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Mood Disorders Depressive and Bipolar DO. Mary Vercoutere, RN, MSN. Introduction. Mood DO Depressive DO disabling due to effect on thoughts, emotions, behaviors. Bipolar DO Coexisting Disorders Prevalence. Topics of Discussion. - PowerPoint PPT Presentation
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04/22/23 1
Mood DisordersDepressive
and Bipolar DO
Mary Vercoutere, RN, MSN
04/22/23 2
Introduction
Mood DODepressive DO disabling due to effect on thoughts, emotions, behaviors.Bipolar DOCoexisting DisordersPrevalence
04/22/23 3
Topics of Discussion
DSM IV Definition of Mood DO: Major Depression Or Unipolar DiseaseBipolar Disease Theory of cause: Genetic,Gender, Biological, Psychological, Situational.Assessing Suicide Potential.Nursing Interventions.
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DSM IV Criteria
Major Depression A change in functionClinical distress,impairedsocial, occupational, or other
important areas of functioning.
Five or more of the following most days for 2 weeks:
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Major DepressionDepressed Mood,every dayAnhedoniaSignificant weight gain or lossSleep disturbancesIncreased / decreased motor activityAnergia (lethargy)Feelings of guilt, helplessness, hopelessnessPoor concentration Recurrent thoughts of death/suicide
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Theory of Cause
Presence evaluated on a spectrum.Genetic abnormalities,
Activated (Shine)Dormant-normal development
The occurrence of stressful events.Difficult ongoing life situations with
a depletion of neurotransmitters.Grief-Support and coping skills
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Genetic Basis• Depression• 20% have one episode only.• An individual with a first-degree
relative has up to 40%-50% chance with an 8% vulnerability in the general population.
• Multiple genes are involved in Depression, more prevalent in women.
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Genetic Influence
Bipolar disease85% of risk inheritedMultiple genes involved in disease.
• Up to 60% chance of having the disease in identical twins.More prevalent in men.
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Spectrum of Mood Disorders
DysthymicCyclothymicSchizoaffective Post-partumCo-morbid Disorders
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Biochemical Basis of Mood DO
The neural networks of the brain and the prefrontal cortex.Limbic System: the emotional brain.Altered neurotransmitters: serotonin (5HT), dopamine, norepinephrine, acetylcholine (a critical neurotransmitter in brain plasticity).
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Neurobiology
Depression and PTSD have shown to damage the hippocampus.Hypercortisolemia: majority of unipolar and bipolar individuals have elevated cortisol levels.This causes neurotoxic effects: hippocampal atrophy.
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Organic Causes• Endocrine disorders:Diabetes, Cushing’s disease• Neurologic diseases:Parkinson’s and Alzheimer’s
disease Metabolic disturbances:Hypoxia and hypercalcemia• Cardiovascular diseases:Heart failure, Open Heart OR• Pulmonary disorders:COPD
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Drugs can cause depressionAntihypertensivesPsychotropicsAntiparkinsonian drugsAnalgesicsCardiovascular drugsSteroidsChemotherapeutic agentsCimetidine (Tagamet)Alcohol
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Symptom AssessmentSymptoms:
Client may report feeling “down in the dumps”.
• Change in appetite• Sleep disturbances• Difficulty concentrating and
easy distractibility• Low self-esteem• Poor coping and problem
solving skills
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Assessment Interview
You may notice agitation (wringing hands, restlessness)OrPsychomotor retardation (slow movement)With severe depression persons may have delusions of persecution or guilt.
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Nursing Assessment and Interventions
Assess for suicidalityStay alert for clues to suicidal
thoughts, stay with client.Findings:A preoccupation with death.Previous suicide attempts.Presence of a plan.
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Assessment FindingsPresence of Significant risk factorsProfound hopelessness.Concurrent medical illness.Substance abuse.
ALERT Mental Health staff!!!!
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Pharmacological Interventions
Antidepressants Prescribed: Variety of antidepressants that alter specific neurotransmitters.
Often 4 –6 weeks until a therapeutic result, if none another tried or added to initial
medication tried.
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Non-Pharmacological Therapies
Electroconvulsive Therapy-ECTAlternative Therapy.LifestyleNutritionalHerbal: SAMe St. John’s Wort
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Maintaining a Healthy Brain
A key to activating neuroplasticity:Paying Attention.
Learn something new.Evoking a mental picture will increase metabolic activity.Repeated activation strengthens areas of the brain.Exercise creates new capillaries to the brain.
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Integrative Medicine
CBT (cognitive behavioral therapy) modifies sensitivity to anxiety.Family Focused Therapy: problem solving for the family and psychosocial pressuresNational Alliance for the Mentally ill
NAMIEach client needs to be an involved
member of the team.
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Bipolar DisordersDepression is a low, sad state in which life seems dark and its challenges overwhelming,Bipolar is a pattern of alternating between moods.
Mania, the opposite of depression, is a state of breathless euphoria, and a frenzied energy.People have the mistaken belief that the world is theirs.
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Bipolar I and Bipolar II
Bipolar I is most severePatient has manic episodes and major depression.Bipolar IINot a severe mania, a milder one such as hypomania/ alternating with major depressive episodes.
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Incidence
Close to 3 million people have bipolar in the USA.www.manicdepression.orgCauseOnset in 20’ and 30’sMost patients have recurring episodes throughout their lifespan.
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Genetic Influence
Bipolar Disease has an 85% inheritable risk.Multiple genes involved.More prevalent in men.
04/22/23 26
Neurobiology
Bipolar DO:Ventricular enlargementSmaller hippocampus (critical
for memory and emotional regulation) amygdala, temporal lobe.
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Mania
Elation, euphoria, agitation or irritability, hyper-excitability, hyperactivity, rapid thought and speech, exaggerated sexuality, decreased sleep.Psychotic symptomsHypomania:An expansive, elevated, or agitated mood. Similar to mania but is less intense, no psychotic symptoms.
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Treatment for Bipolar Disorders
Mood Stabilizers.Anticonvulsants.Medications combined until therapeutic effect achieved.Quality of life is always important.Compliance is always important.The difficulty in treating women who are pregnant.
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TreatmentTreatment of bipolar I requires medicationLithium still a major therapy.Narrow range of safety as can be toxic (0.5-1mEq/L) Therapeutic blood levels in 7-10 days.Risk for Toxicity is high in patients with renal, heart disease, dehydration, salt depletion, on diuretics.
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Nursing Symptom Assessment
BehaviorAffectInterpersonal RelationshipsCultureAge-specific considerationsFunctionLife-specific considerations
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Assessment Interview
Rapid speechDifficulty sitting in a chair.Physical condition: weight loss, dehydration, poor ADL’sEvidence of psychosisSafety interventions
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Nursing InterventionsDuring manic phase, provide physical needs, ADL’s.Ensure safety with minimal stimulation.Provide emotional support.Limit setting and staff safety.Psycho education.Behavioral therapy re-educates in social skills, with attitude change.Group therapy.
04/22/23 33
Case Study
Client historyCurrent problemsClient’s PerceptionYour Perception and Assessment: non-emotional, non-judgmental, using inductive reasoning.Nursing Diagnosis.