Mood Disorders by Valerie Alford Stone (PDF)

Mood Disorders VALERIE ALFORD STONE This Photo by Unknown Author is licensed under CC BY-SA-NC Types Mental health condition that primarily affects emotional state Depressive Bipolar Somatic Depressive Disorders Widespread issue People and population of all ages One of the leading causes...

Mood Disorders VALERIE ALFORD STONE This Photo by Unknown Author is licensed under CC BY-SA-NC Types Mental health condition that primarily affects emotional state Depressive Bipolar Somatic Depressive Disorders Widespread issue People and population of all ages One of the leading causes of disability Disrupts Social relationships, school/job performance Affects physical well being Types of Depressive Disorders Major Depressive Disorder (MDD) Disruptive Mood-Dysregulation Disorder Dysthymia Disorder Premenstrual Dysphoric Disorder (PMDD) Substance Induced Depressive Disorder Depressive Disorder NOS (not otherwise specified) MDD Persistently depressed Helpless mood lasting longer than 2 Hopeless months Single or recurrent Worthless Lack of interest Poor Concentration Fatigue Persistent thoughts of Suicide Sleep Disturbances Changes in Appetite MDD Preoccupation with death Plan/Visualize Funeral ◦ Give away personal items ◦ Give away family pets Dreams of Death Suicidal Thoughts Mild/Fleeting: thoughts that come and go Plan Intent: intent to kill yourself; anxiety relief MDD Can affect physical activity Psychomotor slowing Psychomotor retardation (more than 30 secs to answer a question) Psychomotor Agitation (depressed with no interest) ◦Restless ◦Pacing ◦Rocking ◦Hand Wringing Grief vs Depression Mimics Depression ◦ Tearfulness ◦ Appetite/sleep disturbances ◦ Loss of Pleasure ◦ Hopeless re future ◦ Lack of Interest ◦Difficult to Diagnose ◦ 2 Months after a loss, the diagnosis of MDD can be given This Photo by Unknown Author is licensed under CC BY-NC Disruptive Mood Regulation Disorder Ages 8-16 Frequent Temper Tantrums (verbal or behavioral) which are exaggerated from a normal response ◦ can last for hours Between outbursts-mood is described as irritable Dysthymia Disorder Depressed feelings greater than 2 years Affects children, adolescents, and adults Social and job interference Most often, no hospitalization is required Onset usually in teen years Can have periods of MDD Never go back to happy Premenstrual Dysphoric Disorder (PMDD) Occurrence ◦Last week prior to onset of period Physical Discomfort: back pains an cramps Emotional symptoms similar to major depression and are severe enough to interfere with work or interact with others Symptoms decrease or disappear with onset of menstruation  Substance Induced Depressive Disorder MDD symptoms occur die to prolonged alcohol or drug intoxication or as the result of withdrawal from alcohol or drugs Symptoms would be absent if there were no alcohol or substance abuse This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY Depressive Disorder Associated with Another Medical Condition Result of illness such as diabetes, kidney disease, Parkinson’s, etc Not considered MDD Epidemiology Leading cause of disability in the United States More likely to be depressed as an adult if first occurrence was during childhood Not a normal result of aging Likelihood increased with age Older Adults with depression are more likely to complete suicide Caucasians diagnosed more than African Americans or Hispanics Etiology/Causes Psychological Biological (fate; genes) ◦ Neurotransmitters ◦ Stressful Life Events Biochemical Hormonal Inflammatory Process Psychological Trauma This Photo by Unknown Author is licensed under CC BY-SA Comorbidities Anxiety Psychotic Disorders Substance Use disorders Eating Disorders: medication side effect is weight gain (causes an increases apettite) Personality Disorders Interview Providing Care for Medical Patients with Psychiatric Issues: Depression and Su icide in Children - Bing video Assessment Identify the most important to Affect (emotions