Mood Disorders chapter 12 and 13

What is Bipolar Disorder? (Bipolar #1) Diagnosing and Treating Bipolar Disorder (Bipolar #2) What is Depression? (Depression #1) Treating Depression (Depression #2) Clinical Depression

Mood Disorders Depression is the oldest and most frequently described psychiatric illness. Transient symptoms are normal, healthy responses to everyday disappointments in life. Pathological depression occurs when adaptation is ineffective.

Types of Mood Disorders Depressive Disorders Bipolar Disorders Others

Depressive Disorders Major Depressive Disorder Dysthymic Disorder Premenstrual Dysphoric Disorder Bipolar Disorders Other Mood Disorders Mood disorder due to a general medical condition Substance-induced mood disorder

Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder

Depression: Predisposing Factors Biological theories – Genetics: – Biochemical influences: Neuroendocrine theories Physiological influences – Psychoanalytical theory Mourning Melancholia Learning theory Object loss Cognitive theory

Depression: Developmental Implications Childhood Depression Symptoms: Adolescence Symptoms include: Senescence Treatment Postpartum Depression Treatment

Assessment Transient depression Mild depression Moderate depression Severe depression

Nursing Diagnosis

Outcome

Planning/Implementation

Client/Family Education

Evaluation

Treatment Modalities

Antidepressants Newer-generation antidepressants – Selective serotonin reuptake inhibitors (SSRIs) – Second- and third-generation antidepressants Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs)

Contraindications/precautions – Contraindicated in known hypersensitivity (SSRIs, MAOIs, tricyclics); acute phase of recovery from myocardial infarction; angle-closure glaucoma (tricyclics); and concomitant with MAOIs (SSRIs and tricyclics). – Caution with elderly or debilitated clients; clients with hepatic, cardiac, or renal insufficiency; psychotic clients; clients with benign prostatic hypertrophy; and those with history of seizures (tricyclics, MAOIs).

Antidepressants- SSRI Generic Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine Brand Prozac Paxil Zoloft Celexa Lexapro Luvox

Serotonin Syndrome DeliriumAgitation TachycardiaSweating HyperreflexiaMuscle spasms ShiveringCoarse tremors More severe cases Hyperthermia Seizures Renal failure Rhabdomyolysis DysrhythmiasDIC

Antidepressants Generic Bupropion Mirtzapine Venlafaxine Duloxetine Amitriptyline Imipramine Phenelzine Selegiline Brand Wellbutrin Remeron Effexor Cymbalta Elavil Tofranil Nardil Emsam

Monoamine Oxidase Inhibitor Nardil Parnate Marplan Selegiline* *Available in a patch form called EMSAM Hypertensive Crisis and Tyramine

Bipolar Disorder (Mania) Assessment Stage I—Hypomania Stage II—Acute mania Stage III—Delirious mania

Bipolar Disorder (Mania) Childhood and Adolescence Lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about 1 percent Diagnosis is difficult Guidelines for diagnosis and treatment have been developed by the Child and Adolescent Bipolar Foundation (CABF)

Nursing Diagnosis

Outcomes

Planning/Implementation

Client/Family Education

Evaluation

Psychopharmacology/Mood Stabilzers Generic Lithum Valproic acid Carbamazepine Oxcarbazepine Lamotrigine Topiramate Brand Eskalith, Lithobid Depakote, Depakene Tegretol, Equetro Trileptal Lamictal Topamax

Planning/Implementation Blood levels are needed for Lithium ( mEg/ml) Depakote (4-12 mEg/ml) Tegretol (4-12 meg/ml) Monitor for side effects of lithium – Drowsiness, dizziness, headache – Dry mouth; thirst; GI upset; nausea/vomiting – Fine hand tremors – Hypotension; arrhythmias, pulse irregularities – Polyuria; dehydration – Weight gain --Potential for toxicity Symbyax is a combination of Prozac an antidepressant and Zyprexa an atypical major tranquilizer.

Monitor for side effects of anticonvulsants – Nausea and vomiting – Drowsiness; dizziness – Blood dyscrasias – Prolonged bleeding time (with valproic acid) – Risk of severe rash (with lamotrigine) – Decreased efficacy with oral contraceptives (with topiramate

Planning/Implementation (cont.) Educate client and family about the medication Outcome Criteria/Evaluation