mood disorder

mood diorder

-change in mood

-change all lvel of activity

-could be unipolar,bipolar

major depression

change in previous function

severe pain suffering

symptom cause distess and impaire in spcial occupational functioning

dsm cristeria MDD

6+ in 2w,at least ne euther depress, loss of interest

-dimish interest

-depress

-weight gain/loss

-insomni-hypersomnia

-incresase/decrease motor activity

-infatigue or loss nergy

-worthless, guilt

-diminish to think, concentrate, indeviveness

-sucical idelation

epidemelogy depression

onset 15-45

more in women

comorbity depression

-anxeity-most common

-sciephrenia

-susbstance use

-personality

-eating

a

rism factor

-female

-early childhood trauma

-stress

-family hx

-substance use

-neuroticism high

-chrnonisiable medical condition

-substance,anxiety, personality

gentic depression risk factor

monozygotic twins

affect by encironetal

biochemical risk factor depression-

serotonin-selep. decrease appetie, low sex drive, poor impulse control

-NE result apathy, reduce responsigveness,slow psychomotor

-dopamine, Ach, GABA. gluctamate

altreation in hormone risk factor depression-p

othalamic-piturary-adrenal regulate body process;digestion,immune, mood, secxuality, energy

-overstimulte it HPA axis

0high cortisol-inflammtion

diathesis -stress model risk facotr depression

-interplay biology and life event

-psyvhosocial and interpersonal event trigger neurophysical and neuroche ical change

-have vulnerability combine with stress

osychological risk factor depression

-cognitve theory;negative intepret life result in sorrow, hopelessness

-lenaress helplessness-anxiety replace depression if no control outcome

dsm criteria mania

-mood siutrabance and increase nergy 3+symptom >1wk

-inflated self esteem

-decrease need of sleep

-flight of diea,racitng thought

-distractibility

-increase goal driected activity

-excessive invvolve in hifh potential ativity for painful conseuqnce

-more talkative

mania

modd siturabannce lcause marked impaire in social /ocuu[ational function

reuqired hipsitalization to prevent harm

hypomania

mild form of mania

short duration

not cause significant impirament in social/occupational activity

without psychotic feaute

not lead to hosptialization

-

classification

1.bipolar I ;at least one episode mania alternate major depression, psychosis present if manic

2.bipolar II:hypmanic with major depression

3,cyclothymia;hypomania with mild/moderate depression 2yr

4.rapid cycle;4+mood episode ofmajor depressibe,manic,mized in 12m

epidemiology manic

onset 18-20

comorbidity manic

anxieyty

substance use

migraine

ADHD

metabolic syndrom

manic gentic risk

pare t that are cretaive and educated

run in familu

mmanic biochemical

increase dopamine,NE, seortonin

gluctate overactive

GABA deficient

neurophysilogic manic risk

-prefrontal cortical and hippocampus

emotional liability,heightened reward sensitivity

emotional dysregulation

encrionmental manic risk

-stress life event

-susbstance

-upper SES

-if comprimised social detrminanat

depression assessment-apearance and behabior

-older

-neglect personal hygiene

-lethargy-psychomotor reyardating

-psychomotor agityation-constant pacing,

-vegetative sign;alteration in eat, sleep,bowel,libido

depression assessment -affect

-flat/convey sadness

-less eye contact

-weeping or not able to cry

depression assessment -mood

anxious, worthelesness, guilt, hopelessnbess, irritable, anger

depression assessment0thought process

-speak slowly

-monotone voice

-frequent sighing

-poor judgement,indiecisive

-poor moermy and concentation

thought concern -dreppsion assessment

suicidal idealtion

exaggret perceived fault/failure

cognition-depression assessment

-mnegatively affect solve problem,

-indecive

-impaire memory

-poor judgement

-diffifcult concentrate

hamilton depression dating score

-depressed mood

-guilt

-suicide

-;loss of weight

-somtic ss

-reproductive ss

-anxiety illness/psyhic/somatic

-agitation

-insomnia early/late

-work and activity

depression assessment-feeling

worthelss, guiolt anger

anhedonia=unable feel happy

manic assesssment-apperance and behavior

-outlandish dress

-overdone makeuo

-hyperactive to do ADL

-enery,enthusiaism,

-pursue grandiose

-lavish party

-spend money

-manipulative

-voraviosu appeite-social engagemnt and sex

manic assessment -affect

animated

cheerful

smile

reactive

manic assesmment-mood

euphira

change from irritationa and anger

manid assessment-thought process

-pressured speech

loudspeech

flight of idea

clang assoiciarion

grnadiose

sedually joke

thought content manic assessment

grandiosity

extroridanation sexual prowness

brilliant businness ability

cognition manic assessment

difficult conventration

short attention

poor insight and judgement

behbiaor manic assessment

increase activity, reduce sleep need

hyperactivity

social engaement

beyong mse manic assessment

how it affect sleep,appeote,elimination

pt knowldge

coping mechanism

SO

adherence

medical problem

rx adherence

self care nutrtion intervention

high caloric,high protein

finger good

provide choices

observe eating pattern

encourage to eat with pther

self care -hygiene intervention

reminder

supervise choice of cloth

encorugae use of

self care-sleep intervention

-stay out of bed

-s,eep disturtion trigger mania

-freuqnet rest period

-decrease neviromental stimulation

-maintain sleep awake cycle

strucutere a safe mileur intervention

-sucide:search for belonging and remove harzardour

check q15-30min

-manic:limit setting,caling activity

pt education intervention

=discuss role of Rx,

identify coiping/problem solving

resource community

prevent relapse:show ss of replase can cause by alohol,subsytance

depression phase implementation

-acute (6-12wk0 :reduce depressive ss,resptre psychosocial and work fx need hospitalization

continuation(4-9m_ thought Rx, depression specific psycotherapy

-maintrenance(1yr+) direct prevent depression of recurrence

ECT process

-process elctric cureent to trigger seizure

0increae acitbity of brain chemical/neurotransmitter lead to improve mood

sual course 2-3 tx /wl

Ect as primary tx

-previous rx not effectibe

-intense suicidla idealtion

-major depression with psychotic

-severe mania and drug resistant

-marked agitation,begetative symptom

-rapid cycler

-severly malnourished,echausted, dejudrated

ECT risk

increase risk for pt with cardiac issue

reuqired informed consent

give anesthetic

adverse reaction ect

retrograde amnesia

loss of meoery

muscle stiffness

confusion

disorientation

post tx assessment

loc

vs

oerrla

sensation

elimination

other tx

psychotherpay

cognitve behaviorla therapy

group therapy