Mood Disorders

chapter 12 and 13

• What is Bipolar Disorder? (Bipolar #1)• http://www.youtube.com/watch?v=MBUOoQk0hhU • Diagnosing and Treating Bipolar Disorder (Bipolar #2)• http://www.youtube.com/watch?v=iMMDYZdJBeM• What is Depression? (Depression #1)• http://www.youtube.com/watch?v=IeZCmqePLzM• Treating Depression (Depression #2)• http://www.youtube.com/watch?v=qVEueGutbSs • Clinical Depression• http://www.youtube.com/watch?v=-bru3sJ8yiU

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 theoriesPhysiological influences– Psychoanalytical theory

• Mourning • Melancholia

Learning theoryObject lossCognitive 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

• 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

• GenericFluoxetineParoxetineSertralineCitalopramEscitalopramFluvoxamine

• BrandProzacPaxilZoloftCelexaLexaproLuvox

Serotonin Syndrome

• Delirium Agitation• Tachycardia Sweating• Hyperreflexia Muscle spasms• Shivering Coarse tremors More severe cases• Hyperthermia Seizures• Renal failure Rhabdomyolysis• Dysrhythmias DIC

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)

AssessmentStage I—HypomaniaStage II—Acute maniaStage 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

• GenericLithumValproic acidCarbamazepine OxcarbazepineLamotrigineTopiramate

• BrandEskalith, LithobidDepakote, DepakeneTegretol, EquetroTrileptalLamictalTopamax

Planning/Implementation• Blood levels are needed

for Lithium (0.4-1.2mEg/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 toxicitySymbyax 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