Lectures Notes on Mood Disorders (Depression and Bipolar Disorders)

Flashcards on Depression and Bipolar Disorders

Earliest Depression Medications

The earliest medications for depression were developed in the 1950s.

Cognitive Behavioral Therapy (CBT)

A type of psychological treatment that works on the ways we think and behave to change how we feel.

Medication Knowledge

Medication categories you need to know for this unit, not specific medication names.

SSRIs (Selective Serotonin Reuptake Inhibitors)

Increase the availability of serotonin in the brain.

Examples of SSRIs

Examples include citalopram (Celexa) and sertraline (Zoloft). Often the first-line choice for depression treatment due to their side effect profile.

Anticholinergic Side Effects

Urinary retention, constipation, dry eyes, and dry mouth are possible side effects of mental health medications.

SSRIs Onset time

Patients need to be aware that it takes three to four weeks for the medication to start impacting them and improving their mood.

Black Box Warning

Information on a medication that the manufacturer and the FDA don't want anyone to miss

Black Box Warning on Antidepressants

People on antidepressants have an increased risk of suicide, particularly once it starts working (about three to four weeks).

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

Increase the availability of serotonin and norepinephrine.

NDRIs (Norepinephrine-Dopamine Reuptake Inhibitors)

Increase the availability of norepinephrine and dopamine.

TCAs (Tricyclic Antidepressants)

Inhibit the reuptake of serotonin and norepinephrine but can be lethal in large doses. High risk of overdose fatalities.

MAOIs (Monoamine Oxidase Inhibitors)

Medications that work on the monoamine process in the brain but interact with many over-the-counter medications, prescription medications, and foods increasing tyramine (aged foods) causing a hypertensive crisis.

Serotonin Syndrome

Caused by medications that increase serotonin availability, leading to changes in level of consciousness with agitation, neuromuscular excitement, rigidity, tremors, jerking, hyperthermia, tachycardia, hypersalivation, and diaphoresis.

Nursing interventions for a patient taking an SSRI experiencing drowsiness and dry mouth

Includes administering in the PM, encouraging patient to suck on sugar-free hard candy, and checking their orthostatic blood pressure.

Psychological Treatments for Depression

Individual psychotherapy (cognitive behavioral therapy), group therapy, and family therapy.

Electroconvulsive Therapy (ECT)

A treatment that uses electrical electrodes on the head to induce a generalized seizure throughout the body.

Side Effects of ECT Treatment

Short-term memory loss and confusion

Other Treatments for Depression

Transcranial magnetic stimulation (TMS), light therapies, and ketamine.

Nursing Interventions for Depression

Prioritize safety, address Maslow's hierarchy of needs (biological, hydration, nutrition, sleep), and engage the patient in activities.

Nonsuicidal Self-Harm

Any way that a person is self-harming without the motivation of ending their life, such as cutting, burning or excessive tattooing

Priorities for Mental Health Patients

Instituting suicide precautions, working on a therapeutic relationship, helping them establish adequate nutrition and hydration, and promoting sleep and rest.

Nurse Response to Self-Harm

When a nurse sees that someone's done some kind of self-harming behavior (like cutting), they must take it seriously but do not overreact giving the patient possible secondary gain.

Exam Tips for Depression

Know bolded terms, medication tables (side effects and nursing interventions), drug alert boxes, and review tables with nursing interventions and rationales.

Mood Disorders Categories

Two categories of mood disorders that are either called mood disorders or affective disorders: depressive disorders and bipolar disorders.

Bipolar Disorders

Mood swings from profound depression to mania (euphoria, anger, high energy, out of touch with reality), with periods of normalcy.

Symptoms of Depression

Depressed mood nearly every day and a loss of interest or pleasure in usual activities (anhedonia).

Symptoms of Mania

Elevated or expansive mood, inflated self-esteem or grandiosity, decreased need for sleep, increased talking (pressured speech), and distractibility.

Mania: Poor Judgement

Excessive involvement in risky or pleasurable activities (sexual promiscuity, gambling, reckless driving).

Bipolar I Disorder

Full syndrome from mania (full mania) and major depression.

Rapid Cycling

More than four mood swings in a year.

Bipolar II Disorder

Major depression and hypomania (less than full mania). No psychosis.

Cyclothymia

Dysthymia (moderate depression) and hypomania (smallest swing).

Symptoms of Bipolar Disorder

Difficulty with flight of ideas, pressured speech, and a labile mood.

Lithium

The drug of choice for bipolar disorder. Acts in the body like a salt. Impacts those with kidney or heart problems. Requires lab monitoring. Can become toxic.

Alternatives for Lithium

Anticonvulsants used as mood stabilizers (e.g., lamotrigine).

Psychotherapy for Bipolar Disorder

Recognizing patterns that precede shifts in mood and improving communication within families.

ECT Nursing Interventions

Monitor vitals, prevent aspiration, be aware of dizziness, allow patient to sleep, treat headaches symptomatically, and allow patient to eat as soon as they are hungry.

Nursing Interventions for Bipolar Disorder

Safety is a huge priority, monitor for suicidal ideation, and redirect energy to safe activities.

Nursing Interventions for Aggressive Patients with Mania

Observe them at least every ten to fifteen minutes, remove sharp objects, mirrors, belts, ties, smoking materials, redirect violent behavior with physical outlets, stay calm, respond matter-of-factly to their hostility, have sufficient staff show support, and always use restraints as a last resort.

Taking Care of Biological Needs

Provide foods that they want to eat that, if they can get them to be high calorie and high protein and finger foods, things that they can just take and eat on the go so that they get enough to eat, keep track of their intake and output, get daily weights, calorie counts, and watch their lab values, supplement with vitamins and minerals.

Safety Interventions

Be sure there is a safe environment and implement any needed suicide precautions.

Prioritization for Patient Needs

What is your order of priorities for this patient?

Regiment for people with Bipolar Disorder

Always follow a consistent routine.

Kay Whitfield Jamison

Used to describe how an individual moves through extreme thoughts and emotions.