Date post: | 23-Dec-2015 |
Category: |
Documents |
Upload: | alexandra-phillips |
View: | 220 times |
Download: | 1 times |
Bipolar and Related Bipolar and Related Disorders, Depressive Disorders, Depressive
Disorders, Schizophrenia Disorders, Schizophrenia SpectrumSpectrum
Trisha EconomidisTrisha Economidis
Marilee EliasMarilee Elias
Lake-Sumter State CollegeLake-Sumter State College
Fall, 2014Fall, 2014
MoodMood
Also called pervasive and sustained Also called pervasive and sustained emotion that may have a major emotion that may have a major influence on a person’s perception of influence on a person’s perception of the world.the world.
DepressionDepression JoyJoy ElationElation AngerAnger AnxietyAnxiety
Bipolar DisorderBipolar Disorder
A psychobiological disorder A psychobiological disorder characterized by alternating mood characterized by alternating mood disturbances of mania, hypomania, disturbances of mania, hypomania, depression and mixed episodesdepression and mixed episodes
Etiology of Bipolar DisorderEtiology of Bipolar Disorder
Strong genetic linkStrong genetic link May be related to hormone May be related to hormone
imbalancesimbalances Neurotransmitter levels definitely Neurotransmitter levels definitely
implicatedimplicated
Mania SymptomsMania Symptoms
Racing thoughts, increased energy, Racing thoughts, increased energy, less need for sleepless need for sleep
TalkativeTalkative More self-confident than usualMore self-confident than usual Focused on getting things done, while Focused on getting things done, while
accomplishing littleaccomplishing little Risky or unusual activities to the Risky or unusual activities to the
extremeextreme
Depression - SymptomsDepression - Symptoms
Sadness, anhedoniaSadness, anhedonia Feeling worthless, hopeless, guiltyFeeling worthless, hopeless, guilty Sleep disturbancesSleep disturbances Appetite/weight changesAppetite/weight changes AnergiaAnergia RestlessnessRestlessness Problems concentrating or making decisionsProblems concentrating or making decisions Thoughts of death or suicideThoughts of death or suicide
Bipolar Disorder TreatmentBipolar Disorder Treatment
LithiumLithium Must be at therapeutic level – Must be at therapeutic level –
1-1.5mEq/L for acute mania; 1-1.5mEq/L for acute mania; 0.6-1.2 mEq/L for maintenance0.6-1.2 mEq/L for maintenance
Can easily become toxicCan easily become toxic Many side-effectsMany side-effects
Other pharmacological Other pharmacological treatmentstreatments
Anticonvulsant (antiepileptic) meds Anticonvulsant (antiepileptic) meds often first-line treatment as well – often first-line treatment as well – Valproic Acid (Depakote), Lamotrigine Valproic Acid (Depakote), Lamotrigine (Lamictal), Carbamazepine (Tegretol)(Lamictal), Carbamazepine (Tegretol)
Antipsychotics may be used alone or in Antipsychotics may be used alone or in combination with lithium; Risperidone combination with lithium; Risperidone (Risperdal), Olanzepine (Zyprexa), (Risperdal), Olanzepine (Zyprexa), Aripiprazole (Abilify)Aripiprazole (Abilify)
Antidepressants used VERY cautiouslyAntidepressants used VERY cautiously AnxiolyticsAnxiolytics
Tips for Preventing Manic Tips for Preventing Manic EpisodesEpisodes
Get plenty of sleepGet plenty of sleep Set reasonable work hoursSet reasonable work hours Join a support groupJoin a support group Take meds as prescribedTake meds as prescribed Track history of episodes, looking for Track history of episodes, looking for
triggerstriggers Avoid destabilizers (alcohol, drugs, Avoid destabilizers (alcohol, drugs,
caffeine)caffeine)
Consider psychotherapyConsider psychotherapy Get regular check-ups with primary Get regular check-ups with primary
care physiciancare physician Have someone you trust monitor Have someone you trust monitor
your behavior and moods. Bipolar your behavior and moods. Bipolar disorder often attacks insight firstdisorder often attacks insight first
Depressive DisordersDepressive Disorders Major Depressive DisorderMajor Depressive Disorder Persistent Depressive DisorderPersistent Depressive Disorder
(Dysthymia)(Dysthymia) Premenstrual Dysphoric DisorderPremenstrual Dysphoric Disorder Depressive Disorder due to Depressive Disorder due to
another medical conditionanother medical condition Substance/Medication-induced Substance/Medication-induced
Depressive DisorderDepressive Disorder
DepressionDepression
Depression and anxiety are most Depression and anxiety are most common psychiatric disorders seen common psychiatric disorders seen in primary carein primary care
Less than 50% of those with Less than 50% of those with depression actually ask for helpdepression actually ask for help
It is a potentially lethal illnessIt is a potentially lethal illness
Risk Factors for DepressionRisk Factors for Depression
Family historyFamily history Personal historyPersonal history Female genderFemale gender Life stressorLife stressor Loss of parents at young ageLoss of parents at young age Childhood abuseChildhood abuse
Risk factors, cont.Risk factors, cont.
