Mental Health Mental Health Nursing IINursing II

NURS 2310NURS 2310

Unit 14Unit 14Affective DisordersAffective Disorders

Key TermsKey TermsMood = A pervasive, sustained emotion

that may have a major influence on a person’s perception of the world (sadness, joy, anger)

Affect = The emotional reaction associated with an experience

Depression = An alteration in mood that is expressed by feelings of sadness, despair, and pessimism; loss of interest in usual activities; change in appetite and sleep patterns; somatic symptoms may be present

Mania = An alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking/speaking; can occur as a biological or psychological disorder, or as a response to substance use or a general medical condition

Hypomania = as per above; not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization; psychotic features are absent

Acute mania = as per above; symptomology becomes intensified to the point of requiring hospitalization

Acute mania (cont’d) = Characterized by euphoria/elation, though mood varies frequently; racing/disjointed thinking which may include psychotic features; increased sexual interest w/poor impulse control; excessive energy; may neglect grooming

Delirious mania = A severe clouding of consciousness w/accompanying confusion, disorientation, and possibly stupor; extreme mood lability; delusional thinking w/grandiosity, religiosity, or persecution; auditory and/or visual hallucinations; frenzied psychomotor activity which places individual at risk for harming self or others, exhaustion, and even death if not resolved

Objective 1Objective 1

Discussing manifestations that identify and differentiate

various affective disorders

Major Depressive Disorder (MDD)Major Depressive Disorder (MDD)Characterized by depressed mood or loss of interest or pleasure in usual activitiesImpaired social/occupational functioning that has existed for at least 2 weeks w/no history of manic behavior

Persistent Depressive DisorderPersistent Depressive DisorderAlso known as “dysthymia”Chronically depressed mood for most of the day, more days than not, for at least 2 years; milder mood disturbance than MDDNo evidence of psychotic symptoms

Premenstrual Dysphoric DisorderPremenstrual Dysphoric DisorderDepressed mood, anxiety, lability, and decreased interest in activities just prior to menses; symptoms improve upon onset

Disruptive Mood Dysregulation Disruptive Mood Dysregulation DisorderDisorder

Childhood depression; presents before age 10Characterized by severe, recurrent temper outbursts that occur 2-3 times per weekOther symptoms include hyperactivity, delinquency, psychosomatic complaints, sleeping/eating disturbances, social isolation, delusional thinking, and suicidality

Postpartum DepressionPostpartum DepressionSymptoms range from feeling “blue” to moderate depression to depressive psychosis“Maternity blues” = Begins within 48 hours of delivery and lasts approximately 2 weeksModerate postpartum depression = Fatigue, irritability, sleep disturbance, loss of appetite; mother fears she will be unable to care for the baby; may last for several monthsDepressive psychosis = depressed mood, agitation, indecision, lack of concentration, guilt; often includes lack of interest in or rejection of the baby; mother may be at risk of suicide and/or infanticide

Bipolar I DisorderBipolar I DisorderIndividual is experiencing or has experienced at least one manic episode; may also have experienced episodes of depression

Bipolar II DisorderBipolar II DisorderRecurrent bouts of MDD w/episodes of hypomania; no history of a full manic episodePresents with symptoms of either depression or hypomaniaMajor depressive episodes may include psychotic or catatonic features

Cyclothymic DisorderCyclothymic DisorderRecurring episodes of hypomanic symptoms and depressive symptoms that do not meet the criteria for either hypomania or MDDIntervening periods of normalcy do not exceed 2 months at a timeSymptoms are severe enough to cause marked impairment in social/occupational functioning and/or to require hospitalizationMood disturbance is chronic in nature, persisting at least 2 years

Objective 2Objective 2

Recalling safety interventions necessary for the depressed

and the manic client

Medication management

Anger management

Support groups

Individual psychotherapy

Crisis hotline

Hospitalization

Objective 3Objective 3

Examining therapies appropriate for clients with an affective disorder

Individual psychotherapy

Group therapy

Family therapy

Cognitive behavioral therapy (CBT)

Psychopharmacology

Electroconvulsive therapy (ECT)

Objective 4Objective 4

Reviewing the use, classifications, side effects, and nursing care related to medications for depression

and mania

Antidepressants elevate mood and alleviate other symptoms associated with moderate to severe depression– SSRIs and tricyclics increase the

concentration of norepinephrine, serotonin, and/or dopamine in the body by blocking the reuptake of these neurotransmitters

– MAOIs inhibit monoamine oxidase enzymes that inactivate norepinephrine, serotonin and/or dopamine in the body

Mood stabilizers help to suppress swings between mania and depression– Enhances reuptake of norepinephrine and

serotonin, decreasing levels in the body and resulting in decreased hyperactivity

Antidepressants– Tricyclics

Amitriptyline (Elavil)– SSRIs

Citalopram (Celexa) Fluoxetine (Prozac) Sertraline (Zoloft)

– MAOIs Phenelzine (Nardil)

– Miscellaneous Agents Bupropion (Zyban, Wellbutrin) Trazodone (Desyrel) Venlafaxine (Effexor) Duloxetine (Cymbalta)

Mood Stabilizers– Antimanics

Lithium carbonate (Eskalith, Lithobid)– Anticonvulsants

Valproic acid (Depakote) Lamotrigine (Lamictal) Topiramate (Topamax)

– Calcium Channel Blockers Verapamil (Isoptin)

– Antipsychotics Aripiprazole (Abilify) Quetiapine (Seroquel) Risperidone (Risperdal)

Side effects of antidepressants may include– Dry mouth, sedation, nausea– Decreased seizure threshold– Increased suicide potential– Discontinuation syndrome

Gradual termination reduces withdrawal symptoms– Serotonin syndrome with SSRI use– Hypertensive crisis with MAOI use

Side effects of mood stabilizers are specific to medication class– Lithium carbonate has narrow margin of safety

Lithium toxicity can be fatal Monitor sodium intake

Objective 5Objective 5

Applying the nursing process to a client with an affective

disorder

Assessment– Gather information about client’s mood and

level of anxiety, thoughts to harm self/others Diagnosis

– Risk for self-directed violence R/T suicidal feelings

– Risk for violence directed toward others R/T homicidal ideation

– Imbalanced nutrition, less than body requirements R/T lack of interest in food

– Disturbed sleep pattern R/T depression– Anxiety R/T panic disorder– Social isolation R/T agoraphobia

Planning– Care plan– Concept map

Implementation– Establish trust– Provide for safety– Perform risk assessment– Administer scheduled and PRN medications

Evaluation– Mental health/psychiatric assessment tool– Review safety plan/contract– Assess for medication side effects