while talking) assess with a patient that is Thought Processes depressed Mood (may be irritable) Physical Behavior Risk Factors ◦ Family hx Communication ◦ Personal Hx Religious Beliefs (can help protect ◦ Age (18-30 most likely to have had a them from self harm) suicidal attempt) ◦ Gender (females are more likely) Assessment Tools Geriatric Depression Rating Scale https://geriatrictoolkit.Missouri.edu/cog/GDS_SHORT_FORM.PDF Patient Health Questionnaire https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/218 Beck Depression Inventory Impact of Daily Life Challenges of Work and School Challenges in relationships Stigma associated with mental health issues Patient Centered Care Milieu Therapy Appropriate care for suicide Risk: no sharp objects or anything that can be used as a weapon; finger foods; watch them with medications Self Care (reminders throughout the day) Communication/Interaction Counseling Medication Planning/Implementation Directed Towards patients’ phase of depression ◦ Acute (suicide precautions, 1 on 1, medications) ◦ Continuation (continued medicatons/therapy) ◦ Maintenance (emergency contact) Symptoms (education on triggers) Personal Goals Include Therapy and Medication Health Teaching and Promotion (diet, avoid caffeine) Teamwork and Safety Pharmacologi cal Interventions Anti depressant Medication ◦ Targets Symptoms ◦ Sleep ◦ Fatigue ◦ Appetite ◦ Decreased Sex Drive ◦ Concentration ◦ Anhedonia This Photo by Unknown Author is licensed under CC BY  Selective Serotonin Reuptake inhibitor (SSRI) Zoloft (Sertraline) Paxil (Peroxetine) Celexa (Citalopram) ◦ First Line Therapy ◦ Selectively blocks neuronal uptake of Serotonin and Antidepress will increase the availability of Serotonin ant ◦ Side Effects Medications ◦ No Anti cholinergic Side effects (no dry mouth, no nausea) ◦ Sleep Disturbances ◦ Tremors ◦ Sexual dysfunction ◦ Headache LOW POTENTIAL FOR OVERDOSE Serotonin Syndrome ◦ Overactivation of Central Serotonin Receptors ◦ Dosage too high ◦ Drug Interactions ◦ Symptoms ◦ Diarrhea ◦ Abdominal Pain ◦ Sweating ◦ Fever (>103) ◦ Tachycardia ◦ Elevated BP ◦ Increased Motor Activity ◦ Irritability This Photo by Unknown Author is licensed under CC BY-SA-NC Tricyclic Antidepressants Elavil (amitriptyline) Side effects resemble those of antipsychotics Anafranil Blurred Vision Inhibit the reuptake of Serotonin and norepinephrine Dry Mouth Constipation Increase time Norepinephrine and Serotonin are available to post Weight Gain (2 lbs or more) synaptic neurons. This can cause mood elevations Postural Orthostatic Hypotension Dysrhythmias 10-14 days to work. Full effects 4-8 weeks Tachycardia MI Monamine Oxidase Inhibitors (MAOI) Enzyme ◦Breaks down certain monamine neurotransmitter s such as: ◦Norepinephrine ◦Serotonin ◦Dopamine ◦Tyramine  Tyramine Inhibited by Monamine Osidase ◦ High BP ◦ Hypertensive crisis ◦ CVA ◦ Must adhere to a tyramine free diet ◦ Foods to AVOID ◦ Avocados ◦ Figs ◦ Bananas ◦ Bologna, pepperoni, salami ◦ Fish-dried, cured, aged ◦ Cheese ◦ Yeast extract ◦ Beer, wine ◦ Chocolate ◦ Caffeine  Weight Gain Edema MAOI Side Effects MAOI Drugs ◦Nardil (phenelzine) ◦Parnate ◦Marplan Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Blocks synaptic reuptake of serotonin and Effexor XR norepinephrine Side Effects Pristiq ◦ Nausea (take at night or during Cymbalta supper) ◦ Diarrhea ◦ Dry mouth (candy; sugar free for diabetic) ◦ Headache ◦ Insomnia ◦ Dry mouth ◦ Sweating Electroconvulsive Therapy Highly effective https://youtu.be/HEot7ow3yfk Can be used in conjunction with medications suicidal or homicidal and need for rapid improvement previous medications have failed marked agitation, vegetation, or catatonia psychotic features or pervasive hallucinations  Transmagnetic Nerve Stimulation Other Deep Brain Stimulation Treatments Vagus Nerve Stimulation for Light Therapy Depression St Johns Wort Ketamine Infusions  Individualized ◦Safety ◦ADL management Evaluation ◦Concentration ◦Medication Compliance ◦Intake (meals)