Mental Health Nursing II NURS 2310

1. Mental Health Nursing IINURS 2310 Unit 14 Affective Disorders

2. Key Terms Mood = 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

3. 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

4. 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

5. Objective 1 Discussing manifestations that identify and differentiate various affective disorders

6. Major Depressive Disorder (MDD) • Characterized by depressed mood or loss of interest or pleasure in usual activities • Impaired social/occupational functioning that has existed for at least 2 weeks w/no history of manic behavior Persistent Depressive Disorder • Also known as “dysthymia” • Chronically depressed mood for most of the day, more days than not, for at least 2 years; milder mood disturbance than MDD • No evidence of psychotic symptoms

7. Premenstrual Dysphoric Disorder • Depressed mood, anxiety, lability, and decreased interest in activities just prior to menses; symptoms improve upon onset Disruptive Mood Dysregulation Disorder • Childhood depression; presents before age 10 • Characterized by severe, recurrent temper outbursts that occur 2-3 times per week • Other symptoms include hyperactivity, delinquency, psychosomatic complaints, sleeping/eating disturbances, social isolation, delusional thinking, and suicidality

8. Postpartum Depression • Symptoms range from feeling “blue” to moderate depression to depressive psychosis • “Maternity blues” = Begins within 48 hours of delivery and lasts approximately 2 weeks • Moderate postpartum depression = Fatigue, irritability, sleep disturbance, loss of appetite; mother fears she will be unable to care for the baby; may last for several months • Depressive 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

9. Bipolar I Disorder • Individual is experiencing or has experienced at least one manic episode; may also have experienced episodes of depression Bipolar II Disorder • Recurrent bouts of MDD w/episodes of hypomania; no history of a full manic episode • Presents with symptoms of either depression or hypomania • Major depressive episodes may include psychotic or catatonic features

10. Cyclothymic Disorder • Recurring episodes of hypomanic symptoms and depressive symptoms that do not meet the criteria for either hypomania or MDD • Intervening periods of normalcy do not exceed 2 months at a time • Symptoms are severe enough to cause marked impairment in social/occupational functioning and/or to require hospitalization • Mood disturbance is chronic in nature, persisting at least 2 years

11. Objective 2 Recalling safety interventions necessary for the depressed and the manic client

12. Medication management • Anger management • Support groups • Individual psychotherapy • Crisis hotline • Hospitalization

13. Objective 3 Examining therapies appropriate for clients with an affective disorder

14. Individual psychotherapy • Group therapy • Family therapy • Cognitive behavioral therapy (CBT) • Psychopharmacology • Electroconvulsive therapy (ECT)

15. Objective 4 Reviewing the use, classifications, side effects, and nursing care related to medications for depression and mania

16. 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

17. 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)

18. 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)

19. 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

20. Objective 5 Applying the nursing process to a client with an affective disorder

21. 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

22. 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