Alterations in Mental Health Mood Disordersfaculty.mc3.edu/bshaeffe/mood.pdf · Alterations in...
Transcript of Alterations in Mental Health Mood Disordersfaculty.mc3.edu/bshaeffe/mood.pdf · Alterations in...
Alterations in Mental HealthAlterations in Mental HealthMood Disorders
Highs
LowsLows
Grief: The normal response to a Grief: The normal response to a significant loss
N l D f i lNormal vs Dysfunctional
• 12-24 Months
• Somatic distress
• Prolonged response
• Delayed response
• Preoccupation
• Guilt/Anger
• Exaggerated symptoms of normal Gu / ge
• Behavior Changes
• Reorganization
grief
Reorganization
• Pp. 615-616 (Varcarolis)(Varcarolis)
F ff i i f Factors effecting grief response
• Level of dependency in the relationship
• Degree of ambivalence in relationshipDegree of ambivalence in relationship
• Age of the deceased +/or grieving person
B d ’ t t• Bereaved person’s support system
• Physical and psychological health of the bereaved individual
N i A iNursing Actions
• Goal– Mourning is complete
• Interventions– Allow privacy and
when the bereaved can remember realistically both the
provide support
– Always offer and allow viewing of deceasedrealistically both the
pleasures and disappointments of the lost relationship;
viewing of deceased
– Recognize cultural needs
the lost relationship; and begin to form new interests and
– Acknowledge feelings
– Simply allowing talking can release relationships. talking can release negative emotions
M d Di dMood Disorders
• Manic mood: Bipolar I
• Hypomanic mood: Bipolar II; Cyclothymic Disorder
• Euthymic mood: normal
• Dysthymic mood:– moderate: Dysthymic
M j – severe:Major Depressive Disorder
Characteristics of Depressive Characteristics of Depressive Disorders• Depressed mood
• Anhedonia
• Feelings of worthlessness &
• Decreased concentration/difficul
inappropriate guilt
• Suicidal thoughts
ty making decisions
• Negative thinking re
• Anger, irritability
• Vegetative signs:self, environment, future
P h t
– disturbance in eating, sleeping; loss of energy libido; • Psychomotor
agitation/retardation
energy, libido; constipation
T f M d Di dTypes of Mood Disorders
• Dysthymic Disorder– Chronic depression (at
• Cyclothymic Disorder– Chronic fluctuating
least 2 years)
– Mild to moderate degree of depression
mood
– Hypomanic & mild to moderate depressiondegree of depression
– Able to function
– Depression is
moderate depression
• Substance -induced – Depressed or elevated p
“normal”
– High risk for major depression
Depressed or elevated mood disturbance within a month of substance intox or depression substance intox or withdrawal
Types of mood disorders: due to Types of mood disorders: due to General Medical Condition• Medication SE
(Steroids, Antihypertensives
• Prevalence of Comorbid Depression:
Stroke 22 50%Antihypertensives, Oral Contraceptives)
• Medical conditions:
– Stroke 22-50%– Cancer 18-39%– MI 15-19%Medical conditions:
Endocrine, Hormonal (PMS), Post-viral syndrome Tumors
MI 15 19%– HIV 8-10%– In-pt 12%
syndrome, Tumors, Diabetes
• (Varcolis p 328)
– Out-pt 2-15%
(Varcolis p.328)
Depression vs DementiaDepression vs Dementia
Depression DementiaDepression
• Onset gradual or in response to a crisis
Dementia
• Slow incidious onset
• Impaired memory, • Impaired concentration,
focus, attention
D d
Impaired memory, judgment, agnosia
• Function deteriorates as th d • Decreased energy,
motivation, early am awakening; morning is their
the day progresses –“sundowning”
• Affect flat, anxiousg g“bad time”
• Affect sad, blunted, irritable
S h l fl l
Affect flat, anxious
• Speech contains confabulation &
i i li• Speech slow, flat, low circumstantiality
M j D i Di dMajor Depressive Disorder