Alcohol or substance abuseAlcohol or substance abuse Anxiety disordersAnxiety disorders Neurologic or medical disordersNeurologic or medical disorders Primary sleep disordersPrimary sleep disorders ElderlyElderly Post-partumPost-partum
Treatment for DepressionTreatment for Depression
Individual PsychotherapyIndividual Psychotherapy Group and/or family therapyGroup and/or family therapy PsychopharmacologyPsychopharmacology
SSRI’sSSRI’s SNRI’sSNRI’s Atypical antidepressants (Mirtazapine Atypical antidepressants (Mirtazapine
(Remeron), Bupropion HCL (Welbutrin))(Remeron), Bupropion HCL (Welbutrin)) Others as discussed with anxiety Others as discussed with anxiety
treatmenttreatment
SuicideSuicide 1111thth leading cause of death in the U.S. leading cause of death in the U.S. Males successful 4 times more often Males successful 4 times more often
than femalesthan females Females attempt suicide 3 times more Females attempt suicide 3 times more
often than malesoften than males Firearms are most commonly used by Firearms are most commonly used by
malesmales Poisoning is most common method by Poisoning is most common method by
femalesfemales
Suicide Myths or FactsSuicide Myths or Facts
People who commit suicide always People who commit suicide always leave a noteleave a note
Myth or FactMyth or Fact
People who die from suicide don’t People who die from suicide don’t warn otherswarn others MythMyth OrOr FactFact
Myth or FactMyth or Fact
People who talk about suicide are People who talk about suicide are only trying to get attention. They only trying to get attention. They won’t really do it.won’t really do it. MythMyth OrOr FactFact
Myth or FactMyth or Fact
Don’t mention suicide to someone Don’t mention suicide to someone who’s showing signs of severe who’s showing signs of severe depression. It will plant the idea in depression. It will plant the idea in their minds, and they will act on it.their minds, and they will act on it. MythMyth OrOr FactFact
Myth or FactMyth or Fact
If a person attempts suicide and If a person attempts suicide and survives, they will never make a survives, they will never make a further attempt.further attempt. MythMyth OrOr FactFact
Myth or FactMyth or Fact
MYTH: Many suicide methods are MYTH: Many suicide methods are very painful.very painful.
Warning Signs of Suicidal Warning Signs of Suicidal Thoughts or IntentThoughts or Intent
Recent suicide or death of a Recent suicide or death of a friend/relativefriend/relative
Previous suicide attemptPrevious suicide attempt Preoccupation with deathPreoccupation with death DepressionDepression Giving away prized possessionsGiving away prized possessions Major change in sleep patternsMajor change in sleep patterns Changes in eating patternsChanges in eating patterns
Warning Signs, cont.Warning Signs, cont.
