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Andrew Solomon “ Depression, The Secret We Share” Watch a Video

Andrew Solomon “ Depression, The Secret We Share” Watch a Video. http :// www.ted.com/talks/andrew_solomon_depression_the_secret_we_share.html. Video Link. Psychobiologic Disorders Part One. PVN 123 Mental Health Nursing. Objectives.

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Andrew Solomon “ Depression, The Secret We Share” Watch a Video

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  1. Andrew Solomon“Depression, The Secret We Share”Watch a Video http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share.html Video Link

  2. Psychobiologic DisordersPart One PVN 123 Mental Health Nursing

  3. Objectives Identify common subjective and objective evidence associated with common mental health disorders Anxiety Disorders Depression Bipolar Disorders Schizophrenia Personality Disorders Cognitive Disorders Substance and other dependencies Eating Disorders Identify nursing interventions, therapies, screening tools, that may be utilized in the safe care, management, and health promotion, for individuals who experience these disorders. Determine desired outcomes associated with these disorders

  4. Anxiety Disorders Panic Disorder Phobias OCD GAD Stress Related Disorders (Acute Stress Disorder & PTSD)

  5. Anxiety • Anxiety • Response to stress • High levels result in behavior changes • Tends to be persistent (often disabling) • Levels of anxiety • Mild (restless/irritable/increased motivation) • Moderate (agitated/muscles tighten) • Severe (unable to function / ritualistic behaviors / unresponsive) • Panic (distorted perception / hallucinations / loss of rational thought / immobility)

  6. Anxiety Disorders • Panic Disorder • Recurrent panic attacks • Phobias • Unreasonable fear of objects or situations • Obsessive-Compulsive Disorder (OCD) • Unrealistic obsessions (thoughts) • Compensated for with compulsive behaviors • Ex: repeatedly cleaning an object or constant hand washing • Generalized Anxiety Disorder (GAD) • Excessive worry (more than 6 months) • Stress-related Disorders • Acute Stress Disorder • After exposure to traumatic event • Causes numbing, detachment, amnesia about the event (no more than 4 weeks) • Posttraumatic Stress Disorder (PTSD) • Caused by a traumatic event • Fear, horror, flashbacks, detachment, foreboding, restricted affect • Impairment lasts longer than one month and can last for years

  7. Coping and Defense Mechanisms Anxiety Disorders: • Displacement • Undoing, reaction formation • Intellectualization • Isolation • Repression *** If you don’t remember these from last class… look them up!!!

  8. Risk Factors – Anxiety Disorders: • Much more likely in women (except OCD) • Precipitated by exposure to traumatic event or experience • Experiencing smells or sounds associated with the event • Can trigger panic attack • Can be due to acute medical condition • Always rule out a physical cause • Can be related to current use or withdrawal from a chemical substance (ex: alcohol)

  9. Subject/Objective DataPanic Disorder • Panic episodes last 15 to 30 minutes • Four or more of the following: • Palpitations • SOB • Choking / sense of smothering • Chest pain • Nausea • Feelings of depersonalization • Fear of dying / insanity • Chills and hot flashes • Behavior changes / persistent worries about next attack • Agoraphobia (fear of being in places or situations of previous attacks)

  10. Subjective/Objective DataPhobias: • Social Phobia (fear of embarrassment) • Unable to perform in front of others • Dread social situations • Believe others are judging them negatively • Impaired relationships • Agoraphobia (fear of being outside) • Impaired ability to work or perform duties • Other Phobias (ex: fear of strangers, flying, the dark) • Fear specific objects, experiences or situations

  11. Subjective/Objective DataOCD • Ritualistic behaviors • Difficulty meeting self care needs • If performing constant hand washing • Skin damage • Infection

  12. Subjective/Objective DataGAD • Impairment in one or more areas of functioning • Ex: work-related duties, self care • At least three of the following manifestations • Fatigue • Restlessness • Trouble concentrating • Irritability • Muscle tension • Sleep disturbance

  13. Subjective/Objective DataStress-Related Disorders

  14. Standardized Screening ToolsAnxiety Disorders • Hamilton Rating Scale for Anxiety • Modified Spielberger State Anxiety Scale • (see handouts)

  15. Nursing CareAnxiety Disorders • Structured interview – keep client focused • During Crisis or in Acute Anxiety: • Provide safety and comfort for client and staff • Do not reinforce teaching – unable to problem-solve • Remain with client and provide reassurance • THEN……

  16. Nursing Care (continued)Anxiety Disorders • Provide Milieu Therapy • Structured environment • Monitor/protect from harm • Daily activities / focus on cooperation and sharing • Use therapeutic communication skills • Open ended questions • Help client to express, validate, and acknowledge feelings • Allow client to participate in decision making • Encourage relaxation techniques • Mild to moderate anxiety • Instill hope for good outcomes (no false reassurance) • Enhance self-esteem • Encourage positive statements • Discuss past achievements • Assist to identify interfering defense mechanisms • Client Education

