Chapter 15 Mood Disorders

1
Chapter 15 Mood Disorders
2

• Mood disorders are diagnosed when these
  alterations in emotions are pervasive and
  interfere with the persons ability to live life.
• Depression- could just happen for no specific
  reason.

3
Categories

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

4
Related Disorders

• Dysthymic disorder sadness, low energy, but not
  severe enough to be diagnosed as major depression
  disorder
• Cyclothymic disorder mood swings not severe
  enough to be diagnosed as bipolar disorder
• Seasonal affective disorder (SAD)
• Depressive personality disorder
• Postpartum or maternity blues

5
Related Disorders (contd)

• Postpartum depression
• Postpartum psychosis

6
(No Transcript)
7
(No Transcript)
8
Etiology

• Biologic theories include genetics.
  neurochemical theories, and neuroendocrine or
  hormonal fluctuations.

9
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, such as anhedonia, changes in
  weight, sleep, energy, concentration,
  decision-making, self-esteem, goal-setting
• Untreated, can last 6 to 24 months recurs in 60
  of people
• Symptoms range from mild to moderate to severe.

10
(No Transcript)
11

• Treatment and Prognosis
• Antidepressants
• SSRIs include Prozac, Zoloft, Paxil, Celexa.
  Prescribed for mild and moderate depression.
• Tricyclic antidepressants (TCAs) include Elavil,
  Tofranil, Norpramin, Pamelor, Sinequan used for
  moderate and severe depression.
• Atypical antidepressants include Effexor,
  Wellbutrin, Serzone.

12

• MAOIs include 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. After anesthesia and muscle
  relaxants, a shock (nurse must maintain airway)
  is administered via electrodes to produce seizure
  activity in the brain. Treatments are
  administered in a series (for instance, three
  times a week for 6 weeks). After ECT, there is
  short term memory loss-for recent events,
  confusion, headache, drowsiness. allow client to
  take tylenol and take a nap.
• Psychotherapy in conjunction with medication is
  considered most effective treatment. Useful
  therapies include behavioral, cognitive,
  interpersonal, family therapy.

13
Application of the Nursing Process Major
Depressive Disorder

• Assessment
• Must include determination of suicidal ideas and
  lethality and clients perception of the problem

14

• Psychomotor retardation or agitation, feelings of
  helplessness, anxiety, sadness, guilt,
  frustration, negativism and pessimism, lack of
  pleasure, social withdrawal, reduced
  concentration decision-making, fatigue
  exhaustion, low self-esteem and rumination about
  past bad deeds or failures, loss of ability to
  function in life roles, sleep disturbances,
  overeating or undereating, lack of attention to
  hygiene and grooming

15

• Depression and rating scales may be used.

16

• Data Analysis
• Nursing diagnoses may include
• Risk for Suicide
• Imbalanced Nutrition
• Anxiety
• Ineffective Coping
• Hopelessness

17

• Outcomes
• The client will
• Not injure self or others
• Carry out activities of daily living
  independently
• Establish a balance of rest, sleep, and activity
• Establish a balance of adequate nutrition,
  hydration, and elimination-nurse monitors diet
  intake (50 taken in two snacks) constipation
  is due to inactivity and lack of exercise.
• Evaluate self-attributes realistically
• Client that is lethargic and apathetic but agrees
  to participate in a leisure group-action that
  would make a client feel more successful-structur
  e the activity to facilitate completion of one
  specific task.

18

• Intervention
• Providing for the clients safety and the safety
  of others listen to what the client says Im
  so sorry I didnt succeed this time. Suicidal
  precautions-remove harmful items close
  supervision
• Promoting a therapeutic relationship-EXgt If you
  observe client sitting alone looking sad and
  preoccupied-you approach client tell them you
  would like to keep them company-the client turns
  away-the nurse should move to a chair a little
  further away and say we can just sit together
  quietly.
• Promoting activities of daily living and physical
  care-Ex. Client pacing in hallway, muttering how
  hopeless life is. walk with client as he paces
  the hallway.
• Using therapeutic communication-listen to client-
  EX client states Im a burden to everyone. You
  respond-I care about you and want to work with
  you.
• Managing medications
• Providing client and family teaching
• telling jokes is not effective communications
  with depressed client.