• 17%Lifetime prevalenc
• >25% rate in Nsg H’s
• 15% Suicide rate
• 2x rate in womena e o e
• “Masked” by somatic complaints, hyperactivity & poor school performance
• Comorbid anxiety common
Major Depressive Disorder, with Major Depressive Disorder, with …..(Specifiers)• Psychotic features (Mood congruent)
• Catatonic features(Psychomotor Catatonic features(Psychomotor disturbance)
• Melancholic features(Vegetative signs)• Melancholic features(Vegetative signs)
• Seasonal Affective Patterns
• Postpartum onset – Severe depression occurring within 4 weeks of
delivery/30-50% risk of recurrence with each subsequent delivery
E i l f D iEtiology of Depression
• Biologic Theories– Genetic: 1.5-3x in 1st
• Cognitive Theories: identify, refute and
degree relatives/>incidence in alcohol dep. & ADHD
replace negative thoughts
P h l ti in alcohol dep. & ADHD
– Biochemical: Seratonin;Neurepineph i / l ti hi t
• Psychoanalytic: Aggression turned inwardhrine/ relationship to
stress regulation
– Sleep: REM latency
inward
• Learned HelplessnessSleep: REM latency
Ri k F f D iRisk Factors for Depression
• Chronic Illness
• Female Gender
• Bereavement
• Perfectionistice ec o s c
• Situational stressors
• Previous HistoryPrevious History
• Family History
• Social IsolationSocial Isolation
N i ANursing Assessment
• Where/ Who? ALL clients in ALL settings
• Affect: Sad blunted tearfulAffect: Sad, blunted, tearful
• Thought Process: Slow, negative, indecisive poor memory&concentrationindecisive, poor memory&concentration
• Feelings: Worthless, guilty, sad, helpless & hopeless angr & irritablehopeless, angry & irritable
• Physical: Disturbance in grooming, eating , sleeping, energy, elimination, activity
S i id ASuicide Assessment
• 75-80% give clues
• Verbal clues– overt statements
– covert statements
– Behavioral clues
– sudden changes
i i – giving away possessions
S i id ASuicide Assessment
• Assessing risk factors:– Is there a plan?
• How lethal? How lethal? • How available?
– Support system– Severe life stressorsS– Men over 65– Previous attempts increase
risk– As meds lift depression, it
may allow for energy to act on suicidal thoughts
AnalysisAnalysisNursing Diagnoses• Risk for Suicide
• Hopelessness /Ineffective Individual Hopelessness /Ineffective Individual Coping
• Altered Nutrition / Disturbed Sleep Pattern• Altered Nutrition / Disturbed Sleep Pattern
• Impaired Social Interaction
• Chronic Low Self-esteem
• Disturbed Thought Processesg
• Interrupted Family Processes
Pl iPlanning
• Short term goals– safety needs met
– physiologic needs met
• Long Term Goals– improved coping
l – resume role expectations
Nursing InterventionsNursing InterventionsIn the Hospital• Remove harmful items
• Support self-care
• Educate client and family re S&S of
activities
• Monitor food, fluid,
depression and management of meds
P id t tweight, sleep, elimination
• Provide structure– 1:1 relationship
Socialization as • Support and encourage
M it ff t f t
– Socialization as tolerated
– Support coping skills• Monitor effects of tx
pp p g
Suicide Precautions in the Suicide Precautions in the Hospital• Safe environment:
Check on admission, • Levels of suicide
precaution (p.739, after passes and after visitors
A i t
Varcarolis)– q 15-30” checks
Cl b ti • Assign to room near the nursing station with other clients
– Close observation, accompany to BR
– 1:1 - Arms-length 24 with other clients
• Change of shift
• No suicide contract
1:1 Arms length 24 hours/day
• No suicide contract
Nursing Interventions in the Nursing Interventions in the Community• Work with the client and their family to:
– Make the home safe (weapons, pills, etc.)Make the home safe (weapons, pills, etc.)
