Alterations in Mental Health Mood Disorders

7/31/2019 Alterations in Mental Health Mood Disorders

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Mood Disorders

Highs


2/29

significant loss


3/29

orma vs ys unct ona

12-24 Months Somatic distress

Prolonged response Delayed response

Preoccupation

Guilt/An er

Exaggerated

symptoms of normal

Behavior Changes

grief

Pp. 615-616

(Varcarolis)


4/29

actors e ect ng gr e response

Level of dependency in the relationship

Age of the deceased +/or grieving person ereave person s suppor sys em

Physical and psychological health of the

bereaved individual


5/29

urs ng ct ons

Goal Mourning is complete

Interventions Allow privacy and

when the bereaved

can remember

realisticall both the

provide support

Always offer and allow

pleasures and

disappointments of Recognize cultural

needs

and begin to form new

interests and

Acknowledge feelings

Simply allowing

relationships.

negative emotions


6/29

oo sor ers

Manic mood: Bipolar I Hypomanic mood:

Bipolar II; Cyclothymic

Disorder Euthymic mood:

normal

Dysthymic mood: moderate: Dysthymic

severe: a or

Depressive Disorder


7/29

Disorders

Depressed mood Anhedonia

Feelings ofworthlessness &

Decreased

concentration/difficul

inappropriate guilt

Suicidal thoughtsty making decisions

Negative thinking re

Anger, irritability

Vegetative signs:

self, environment,future

disturbance in eating,sleeping; loss of

syc omotor

agitation/retardation

,

constipation


8/29

ypes o oo sor ers

Dysthymic Disorder Chronic depression (at

Cyclothymic Disorder Chronic fluctuating

least 2 years)

Mild to moderate

mood

Hypomanic & mild to

Able to function

Depression is

Substance -induced

normal

High risk for major

mood disturbance

within a month of

withdrawal


9/29

General Medical Condition

Medication SE(Steroids, Prevalence ofComorbid Depression:

,Oral Contraceptives)

ro e -

Cancer 18-39%

-Endocrine, Hormonal(PMS), Post-viral

HIV 8-10%

In-pt 12%

, ,Diabetes

Out-pt 2-15%

.


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Onset gradual or inresponse to a crisis

Slow incidious onset

Impaired concentration,

focus, attention

judgment, agnosia

Function deteriorates as ecrease energy,

motivation, early am

awakening; morning is their

e ay progresses

sundowning

bad time

Affect sad, blunted, irritable

,

Speech contains

confabulation &

peec s ow, at, ow c rcumstant a ty


11/29

a or epress ve sor er

17%Lifetime prevalenc >25% rate in Nsg Hs

15% Suicide rate

2x rate in women

Masked by somatic

complaints,

hyperactivity & poorschool performance

Comorbid anxiety

common


12/29

,..(Specifiers)

Psychotic features (Mood congruent)

disturbance)

Seasonal Affective Patterns

Postpartum onset Severe depression occurring within 4 weeks of

delivery/30-50% risk of recurrence with each

subsequent delivery


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t o ogy o epress on

Biologic Theories Genetic: 1.5-3x in 1st

Cognitive Theories:identify, refute and

degree

relatives/>incidence

in alcohol de . & ADHD

replace negative

thoughts

Biochemical:

Seratonin;Neurepinep

syc oana yt c:

Aggression turned

r ne re a ons p ostress regulation

Learned Helplessness


14/29

s actors or epress on

Chronic Illness Female Gender

Bereavement

Perfectionistic

Situational stressors

Family History


15/29

urs ng ssessment

Where/ Who? ALL clients in ALL settings , ,

Thought Process: Slow, negative,

,

Feelings: Worthless, guilty, sad, helpless &

ope ess, angry rr a e Physical: Disturbance in grooming, eating ,

sleeping, energy, elimination, activity


16/29

u c e ssessment

75-80% give clues Verbal clues

overt statements

covert statements Behavioral clues

sudden changes

g v ng awaypossessions


17/29

u c e ssessment

Assessing risk factors: Is there a plan? How lethal?

How available?

Support system

Severe life stressors

Men over 65

Previous attempts increaserisk

As meds lift depression, itmay allow for energy to acton suicidal thoughts


18/29

Nursing Diagnoses

Risk for Suicide

Coping

Impaired Social Interaction

Chronic Low Self-esteem Disturbed Thou ht Processes

Interrupted Family Processes


19/29

ann ng

Short term goals safety needs met

physiologic needs met

Long Term Goals

improved coping

resume ro eexpectations


20/29

In the Hospital

Remove harmful items Support self-care

Educate client andfamily re S&S of

activities

Monitor food, fluid,

depression and

management of meds

weight, sleep,

elimination

rov e structure

1:1 relationship

Support andencourage

tolerated

Su ort co in skills on tor e ects o tx


21/29

Hospital

Safe environment:Check on admission,

Levels of suicideprecaution (p.739,

after passes and after

visitors

Varcarolis)

q 15-30 checks ss gn to room near

the nursing station

ose o serva on,

accompany to BR

- -

Change of shifthours/day


22/29

Community

Work with the client and their family to:

Assess for Substance Abuse

,establishing structure for self-care

Establish healthy methods to express feelings

and obtain emotional su ort


23/29

Electroconvulsant Therapy -ECT

90% efficacy seizure occurs

Informed consent Short procedure

6-12 treatments

Refractor

NPO

Atropine, Brevital,

depression, suicidal,

psychotic depression

nect ne,

Short-term side

Medical conditionscontraindicating

,

disorientation

me s


24/29

Inhibitors (SSRI)

Block neuronalreuptake of seratonin,

Prozac, Paxil, Zoloft,Luvox, Celexa, Lexapro

enhancing action of

seratonin at synapse

Side Effects:

GI complaints as y to erate

Tx of

Anxiety/agitation

Insomnia/Somnolence

, , ,Bulimia

Appetite increase or

-

Less toxic in overdose


25/29

TCA

Inhibit reuptake of NE& Seratonin by

Side Effects: Anticholinergic

presynaptic neurons

Effects in 2 weeks, full

Sedation

Changes in appetitee ects - wee s

Dangerous in

ar otox c n sma

percent: Dysrhythmias,

tachycardia, MI, Heart

cardiotoxic effects /block

Elavil, Norpramin,

supplydisorder)


26/29

typ ca nt epressants

Desyrel (Trazadone):Used for mild- Wellbutrin: Used totreat refractory

moderate depression/

commonly used for

depression and

marketed for smoke

disturbance

.

Greater incidence of

Benzodiazepine used

to treat anxious mild-

fewer sexual SE

moderate depression


27/29

(MAO Inhibitors)

MAO is an enzyme thatbreaks down Diet restrictions:Aged cheeses &

tyramine, therefore,

these drugs create a

wines, yeast, salami,

pepperoni, game meat

crisis resulting from

, ,

organ meats, bananas,

Tx atypical depression

Many drug-drug

interactions, ,

Marplan


28/29

Inhibitors

Inhibit both Seratoninand NE without the Serzone: sedating Effexor: Short half-lifenumber of SE of TCAs

Remeron: Increases

appetite, fewer druginteractions

Cymbalta


29/29

Antidepressant Medications Assess for Effects & SE

Encourage use for at least

Assess for suicidepotential

Assess for use of over the

counter drugs (Herbal

abuse

Assess clients

Seratonin Syndrome:agitation, flushing,

compliance withprescribed regimen

diaphoresis, diarrhea,mental statuschange,tremors

Encourage psychotherapyin addition to drug tx

Alterations in Mental Health Mood Disorders

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