Withdrawal from friends/familyWithdrawal from friends/family Dropping out of group activitiesDropping out of group activities Personality changesPersonality changes Irritability or unexplained cryingIrritability or unexplained crying Expressions of failureExpressions of failure Lack of interest in the futureLack of interest in the future
Warning Signs, cont.Warning Signs, cont. Frequent school absence, poor Frequent school absence, poor
performanceperformance Expressions of self-destructive Expressions of self-destructive
behavior, verbal hintsbehavior, verbal hints SUDDEN cheerfulness after a SUDDEN cheerfulness after a
period of depression as though period of depression as though there is relief from the sufferingthere is relief from the suffering
SAD PERSONS SCALESAD PERSONS SCALEA Suicide Risk AssessmentA Suicide Risk Assessment
S – Sex – 1 pt if maleS – Sex – 1 pt if male A – Age – 1 pt if 25-44, or 65+A – Age – 1 pt if 25-44, or 65+ D – Depression – 1 pt if presentD – Depression – 1 pt if present P – Previous attempt – 1 ptP – Previous attempt – 1 pt E – Ethanol use – 1 ptE – Ethanol use – 1 pt R – Rational thinking loss – 1 pt if R – Rational thinking loss – 1 pt if
psychoticpsychotic
SAD Person Scale, cont.SAD Person Scale, cont.
S – Social supports lacking – 1 ptS – Social supports lacking – 1 pt O – Organized plan – 1 ptO – Organized plan – 1 pt N – No spouse – 1 ptN – No spouse – 1 pt S – Sickness – 1 ptS – Sickness – 1 pt 0-2 Send home with follow-up0-2 Send home with follow-up 3-4 Closely follow or hospitalize3-4 Closely follow or hospitalize 5-6 Strongly consider hospitalization5-6 Strongly consider hospitalization 7-10 Hospitalize or commit7-10 Hospitalize or commit
Interventions for Outpatient Interventions for Outpatient Client Client
Don’t leave client aloneDon’t leave client alone Establish a no-suicide contractEstablish a no-suicide contract Make sure environment is safeMake sure environment is safe Establish frequent appt scheduleEstablish frequent appt schedule Establish therapeutic relationshipEstablish therapeutic relationship Be directBe direct
Interventions, cont.Interventions, cont.
Be aware that antidepressant use Be aware that antidepressant use may increase risk of suicide in 1-3 may increase risk of suicide in 1-3 weeks after they’ve been started. weeks after they’ve been started. Level of energy increases and they Level of energy increases and they are more able to carry out a plan.are more able to carry out a plan.
Schizophrenia Spectrum Schizophrenia Spectrum and other Psychotic and other Psychotic
DisordersDisorders Now viewed as a spectrum of Now viewed as a spectrum of
disorders from least severe to most disorders from least severe to most severesevere
Brief Psychotic DisorderBrief Psychotic Disorder Delusional Disorder Delusional Disorder Psychotic Disorder due to another Psychotic Disorder due to another
medical conditionmedical condition SchizophreniaSchizophrenia
SchizophreniaSchizophrenia
Affects more than 2 million people in Affects more than 2 million people in the USthe US
1 in every 100 people, across 1 in every 100 people, across culturescultures
Chronic, severe, disabling brain Chronic, severe, disabling brain disease that has no known disease that has no known singlesingle causecause
Schizophrenia EtiologySchizophrenia Etiology
Current theory is Variable Current theory is Variable Combination of:Combination of: Genetic PredispositionGenetic Predisposition Biochemical DysfunctionBiochemical Dysfunction Physiological FactorsPhysiological Factors Psychosocial StressPsychosocial Stress
Common Symptoms – Content Common Symptoms – Content of Thoughtof Thought
Delusions:Delusions: Delusion of PersecutionDelusion of Persecution Delusion of GrandeurDelusion of Grandeur Delusion of ReferenceDelusion of Reference Delusion of ControlDelusion of Control
ReligiosityReligiosity
ParanoiaParanoia
Symptoms – Form of Symptoms – Form of ThoughtThought
Associative LoosenessAssociative Looseness NeologismsNeologisms Concrete ThinkingConcrete Thinking Clang associationsClang associations Word SaladWord Salad TangentialityTangentiality PerseverationPerseveration