19
Bipolar Disorder

• Involves mood swings of depression (same symptoms
  of major depressive disorder) and mania. Major
  symptoms of mania include grandiose mood,
  agitation, exaggerated self-esteem,
  sleeplessness, pressured speech, flight of ideas,
  easily distractible, intrusive behavior, with
  lack of personal boundaries, high-risk activities
  with potentially severe consequences, poor
  judgment.
• EX used as a positive intervention-distractible-r
  edirect them-take a walk draw and fold towels
• EX client with mania-demonstrating hypersexual
  behavior-blowing kisses, removing some articles
  of clothing-intervention-accompany the client to
  room to get dressed.

20
(No Transcript)
21

• Treatment and Prognosis
• Treatment may involve medication with lithium
  regular monitoring of serum lithium levels is
  needed.
• Anticonvulsant drugs are used for their
  mood-stabilizing effects Tegretol, Depakote,
  Lamictal, Topamax, Trileptal, Neurontin and
  Klonopin (a benzodiazepine)

22
Application of the Nursing Process Bipolar
Disorder

• Assessment
• General appearance and motor behavior Assessing
  a client in the manic phase may be difficult and
  based more on observations of the client rather
  than clients responses to structured questions.
  Client jumps from one subject to another, cannot
  sit still, may wear flamboyant clothing or
  makeup.
• Mood and affect psychomotor agitation, racing
  thoughts, pressured speech, ignores directions or
  requests from others, unusual speech patterns

23

• Assessment (contd)
• Thought processes and content starts many
  grandiose projects but finishes none careless
  spending sprees
• Sensorium and intellectual processes loud voice
  may be hypersexual
• Judgment and insight poor
• Self-concept false, grandiose sense of
  well-being that covers low self-esteem

24

• Assessment (contd)
• Roles and relationships may be charming and
  playful, then sarcastic and angry cannot take
  no for an answer. Ex client comes to nurses
  station-demands psychiatrist write a pass- you
  reply-I cant call the Dr. now but you and I can
  talk about your request.
• Physiologic and self-care considerations
  inattention to hygiene and grooming, hunger
  (finger foods-ex. Peanut butter
  sandwich/hamburger/glass of milk) or fatigue

25

• Data Analysis
• Nursing diagnoses may include
• Risk for Other-Directed Violence
• Risk for Injury
• Imbalanced Nutrition
• Ineffective Coping
• Noncompliance

26

• Outcomes
• The client will
• Not injure self or others
• Establish a balance of rest, sleep, and activity
• Establish adequate nutrition, hydration, and
  elimination
• Participate in self-care activities
• Evaluate personal qualities realistically
• Engage in socially appropriate, reality-based
  interaction. Ex client taking food from others
  clients trays-nurse intervention-You must
  consider the other clients need to be protected
  from the intrusive behavior.

27

• Intervention
• Providing for safety of client and others-EX
  client talking loud, walking back and
  forth-remove from environment-decrease
  stimuli-take to a quiet place-conference room
  and talk for a while. Ex client attempts to hit
  the nurse best response Do not swing at me
  again. If you cannot control yourself, we will
  help you.
• Meeting physiologic needs
• Providing therapeutic communication
• Promoting appropriate behaviors
• Managing medications

28
Suicide

• Families need support when a member has committed
  suicide or is making attempts to do so. They may
  feel guilty, angry, and ashamed and are at
  increased risk for suicide themselves.
• Assessment
• Populations at risk
• Warnings of suicidal intent EX you receive a
  call from a client stating they had taken a large
  number of pills. Best response I want to help
  you tell me how to find you.
• Risky behaviors
• Lethality assessment
• ASSESS FOR SUICIDAL POTENTIALIm sorry I did not
  succeed this time. everything will be OK
  tomorrow. How often does the staff come
  around. Youll get your money sooner than you
  think.

29
(No Transcript)
30

• Outcomes
• The client will
• Be safe from harm self or others
• Engage in a therapeutic relationship
• Establish a no-suicide contract
• Create a list of positive attributes
• Generate, test, and evaluate realistic plans to
  address underlying issues

31

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

32
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.