Depression and Other Mood Disorders

Depression and Other Mood Disorders Chapter 21 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 21.1: Depression and Other Mood Disorders (Slide 1 of 2) 1. Describe the continuum of em...

Depression and Other Mood Disorders Chapter 21 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 21.1: Depression and Other Mood Disorders (Slide 1 of 2) 1. Describe the continuum of emotional responses. 2. Compare four theories relating to emotions and their disorders. 3. Explain how emotions affect individuals throughout the life cycle. 4. Compare the differences between a depressive episode and a depressive disorder. 5. List the diagnostic criteria for bipolar disorders. Copyright © 2021 by Elsevier, Inc. All rights reserved. 2  Learning Objectives Lesson 21.1: Depression and Other Mood Disorders (Slide 2 of 2) 6. Explain seasonal affective disorder. 7. Discuss behaviors associated with postpartum depression. 8. Identify three drug classes used for the treatment of depression and other mood disorders. 9. Apply four nursing (therapeutic) interventions for clients with mood disorders. Copyright © 2021 by Elsevier, Inc. All rights reserved. 3 Continuum of Emotional Responses ⬤The spectrum of human emotion ranges from elation(great happiness) to despair (absence of hope) ⬤Emotional responses can be growth- promoting and adaptive ⬤They can lead to ineffective behaviors that soon could become maladaptive Copyright © 2021 by Elsevier, Inc. All rights reserved. 4  Theories Related to Emotions and Their Disorders (Slide 1 of 2) ⬤Biological evidence ⮚ Defects in immune system may be related to depression ⮚ Genetics may be a factor in mood disorders ⮚ Major neurotransmitters excite or inhibit brain circuits involved in mood regulation ⮚ The pituitary gland controls the hormones by balancing thyroid and adrenal hormones ⬤Depression is related to physical illness Copyright © 2021 by Elsevier, Inc. All rights reserved. 5  Theories Related to Emotions and Their Disorders (Slide 2 of 2) ⬤Other theories ⮚ Psychoanalytic theories see mood disorders as anger turned inward ⮚ Behaviorists view depression as a group of learned responses ⮚ Social theorists consider depression the result of faulty social interactions ⮚ A holistic viewpoint is usually used by healthcare providers. It considers all areas of human functioning and provides a framework from which to work with the whole person Copyright © 2021 by Elsevier, Inc. All rights reserved. 6  Theories Related to Emotions and Their Disorders ⬤Social factors influence mood disorders ⬤Adults who were not nurtured in childhood are at high risk for depression ⬤Repeated stress and crises wears one’s emotions 7  Emotions Throughout the Life Cycle (Slide 1 of 4) ⬤Emotions in childhood ⮚ Situational depression Acute depression/Depressive responses in children are tied to a specific event or situation ⮚ Depressed children have a distinct way of thinking ⮚ There are feelings of hopelessness, low self- esteem and tendency to take blame for a negative event ⮚ Respond with irritability, tearfulness and sadness ⮚ The incidence of depression in childhood is increasing Copyright © 2021 by Elsevier, Inc. All rights reserved. 8  Emotions Throughout the Life Cycle (Slide 2 of 4) ⬤Emotions in adolescence ⮚ Moods swing from feeling vulnerable and independent to knowing they are the smartest one in the family ⮚ Depression in adolescence usually is related to four factors Low Self-esteem - individual feels depressed or helpless Loneliness - may be surrounded by others but still feel emotionally alone Family strengths -parents have high achievement standards Parent-teen communications -teens ability to discuss concerns with understanding parents, have lower rates of depression Copyright © 2021 by Elsevier, Inc. All rights reserved. 9  Emotions Throughout the Life Cycle (Slide 3 of 4) ⬤Emotions in adulthood ⮚ Society expects adults to practice emotional control ⮚ Adults must cope with a wide range of situations, events, developmental tasks, and responsibilities as well as emotional reactions ⮚ Certain behaviors such as drug use, dieting or refusal to seek help, can result in the development of a mood disorder ⮚ Public stigma follows individuals with mood disorders ⮚ Disorders are seen as lack of willpower or character flaw Copyright © 2021 by Elsevier, Inc. All rights reserved. 10  Emotions Throughout the Life Cycle (Slide 4 of 4) ⬤Emotions in older adulthood ⮚ Depression is very common in older adults ⮚ Depression can be treated ⬤Signals of depression ⬤changes in daily routine ⬤How to detect depression in older adults ⮚ Active listening ⮚ Gentle questioning ⮚ Alert assessment Copyright © 2021 by Elsevier, Inc. All rights reserved. 11  Characteristics of Mood Disorders ⬤Mood disorders ⮚ Is defined as a disturbance in emotional dimension of human functioning ⮚ Mania Emotions that are elevated, expansive, and irritable accompanied by loss of identity, increased activity, and grandiose thoughts and actions ⮚ Depression Feelings of sadness, disappointment, and despair Copyright © 2021 by Elsevier, Inc. All rights reserved. 