Mood/Affective Disorders

Mood/Affective Disorders

• Psychological disorders involve pervasive alterations in emotions
• These manifest as depression, mania, or a combination of both

Common Etiological Theories of Mood Disorders

• Genetic factors contribute to mood disorders
• Offspring of a parent with bipolar disorder has a 25% chance of developing the condition
• Overdeveloped superegos may lead to depression, per the Aggression Turned Inward Theory
• The risk of depression increases with loss of a parent before the age of 11 based on Object Loss Theory
• Certain personality types, such as obsessive-compulsive or hysterical may predispose people to mood disorders according to Personality Organization Theory
• Negative views of self and future can cause Mood disorders
• Negative interpretations of experiences can cause mood disorders
• Mood disorders can stem from a belief that one has no control over their environment
• Learned Helplessness Theory explains this phenomenon
• Biological factors may contribute to mood disorders
• Mania is linked to elevated norepinephrine levels
• Depression may be related to decreased norepinephrine levels

Precipitating Factors

• Major life events can trigger mood disorders
• Decreased coping resources can trigger mood disorders
• Drastic physiological changes can trigger mood disorders
• The loss of a loved one can trigger mood disorders

Categories of Mood Disorders

• Mood disorders include major depressive disorder and bipolar disorder

Major Depressive Disorder

• Must last at least 2 weeks
• Characterized by depressed mood or loss of pleasure in nearly all activities
• Changes in appetite or weight can be Major depressive disorder symptoms
• Changes in sleep or psychomotor activities can be Major depressive disorder symptoms
• Decreased energy can be Major depressive disorder symptoms
• Feelings of worthlessness or guilt can be Major depressive disorder symptoms

Bipolar Disorder

• Mood cycles between the extremes of mania and depression characterize Bipolar Disorder

Mania

• Mood that is abnormally persistently elevated, expansive, or irritable defines mania
• To meet the criteria for mania, the period must last for 1 week
• Inflated self-esteem/grandiosity can be a symptom of mania
• Decreased need for sleep and pressured speech can be symptoms of mania
• Having flight of ideas and distractibility can be symptoms of mania
• Psychomotor agitation and hallucinations can be symptoms of mania
• Feelings like Elation, Euphoria, Humorous, Lack of Shame or Guilt can be affective symptoms
• Physiologic symptoms can include: Dehydration, Poor Nutrition, Decrease sleeping time , Weight loss
• Cognitive symptoms can include: Ambitious, Grandiosity, Illusion, Flight of Ideas (Racing thoughts/ideas), Lack of judgement, Deny anger
• Behavioral symptoms can include: Agitation, Aggression, Hyperactive, Poor Hygiene, Argumentative

Hypomania

• The abnormally elevated, expansive, or irritable mood lasts for 4 days
• The mood must include three or four additional symptoms
• Hypomanic episodes do not impair the person's ability to function
• There are no psychotic features present
• Hypomania is less severe than mania

Mixed Episode

• Also termed rapid-cycling
• Diagnosed when both mania and depression symptoms occur nearly every day for at least 1 week

Bipolar I Disorder

• History of mania
• One or more manic or mixed episodes
• Usually accompanied by a major depressive episode

Bipolar II Disorder

• No history of mania
• One or more major depressive episodes
• Accompanied by at least one hypomanic episode

Additional Mood Disorders

• Dysthymic disorder, Cyclothymic disorder, Seasonal affective disorder (SAD), Postpartum blues, Postpartum depression, Postpartum psychosis can be other
• Dysthymic Disorder is Less severe than major depression
• People will be characterized with at least 2 years of a depressed mood for more days than with some additional less severe symptoms
• Cyclothymic Disorder is characterized by 2 years of numerous periods of both hypomanic symptoms
• They don't meet the criteria of bipolar disorders
• Substance-Induced Mood Disorder, which has a prominent and persistent disturbance in mood

Seasonal Affective Disorder (SAD)

• Changes in mood can result from SAD
• The Winter-Depression Fall-onset SAD will cause increased sleep, appetite and carbohydrate cravings, weight gain
• Interpersonal conflict beginning in the late autumn and a bating in spring and summer can be SAD
• With Spring-onset, Insomnia, weight loss, and poor appetite
• It will Lasts from late spring or early summer until early fall.

