Mood%20Disorders

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Mood Disorders
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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.

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Types of Mood Disorders

• Depressive Disorders
• Bipolar Disorders
• Others

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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

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Bipolar Disorders

• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder

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Depression Predisposing Factors

• Biological theories
• Genetics
• Biochemical influences
• Neuroendocrine theories
• Physiological influences
• Psychoanalytical theory
• Mourning
• Melancholia
• Learning theory
• Object loss
• Cognitive theory

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Depression Developmental Implications

• Childhood Depression
• Symptoms
• Adolescence
• Symptoms include
• Senescence
  Treatment
• Postpartum Depression Treatment

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Assessment

• Transient depression
• Mild depression
• Moderate depression
• Severe depression

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Nursing Diagnosis
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Outcome
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Planning/Implementation
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Client/Family Education
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Evaluation
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Treatment Modalities
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Antidepressants

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

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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).

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Antidepressants- SSRI

• Generic
• Fluoxetine
• Paroxetine
• Sertraline
• Citalopram
• Escitalopram
• Fluvoxamine

• Brand
• Prozac
• Paxil
• Zoloft
• Celexa
• Lexapro
• Luvox

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Serotonin Syndrome

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

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Antidepressants

• Generic
• Bupropion
• Mirtzapine
• Venlafaxine
• Duloxetine
• Amitriptyline
• Imipramine
• Phenelzine
• Selegiline

• Brand
• Wellbutrin
• Remeron
• Effexor
• Cymbalta
• Elavil
• Tofranil
• Nardil
• Emsam

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Monoamine Oxidase Inhibitor

• Nardil
• Parnate
• Marplan
• Selegiline
• Available in a patch form called EMSAM
• Hypertensive Crisis and Tyramine

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Bipolar Disorder (Mania)

• Assessment
• Stage IHypomania
• Stage IIAcute mania
• Stage IIIDelirious mania

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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)

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Nursing Diagnosis
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Outcomes
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Planning/Implementation
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Client/Family Education
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Evaluation
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Psychopharmacology/Mood Stabilzers

• Generic
• Lithum
• Valproic acid
• Carbamazepine
• Oxcarbazepine
• Lamotrigine
• Topiramate

• Brand
• Eskalith, Lithobid
• Depakote, Depakene
• Tegretol, Equetro
• Trileptal
• Lamictal
• Topamax

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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 toxicity
• Symbyax is a combination of Prozac an
  antidepressant and Zyprexa an atypical major
  tranquilizer.

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• 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

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