  17. Other Therapies – Anxiety Disorders • Cognitive Reframing • Behavioral Therapies • Relaxation Training • Modeling • Systematic desensitization • Flooding • Response prevention • Thought stopping • Eye Movement Desensitization Therapy (EMDR) • Unfreezes fragments or trauma • Group/Family Therapy (PTSD)

  18. Medications – Anxiety Disorders • Antidepressants • Zoloft, Elavil • Sedative hypnotic anxiolytics • Valium • Serotonin Norepinephrine reuptake inhibitors • Effexor • Non-barbiturate anxiolytics • Buspar • Other Medications ***( used as mood stabilizers) • Beta Blockers • Antihistamines • Anticonvulsants • Remeron (serotonin norepinephrine dis-inhibitor) • Used to help clients rest when panic attack occurs during sleep

  19. Client Outcomes!Anxiety Disorders • Will verbalize decreased anxiety • Will be rested upon awakening • Will develop realistic goals for the future • Will regularly attend support group • Will demonstrate appropriate use of relaxation techniques

  20. Quick Quiz! (answers in your book!)

  21. Quick Quiz! • A client being evaluated in her provider’s office tells the nurse, “I remove my old makeup and apply new makeup every hour or so because I look horrible.” The nurse should understand that this behavior is characteristic of which of the following disorders? • A. GAD • B. Agoraphobia • C. OCD • D. PTSD

  22. Quick Quiz! When collecting data from a client who states that she has been dealing with constant anxiety for the past few weeks, the nurse should use which of the following communication techniques? _____ Ask open ended questions _____ Provide reassurance _____ Discuss the client’s past achievements _____ Offer advice about how to reduce anxiety _____ Invite the client to participate in decision making

  23. Depression Dysthymic Disorder Major Depressive Disorder

  24. I Had A Black Dog Watch the Video! http://youtu.be/XiCrniLQGYc

  25. About Depression • Client may be at risk for suicide • Personal or family history of suicide attempts • Comorbid anxiety or panic attacks • Comorbid substance abuse or psychosis • Poor self esteem • Lack of social support • Chronic medical condition • Mood (affective) disorder • Widespread issue • Ranks high among causes of disability • Can be comorbid with: • Anxiety disorders • Schizophrenia • Substance abuse • Eating disorders • Personality disorders

  26. Depressive Disorders - MDD • Major Depressive Disorder (MDD) • Single or recurrent episodes of unipolar depression • Not associated with mood swings (unipolar) • Change in normal functioning • Social, occupational and self care deficits Plus…. At least 5 of the following occurring nearly every day (for most of the day) for a minimum of 2 weeks: Depressed mood Difficulty with or excessive sleeping Indecisiveness Decreased concentration Suicidal ideation Changes in motor activity Unable to feel pleasure Increase or decrease in weight ( 5% of total body weight over one month)

  27. Dysthymic Disorder • Milder and more chronic form of depression • Onset is early • Childhood and adolescence • Lasts at least 2 years (adults) • 1 year in children • At least three clinical findings of depression • May become MDD later in life • Clinical manifestations less severe than with MDD

  28. MDD – Specific Classifications • Psychotic Features • Auditory hallucinations, delusions • Atypical Features • Changes in appetite, wt. gain, excessive daytime sleeping • Postpartum Onset • Begins within 4 weeks of childbirth • May include delusions • Mother and infant may be at high risk • Seasonal Characteristics • Seasonal Affective Disorder (SAD) • Occurs during winter • Can be treated with light therapy • Chronic Features • Episode lasting more than 2 years

  29. Phases of Depression

  30. Depression – Risk Factors • Family history / previous personal history of depression • Twice as common among females 15 – 40 years • Very common among elderly • More difficult to recognize • May go untreated • May look like dementia • Memory loss • Confusion • Behavioral problems • May seek help for somatic symptoms • Other Risk Factors: • Stressful events • Medical illness • Postpartum female • Poor social network • Comorbid substance abuse • *May be primary disorder or response to another mental or physical disorder

  31. Subjective DataDepression • Anergia (lack of energy) • Anhedonia (lack of pleasure in normal activities) • Anxiety • Sluggish (most common) or unable to relax or sit still • Change in eating patterns • Usually anorexia in MDD • Increased intake with Dysthymia • Change in bowel habits (usually constipation) • Sleep Disturbances • Decreased interest in sexual activity • Somatic complaints (fatigue, GI symptoms, pain)

  32. Objective DataDepression • Sad with blunted affect • Poor grooming / lack of hygiene • Slowed physical movement / slumped posture • Agitation (pacing/finger tapping) can also occur • Little or no effort to interact / socially isolated • Slowed speech • Decreased verbalization • Delayed responses

  33. Standardized Screening ToolsDepression • Hamilton Depression Scale • Beck Depression Inventory • Geriatric Depression Scale • Zung Self-Rating Depression Scale • Confidential Screening Tool • http://depressionscreen.org/ See handouts!