Postpartum Blues

• Postpartum Blues is a Frequent normal experience after delivery of a baby
• Characterized by labile mood and affect, sadness, insomnia and anxiety.

Postpartum Depression

• Postpartum Depression has depressive episodes weeks after delivery

Postpartum Psychosis

• Includes a psychotic episode developing within 3 weeks of delivery.
• Postpartum Psychosis begins with fatigue, sadness, emotional lability, poor memory, and confusion sod progressing to delusions & hallucinations

Assessment of Affective Symptoms

• Includes Difficult thinking, concentrating or making decisions
• Suicidal ideation, plans, or attempts
• Symptoms must be present every day for 2 weeks

Assessment of Affective Symptoms

• Anger in self
• Anxiety
• Bitterness
• Guilt
• Sadness

Assessment of Triad of Depression

• Feeling of helpless, hopeless, and worthless
• Feelings like: Provocative and Sexually overactive and Excessive spending of money

Assessment of Physiologic Symptoms

• Physiologic symptoms can include: Somatic Pain, GI Problem – vomiting, nausea, flatulence, diarrhea; Sleep and eating problem; Atypical depression

Assessment of Mental Health

• Amenorrhea can be a hormonal symptoms to look for

Mental Health Assessment

• Ambivalence and Anhedonia are cognitive symptoms
• Confusion, decreased memory/concentration, and decreased decision making are cognitive symptoms
• The symptom of Self-blame, self-destruction has Suicide as a priority
• Restlessness, irritability, isolation/withdrawal, and morbid addiction are behavioral symptoms

Assessing for Suicidal Ideation

• Use SAD PERSON SCALE
• Determine the client's plan
• Stay with the patient
• Check for previous attempts

Nursing Management for Mania

• PROVIDE SAFETY
• Provide limits and consistency
• Divert, Distract, Redirect using activities, but avoiding competitive activities
• PROVIDE PHYSIOLOGICAL NEEDS
• Offer nutritious finger foods

Nursing Diagnoses include:

• Risk for other-directed violence
• Risk for Injury
• Imbalanced Nutrition: Less than Body Requirements
• Ineffective coping
• Disturbed Sleep Pattern

Treatment

• Treatment includes: LITHIUM CARBONATE, LITHIUM THERAPHY, ECT, PSYCHOEDUCATION

LITHIUM CARBONATE

• Works in the synapses to hasten destruction of catecholamines, inhibit neurotransmitter releases & decrease the sensitive of postsynaptic receptors
• Crosses the blood-brain barrier and placenta
• Medication Administration Best taken after meals
• Normal level 0.6- 1.2 mEq/L
• Medication should be taken after meals
• Normal level 0.6-1.2 mEq/L
• Fluids- Adequate amount of fluid (2-3 L/day)
• Sodium Salt intake (2-3 L/day)
• Weight- Monitor daily weights and the balance between intake and output and checking for dependent edema

If there is too much water:

• Lithium is diluted and low

If there is too little water:

• Losing fluid through excessive sweating, vomiting or diarrhea will increase the lithium level, which may result in toxicity

Nursing Intervention-

• Provide clear expectations for client behavior
• Promote rest and sleep by decreasing environmental stimulation
• Establish a bedtime routine
• Clarity the meaning of client's communication
• Treat clients with dignity, respect and matter-of-factness

Lithium carbonate is contraindicated during pregnancy

Treatment Modalities for Depression include:

• Electroconvulsive Therapy and Psychopharmacology
• Blocking NOR/EPI reuptake: tricyclic antidepressant
• Breaking down the monoamine enzyme: MAOI
• WOF: Hypertensive Crisis and SSRI: blocking serotonin reuptake

Mental Health Global Action Program (mhGAP)

• Mania multiple symptoms, lasting 1 week should have treatment starting with: Lithium (if lab is available to the facility),Antimanic and Antipsychotic (Typical or Atypical)/Anxiolytics
• DON’T GIVE ANTI-DEPRESSANT! for mental health

Mental Health interventions

• Bipolar Depression Treatment: same with MANIA and Include Anti-Depressant
• Nursing Intervention of PSYCHOEDUCATION can help patients
• Ensure adequate attention to: 1. Disease Definition, Treatment Plan; Available Therapy and S/Sx of Relapse
• NOTE: Pregnant women: low dose of Haloperidol but continue maintenance treatment with the mood stabilizer for 2 years after the last bipolar episode.

