Untitled

Mood Disorders

• Mood relates to a person's emotional state over time.
• Euphoria (elevated mood) and Anhedonia (inability to feel pleasure) are signs of mood.
• Major Depressive Disorder (MDD) involves sadness, hopelessness, loss of interest, sleep/appetite disturbances, low energy, and increased suicide risk.
• Bipolar Disorder (BPD) involves alternating depression and mania.
• Mania presents as hyperactivity, little need for sleep, grandiosity, impulsivity, and possible delusions/hallucinations.
• The key difference between MDD and BPD is at least one manic episode in BPD.

Mood Disorders Across the Lifespan

• Genetic predisposition, bullying, financial stress, school issues, and difficulty articulating emotions are associated with mood disorders in Children & Adolescents.
• High-stress professions, relationship struggles, and life transitions are associated with mood disorders in Adults.
• Chronic illnesses, loss of loved ones, and isolation are associated with mood disorders in Older Adults.
• Maternal stress impacting fetal development and increasing risk of neuropsychiatric disorders are associated with mood disorders in prenatal & postpartum stages.

Assessment and Nursing Interventions

• Key factors of Depression Assessment are sleep disturbances, loss of interest in activities, overwhelming sadness/guilt/hopelessness, appetite changes, and suicidal thoughts.
• When assessing for depression, screen for suicidal thoughts; especially during the first 3 months of symptoms.
• Nursing Assessment includes evaluating family relationships, support systems, screening for substance use, and coping skills.

Mood Disorder Treatments

• Medication options include antidepressants (SSRIs, SNRIs, TCAs, MAOIs, atypical antidepressants), and mood stabilizers.
• SSRIs (e.g., Paroxetine) are generally first-line but take weeks to take effect.
• SNRIs (e.g., Duloxetine, Venlafaxine) requires pre-assessment because it can lower blood pressure.
• MAOIs (e.g., Phenelzine) require avoiding tyramine to prevent hypertensive crisis.
• Atypical antidepressants (e.g., Trazodone) are often used for insomnia; avoid caffeine.
• NDRIs (e.g., Bupropion) are prescribed for depression and to aid in smoking cessation.
• Mood stabilizers include lithium, valproic acid, lamotrigine, and carbamazepine.
• Lithium enhances norepinephrine and serotonin reuptake, reducing hyperactivity.
• Key considerations for patients on lithium: monitor sodium intake, hydration (2-3L/day), kidney function, and therapeutic drug levels.
• Signs of lithium toxicity are N/V/D, mental confusion, seizures, and MI.
• Therapeutic range for lithium: 0.5-1.5 mEq/L with concern above 1.8, toxicity above 2.0.
• Anticonvulsants (Depakote, Lamictal, Carbamazepine, Valproic Acid) require monitoring liver function and checking for side effects like severe rash with Lamictal.
• Antipsychotics can be used for treatment-resistant depression or severe mania.
• Electroconvulsive Therapy (ECT) is an option for treatment-resistant depression, catatonia, or severe mood disorders. Requires informed consent, pre-oxygenation, anticholinergic administration, and sedation and involves a controlled seizure to reset neurotransmitters.
• Combination therapy includes medication, psychotherapy, and social support, which is important because medications alone do not resolve underlying behavioral patterns.

Nursing Interventions

• Nursing interventions include prioritizing safety, promoting nutrition (small, frequent meals), structured sleep patterns, therapeutic communication (open-ended questions), and medication adherence.
• SSRIs (e.g., Paroxetine) take weeks to work; side effects include nausea, weight gain, and sexual dysfunction.
• SNRIs (e.g., Duloxetine, Venlafaxine) can lower blood pressure and require pre-assessment.
• TCAs (e.g., Amitriptyline) can cause sedation, weight gain, dry mouth, and cardiac effects.
• MAOIs (e.g., Phenelzine) require avoiding tyramine-rich foods to prevent hypertensive crisis.
• For lithium: monitor for toxicity (N/V/D, tremors, confusion, blurred vision, MI risk) and requires regular monitoring of sodium levels and kidney function.
• Interventions include continuous monitoring for suicidal/homicidal ideation focused on safety, medication education on adherence and adverse effects (lithium toxicity), supporting independence with ADLs and regular meals/rhythm, therapeutic communication (“Tell me more”), and ensuring environmental safety.

Schizophrenia

• Key components for assessment include positive symptoms (hallucinations, delusions, and illusions), negative symptoms (flat affect, apathy, poor self-care, and poverty of speech), and cognitive symptoms (memory issues, impaired judgment, the difficulty of making decisions).
• Open-ended questions help assess the severity and risk of harm (e.g., ask about voices). It is important to recognize command hallucinations, as the increase the risk of self-harm or harm to others.

