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Mood Disorders

Mood Disorders. chapter 12 and 13. What is Bipolar Disorder? (Bipolar #1) http://www.youtube.com/watch?v=MBUOoQk0hhU Diagnosing and Treating Bipolar Disorder (Bipolar #2) http://www.youtube.com/watch?v=iMMDYZdJBeM What is Depression? (Depression #1)

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Mood Disorders

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  1. Mood Disorders chapter 12 and 13

  2. What is Bipolar Disorder? (Bipolar #1) • http://www.youtube.com/watch?v=MBUOoQk0hhU • Diagnosing and Treating Bipolar Disorder (Bipolar #2) • http://www.youtube.com/watch?v=iMMDYZdJBeM • What is Depression? (Depression #1) • http://www.youtube.com/watch?v=IeZCmqePLzM • Treating Depression (Depression #2) • http://www.youtube.com/watch?v=qVEueGutbSs • Clinical Depression • http://www.youtube.com/watch?v=-bru3sJ8yiU

  3. Mood Disorders • 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.

  4. Types of Mood Disorders • Depressive Disorders • Bipolar Disorders • Others

  5. Depressive Disorders • Major Depressive Disorder • Dysthymic Disorder • Premenstrual Dysphoric Disorder • Bipolar Disorders Other Mood Disorders • Mood disorder due to a general medical condition • Substance-induced mood disorder

  6. Bipolar Disorders • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder

  7. Depression: Predisposing Factors • Biological theories • Genetics: • Biochemical influences: Neuroendocrine theories Physiological influences • Psychoanalytical theory • Mourning • Melancholia Learning theory Object loss Cognitive theory

  8. Depression: Developmental Implications Childhood Depression • Symptoms: Adolescence • Symptoms include: • Senescence Treatment • Postpartum Depression Treatment

  9. Assessment • Transient depression • Mild depression • Moderate depression • Severe depression

  10. Nursing Diagnosis

  11. Outcome

  12. Planning/Implementation

  13. Client/Family Education

  14. Evaluation

  15. Treatment Modalities

  16. Antidepressants Newer-generation antidepressants • Selective serotonin reuptake inhibitors (SSRIs) • Second- and third-generation antidepressants • Tricyclic antidepressants • Monoamine oxidase inhibitors (MAOIs)

  17. Contraindications/precautions • Contraindications/precautions • Contraindicated in known hypersensitivity (SSRIs, MAOIs, tricyclics); acute phase of recovery from myocardial infarction; angle-closure glaucoma (tricyclics); and concomitant with MAOIs (SSRIs and tricyclics). • Caution with elderly or debilitated clients; clients with hepatic, cardiac, or renal insufficiency; psychotic clients; clients with benign prostatic hypertrophy; and those with history of seizures (tricyclics, MAOIs).

  18. Antidepressants- SSRI • Generic Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine • Brand Prozac Paxil Zoloft Celexa Lexapro Luvox

  19. Serotonin Syndrome • Delirium Agitation • Tachycardia Sweating • Hyperreflexia Muscle spasms • Shivering Coarse tremors More severe cases • Hyperthermia Seizures • Renal failure Rhabdomyolysis • Dysrhythmias DIC

  20. Antidepressants • Generic Bupropion Mirtzapine Venlafaxine Duloxetine Amitriptyline Imipramine Phenelzine Selegiline • Brand Wellbutrin Remeron Effexor Cymbalta Elavil Tofranil Nardil Emsam

  21. Monoamine Oxidase Inhibitor • Nardil • Parnate • Marplan • Selegiline* *Available in a patch form called EMSAM Hypertensive Crisis and Tyramine

  22. Bipolar Disorder (Mania) Assessment Stage I—Hypomania Stage II—Acute mania Stage III—Delirious mania

  23. Bipolar Disorder (Mania) Childhood and Adolescence • Lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about 1 percent • Diagnosis is difficult • Guidelines for diagnosis and treatment have been developed by the Child and Adolescent Bipolar Foundation (CABF)

  24. Nursing Diagnosis

  25. Outcomes

  26. Planning/Implementation

  27. Client/Family Education

  28. Evaluation

  29. Psychopharmacology/Mood Stabilzers • Generic Lithum Valproic acid Carbamazepine Oxcarbazepine Lamotrigine Topiramate • Brand Eskalith, Lithobid Depakote, Depakene Tegretol, Equetro Trileptal Lamictal Topamax

  30. Planning/Implementation • Blood levels are needed for Lithium (0.4-1.2mEg/ml) Depakote (4-12 mEg/ml) Tegretol (4-12 meg/ml) • Monitor for side effects of lithium • Drowsiness, dizziness, headache • Dry mouth; thirst; GI upset; nausea/vomiting • Fine hand tremors • Hypotension; arrhythmias, pulse irregularities • Polyuria; dehydration • Weight gain --Potential for toxicity Symbyax is a combination of Prozac an antidepressant and Zyprexa an atypical major tranquilizer.

  31. Monitor for side effects of anticonvulsants • Nausea and vomiting • Drowsiness; dizziness • Blood dyscrasias • Prolonged bleeding time (with valproic acid) • Risk of severe rash (with lamotrigine) • Decreased efficacy with oral contraceptives (with topiramate

  32. Planning/Implementation(cont.) • Educate client and family about the medication Outcome Criteria/Evaluation

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