12  Mood Disorders (Slide 1 of 4) ⬤Depression can occur on several levels ⮚ Mild depression Short-lived Triggered by life events or situations out of our control Individuals complain of feeling lost, let down or disappointed Drug or alcohol may be increased ⮚ Moderate depression (dysthymia) Persists over time Physically fatigued, difficulty eating and sleeping, changes in sexual function Unable to find joy in life, slowed thoughts and impaired concentration ⮚ Major depressive episode When depression is severe and lasts longer than 2 weeks ⮞ Symptoms range from paralysis to agitation ⮞ Suicidal thoughts may be entertained Copyright © 2021 by Elsevier, Inc. All rights reserved. 13  Mood Disorders (Slide 2 of 4) ⬤Bipolar Disorder ⬤ Hallmark is sudden and dramatic shifts in emotional extreme ⬤ Emotions seesaw between extreme mania and depression ⬤Bipolar I ⮚ Episodes of major depression alternate with episodes of mania ⮚ More severe and incapacitating form of bipolar illness ⮚ Delusions (false belief) common during periods of mania ⮚ Hallucinations (believes they see, hear something) may occur ⬤Bipolar II ⮚ Major episodes of depression alternate with periods of hypomania ⮚ Does not progress to full manic state ⮚ Often marked by 1 to 2 weeks of severe lethargy, withdrawal, and melancholy followed by several days of mania Copyright © 2021 by Elsevier, Inc. All rights reserved. 14  Mood Disorders (Slide 3 of 4) ⬤Cyclothymic disorder ⮚ Behavior of repeated mood swings alternating between hypomania and depressive symptoms, occurring for 2 years ⬤Seasonal affective disorder ⮚ Known as “Winter depression” ⮚ Occurs in many people from October to April ⮚ Daily exposure to full-spectrum light (phototherapy) lessens the symptoms of sadness and social withdrawal in persons with seasonal affective disorder Copyright © 2021 by Elsevier, Inc. All rights reserved. 15  Mood Disorders (Slide 4 of 4) ⬤Postpartum depression ⮚ Is a connection between hormones and emotions ⮚ Occurs after childbirth ⮚ Symptoms include: Tearfulness; irritability Hypochondria Sleeplessness Impaired concentration Headache ⬤Substance-induced mood disorder ⮚ Persistent emotional disturbance that can be directly traced to the effects of a chemical Copyright © 2021 by Elsevier, Inc. All rights reserved. 16  Therapeutic Interventions ⬤Treatment and therapy ⮚ Acute treatment phase (6-12 weeks) ⮚ Goal reduce symptoms and inappropriate behaviors ⮚ Continuation phase (4-9 months) ⮚ Goal to prevent relapse into distressing emotional state ⮚ Maintenance treatment phase (Indefinite) ⮚ Goal to prevent recurrence with maintenance psychotherapy and medications ⬤Current standard treatments for mood disorders include: ⮚ Psychotherapy ⮚ Pharmacologic therapy ⮚ Electroconvulsive therapy ⮚ Transcranial direct current stimulation - mild current to stimulate the brain Copyright © 2021 by Elsevier, Inc. All rights reserved. 17 Electroconvulsive Therapy 18  Drug Therapies (Slide 1 of 2) ⬤Antidepressants ⮚ Tricyclics ⮚ Nontricyclics ⮚ Monoamine oxidase inhibitors (MAOIs) ⮚ Selective serotonin reuptake inhibitors (SSRIs) - mostly prescribed due to low incidence of side effects ⮚ Atypical antidepressants ⮚ With many antidepressants, 2 to 4 weeks are required before their effects are noted and the client’s well-being improves ⮚ Clients require education and reminders that these drugs require time to take effect and encouragement to continue the medication Copyright © 2021 by Elsevier, Inc. All rights reserved. 19  Drug Therapies (Slide 2 of 2) ⬤Antimanics ⮚ Lithium Interaction between the level of lithium in the blood and common table salt Therapeutic blood levels of lithium range from 0.6 to 1.2 mEq/L Once client is no longer manic, the need for lithium drugs drops dramatically Copyright © 2021 by Elsevier, Inc. All rights reserved. 20  Nursing (Therapeutic) Process ⬤First assess for level of depression or mania ⬤Then a thorough history and physical ⬤Nursing diagnoses and therapeutic interventions then are chosen based on the client’s most distressing problems ⬤The Holistic approach is very effective ⬤ Interventions should look at: ⮚ Physical - hygiene, nutrition and physical activity ⮚ Emotional - acceptance and support, trust and encouragement ⮚ Social - encouragement to begin interacting, once medications start stabilizing mood ⮚ Intellectual - require extra patience, non judgemental guidance ⮚ Spiritual - question their spiritual beliefs, therapeutic listening is helpful Copyright © 2021 by Elsevier, Inc. All rights reserved. 21  Question A 10 year old boy is waiting for a dental procedure. The father is biting his nails and pacing. The son asks if everything is going to be ok. The fathers said yes but continues to pace and bite his nails. What is the most appropriate response from the nurse. 1. Reassure the father 2. Allow father to verbalize his concerns 3. Tell the child to ignore the father 4. Have the father wait in the waiting room Copyright © 2021 by Elsevier, Inc. All rights reserved. 22  Answer 1. Have the father wait in the waiting room Children learn to cope with anxiety by imitating and learning from others. In this case, the father is demonstrating emotional/behavioral manifestations of anxiety. By allowing the father to remain in the room in his current emotional state, anxious behavior is reinforced to the child as a method of coping. 23