Download Mood Disorders Mental Health vs Mental Illness

Mood Disorders
Mental Health vs Mental Illness
Maslow
• Identified self actualization as being
“psychologically healthy, fully human, highly
evolved, and fully mature.”
• Appropriate perception of reality
• Ability to accept oneself and others
• Ability to focus (concentrate) and problem
solve
• Ability to have satisfactory interpersonal
relationships
• Creativeness
• Desire for a certain amount of privacy and
ability to detach if needed
• Sense of ethics
• Creativity
• A degree of conformance
Jahoda
• Positive attitude
• Growth, development, and the Ability to
Achieve Self-Actualization
• Integration
• Autonomy
• Perception of reality
• Environmental mastery
Locus of Control
• External
• Internal
Mental Health
Viewed as the successful adaptation to stressors
from the internal or external environment,
evidenced by thoughts, feelings, and behaviors
that are age-appropriate and congruent with
local and cultural norms.
Mental Illness
• Universal concept is difficult because of the
influence of cultural factors.
• Maladaptive responses to stressors from the
internal or external environment, evidenced
by :
Anxiety and Grief
• Two major primary responses to stress
• Continuum of health to illness
Mild anxiety or feelings of sadness or life’s
everyday disappointments-use coping
mechanisms such as smoking, talking it out
Moderate anxiety-add in defense mechanisms
(such as denial) and/or psychophysiological
responses (such as headaches, ulcers). Also see
Neurotic responses, dysthymia (non psychotic
depression)
Severe anxiety to panic- add in psychoneurotic
responses such as obsessions, amnesia.
Can even become delusional (psychotic)
Depression
Non psychotic mood disorders
• An occasional bout with the blues
Short lived, normal, utilized learned coping
skills.
Transient depression –life’s everyday
disappointments
Seasonal depression
• Grief
Normal response to losses perceived as
important to the individual. What might cause
grief in one person can cause little or no sadness
in another.
• Cyclothymia
Possible nursing diagnoses for mood
disorders
• Mild depression
May experience anorexia or overeating,
insomnia or hypersomnia, headaches,
backaches, chest pain, tearfulness, blaming
others, guilt, anger
• Moderate depression
Signs and Symptoms:
• Severe Depression
• Major Depression
• Will learn more about this in Soph II but we
will have a brief description
Affect:
Blunted: significantly reduced intensity of
emotional expression
Flat: absent or nearly absent affective
expression
Inappropriate: expression does not reflect the
content of speech or ideation
Labile: varied, rapid, abrupt shifts in affective
expression
Bipolar disorder
• Theory -Etiology is unclear. Most believe that
biological and psychosocial factors come into
play.
• Affect-
• May or may not have delusions/hallucinations.
• Delusions-many times grandiosity or paranoia
Grandiosity is an exaggerated sense of self
importance, power, or status. Employed to reduce
feelings of insecurity and increases feeling of power.
• Hallucinations
Interventions
• Accurate assessment of s/sx
• Develop a trusting relationship, encourage
client to express feelings openly
• Encourage them to express anger (do not
become defensive)
• Participation in large motor activities just as
physical exercises, volleyball, punching bag
help discharge pent-up anger
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Assist in problem solving
Encourage support groups
Intake and output
Teach effective communication (I message,
etc)
• Provide helpful measures to promote sleep
• Watch for suicidal gestures or ideation
• Suicide watch if nurse feels it is warranted
(usually 1:1 to closely monitor patient)
Remember that when in deepest depression,
patients aren’t as likely to commit suicide
because of decreased energy. It’s when they
start to feel more energy that they are more
likely to harm self. But be aware IT CAN
HAPPEN ANYTIME.
• Clients are usually very withdrawn when
depressed with little energy. We don’t want
to overtax, but we want them to participate
as soon as possible. Maybe have to walk them
to their activity.
• Newly admitted depressed patients do better
with one on one interaction, then progressed
to socialization with others/groups.
