Mood, Schizophrenia, and Personality Disorders

• These notes cover mood disorders, schizophrenia, and personality disorders.

Mood Disorders

• Milieu refers to the patient's environment.
• Mood is how a patient describes their feelings in their own words.

Major Depressive Disorder

• "Offering self" involves spending time with the patient in intervals throughout the day.
• Example: "I will sit with you for 10 min now, return for 10 min at lunchtime and again at 2:30 pm this afternoon."
• A goal could be: The patient will verbalize realistic positive characteristics about self by a specific date.
• Positive self-esteem can be reinforced with neutral comments.
• Example: “You were wearing a new shirt today.”
• Priority nursing intervention: 24/7 observation due to suicide risk.
• Risk factors: trauma, job loss, financial problems, stress, mental illness, legal problems, risky behavior.
• Anhedonia is the inability to feel pleasure.
• When taking tricyclic antidepressants, patients should change positions slowly to avoid postural hypotension.
• A priority side effect of SSRIs: increased suicidal thoughts.
• Patients should report any suicidal thoughts.
• Tyramine-restricted diet avoids aged cheese, processed meats, fermented fruits, and red wine.
• An ideal meal: mashed potatoes, ground beef, corn, green beans, and apple pie.
• Patients taking MAOIs need a tyramine-restricted diet to prevent hypertensive crisis.
• Before ECT: remove glasses, dentures, contact lenses, and hearing aids.
• Pretreatment meds are administered 30-45 minutes prior.
• Withhold food and fluids for 6 hours after treatment.
• Post-ECT nursing care focuses on physiological stability, monitoring vitals, and reorientation.
• Phenelzine belongs to the MAOI drug class.
• When taking MAOIs, consult a pharmacist before using OTC medications.
• Uninterrupted sleep is especially important for patients with major depressive disorder.
• Priority nursing diagnosis for postpartum depression: risk for other-directed violence (usually against the newborn).
• Milk is an appropriate beverage choice for patients who are not eating.
• Flat affect: lack of emotional responsiveness (blank expression).
• Labile affect: abnormal variability in affect with repeated and abrupt shifts in expressions.
• Depressed mood: appears sad, mournful expression, speaks in monotone.
• Address patients who have not bathed in several days by firmly and neutrally assisting them with bathing.
• Escitalopram takes 1-3 weeks to start working, with full effect in 4-6 weeks.
• Symptoms of taking too much paroxetine: tachycardia, hypertension.
• Monitor vital signs.
• Ask about abdominal pain, diarrhea, hyperactivity, and feelings of restlessness.
• Side effects include increased suicidal thoughts.

Mania

• Features include: trouble processing thoughts, speaking quickly, confused content, decreased cognitive functioning.
• Labile: rapid mood swings, seemingly without understandable reason.
• Euphoria: excessive feeling of happiness.
• Rapid cycling: 4 or more mood shifts in a year.
• Unipolar: depressive episode without hypomania or mania.
• Grandiosity: thinking of self as excessively important.
• Communication: set limits in simple and concrete terms.
• Example: "Do not hit anyone," or "If you are unable to control yourself, we will help you."
• Nursing diagnoses for patients experiencing mania: risk for injury.
• Additional nursing diagnoses for bipolar disorder: risk for others, imbalanced nutrition, ineffective coping.
• Ideal room décor: pale colored walls, simple accessories.
• Nursing interventions: ensure safety and reduce environmental stimuli.
• A rare, life-threatening side effect of lamotrigine: Stevens-Johnson Syndrome.
• Best food choices: nutrient-dense, high-calorie, easy to consume.
• If staff members are fatigued, hold a meeting to discuss consistency and limit-setting approaches.
• Goals for treatment include: adherence to medication, lack of suicide ideation, functioning in relationships, sleep stability, and self-control.
• Treatment is effective if the patient can converse without interrupting, their clothes match, and they participate in activities.
• Lithium is used to treat bipolar disorder.
• Take lithium with food to reduce nausea.
• Maintain normal salt and fluid intake.
• Signs of lithium toxicity: diarrhea, thirst, vomiting.
• Continue taking lithium every day, even when mood is stable, to prevent relapse.

Suicide

• Components of the SAD PERSONS scale:
  • Sex (male )
  • Age 45
  • Depression
  • Previous attempt
  • Ethanol (alcohol abuse)
  • Rational thinking loss
  • Social support lacking
  • Organized plan
  • No partner
  • Sickness (major/chronic)
• Immediate warning signs of suicide: giving away loved possessions.
• Suicidal ideation: thinking about, considering, or planning suicide.
• Suicide attempt: nonfatal, potentially injurious behavior with intent to die.
• Social groups at highest risk: American Indians, Alaskan natives, Non-Hispanic white people.
• Premenstrual dysphoric disorder symptoms occur the week before the period: dysphoria, feelings of sadness and depression.

Schizophrenia

• Idea of reference: belief that casual events have a special meaning for the individual.
• Auditory hallucination: hearing voices or noises that don't exist in reality.
• Haloperidol side effects, such as sedation and muscle stiffness, might cause a patient to stop taking it.
• Signs of auditory hallucinations: intense staring off, head tilting, mumbling to self.
• Pseudoparkinsonism: side effect of fluphenazine - drooling, shuffling gait, mask-like face.
• Tardive dyskinesia: neck and shoulders may twist, smacking lips.
• Positive symptoms: behaviors, emotions, or experiences that aren’t usually present, Added to but should not be there such as delusions and hallucinations.
• Delusions: false beliefs. Delusions: false beliefs.
• Hallucinations: false hallucinations.
• Disorganized speech.
• Negative symptoms: behaviors, emotions or experiences that are present but diminish in severity, Lack of pleasure, lack of expression, lack of interest, lack of speech, lack of motivation.
• Neuroleptic malignant syndrome: high fever, altered mental status. MEDICAL EMERGENCY - notify physician.
• Clang association: string of words in rhyming phrases or related words together.
• Anergia: being tired and decreased energy.
• Alogia: significant reduction in speech.

Personality Disorders

• Highest risk for self-harming behavior in borderline personality disorder: discharge from hospital d/t feeling of rejection.
• Cluster A: odd, reclusive, or eccentric behaviors.
  • Paranoid: suspicious/distrustful.
  • Schizotypal: thinks they have magical powers, visual disturbances.
  • Schizoid: blunt and difficulty with relationships, loner, poor grades.
• Cluster B: impulsive and dramatic behavior.
  • Antisocial: disrespect for others, constantly getting in trouble with the law.
  • Borderline: unstable relationships, splitting, higher risk for self-harm.
  • Narcissistic: believe that rules do not apply to them, grandiose sense of self.
  • Histrionic: always wants to be the center of attention, seductive, exaggerated emotions
• Cluster C: anxious or fearful behaviors.
  • Aviodant: solitude job, not interacting with other people.
  • Dependent: fearful of making decisions.
  • OCD: rule followers, perfectionist.
• After diagnosis, a patient should see a mental health provider.
• Splitting: describing people as all good or all bad, extreme, no gray area.
• Gerontological Personality Disorder Scale is appropriate for older adults.
• Comorbidity for histrionic personality disorder: Generalized Anxiety Disorder.
• Cluster A comorbidities: major depressive disorder, substance abuse, agoraphobia, schizophrenia, delusional disorder, bipolar, PTSD, OCD. Cluster B comorbidities: generalized anxiety disorders, substance abuse disorder, OCD, Social Phobias.
• Cluster C comorbidities: Anorexia, substance abuse disorder, OCD, social phobias.
• Environmental causes: abuse, hostility, or neglect at any age.