Lecture 6

1. Lecture 6 Mental Health Nursing-NUR 417 Mood Disorders Depressive disorders Bipolar disorder

2. Mood Disorders Part I Depressive disorders

3. Outline-Part I-Depressive disorders • Introduction • Epidemiology • Types • Etiological Implications • Developmental Implications • Nursing Process

4. Introduction Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep,appetite, and mental processes are a common accompaniment.

5. Introduction (cont.) • Depression is the oldest and most frequently described psychiatric illness. • Transient symptoms are normal, healthy responses to everyday disappointments in life. • Pathological depression occurs when adaptation is ineffective.

6. Epidemiology • Gender prevalence • Higher in women than in men by about 2 to 1 • Age • Depression more common in young women than in older women • Opposite is true for men • Marital status: Single and divorced people more likely to experience depression than married people

7. Epidemiology (cont.) • Social class: There is an inverse relationship between social class and report of depressive symptoms; the opposite is true with bipolar disorder. • Seasonality: Affective disorders are more prevalent in the spring and in the fall.

8. Types of Depressive disorders • Major depressive disorder • Dysthymic disorder • Premenstrual dysphoric disorder

9. Major Depressive Disorder • Loses interest or pleasure in usual activities • Social and occupational functioning impaired for at least 2 weeks

10. Dysthymic Disorder • Sad or “down in the dumps” • No evidence of psychotic symptoms • Essential feature is a chronically depressed mood for • Most of the day • More days than not • For at least 2 years

11. Premenstrual Dysphoric Disorder • Essential Features • Depressed mood • Anxiety • Mood swings • Decreased interest in activities • Symptoms occur during the week prior to menses and subside shortly after onset of menstruation

12. Etiological Implications-Depressive Disorders • Biological theories • Genetics: Hereditary factor may be involved • Biochemical influences: • Deficiency of norepinephrine, serotonin, and dopamine has been implicated • Possible diminished release of thyroid- stimulating hormone

13. Etiological Implications-Depressive Disorders (cont.) • Physiological influences • Medication side effects • Neurological disorders • Electrolyte disturbances • Hormonal disorders • Nutritional deficiencies • Secondary depression related to: • Cardiovascular disease • Infections (e.g., hepatitis, pneumonia) • Metabolic disorders (e.g., diabetes mellitus)

14. Developmental Implications Adolescence • Symptoms include: • Anger, aggressiveness • Social withdrawal • Substance abuse • Restlessness; apathy

15. Developmental Implications (cont.) Postpartum Depression • May last for a few weeks to several months • Usually associated with hormonal changes • Treatments: antidepressants and psychosocial therapies • Symptoms include: • Fatigue • Irritability • Loss of appetite • Sleep disturbances • Loss of libido • Concern about inability to care for infant

16. Nursing Process/Assessment

17. Nursing Diagnosis • Risk for suicide • Dysfunctional grieving • Low self-esteem • Powerlessness • Social isolation/Impaired social interaction • Disturbed thought processes • Imbalanced nutrition less than body requirements • Disturbed sleep pattern • Self-care deficit

18. Planning • The client • Is able to identify aspects of self-control over life situation • Is able to maintain reality orientation • Is able to concentrate, reason, and solve problems

19. Implementation • Maintaining client safety • Promoting increase in self-esteem • Encouraging client self-control and control over life situation

20. Client/Family Education • Management of the illness • Medication management • Stress management techniques • Ways to increase self-esteem • Electroconvulsive therapy • Support services • Suicide hotline • Support groups • Legal/financial assistance

21. Evaluation • Evaluation of the effectiveness of nursing interventions is measured by fulfillment of the outcome criteria.