  34. Medications - Depression

  35. Nursing CareDepression • Milieu Therapy • Self-Care • Monitor abilities to perform ADLs • Encourage independence • Encourage participation in decision making • Communication • Relate therapeutically • Make time to be with client • Make observations rather than asking questions • “I notice that you were at group today” • Give simple concrete directions • Give client time to respond • Maintain a safe environment

  36. Client Teaching for Anti-Depressant Medications • Do not discontinue medications suddenly • May take time for therapeutic effect • 1 – 3 weeks for initial effect • Up to 2 months for maximal response • Avoid hazardous activities • Driving • Operating heavy equipment / machinery

  37. Serotonin Syndrome • Watch the video • http://www.youtube.com/watch?v=egfXW74LMi8

  38. Other Treatments • Psychotherapy • Problem solving • Increasing coping abilities • Changing negative thinking • Increasing self-esteem • Assertiveness training • Using community resources • Alternative Therapies • St. John’s Wort • Side effects (photosensitivity, skin rash, rapid heart rate, GI distress, abdominal pain) • Can increase or reduce levels of medications being taken • Serotonin Syndrome may occur if taken with SSRIs, MAOIs, atypical antidepressants, tricyclic antidepressants. • Light Therapy • First line treatment for SAD • Inhibits nocturnal secretion of melatonin • Expose face to 10,000-lux light box for 30 min/day • Electroconvulsive Therapy (ECT) • Specially trained nurse monitors the client before and after procedure • Watch for cardiovascular disease, neuromuscular disorders, complicated pregnancy prior to treatment • Transcranial Magnetic Stimulation (TMS) • Electromagnets stimulate the brain • Vagus Nerve Stimulation (VNS) • Implanted device stimulates vagus nerve

  39. Electroconvulsive Therapy (ECT) • Watch the video • Sherwin Nuland: How Electro-shock Therapy Changed Me • http://www.ted.com/playlists/9/all_kinds_of_minds.html

  40. Client Education and Outcomes • Education after discharge • Review clinical manifestations with clients and family • Helps to identify relapse • Reinforce intended effects and side effects of meds • Explain importance and benefits of adherence to therapies • Encourage • Regular exercise (30 min/day 3 to 5 days/wk) • Shorter intervals are helpful • Outcomes • The client will express increase in mood. • The client will adhere to the medication regimen. • The client will remain safe and notify provider of any thoughts of suicide.

  41. Quick Quiz! • A nurse is interviewing a 25 year-old client diagnosed with dysthymia. Which of the following findings should the nurse expect? • A. There are wide fluctuations in mood. • B. There is no evidence of suicidal ideation. • C. The symptoms last for at least two years. • D. There is an inflated sense of self-esteem.

  42. Quick Quiz! • A client is prescribed the SSRI paroxetine (Paxil), but wants to continue taking St. John’s Wort. What should the nurse tell the client and spouse about taking this medication concurrently with St. John’s Wort?

  43. Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymia

  44. Watch a Movie! - EXCELLENT!! • "Up/Down" • Bipolar Disorder Documentary FULL MOVIE (2011) • About 1 ½ hours long • Make some popcorn and get comfy! • Put up the “Big Screen” • Enjoy and learn lots!! • http://www.youtube.com/watch?v=eyiZfzbgaW4

  45. Bipolar Disorders • Mood disorders • Recurrent episodes of depression and mania • Usually emerge in late adolescence and early adulthood • Can be diagnosed in school age children • Side effects of medication and clinical manifestations of bipolar disorders mimic symptoms of ADHD • Children not usually diagnosed until after age 7 • Periods of normal functioning alternating with illness • Some clients maintain occupational and social function • Care mimics the phase of the disease experienced

  46. Bipolar Disorders and Comorbidities • Bipolar Disorders • Bipolar I Disorder • At least one episode of mania alternating with depression • Bipolar II Disorder • More than one or more hypomanic episodes alternating with MDD. • Differs from Bipolar I • Clients do not have manic phases • Cyclothymia • 2 years of repeated hypomanic episodes alternating with MINOR depressive episodes • Comorbidities • Substance abuse • More rapid cycling of mania • Used for self-medication • Direct impact on onset of mental health disorder • Anxiety Disorders • Eating Disorders • ADHD

  47. Watch a Video • Laura Bain - Living with Bipolar Type II • http://www.youtube.com/watch?v=8Ki9dgG3P5M

  48. Watch a Video • Understanding Bipolar Disorder • http://www.youtube.com/watch?v=CDK50WQEOJc

  49. Phases, Characteristics and Treatment Bipolar Disorders

  50. Bipolar Behaviors • Mania • Abnormal elevated mood • Described as expansive or irritable • Normally requires inpatient treatment • Hypomania • Less severe than mania • Lasts at least 4 days • Accompanied by 3 to 4 clinical findings of mania • Hospitalization may not be necessary • Client is less impaired • Mixed Episode • Manic and major depression experienced simultaneously • Impaired functioning • May require hospitalization (self harm or other violence) • Rapid Cycling • Four or more episodes of mania in 1 year

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