoting appropriate behaviors Managing medications Providing client and family teaching

ENJOY THE VIEW OF PEARL FARM SAMAL ISLAND DAVAO

EACH TA B SAN ABO AT B

IKOD TAL

AND I SL

Suicide

Assessment
Men commit suicide three times the rate of women Women are four times more likely than men to attempt suicide Populations at risk
Men, young women, Caucasians, adults older than 65, and separated and divorced people Clients disorders with psychiatric

 Assessment Environmental factors include isolation, recent loss, lack of social support, unemployment, critical life events, and family history of depression or suicide Behavioral factors include impulsivity, erratic or unexplained changes from usual behavior, and unstable lifestyle

 Warnings of suicidal intent Risky behaviors Lethality assessment

Does the client have a specific plan? Are the means available to carry out this plan? If the client carries out the plan, is it likely to be lethal? Has the client made preparations for death? Where and when does the client intend to carry out the plan? Is the intended time a special date or anniversary that has meaning for the client?

Intervention Using an authoritative role Providing a safe environment Initiating a no-suicide contract Creating a support system list

Legal and Ethical Considerations Often nurses must care for terminally or chronically ill people with a poor quality of life The nurses role is to provide supportive care for clients and family

Elder Considerations
Depression is common among the elderly and is markedly increased when elders are medically ill Elders tend to have psychotic features, particularly delusions, more frequently than younger people with depression Suicide among persons over age 65 is doubled compared with suicide rates of persons younger than 65 years Elders are treated for depression with ECT more frequently than younger persons Elder persons have decreased tolerance of side effects of antidepressant medications

Self-Awareness Issues Nurses and other staff members need to deal with their own feelings about suicide Depressed or manic clients can be frustrating and require a lot of energy to care for Keeping a written journal may help deal with feelings; talking to colleagues is often helpful

R THE OVE AYAK K RDEN A L GA COR

RM, P FA GA VAO A DA MA

PHI MA LIPPI LAG NE EAG OS DA CALI LE VA O NAN

Prepare a presentation on the nursing management of the following:

C1 : catatonic C2 : paranoid C3 : disorganized C4 : major depression C5 : bipolar 1

Present a scenario