Transcript NUR 104 Mood disorder

NUR 104 Mood disorder
• Neurotransmitters affecting depression?
• Define clinical depression
Sad versus Depressed
• Clinical Depression- no identifiable cause and
has physical symptoms as well, no pleasure in
social activities, feelings of hopelessness,
helplessness, suicide, problems with sleep and
daily functioning.
• Difference between major depression and
chronic persistent depression
Depressive D/O Diagnostic Criteria
• Major Depressive D/O
– DSM V-TR Criteria
– Five or more symptoms
• One of the 5 symptoms
– Depressed mood
– Anhedonia-inability to
feel pleasure
– Worse in the AM
– May also have psychosis
Shorter duration
More severe symptoms
Be able to differentiate between MDD and DD
• Persistent depressive
disorder D/O-chronic or
neurotic depression
–
–
–
–
–
–
DSM-V-TR Criteria
Depressed mood
Two or more symptoms
Longer duration
Less severe symptoms
Occurs slowly over 2
years
• What do cognitive therapist believe about
depression?
Cognitive Theory
• A person’s thoughts will result in emotions.
• Researchers believe that negative early life
experiences lead to illogical, irrational
thoughts that remain dormant until major
stress occurs.
• So automatic, negative repetitive thoughts
cause depression
• Define cognitive restructuring
Cognitive Restructuring
• Technique taught and used by therapists for
mood disorders, anxiety and binge eating
• 1-become aware of having a cognitive distortion
such as, “I won’t like that party”, “My boss won’t
like my plan”.
• 2- Ask about others ways to think about it
• What’s the worse that could happen?
• The best possible thing that could happen?
• The most realistic?
• ECT therapy used for?
• Describe what happens
Electroconvulsive Therapy (ECT)
•
Mr. D has major depression, and in addition to receiving pharmacologic and milieu therapy he is to
undergo electroconvulsive therapy (ECT). Which member(s) of the team (RN, NA, nurse
anesthetist, and psychiatrist) should perform the following tasks related to the ECT? (More than
one staff member may be appropriate to list for some tasks.)
•
Before the procedure: Explain the risks associated with the procedure (i.e., increased intracranial
pressure, increased blood pressure) and obtain informed consent__________
Before the procedure: Perform patient education about short-term memory loss, occasional
headaches, and confusion, which will resolve in minutes to hours after the procedure__________
Before the procedure: Ensure that the patient has nothing by mouth for 6 to 8 hours___________
Before the procedure: Remove jewelry and assistive devices such as dentures, contact lenses, and
hearing aids__________
Before the procedure: Give a preoperative medication such as atropine__________
During the procedure: Administer a short-acting general anesthetic (?) and a muscle-paralyzing (?)
agent__________
After the procedure: Measure and report vital sign values__________
After the procedure: Reorient the patient and remind the family about temporary short-term
memory loss__________
After the procedure: Assist the patient to eat a meal__________
•
•
•
•
•
•
•
•
• What is bipolar I and II?
Bipolar Disorder
• Bipolar I Disorders
– Presence or history of at
least one Major Depressive
Episode and one Manic
Episode. Psychosis may be
present
– Mania
• Abnormally & persistently
elevated, expansive, or
irritable mood for at least one
week*
• Bipolar II Disorder
– Hypomanic (low level
mania)episode(s) alternate
with major depression.
– Psychosis is not present
Assessing bipolar
Assessment BiPolar
• Mental Status Examination
(MSE)
–
–
–
–
–
–
–
–
Appearance
Behavior
Speech
Mood/Affect
Thought processes
Perceptual disturbance
Cognition
Ideas of harming self or others
Alcohol or substance abuse
Martial or work problems
•
•
Euphoric mood is unstable
One minute over cheerful and joyous and suddenly angry
Pharmacology for bipolar
Pharmacologic Treatment
• Mood Stabilizer
– Antimanic
• lithium carbonate
– Therapeutic range
» 0.4- 1.2 mEq/L
– Severe toxicity
» 2.0-2.5 mEq/L
– Anticonvulsants
– Anxiolytics
– Antipsychotics
Anxiety types?
Types
• Mild-a normal experience of living
• Moderate- Now some problems grasping
information(selective inattention)
• Severe-Perceptual field very reduced problem
solving impossible
• Panic- Marked disturbed behavior
• Running, shouting, screaming or with
• drawal
Anxiety disorders?
Anxiety disorders
•
•
•
•
Separation anxiety
Panic disorder
Agoraphobia
Generalized anxiety disorder
OCD?
OCD
• Obsessions- thoughts or images that persist and
recur and even can seem senseless to the person
feeling them
• Compulsions- ritualistic behaviors they must
preform to reduce anxiety Only relieves it for a
while then compulsion needs to be repeated.
• Mind traits in everyone- recheck the door that its
locked
• Pathological- time consuming, cause person to
feel distress and ashamed, interfere with life and
social activities
Body Dysmorphic disorder?
Body dysmorphic disorder
• Have normal appearance but they think they
have a defective body.
• Obsessed thinking about body
• Constant checking the mirror
• False assumptions about importance of
appearance with fear of rejection
• Plastic surgery, over and over again
Behavioral theories for anxiety
Behavioral theories
• Anxiety is a learned response to specific stimuli or
a conditioned response
• A child with an abusive mother is afraid of all
women
• Or a child who has a parent afraid of lightening, is
also afraid
• Both can benefit from modeling others
behaviors- how people act in a storm or a woman
who is safe and loving
Cognitive theories for anxiety?
Cognitive theories
• Anxiety are caused by distortions in a person
thoughts and perceptions. Overreacting to
situations by making them appear dangerous.
Pharmacology for anxiety?
• Antidepressants
• Antianxiety drugs