FEAR vs ANXIETY vs STRESS

FEAR – An immediate, instinctive reaction to a real or perceived danger:

• Survival mechanism is on
  

STRESS –

• A physiological and psychological response to demanding or challenging situations. Natural reaction to pressure, deadlines, or task

ANXIETY-

• A mor generalized and persistent feeling of worry of apprehension about future events or situations. It’s often triggered by uncertainties or imagined threats.

HANS SELYE’S RESPONSE TO STRESS

1. Alarm
2. Resistance
3. Exhaustion

MILD ANXIETY

• Positive states of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems with an enlarged perceptual field

MODERATE ANXIETY

• Decreased perceptual field (focus on immediate task only)

SEVERE ANXIETY

• Feelings of dread or terror. The person cannot be redirected into a task with physiological symptoms of tachycardia, diaphoresis, and chest pain.

PANIC ANXIETY

• Loss of rational thoughts, delusion, hallucinations, complete physical Immobility and muteness
• The person may bolt and run aimlessly and will expose injury for self and other

ANXIETY DISORDER

• Characterized by emotional illness by: fear, automatic nervous system symptoms and avoidance behavior
• Diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change but become Chronic which leads to maladaptive and emotional instability.

Symptoms of Anxiety Disorder

Includes: Agoraphobia, Panic Disorder, Panic attack, Social Phobia

Agoraphobia

• Anxiety about or avoidance of places or situations where escape might be difficult or help might be unavailable
• Symptoms: avoids being alone, traveling in vehicles, difficulty meeting daily responsibilities

Panic Disorder

• Recurrent, unexpected panic attacks that cause constant concern

Panic attacks

• Sudden onset of intense apprehension, fearfulness, or terror associated feeling of impending doom
• Discreet episode of panic lasting 15 to 30 minutes with four or more of the following: Palpitations, Sweating, Trembling or shaking, Shortness of breath, Choking, Chest pain or discomfort, Nausea, Derealization/depersonalization, Fear of dying or going crazy, Paresthesias, Chills or hot flashes

Social Phobia

• Anxiety provoked by social or performance situations, which leads to avoidance behavior

Symptoms of Social Phobia:

• Fear of embarrassment or inability to perform and Avoidance or dreaded endurance of behavior or situation is anxiety
  

• Belief that others are judging negatively, significant distress or impairment in relationship, work and social, Anxiety can be severe or panic level

GENERAL ANXIETY DISORDER

• Is characterized by at least 6 months of persistent and excessive worry and anxiety with Symptoms that include Apprehensive expectation more days than not, uncontrollable worrying and significant distress or impaired social or occupational functioning
• Three of the following symptoms will classify it the same: Restlessness, Easily fatigued, Difficulty concentrating of mind going blank, Irritability, Muscle tension and Sleep disturbance

Management

• GAB Management includes Non-Benzodiazepine – BuSpar
• SSRI- Prozac - Paxil - Zoloft and Alpha-adrenergic agonist – Inderal

SPECIFIC PHOBIA

Provoked by a specific feared object or situation which leads to avoidance behavior. and Marked anxiety response to the object or situation Significant distress or impairment

Management

• Medications (Benzodiazepine – Xanax, Non-benzodiazepine – BuSpar and SSRI– Paxil – Zoloft), Systematic Desensitization, Implosive therapy/Flooding technique