Therapies
• Cognitive therapy-individual is taught about
thought distortions (individual and/or group)
• Group therapy-used once acute phase of
depression passed. Peer support provides
feeling of security. Yalom’s curative factors
• Family therapy- aimed at restoring family
functioning
• Behavioral therapy
• Light therapy
• ECT
• Psychopharmacology
Medications for depression
Antidepressants
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Tricyclics
Monoamine Oxidase Inhibitors
Selective Serotonin Reuptake Inhibitors
Others
Antidepressants may cause sedation at first. But
over time, the patient’s body gets used to the
medication, and the patient is not sleepy from
taking it.
Many antidepressant will lower the seizure
threshold.
Many cause anticholinergic side effects.
• Tricyclic antidepressants
Blocks the absorption (reuptake) of the
neurotransmitters serotonin and
norepinephrine, making more of these
chemicals available in the brains. Helps brain
cells send and receive messages, which in turn,
boosts mood. There is also a drug that is a
tetracyclic that you may see (Maprotiline)
• Side effects of tricyclics:
Anticholinergic effects (dry mouth, urinary
retention)
Increased appetite
Drop in blood pressure when moving to a
standing position.
Increased sweating
Other side effects
• Interactions
Taking a tricyclic with other drugs can cause
many drug interactions. Always note this when
you look up and read about an antidepressant.
For example: when used with phenothiazines
(antipsychotic drugs) risk for seizure increases.
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• Decreased or increased effects of other drugs
can occur .
• Example-increased anticoagulation effects
may occur with dicumarol. (So patient could
have bleeding)
• Some names you might see
Amitriptyline-Elavil
Amoxapine
Imipramine-(Tofranil)
Nortriptyline-Pamelor
Tricyclic antidepressants are ordered per their
generic name at this time.
• Monoamine Oxidase Inhibitors
Major problem-Interaction with tyramine-rich
foods and certain medication that can result in
hypertensive crisis.
Names: Isoboxazid (Marplan), Tranylcypromine
(Parnate), and Phenelzine (Nardil)
• Tyramine Rich Foods:
• Sympathomimetics
• SSRI’s
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
• SSRI’s Action:
Decreased serotonergic neurotransmission has
been proposed to play a key role in depression.
Prozac was the first of a class of drugs that
acted “selectively” on serotonin. All SSRIs
inhibit the reuptake of serotonin by blocking its
transport into the presynaptic neuron, which in
turn increases the concentration of synaptic
serotonin.
• Side effects of SSRIs
Headache, anxiety, insomnia, transient nausea
and vomiting, diarrhea. Sedation may occur.
See chapter 11 for other side effects.
• Norepinephrine Dopamine Reuptake
Inhibitors
Bupropion (Wellbutrin) inhibits reuptake of
norepinephrine, serotonin, and dopamine.
Some have experienced anxiety, insomnia,
appetite suppression. A few have experienced
hallucinations and delusions. Lowers seizure
threshold. (So not good to give to head injury
pt)
Lithium
• Once dosage adjusted, don’t change salt
intake.
• Lithium levels
• Drink plenty of fluids
• Lithium is prescribed as a mood stabilizer for
the treatment of bipolar disorder. It acts to
help control the associated mania,
hypomania, depression and psychosis.
• Lithium is formally approved to treat manic episodes of
bipolar disorder when symptoms such as grandiosity,
racing thoughts, hypersexuality, delusions,
hallucinations, and decreased need for sleep appear.
• However, it has also been shown to help with
depressive symptoms
• Some research has shown that lithium can be effective
in treating unipolar depression when added to one or
more other depression medications, so it is sometimes
prescribed for this use.
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Warnings About Lithium
There are several important warnings for people taking lithium. These include:•Serum blood level
must be monitored regularly. Lithium can be toxic if this gets too high. Symptoms of lithium toxicity
include diarrhea, vomiting, tremor, mild problems walking, drowsiness, or muscular weakness.
Report such symptoms to a doctor immediately.
•There is a danger of a condition called lithium nephrogenic diabetes insipidus (NDI). If you notice
that you are excessively thirsty and are urinating too often, check with a doctor at once.
Precautions When Taking Lithium
•Make sure you maintain normal fluid and salt intake when taking lithium. Dehydration or low
levels of sodium in the blood may have serious consequences.