22. Mood Disorders Part II Bipolar disorders

23. Outline-Part II- Bipolar disorders • Introduction • Etiological Implications • Types • Nursing Process

24. Introduction • Bipolar disorder • also known as manic depression • Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy • Delusions or hallucinations may or may not be part of clinical picture

25. Bipolar Disorder (Mania) Etiological implications • Biological theories: Strong hereditary implications • Biochemical influences: Possible excess of norepinephrine, serotonin, and/or dopamine

26. Bipolar Disorder (Mania) (cont.) Physiological influences • Alterations in electrolyte transfer • Brain lesions • Medication side effects • Steroids • Amphetamines • Antidepressants

27. Types of Bipolar disorder • Bipolar I disorder • Bipolar II disorder • Cyclothymia

28. Bipolar I Disorder • Individual is experiencing, or has experienced, a full syndrome of manic or mixed symptoms • May also have experienced episodes of depression

29. Bipolar II Disorder • Recurrent bouts of major depression • Episodic occurrences of hypomania • Has not experienced an episode that meets the full criteria for mania or mixed symptomatology

30. Nursing Process/Assessment

31. Nursing Diagnosis • Risk for Injury related to: • Extreme hyperactivity • Disturbed thought processes related to: • Biochemical alterations in the brain • Disturbed sleep pattern related to: • Excessive hyperactivity and agitation

32. Nursing Diagnosis (cont.) • Imbalanced Nutrition less than body requirements related to: • Refusal or inability to sit still long enough to eat • Disturbed sensory perception related to: • Biochemical alterations in the brain and to possible sleep deprivation • Impaired Social Interaction

33. Planning • The client • Exhibits no evidence of physical injury • Has not harmed self or others • Eats a well-balanced diet to prevent weight loss and maintain nutritional status • Interacts appropriately with others

34. Implementation • Maintaining safety of client and others • Restoring client nutritional status • Encouraging appropriate client interaction with others • Assisting client to define and test reality • Meeting client’s self-care needs

35. Client/Family Education • Management of illness • Medication management • Support services • Crisis hotline • Support groups • Individual psychotherapy • Legal/financial assistance

36. Evaluation • Evaluation of the effectiveness of the nursing interventions is measured by fulfillment of the outcome criteria.

37. Treatment Modalities for Mood Disorders • Psychological treatment • Individual psychotherapy • Group therapy • Family therapy • Cognitive therapy • Organic Treatments

38. Treatment Modalities for Mood Disorders (cont.) • Psychopharmacology • For Depression * Maprotiline * Mirtazapine * Amoxapine * Serzone * Trazodone * Effexor • Bupropion • For mania: • Lithium carbonate • Anticonvulsants • Verapamil • Olanzapine

39. Treatment Modalities for Mood Disorders (cont.) • Electroconvulsive Therapy • For depression and mania • Mechanism of action: increase levels of biogenic amines (norepinephrine, serotonin, and dopamine) • Side effects: temporary memory loss and confusion • Risks: mortality; permanent memory loss; brain damage • Medications: pretreatment medication; muscle relaxant; short-acting anesthetic

40. Nursing Process: Suicide Assessment • Epidemiological factors • Marital status: Suicide rate for single people twice that of married people • Single, divorced, and widowed people have rates four to five times greater than those who are married • Gender: Women attempt suicide more often; more men succeed • Age: Suicide highest in persons older than 50 years; adolescents also at high risk

41. Nursing Process: Suicide Assessment (cont.) • Epidemiological factors (cont.) • Socioeconomic status: People in the highest and lowest social classes have higher suicide rates than those in the middle classes. • Professionals: Professional healthcare personnel and business executives are at the highest risk. • Religion

42. Nursing Process: Suicide Assessment (cont.) • Presenting symptoms/Medical- psychiatric diagnosis • Mood disorders (major depression and bipolar disorders) are the most common disorders that precede suicide. • Other disorders include • Anxiety disorders • Schizophrenia

43. Nursing Process: Suicide Assessment (cont.) • Suicidal ideas or acts • Assess: plan, previous attempts • Verbal clues: • Direct statements:“I want to die.” • Indirect statements:“I don’t have anything to live for anymore.”

44. Intervention with the Outpatient Suicidal Client • Do not leave the person alone. • Schedule daily appointments. • Establish trusting relationship. • Antidepressant medication. • Take any hint of suicide seriously. • Report threats of suicide immediately.