Symptoms - PerceptionSymptoms - Perception
HallucinationsHallucinations AuditoryAuditory VisualVisual TactileTactile GustatoryGustatory OlfactoryOlfactory
IllusionsIllusions
Symptoms – Sense of SelfSymptoms – Sense of Self
EcholaliaEcholalia EchopraxiaEchopraxia DepersonalizationDepersonalization
Symptoms - AffectSymptoms - Affect
Inappropriate AffectInappropriate Affect Flat or blunted affectFlat or blunted affect ApathyApathy
Symptom - VolitionSymptom - Volition
Ambivalence – Conflicting ideas, Ambivalence – Conflicting ideas, emotions, ideas at the same time emotions, ideas at the same time about a particular person, situationabout a particular person, situation
Symptoms – Impaired Symptoms – Impaired Interpersonal FunctioningInterpersonal Functioning
Autism – living in a fantasy worldAutism – living in a fantasy world Deteriorated appearance – lack of Deteriorated appearance – lack of
self-careself-care
Symptoms – Psychomotor Symptoms – Psychomotor BehaviorBehavior
Pacing and rockingPacing and rocking Anergia – lack of energyAnergia – lack of energy
Symptoms – Associated Symptoms – Associated featuresfeatures
AnhedoniaAnhedonia RegressionRegression
Positive Symptoms (Something Positive Symptoms (Something present that shouldn’t be present that shouldn’t be
there)there) DelusionsDelusions HallucinationsHallucinations Disorganized thinking and Disorganized thinking and
speechspeech Disorganized behaviorsDisorganized behaviors
Negative Symptoms Negative Symptoms (Something missing that (Something missing that
should be there)should be there) Flat or blunted affectFlat or blunted affect AlogiaAlogia Avolition/apathyAvolition/apathy AnhedoniaAnhedonia Social IsolationSocial Isolation
TreatmentTreatment
Psychoanalytic psychotherapy?Psychoanalytic psychotherapy? Why NOT?Why NOT?
Treatment ProgramsTreatment Programs PsychopharmacologyPsychopharmacology Teaching Client to manage symptomsTeaching Client to manage symptoms Supportive Family TherapySupportive Family Therapy Reality Oriented PsychotherapyReality Oriented Psychotherapy
PsychopharmacologyPsychopharmacology
AntipsychoticsAntipsychotics Side effects make compliance difficultySide effects make compliance difficulty Up to 75% of schizophrenics smoke – Up to 75% of schizophrenics smoke –
the nicotine decreases the effectiveness the nicotine decreases the effectiveness of the medicationof the medication
Dopamine believed to be the Dopamine believed to be the neurotransmitter most closely linked to neurotransmitter most closely linked to schizophreniaschizophrenia
Atypical AntipsychoticsAtypical Antipsychotics
Block both serotonin and dopamine Block both serotonin and dopamine receptorsreceptors
Treat positive and negative symptomsTreat positive and negative symptoms Have fewer side effects by still have Have fewer side effects by still have
unpleasant onesunpleasant ones Clozapine (Clozaril), Respiridone Clozapine (Clozaril), Respiridone
(Risperdal), Olanzepine (Zyprexa), (Risperdal), Olanzepine (Zyprexa), Quietapine (Seroquel), Ziprasidone Quietapine (Seroquel), Ziprasidone (Geodon), Aripiprazole(Abilify)(Geodon), Aripiprazole(Abilify)
Typical or Conventional Typical or Conventional AntipsychoticsAntipsychotics
Many side effects including Extrapyramidal Many side effects including Extrapyramidal symptoms:symptoms: DystoniasDystonias AkathesiaAkathesia ParkinsonismParkinsonism Tardive dyskinesiaTardive dyskinesia Life-Threatening Side Effect: Neuroleptic Life-Threatening Side Effect: Neuroleptic
Malignant SyndromeMalignant Syndrome Haloperidol (Haldol), Fluphenazine (Prolixin), Haloperidol (Haldol), Fluphenazine (Prolixin),
Chlorpromazine (Thorazine), Thioridazine Chlorpromazine (Thorazine), Thioridazine (Mellaril)(Mellaril)
Coming AttractionsComing AttractionsIt’s All Psych The End Class It’s All Psych The End Class
55 Personality D/OsPersonality D/Os Eating D/OsEating D/Os D/Os common in Children & D/Os common in Children &
AdolescentsAdolescents Pharmacological & Non-Pharmacological & Non-
pharmacological management of pharmacological management of these D/Osthese D/Os