•Prolonged sweating, diarrhea, or a high fever can cause your tolerance to lithium to decrease and
may require medical treatment. Check with your doctor if any of these conditions occurs.
•Lithium can cause increased thyroid and parathyroid activity. Your doctor should check blood
calcium levels periodically, as these are connected to the workings of the parathyroid gland, as well
as for overactive thyroid.
Be extremely careful when used with diuretic.
• Serum blood level describes the amount of a given medication
present in your blood at the time of testing. Blood serum is the
liquid part of the blood that contains no clotting factors or blood
cells.
• Some medications used to treat bipolar disorder require serum
blood level testing. People taking lithium in particular must be
tested regularly, as there is a narrow "therapeutic window" for
lithium. That means that the difference between a therapeutic level
and toxic level can be small in some individuals. .5-1.5 mEq/L
• Above 1.5 is considered critical
• Other medications that require serum blood level testing include
Tegretol (carbamazepine) and Depakote / Depakene (sodium
valproate, valproic acid). (These are anti seizure meds but are also
used for mood disorders)
Anticonvulsants: ( also used for mood stabilizers) Need blood levels
Tegretol (Carbamazepine)-watch for hematologic and hepatic toxicity. Also may
have neurotoxic side effects and EKG changes. Sedation is common. Decreases blood
levels of doxycycline, theophylline, coumadin, and birth control pills.
May aggravate CV disease, so no smoking when on drug.
Depakote (divalproex sodium) -Fewer drug interactions than carbamazepine.
Neurotin (gabapentin)- Side effect of gait instability.
Trileptal-(Oxcarbazepine)
-Watch for adverse neurologic events such as speech problems, gait disturbance,
fatigue, somnolence, abnormal cooridation.
ECT
• Electroconvulsive Therapy
• Meds used: Short acting anesthetic
Succinylcholine- Muscle relaxant
Airway applied
Shock applied-seizure must be 25 sec
Ventilation
Airway removed
Confusion when awakes-protect and reorient
Suicide
Risk for suicide
Ask the client directly, “Have you thought about
killing/harming yourself today”?
If yes, do they have a plan. If so, risk is higher
that it happens soon.
Create a safe environment. No sharps, etc.
Short term verbal or written contract with the
client that he /she won’t harm self during a
specific time period. Have them commit to
Notifying staff if the thought enters their mind.
Maintain close observation.
Encourage verbalization of honest feelings.
Identify community resources/support people,
etc.
Orient as needed.
Spend time with the client. Conveys the
message “You are important”.
Signs of possible suicide ideation
Signs/symptoms of suicidal thoughts
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Talking about suicide
Obtaining the means to do it
Withdrawal
Mood swings
Preoccupied with death
Feeling trapped or hopeless
Increased use of drugs or alcohol
• Giving away belongings or getting affairs in
order
• Changing normal routine, including eating or
sleeping patterns
• Doing risky or self destructive things
• Saying goodbye to people
• Personality changes or being severely agitated
• What do you do when a client is suicidal?
• If a patient says he’s thinking of harming himself,
ask him if he has a plan. Find out what the plan
is/lethality
• No suicide contract
• 1:1
• No sharps, eating utensils, strings, ropes, cords,
etc.
High risk for suicide
• Elderly men (especially if wife dead)
• Adolescents taking antidepressants-not as
high risk typically as elderly men
• Others
Aging Adult
• Cognitive Changes: Depression
NOT a normal part of aging
Contributing factor to social/physical limitations
Complicates/interferes with medical tx
Decrease in overall happiness-Isolates
Increases risk for suicide
Often caused by transitions in life and loss
During retirement
• Causes of stressors are often: economic,
relationships, loss to death of loved ones and
friends, changes in routine
• Affects spouse, children, grandchildren
• Early planning for retirement smooths
transition
Psychosocial changes
• Correlation with extent of isolation and age
• Attitudes/problems that may be seen:
“My family no longer needs me”
Inability to provide adequate self care
May exhibit odd/off putting behaviors
If no longer able to drive self or institutionalized,
may suffer from not seeing loved ones
Children and Adolescents
• Two week period of change of behavior-may
indicate an underlying depressive disorder