Transcript Unit14
Mental Health Nursing II
NURS 2310
Unit 14
Affective Disorders
Key Terms
Mood = A pervasive, sustained emotion that
may have a major influence on a person’s
perception of the world (sadness, joy,
anger)
Affect = The emotional reaction associated
with an experience
Depression = An alteration in mood that is
expressed by feelings of sadness, despair,
and pessimism; loss of interest in usual
activities; change in appetite and sleep
patterns; somatic symptoms may be present
Mania = An alteration in mood that is expressed
by feelings of elation, inflated self-esteem,
grandiosity, hyperactivity, agitation, and
accelerated thinking/speaking; can occur as a
biological or psychological disorder, or as a
response to substance use or a general
medical condition
Hypomania = as per above; not severe enough
to cause marked impairment in social or
occupational functioning or to require
hospitalization; psychotic features are absent
Acute mania = as per above; symptomology
becomes intensified to the point of requiring
hospitalization
Acute mania (cont’d) = Characterized by
euphoria/elation, though mood varies
frequently; racing/disjointed thinking which
may include psychotic features; increased
sexual interest w/poor impulse control;
excessive energy; may neglect grooming
Delirious mania = A severe clouding of
consciousness w/accompanying confusion,
disorientation, and possibly stupor; extreme
mood lability; delusional thinking
w/grandiosity, religiosity, or persecution;
auditory and/or visual hallucinations; frenzied
psychomotor activity which places individual
at risk for harming self or others, exhaustion,
and even death if not resolved
Objective 1
Discussing manifestations that
identify and differentiate various
affective disorders
Major Depressive Disorder (MDD)
Characterized by depressed mood or loss of
interest or pleasure in usual activities
Impaired social/occupational functioning that
has existed for at least 2 weeks w/no history
of manic behavior
Persistent Depressive Disorder
Also known as “dysthymia”
Chronically depressed mood for most of the
day, more days than not, for at least 2 years;
milder mood disturbance than MDD
No evidence of psychotic symptoms
Premenstrual Dysphoric Disorder
Depressed mood, anxiety, lability, and
decreased interest in activities just prior to
menses; symptoms improve upon onset
Disruptive Mood Dysregulation
Disorder
Childhood depression; presents before age 10
Characterized by severe, recurrent temper
outbursts that occur 2-3 times per week
Other symptoms include hyperactivity,
delinquency, psychosomatic complaints,
sleeping/eating disturbances, social isolation,
delusional thinking, and suicidality
Postpartum Depression
Symptoms range from feeling “blue” to
moderate depression to depressive psychosis
“Maternity blues” = Begins within 48 hours of
delivery and lasts approximately 2 weeks
Moderate postpartum depression = Fatigue,
irritability, sleep disturbance, loss of appetite;
mother fears she will be unable to care for
the baby; may last for several months
Depressive psychosis = depressed mood,
agitation, indecision, lack of concentration,
guilt; often includes lack of interest in or
rejection of the baby; mother may be at risk
of suicide and/or infanticide
Bipolar I Disorder
Individual is experiencing or has
experienced at least one manic episode;
may also have experienced episodes of
depression
Bipolar II Disorder
Recurrent bouts of MDD w/episodes of
hypomania; no history of a full manic
episode
Presents with symptoms of either
depression or hypomania
Major depressive episodes may include
psychotic or catatonic features
Cyclothymic Disorder
Recurring episodes of hypomanic symptoms
and depressive symptoms that do not meet
the criteria for either hypomania or MDD
Intervening periods of normalcy do not
exceed 2 months at a time
Symptoms are severe enough to cause
marked impairment in social/occupational
functioning and/or to require hospitalization
Mood disturbance is chronic in nature,
persisting at least 2 years
Objective 2
Recalling safety interventions
necessary for the depressed and
the manic client
Medication management
Anger management
Support groups
Individual psychotherapy
Crisis hotline
Hospitalization
Objective 3
Examining therapies
appropriate for
clients with an
affective disorder
Individual psychotherapy
Group therapy
Family therapy
Cognitive behavioral therapy (CBT)
Psychopharmacology
Electroconvulsive therapy (ECT)
Objective 4
Reviewing the use,
classifications, side effects, and
nursing care related to
medications for depression and
mania
Antidepressants elevate mood and alleviate
other symptoms associated with moderate
to severe depression
– SSRIs and tricyclics increase the concentration
of norepinephrine, serotonin, and/or dopamine
in the body by blocking the reuptake of these
neurotransmitters
– MAOIs inhibit monoamine oxidase enzymes
that inactivate norepinephrine, serotonin
and/or dopamine in the body
Mood stabilizers help to suppress swings
between mania and depression
– Enhances reuptake of norepinephrine and
serotonin, decreasing levels in the body and
resulting in decreased hyperactivity
Antidepressants
– Tricyclics
Amitriptyline (Elavil)
– SSRIs
Citalopram (Celexa)
Fluoxetine (Prozac)
Sertraline (Zoloft)
– MAOIs
Phenelzine (Nardil)
– Miscellaneous Agents
Bupropion (Zyban, Wellbutrin)
Trazodone (Desyrel)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Mood Stabilizers
– Antimanics
Lithium carbonate (Eskalith, Lithobid)
– Anticonvulsants
Valproic acid (Depakote)
Lamotrigine (Lamictal)
Topiramate (Topamax)
– Calcium Channel Blockers
Verapamil (Isoptin)
– Antipsychotics
Aripiprazole (Abilify)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Side effects of antidepressants may include
– Dry mouth, sedation, nausea
– Decreased seizure threshold
– Increased suicide potential
– Discontinuation syndrome
Gradual termination reduces withdrawal symptoms
– Serotonin syndrome with SSRI use
– Hypertensive crisis with MAOI use
Side effects of mood stabilizers are specific to
medication class
– Lithium carbonate has narrow margin of safety
Lithium toxicity can be fatal
Monitor sodium intake
Objective 5
Applying the nursing process to a
client with an affective disorder
Assessment
– Gather information about client’s mood and
level of anxiety, thoughts to harm self/others
Diagnosis
– Risk for self-directed violence R/T suicidal
feelings
– Risk for violence directed toward others R/T
homicidal ideation
– Imbalanced nutrition, less than body
requirements R/T lack of interest in food
– Disturbed sleep pattern R/T depression
– Anxiety R/T panic disorder
– Social isolation R/T agoraphobia
Planning
– Care plan
– Concept map
Implementation
– Establish trust
– Provide for safety
– Perform risk assessment
– Administer scheduled and PRN medications
Evaluation
– Mental health/psychiatric assessment tool
– Review safety plan/contract
– Assess for medication side effects