– Assess for Substance Abuse
– Develop a routine for taking meds and Develop a routine for taking meds, and establishing structure for self-care
– Relieve isolation and reestablish social tiesRelieve isolation and reestablish social ties
– Establish healthy methods to express feelings and obtain emotional supportpp
Treatments for DepressionTreatments for DepressionElectroconvulsant Therapy -ECT• 90% efficacy
• seizure occurs
• Informed consent
• Short procedure
• 6-12 treatments
• Refractory
– NPO
– Atropine, Brevital, A i O2
e ac o ydepression, suicidal, psychotic depression
Anectine, O2
– Short-term side effects: confusion
• Medical conditions contraindicating
d
effects: confusion, disorientation
meds
Selective Seratonin Reuptake Selective Seratonin Reuptake Inhibitors (SSRI)• Block neuronal
reuptake of seratonin, • Prozac, Paxil, Zoloft,
Luvox, Celexa, Lexaproenhancing action of seratonin at synapse
E il t l t d
• Side Effects:– GI complaints
• Easily tolerated
• Tx of PMS Depression OCD
– Anxiety/agitation
– Insomnia/Somnolence
Sexual dysfunctionPMS,Depression,OCD, Bulimia
• Effective in 2 4 weeks
– Sexual dysfunction
– Appetite increase or decrease• Effective in 2-4 weeks
• Less toxic in overdose
decrease
Tricyclic AntidepressantsTricyclic AntidepressantsTCA• Inhibit reuptake of NE
& Seratonin by • Side Effects:
– Anticholinergicpresynaptic neurons
• Effects in 2 weeks, full ff t 4 8 k
– Sedation
– Changes in appetite
C di i i ll effects 4-8 weeks
• Dangerous in overdose due to
– Cardiotoxic in small percent: Dysrhythmias, tachycardia, MI, Heart
overdose due to cardiotoxic effects / only give 1 week
y , ,block
– Elavil, Norpramin, Tofranil(panic only give 1 week
supply Tofranil(panic disorder)
A i l A idAtypical Antidepressants
• Desyrel (Trazadone): Used for mild-
• Wellbutrin: Used to treat refractory
moderate depression/ commonly used for treating sleep
depression and marketed for smoke cessation (Zyban) treating sleep
disturbance
• Xanax:
cessation (Zyban). Greater incidence of seizure activity and • Xanax:
Benzodiazepine used to treat anxious mild-
seizure activity and fewer sexual SE
to treat anxious mildmoderate depression
Monoamine Oxidase InhibitorsMonoamine Oxidase Inhibitors(MAO Inhibitors)
• MAO is an enzyme that breaks down
• Diet restrictions: Aged cheeses &
tyramine, therefore, these drugs create a risk for hypertensive
wines, yeast, salami, pepperoni, game meat herring soy sauce risk for hypertensive
crisis resulting from too much tyramine
herring, soy sauce, organ meats, bananas, figs, raisins, etc.too much tyramine
• Tx atypical depression
• Nardil Parnate
figs, raisins, etc.
• Many drug-drug interactionsNardil , Parnate,
Marplan
interactions
Seratonin/NE Reuptake Seratonin/NE Reuptake Inhibitors
• Inhibit both Seratonin and NE without the
• Serzone: sedating
• Effexor: Short half-lifenumber of SE of TCA’s • Remeron: Increases
appetite, fewer drug interactions
• Cymbalta
Nursing Interventions R/T Nursing Interventions R/T Antidepressant Medications• Assess for Effects & SE• Encourage use for at least
4 weeks
• Assess for suicide potential
• Assess for substance 4 weeks• Assess for use of over the
counter drugs (Herbal remedies)
• Assess for substance abuse
• Assess client’s understanding and remedies)
• Seratonin Syndrome: agitation, flushing,
understanding and compliance with prescribed regimen
diaphoresis, diarrhea, mental status change,tremors
• Encourage psychotherapy in addition to drug tx