Schizophrenia - Nursing

• Assess for safety concerns (command hallucinations, self-harm risk), medication adherence, and side effects, plus nutritional status, hygiene, and overall self-care.
• Risks include self-harm or harm to others, impaired thought processes and social interaction, social isolation, self-care deficit, and medication nonadherence due to paranoid delusions.
• Planning involves establishing short- and long-term goals (medication adherence, participation in therapy) and developing interventions based on symptoms (communication strategies for hallucinations, reinforcement for self-care activities).
• During the acute phase (hospitalized care), ensure safety by reducing stimuli, monitoring hallucinations/delusions, and preventing self-harm, plus establishing trust with simple, direct communication, and administering prescribed antipsychotics.
• Focus on medication adherence (patients resist due to paranoia/side effects), psychotherapy ( CBT/Group) and family education, and support for relapse prevention in the maintenance/stabilization phase.
• Use therapeutic communication ("Tell me more about the voices") and administer medications as prescribed, while monitoring for side effects (EPS, metabolic syndrome, NMS).
• Provide education on medication adherence and symptom management, encouraging therapy/support groups and promote family involvement/psychoeducation.
• Evaluate for reduced hallucinations and improved reality-based thinking, improved medication adherence and symptom management, and increased social interaction/self-care abilities.

Positive, Negative and Cognitive Symptoms of Schizophrenia

• Positive symptoms are hallucinations (sensory perceptions without external stimuli), delusions (false fixed beliefs), illusions (misinterpretation of stimuli), and disorganized thinking (associative looseness, word salad).
• Negative symptoms are flat affect (little emotional expression), apathy (lack of motivation), anhedonia (inability to feel pleasure), poverty of speech (one-word answers, minimal speech), and social withdrawal/lack of motivation for self-care.
• Cognitive Symptoms are impaired problem-solving skills, memory/concentration, inability to plan/organize thoughts, and associative looseness (disconnected thoughts).
• First-generation antipsychotics (Haloperidol, Chlorpromazine) treat positive symptoms but carry a high risk for extrapyramidal symptoms (EPS) (dystonia, akathisia, tardive dyskinesia).

Treatment

• Second-generation antipsychotics treat both positive and negative symptoms; for Clozapine, monitor WBC for agranulocytosis because flu-like symptoms indicate risk for sepsis.
• Risperidone, Olanzapine, and Quetiapine can cause metabolic syndrome (weight gain, diabetes, cardiovascular risks).
• Third-generation antipsychotic Aripiprazole carries a lower risk of EPS/metabolic side effects, plus a Black Box Warning for increased mortality in dementia patients and suicidal ideation in young adults.
• Benztropine reduces dystonia and tardive dyskinesia, to manage EPS.
• Monitor weight, blood sugar, and cholesterol for metabolic syndrome, and educate about slow position changes for orthostatic hypotension.
• Family support/education reduces relapse rates, and encourage community programs for stable housing/job support.
• Common nonadherence is often due to paranoia/severe side effects, family plays a key role in ensuring treatment adherence.
• Benztropine reduces symptoms like dystonia and akathisia, to manage EPS, plus monitor for tardive dyskinesia/parkinsonism-like symptoms.
• Non-pharmacological treatments are psychotherapy, CBT, family therapy, and community support.
• Prodromal Phase includes early signs, like anxiety, withdrawal, and intrusive thoughts for 1mo-1yr before the psychotic episode.
• Acute Phase includes active psychotic symptoms, hospitalization often required.
• Clients with schizophrenia experience a 15% shorter lifespan due to lifestyle factors, medication side effects (cardiovascular risk, diabetes), and social determinants (housing instability, access to care).
• Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to antipsychotics (fever, muscle rigidity, altered mental status).
• Metabolic Syndrome's risk increases with atypical antipsychotics, plus requires monitoring for obesity, cardiovascular issues, and diabetes.

Nursing Interventions

• Assess safety risk (command hallucinations).
• Administer Rx and watch for side effects.
• Teach symptom management and adherence.
• Call social work for housing and support.
• Address community resources: housing, employment support, case management. Use therapeutic communication: "Tell me more..". Administer Rx’s. Monitor for side effects.
• Provide education: medication adherence and symptom management.

