Affective Disorders Nursing Quiz

Affective Disorders - Objectives

• Assess client's mental status, focusing on areas impacted by affective disorders
• Develop a nursing care plan based on etiological theories to meet safety and human needs, including medication management
• Implement safety measures for clients at risk of suicide or violence
• Assess clients for suicidal/violent thoughts and intentions
• Safely and appropriately implement restraints or seclusion
• Plan client teaching, outlining the benefits and potential side effects of antidepressant and mood-stabilizing medications
• Describe the nurse's role in electroconvulsive therapy (ECT)
• Use effective communication to meet basic needs, build trust, and set limits with depressed or manic clients
• Create a discharge plan including medication education and community resources
• Demonstrate self-awareness of nurse reactions to depressed or manic clients
• Identify National Patient Safety Goals related to suicide risk

Affective Disorders - Vocabulary

• Mania: 1.4 or more mood episodes in 12 months, sometimes as short as 24 hours, accompanied by euphoria and increased energy lasting at least 4 days; may progress to psychosis.
• Hypomania: Intense mood with elevation, energy, and irritability lasting longer than a week, potential psychiatric emergency; may lead to psychosis.
• Normal mood: The patient's baseline mood.
• Rapid cycling: Frequent shifts between mood episodes.

Bipolar Disorder

• Bipolar disorder presents as a continuum of mental health, just as all mental health issues do

Bipolar Disorder - Symptoms (Graphic)

• Manic: Elevated mood, expansive or irritable, rapid speech, racing thoughts, poor judgment, increased energy, decreased need for sleep, grandiose delusions, distractibility, hyperactivity, inappropriate dress, and flight of ideas.
• Depressive: Previous manic episodes, feelings of worthlessness, guilt, hopelessness, increased anger and irritability, low interest in pleasurable activities, negative views, fatigue, reduced energy, changes in appetite, constipation, insomnia, and suicidal thoughts or actions.

Types of Bipolar Disorders

• Bipolar I: Includes full manic and depressive episodes.
• Bipolar II: Includes hypomanic and depressive episodes.
• Cyclothymic disorder: Least severe form, with mild to moderate depression and hypomania; episodes of irritable hypomania.
• Cyclical moods: Often rapid, mixed, or lasting longer.

Misdiagnosis Monday (Bipolar 1 vs Bipolar 2)

• Bipolar 1: Common depression but not required, about 50% experience psychosis during manic episodes, highly disruptive to functioning, episodes show a ratio of at least 3 depressive episodes for every manic one.
• Bipolar 2: For diagnosis, both hypomanic and a depressive episode are required, depression dominant, with a ratio of about 10 depressive episodes per hypomanic one.

Cyclothymic vs Bipolar II

• Cyclothymic: Least severe form of bipolar disorder, featuring minimal disturbances in mood.
• Bipolar II: Displays moderately severe features. Severe depression to hypomania. Depression can cause psychosis. Minimal impact on work but significant impact on mortality.

Bipolar 1 (Worst Case)

• Most severe form progressing to manic episodes.
• Significant mood shifts impacting functioning
• Presents a high mortality rate
• Associated with chronic interpersonal & occupational challenges

Risk Factors

• Biological: Genetic predisposition, neurobiological factors, neuroendocrine factors, and peripheral inflammation
• Environmental: Factors that contribute to the disorder from outside forces of biology
• Cognitive: Factors related to thinking styles

Assessment - Mood

• Altman's Self-Rating Mania Scale (ASRM)
• Assess mood, behavior patterns, thought processes & content

Assessment - Thought Processes & Speech Patterns

• Pressured speech
• Circumstantial speech
• Tangential speech
• Loose associations
• Flight of ideas
• Clang associations
• Grandiose delusions
• Persecutory delusions

Pressured Speech

• Rapid, intense and uncontrollable talking.
• Feels like an urgent or compelling need to keep talking
• Distinguishable from fast talking

Mania vs Hypomania

• Mania: Lasts at least 7 days, Causes severe impairment in social or occupational functioning, and may necessitate hospitalization to prevent harm to self or others. Can include psychotic features
• Hypomania: Lasts at least 4 days, has no serious impact on social or occupational functioning, does not require hospitalization and does not include psychotic features

Safety & Physical Needs (Acute Mania)

• Safety: Self-and others
• Physical health: Hydration, Nutrition, Sleep, Hygiene, Elimination, and Structure
• Discharge planning: Considerations for long-term wellness

Acute Mania Communication Strategies

• Firm, calm approach
• Concise explanations
• Maintain neutrality
• Regular staff meetings to align on management approach & limits
• Address legitimate complaints
• Redirect energy appropriately

Seclusion & Restraints

• Seclusion is warranted when the client poses a risk of harm to themselves or others, unable to control their actions, and other measures have failed.
• Use as last resort, indicated during hyperactive behavior.
• Protects the client from harming themselves or others, reduces overwhelming environmental stimuli and prevents property damage.

Milieu Therapy - Seclusion

• Seclusion is warranted if there is a documented risk of the patient harming themselves or others.
• The client must be unable to control their actions.
• Other approaches like verbal de-escalation and chemical restraints should have been exhausted first.

Medications (Lithium, Valproate/Valproic Acid, Divalproex Sodium, Carbamazepine, Lamotrigine)

• Lithium: A mood stabilizer, first-line treatment for bipolar disorder; Alters sodium (Na+) transport, inhibits norepinephrine & dopamine release
• Valproate/Valproic Acid & Divalproex Sodium: Mood stabilizer, used to prevent seizures.
• Carbamazepine: Mood stabilizer and anticonvulsant; can cause serious side effects including rashes, bone marrow depression, and other serious complications.
• Lamotrigine: Mood stabilizer and anticonvulsant, Hepatotoxic

Non-Pharmacological Management

• Electroconvulsive therapy (ECT): Electrodes deliver electric shocks.
• Milieu management: The physical environment & support.
• Support Groups: Groups that provide support and resources for clients & their caregivers.
• Health teaching & health promotion & wellness: Teaching concerning health & well-being.

After the Manic Mood is Gone

• Picking up the pieces
• Discharge planning
• Family/patient education
• Medication adherence
• Reporting to healthcare providers
• Support groups
• Community mental health resources
• Medication clinics
• Support persons
• Outpatient treatment
• Regular medical checkups

Test your knowledge on the nursing care for clients with affective disorders. This quiz covers mental status assessment, safety measures, medication management, and the nurse's role in electroconvulsive therapy. Prepare to demonstrate your understanding of effective communication and discharge planning.