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7/31/2019 Alterations in Mental Health Mood Disorders
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Mood Disorders
Highs
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significant loss
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orma vs ys unct ona
12-24 Months Somatic distress
Prolonged response Delayed response
Preoccupation
Guilt/An er
Exaggerated
symptoms of normal
Behavior Changes
grief
Pp. 615-616
(Varcarolis)
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actors e ect ng gr e response
Level of dependency in the relationship
Age of the deceased +/or grieving person ereave person s suppor sys em
Physical and psychological health of the
bereaved individual
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urs ng ct ons
Goal Mourning is complete
Interventions Allow privacy and
when the bereaved
can remember
realisticall both the
provide support
Always offer and allow
pleasures and
disappointments of Recognize cultural
needs
and begin to form new
interests and
Acknowledge feelings
Simply allowing
relationships.
negative emotions
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oo sor ers
Manic mood: Bipolar I Hypomanic mood:
Bipolar II; Cyclothymic
Disorder Euthymic mood:
normal
Dysthymic mood: moderate: Dysthymic
severe: a or
Depressive Disorder
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Disorders
Depressed mood Anhedonia
Feelings ofworthlessness &
Decreased
concentration/difficul
inappropriate guilt
Suicidal thoughtsty making decisions
Negative thinking re
Anger, irritability
Vegetative signs:
self, environment,future
disturbance in eating,sleeping; loss of
syc omotor
agitation/retardation
,
constipation
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ypes o oo sor ers
Dysthymic Disorder Chronic depression (at
Cyclothymic Disorder Chronic fluctuating
least 2 years)
Mild to moderate
mood
Hypomanic & mild to
Able to function
Depression is
Substance -induced
normal
High risk for major
mood disturbance
within a month of
withdrawal
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General Medical Condition
Medication SE(Steroids, Prevalence ofComorbid Depression:
,Oral Contraceptives)
ro e -
Cancer 18-39%
-Endocrine, Hormonal(PMS), Post-viral
HIV 8-10%
In-pt 12%
, ,Diabetes
Out-pt 2-15%
.
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Onset gradual or inresponse to a crisis
Slow incidious onset
Impaired concentration,
focus, attention
judgment, agnosia
Function deteriorates as ecrease energy,
motivation, early am
awakening; morning is their
e ay progresses
sundowning
bad time
Affect sad, blunted, irritable
,
Speech contains
confabulation &
peec s ow, at, ow c rcumstant a ty
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a or epress ve sor er
17%Lifetime prevalenc >25% rate in Nsg Hs
15% Suicide rate
2x rate in women
Masked by somatic
complaints,
hyperactivity & poorschool performance
Comorbid anxiety
common
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,..(Specifiers)
Psychotic features (Mood congruent)
disturbance)
Seasonal Affective Patterns
Postpartum onset Severe depression occurring within 4 weeks of
delivery/30-50% risk of recurrence with each
subsequent delivery
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t o ogy o epress on
Biologic Theories Genetic: 1.5-3x in 1st
Cognitive Theories:identify, refute and
degree
relatives/>incidence
in alcohol de . & ADHD
replace negative
thoughts
Biochemical:
Seratonin;Neurepinep
syc oana yt c:
Aggression turned
r ne re a ons p ostress regulation
Learned Helplessness
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s actors or epress on
Chronic Illness Female Gender
Bereavement
Perfectionistic
Situational stressors
Family History
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urs ng ssessment
Where/ Who? ALL clients in ALL settings , ,
Thought Process: Slow, negative,
,
Feelings: Worthless, guilty, sad, helpless &
ope ess, angry rr a e Physical: Disturbance in grooming, eating ,
sleeping, energy, elimination, activity
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u c e ssessment
75-80% give clues Verbal clues
overt statements
covert statements Behavioral clues
sudden changes
g v ng awaypossessions
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u c e ssessment
Assessing risk factors: Is there a plan? How lethal?
How available?
Support system
Severe life stressors
Men over 65
Previous attempts increaserisk
As meds lift depression, itmay allow for energy to acton suicidal thoughts
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Nursing Diagnoses
Risk for Suicide
Coping
Impaired Social Interaction
Chronic Low Self-esteem Disturbed Thou ht Processes
Interrupted Family Processes
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ann ng
Short term goals safety needs met
physiologic needs met
Long Term Goals
improved coping
resume ro eexpectations
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In the Hospital
Remove harmful items Support self-care
Educate client andfamily re S&S of
activities
Monitor food, fluid,
depression and
management of meds
weight, sleep,
elimination
rov e structure
1:1 relationship
Support andencourage
tolerated
Su ort co in skills on tor e ects o tx
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Hospital
Safe environment:Check on admission,
Levels of suicideprecaution (p.739,
after passes and after
visitors
Varcarolis)
q 15-30 checks ss gn to room near
the nursing station
ose o serva on,
accompany to BR
- -
Change of shifthours/day
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Community
Work with the client and their family to:
Assess for Substance Abuse
,establishing structure for self-care
Establish healthy methods to express feelings
and obtain emotional su ort
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Electroconvulsant Therapy -ECT
90% efficacy seizure occurs
Informed consent Short procedure
6-12 treatments
Refractor
NPO
Atropine, Brevital,
depression, suicidal,
psychotic depression
nect ne,
Short-term side
Medical conditionscontraindicating
,
disorientation
me s
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Inhibitors (SSRI)
Block neuronalreuptake of seratonin,
Prozac, Paxil, Zoloft,Luvox, Celexa, Lexapro
enhancing action of
seratonin at synapse
Side Effects:
GI complaints as y to erate
Tx of
Anxiety/agitation
Insomnia/Somnolence
, , ,Bulimia
Appetite increase or
-
Less toxic in overdose
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TCA
Inhibit reuptake of NE& Seratonin by
Side Effects: Anticholinergic
presynaptic neurons
Effects in 2 weeks, full
Sedation
Changes in appetitee ects - wee s
Dangerous in
ar otox c n sma
percent: Dysrhythmias,
tachycardia, MI, Heart
cardiotoxic effects /block
Elavil, Norpramin,
supplydisorder)
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typ ca nt epressants
Desyrel (Trazadone):Used for mild- Wellbutrin: Used totreat refractory
moderate depression/
commonly used for
depression and
marketed for smoke
disturbance
.
Greater incidence of
Benzodiazepine used
to treat anxious mild-
fewer sexual SE
moderate depression
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(MAO Inhibitors)
MAO is an enzyme thatbreaks down Diet restrictions:Aged cheeses &
tyramine, therefore,
these drugs create a
wines, yeast, salami,
pepperoni, game meat
crisis resulting from
, ,
organ meats, bananas,
Tx atypical depression
Many drug-drug
interactions, ,
Marplan
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Inhibitors
Inhibit both Seratoninand NE without the Serzone: sedating Effexor: Short half-lifenumber of SE of TCAs
Remeron: Increases
appetite, fewer druginteractions
Cymbalta
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Antidepressant Medications Assess for Effects & SE
Encourage use for at least
Assess for suicidepotential
Assess for use of over the
counter drugs (Herbal
abuse
Assess clients
Seratonin Syndrome:agitation, flushing,
compliance withprescribed regimen
diaphoresis, diarrhea,mental statuschange,tremors
Encourage psychotherapyin addition to drug tx