Foundations of the Psychosocial Concept

• COVID-19 effects (decreased socialization leads to decline in nonverbal behavior) and pediatric impacts (children both detached/connected through technology) are among social factors influencing mental health.
• Seasonal depression (lack of sunlight) and stressors at home (food insecurity and unstable housing) are among environmental factors influencing mental health.
• Stress level (unique thresholds and coping mechanisms) contribute to overall mental health, as chronic stress leads to deterioration. Mental health is well-being concerning stress tolerance and contribution to community.
• Mental illness disrupts thinking, feeling, mood, ability to socialize and function daily.
• Mental health/illness exists on a spectrum rather than distant categories and all affect sleep, appetite, energy and immunity.
• Brain neurotransmitters regulate mood/cognition, behavior, and imbalances in epinephrine cause depression/anxiety. Thyroid imbalances cause fatigue, weight shifting, anxiety and palpitations.
• Role of brain/neurotransmitters influence neuroanatomy and neurotransmitter imbalances affect cognition.
• Mental health is influenced by basic needs in Maslow's hierarchy (food,safety, love/belonging, self-esteem) and meeting physiological and safety needs.
• Grief stages must be recognized, providing support, and blending physical and mental health. Assessment and Safety includes active listening, observation, psychosocial risks/needs, and client-centered care is collaborating on the individualized plan.
• Collaboration forms care plan; HIPAA should be maintained.
• Health impacts increase stress and disease risk from immunity, and the thyroid is affected.
• Promote wellness, challenge misconceptions.

Nursing Assessment - Psychosocial Priorities

• Signs are what the MD, RN, etc. see and symptoms are the client reports.
• Changes are assessed in intellect, thought, level, mood and effect by progress, number scale, with physical integration.
• Observe psychomotor, note personal bias such as hygiene, and gauge responses.
• Emotional affect is the patient's self-reported mood tone perceived by the observer with inconsistency.
• Deviations are dysphoric/irritable, euphoric/manic, or rapid/labile in BPD, but the hallucinations can be any sensory type.
• Objective proofs are absent for delusion, although they can believe they are the president. Speech is assessed by rate, coherence, and flow for disturbances: blocking, high ideas, loosens association, or behaviors.

Suicide and Violence Indicators

• Indicators include “have you wanted to die”, or “harm yourself” and should be assessed with a violence checklist.
• Cultural or linguistic impacts with stigma should be eliminated.
• Trauma-informed care is provided with stress response addressed while validated.

Legal and Ethical Considerations in Psych Nursing

• Nurse Practice Act defines nurses' legal roles in psychiatric.
• Individuals who are ill are mandated to attend the civil/criminal commitment with warnings to potential victims.
• Patient info must stay private.
• Hospitalization is agreed to with the release available unless a danger.
• Medication cannot be refused with treatment (except for mental).
• Justifications for restraints include: mental emergency or danger to life.
• Restrict the least treatment possible.

Anxiety Disorders and Nursing Response

• Stress/life transitions overwhelms coping when the failure to cope results in mental health distress.
• The goal is to help the client to function at baseline, and cultures vary.
• Nursing should be calm and comforting with basic needs and tools such as benzodiazepines.
• Support groups also help with support.
• Anxiety becomes a disorder when it persists for long term disruption, which ranges from genetic or panic.
• Intense fear can also impact lifestyle and behavior

Interventions for Anxiety

• Create a calming enviroment, cognitive therapy and Rx.
• SSRI with acute benzo is offered to regulate breathing.
• Therapy is optimal. Hypertensive and orthostatic crisis can occur in severe cases.
• Lifestyle change should be considered.
• Assess the type and severity of anxiety disorders.
• SSRIs are first-line medications that take 3-6 weeks for effect.
• Benzodiazepines are for acute pharmacologic management and should be used to monitor for CNS depression and respiratory issues.
• Combination therapy (cognitive, psychotherapy, and medication) yields the most efficacious results.
• Serotonin syndrome involving elevated levels of serotonin, involves elevated levels of serotonin (SSRIs + MAOIs/St. John's Wort) and is characterised by fever and severe muscle rigidity.
• Hypertensive crisis from MAOIs + tyramine foods can be lethal.
• Orthostatic hypotension can be caused by tricyclic antidepressants (TCAs), which can cause falls and sedation.

Substance Use Disorder

• Addiction is a brain disease.
• Safety, homestasis (withdrawal is uncomfortable/life threat), or root causes in environment needs should be considered.
• Focus on substance type, safety, culture for treatment.
• Environmental and genetic influence should be assessed.
• Check controlled medications but caution about acetaminophen or liver issues.
• Withdrawal starts 4-36 hours with tremors/complications where intakes can cause death.