Types of phobias include

Acrophobia - height Ailurophobia - cats Algophobia - pain Androphobia - man Arachnophobia – spider/arachnids Astraphobia - storms Belonophobia - needles Brontophobia - thunder Claustrophobia- enclosed places Cynophobia - dogs Entomophobia - insects Genophobia - dirt Gynophobia - women Hematophobia – blood Kakorrhaphobia - failure Microphobia - germs Mysophobia - dirt/contamination Nyctophobia - nights/darkplace Ochlophobia - crowds Opidiophobia - snakes Photophobia - light Pathophobia - disease Phonophobia - loud noises Pyrophobia - fire Taphophobia - being buriedalive Topophobia - stage fright Xenophobia - fear of strangers Zoophobia – animals ###Obsessive – Compulsive Personality Disorder involves OBSESSIONS and COMPULSION Obsessions Fear of Dirt and washing Compulsion Fear of Burglary or Checking

Nursing Interventions Include

Encourage negotiation with others and assist clients to make timely decisions and complete work. Cognitive restructuring techniques

ACUTE STRESS DISORDER

anxiety, dissociative, and other symptoms within 1 month with intense fear, helplessness, or horror Significant distress or impaired functioning with numbing ,feeling dazed, ###POST-TRAUMATIC STRESS DISORDER- Symptoms Include: -Flashbacks traumatic events and Exposure to traumatic

COGNITIVE BEHAVIORAL TECHNIQUES

• 1. Positive Reframing

2. Decatastrophizing

PERSONALITY

• The ingrained habits, attitudes, and emotions relating to one's self, one’s relationships with others, and one’s environment

###PERSONALITY CATEGORIES

• Cluster A, Cluster B, and Cluster C

###CLUSTER A

• Has Odd and eccentric behavior- Includes paranoid, Schizoid, and Schizotypal personality

###CLUSTER B-

• Includes people appear dramatic, emotional, or erratic- Includes antisocial, borderline, histrionic, and narcissistic personality disorder

CLUSTER C

• Includes people who appear with anxious or fearful types. Includes avoidant, dependent, and obsessive –compulsive personality disorder

####CLUSTER A ###PARANOID PERSONALITY DISORDER

• Mistrust and suspicion is present. Uses the defense mechanism of projection, blaming others

####NURSING INTERVENTIONS- approach in a formal manner. Teach client to validate before action

###SCHIZOID PERSONALITY DISORDER

• detached social from relationships with little affect. Report no enjoyable activities. Involve themselves ####NURSING INTERVENTIONS Focus in improved functioning

###SCHIZOTYPAL PERSONALITY DISORDER

• Deficits of social function, clothing are not fitting and magical thoughts are constant

####NURSING INTERVENTIONS- Development of self-care skills to establish a routine

####CLUSTER B ###ANTISOCIAL PERSONALITY DISORDER- Violation of others with lying nature. A Consistent irresponsibility setting

####NURSING INTERVENTIONS Promote responsible behavior, setting limits with confrontation of manipulative behavior

###Borderline Personality Disorder-

• Fear of abandonment of relation. Recurrent self-mutilating with gestures.

NURSING INTERVENTIONS

• Promote client Safety, helping them to cope control

####CLUSTER C ###AVOIDANT PERSONALITY DISORDER- discomfort, silence, low evaluation

###NURSING INTERVENTIONS Require support

####DEPENDENT PERSONALITY DISORDER Taken over by submissive behaviors

####NURSING INTERVENTIONS Foster self-reliance

####OBSESSIVE COMPULSIVE Marked w anxiety

###EATING DISORDERS ####ANOREXIA NERVOSA

• client refuses food

###CLINICAL MANIFESTATIONS

• fear of weight ####TREATMEANT Weights. Improve nutrition

####Bulimia nervosa

• Binge eating follow as laxative and food selection
• Low self-esteem. ####TREATMENT
• Improve mental self-esteem. No alcohol

####NEURODEVELOPMENT CATEGORIES Autism disorder. Learning. Elimination.

####Genetic disorders

• Retts. down. Williams.Fragile X

####Autism -

• No respond Treatment- help with sounds. and communication

#####MOTOR SKILLS motor skill is slow

• ####COMMUNIcation Impaired

#####TIC DISORDER Example Complex vocals

####DELLIRIUM confussion and confusion

• DELIRIUM Treat with hallucinations