Comprehensive Study Guide on Depression & Bipolar Disorder (Week 6)

define affect and types

- affect: expression of mood

- blunted (reduced emotion), bright (increased emotion), flat (no expression), inappropriate (doesn't match situation), labile (changes), restricted/constriction (reduced emotion but still showing mood)

presentation of depressive disorder in children vs adolescents vs adults

- children: more likely to have anxiety, somatic complaints, withdrawn

- adolescents: more irritable/angry

- adults: undetected r/t blaming on physical sx

the clinical course of major depressive disorder is...

progressive (starts gradually then picks up) and recurrent (comes back)

what diagnostic criteria is needed for major depressive disorder

sad mood or anhedonia (loss of interest) in nearly all activities for 2wks, disruption in sleep (insomnia & hypersomnia), appetite changes, decreased energy, psychomotor agitation or retardation, guilt, suicidal ideation

how do you go about tx for someone who has major depressive disorder and substance abuse

they need to be sober first in order to effectively tx depression

risk factors of major depressive disorder

prior episodes, family history (first degree relative), lack of support, lack of coping, substance abuse, stressors

define persistent depressive disorder (dysthymia)

major depressive disorder symptoms lasting for 2 years (adult), and 1 year (children and adolescents)

define premenstrual dysphoric disorder

recurring mood swings, feelings of sadness, or sensitivity to rejection in the final week prior to menses

define disruptive mood dysregulation disorder

irritability & outbursts of anger before age of 10

what are the goals of tx in depressive disorders

reduce & control sx, eliminate s/s of depressive syndrome, improve occupational/psychosocial function, reduce likelihood of relapse

what should you be assessing for every visit with major depressive disorder

suicide risk

what is the risk with starting antidepressants

may increase suicide risk by making person more comfortable with plans

what symptoms may be present upon the physical examination for depressive disorders

appetite and weight changes, sleep disturbances, tiredness, decreased energy, fatigue

what self report scales can be used in depressive disorder

Beck Depression Inventory, Hamilton Rating Scale

what important aspects of the therapeutic relationship are needed in nursing care for depressive disorder

availability in times of crisis, education about illness and tx goals, realistic goal setting/monitoring

what med classes may be used for major depressive disorder

SSRIs, SNRIs, NDRIs, tricyclics, and MAOIs

what is the blackbox warning for antidepressants

increased risk of suicide in <26y/o

what are s/s and tx of serotonin syndrome

- s/s: mental status changes, agitation, ataxia, myoclonus, hyperreflexia, fever, shivering, diaphoresis, diarrhea

- tx: d/c drugs, propanolol & lorazepam, VS, fluids, cooling blankets, artificial vent

how long does it take to reach effects for antidepressants

up to 4wks

ECT is only used in...

severe cases of depression or bipolar, when meds dont work

what other somatic therapies may be used for major depressive disorder

light therapy, TMS

define mania and what it is characterized by

- abnormally and persistently elevated mood

- elevated mood (euphoria or elation), grandiosity (superiority), irritable mood

manic episode vs. mood lability

- manic episode: distinct period of mania

- mood lability: rapid shifts in mood with little to no change in external events

define hypomania

low-level and less dramatic mania

what are the 4 a's of mania

anger, agitation/aggression, anxious, attention/disturbances

bipolar disorder is typically seen in...

in the 20s

male vs female differences in bipolar disorder

- female patients at greater risk for depression and rapid cycling

- males at greater risk for manic episodes

how does bipolar disorder change across the lifespan

- children: depression occurring first marked by intense rage

- older adults: neuro abnormalities and decreased incidence of mania

what is the chronobiologic theory of bipolar

disruption in the sleep/wake cycles

bipolar I vs bipolar II

- bipolar I: major depressive, manic, or mixed episodes

- bipolar II: major depression and hypomania (doesn't have full blown manic episodes

what is cyclothymic disorder

elevated mood that does not meet criteria for hypomania and depressive episodes not meeting full criteria for major depressive episode

what is the dsm-5 criteria for mania/manic episode

distinct period of abnormally/persistently elevated and irritable mood and goal directed activity lasting at least 1 week and present most of the day (if <1wk then it is hypomania)

what are symptoms of a manic episode

grandiosity, decreased need for sleep, talkative, flight of ideas, distractability, increased goal directed activity, involvement in activities that have high potential for unwanted consequences

why would someone with bipolar disorder usually end up in the hospital

mania

what diet/food would you implement for someone with bipolar disorder

high calorie finger foods that are easy to eat on the go

a person with bipolar disorder must be on a ____ FIRST before depressive symptoms are treated

mood stabilizer

why is it important to assess if the bipolar pt is on antidepressants?

antidepressants can throw someone into mania if mood is not stabilized first

what med is bets for decreasing suicidality?

lithium

what main aspects of a therapeutic relationship are important for someone that has bipolar disorder

remain calm and avoid power struggles, avoid confrontations, respect personal space

what med is first choice for mania?

lithium

what is client education and nursing considerations for the use of lithium

- eat a diet LOW in sodium to avoid lowering lithium, keep adequate fluid and avoid dehydration to avoid raising lithium

- monitor BUN and CR since it is hard on kidneys, therapeutic maintenance range is 0.6-1.2mEq/L, range for acute mania is 1.0-1.5mEq/L

what are symptoms of lithium toxicity and what should you do

- confusion, repeated jerking or twitching, altered LOC, increased DTR, seizures, syncope, coma, blurred vision

- WITHOLD DOSE and notify HCP, push fluids

what med is second choice for mania?

divalproex sodium (Valproic Acid/Depkote)

what are nursing considerations for Depakote

- monitor LFTs (hepatotoxicity risk), teratogenesis risk

- therapeutic range is 50-120ng/mL

what are manifestations of Depakote and carbamezapine toxicity

agitation, stupor, disorientation, tachycardia, respiratory depression, nystagmus

what med is third choice for mania?

carbamezapine (Tegratol)

what are nursing considerations for carbamezapine (Tegratol)

- does not work well with other drugs, black box warning for aplastic anemia and agranulocytosis

- therapeutic range 8-12 ng/mL

what is the main risk of lamotrigine (Lamictal)

stevens johnsons syndrome!! (monitor for skin rash)

what are examples of atypical antipsychotics

aripiprazole (Abilify), clozapine (Clozaril), risperidone (Risperdal), zipreasidone (Geodon), paliperidone (Invega), lurasidone (Latuda), cariprazine (Vraylar), asenapine (Saphris)

what atypical antipsychotic is given sublingually

asenapine (Saphris)

what atypical antipsychotic must be taken with at least 350cals of food

lurasidone (Latuda)

what is the med combo to help alleviate mania symptoms in bipolar

lithium/Depakote/Tegratol (stabilize mood) + atypical antispsychotic (calm pt)

what is the med combo to help alleviate depressive symptoms in bipolar

atypical antipsychotic + antidepressant (SSRI)