Depressive/Bipolar Disorders and Suicide/NSSI

DSM-5 Diagnostic Criteria Major Depressive Disorder (MDD)

Unipolar Depression = MDD

euthymic = normal mood

• MDD doesn’t go over normal mood

• psychotic features (hallucinations (false sensory perceptions) and delusions (false, fixed beliefs)) happen at the lowest of depressed

terms:

• insomnia (know)

• hypersomnia (know)

• psychomotor agitation/retardation

• anhedonia

• Difficulty sleeping

• Excessive sleep

• Increase/decrease in motor activity

• Inability to feel pleasure

(in order)

Depressive Disorders

Major Depressive Disorder (MDD)

• Full Diagnostic Criteria (DSM-5) – pp. 242-3

• Primary Risk Factors for Depression (BOX 14.1)!!!

Nursing Process w/ Depressive Disorders

• what three things to assess

what three things to assess

• 14.5 and 14.3!!!

Mental Status Exam

Treatment of Depressive Disorders

SSRIs

Know what’s in red for exam

Selective Serotonin Reuptake Inhibitors (SSRIs)

• action

• side effects

• what to look out for

• GI s/s: n/v/d

Serotonin Syndrome

• define s/s

• when does it occur

• how dangerous is it

mnemonic shivers

Encephalopathy is a broad term for any disease, damage, or malfunction that alters brain function

Treatment for Serotonin Syndrome

• hold anything that has serotonin

Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)

• action

• side effects

• what to watch out for

SNRIs

know whats in red for exam

discontinuation syndrome

• why does it happen

• s/s

• abruptly stopping meds

• s/s: flue like symptoms, dizziness, insomnia, anxiety, paresthesia ("pins and needles" sensation), nausea may occur w/ abrupt withdrawal.

Serotonin Antagonists & Reuptake Inhibitors

(SARIs)

• action

• side effects

• what to look out for

SARIs: know what’s in red for exam

Norepinephrine Dopamine Reuptake Inhibitor (NDRI)

• action

• side effects

• No sexual side effects

NDRIs: know whats in red for exam

Noradrenergic & Specific Serotonergic Antidepressant (NaSSA)

• action

• side effects

• works on f norepinephrine & serotonin

NaSSAs: know what’s in red for exam

Tricyclic Antidepressants

• action

• side effects

• what to watch out for

• does same thing as SNRI

• think dried up for s/s

TCAs: know what’s in red for exam

Monoamine Oxidase Inhibitors (MAOIs)

• action

• side effects

• what to watch out for

monoamine: serotonin, dopamine, norepinephrine

oxidase: enzyme

inhibitors: stops/blocks

MAOIs: know what’s in red for exam

HYPERTENSIVE CRISIS

• caused by what med class

• caused by intake of what, examples?

• define

• when does it occur

• note

Treatment of Hypertensive Crisis

When does it start to work?

What about side effects? when do they start

right away

Common Side Effects (of LOTS OF MEDS!!)

Antidepressant Therapy: How does it affect suicidal ideation/suicide risk?

Bipolar Disorders

A complex combination of:

• Manic episodes

• Hypomanic episodes

• Depressive episodes

• Mixed episodes: both mania and depression present nearly every day in rapidly alternating succession for > 1 week (dont need to know)

Bipolar Depression = Bipolar Disorder

experiences both manic and depressed

Manic Episode

• needs to last how long according to DSM-5 criteria

• s/s

• mnemonic DIG FAST

Hypomanic Episode

• lasts how long according to DSM-5 criteria

• s/s

• mnemonic: TAD HIGH

• doesn’t include hallucinations

• hallucinations = manic not hypomanic

Bipolar 1

>1 manic or mixed episodes alternating with major depressive episodes

Bipolar 2

>1 hypomanic episodes accompanied alternating with major depressive episodes

Nursing Process w/ Bipolar Disorders

• what to assess

what to assess

MDQ Screening Tool for Bipolar Disorder

Mental Status Exam --

• Variations Commonly Seen With Mania

Common Nursing Diagnoses R/T Behaviors Commonly

Exhibited with Mania

See Table 13.2

• Risk for Injury

• Risk for violence (self-directed or other-directed)

• Sleep deprivation

• Impaired cognition/concentration

• Self-care deficit (feeding, bathing, dressing)

• Impaired socialization

Bipolar: Outcome Identification

• acute vs maintenance phase

• Desired outcomes vary depending on the current phase of the illness.

• Acute Phase  safety & symptom reduction

• Maintenance Phase  stay out of the hospital

Bipolar: Nursing Care: Planning/Implementation

In general (for mania):

• Keep environmental stimuli low

• Limit group activities until less agitated

• Schedule rest periods

• Provide high-calorie drinks & finger foods

• Set/enforce limits R/T unsafe/socially inappropriate behavior

• If delusions and/or hallucinations, acknowledge the feeling & present reality

Medications for Bipolar Disorder

• mood stabilizers

• Anticonvulsants:

• Antipsychotics:

Mood Stabilizers:

• Lithium

Anticonvulsants:

• Carbamazepine (Equetro)

• Valproate (Valproic Acid, Depakote)

• Lamotrigine (Lamictal)

Antipsychotics – we will discuss these in detail when we get to Schizophrenia Spectrum Disorders

Lithium

• signs

• interventions

lithium

• therapeutic range

• s/s of toxicity

Important Teaching With Lithium

• Effects begin within 10-21 days.

• Take as prescribed and at the same time(s) each day if possible.

• Drink plenty of fluid and keep amounts of sodium in diet consistent.

• Withhold Lithium and seek medical attention if experiencing N/V.

• Ongoing lab monitoring required:

• Baseline kidney function and then periodically to monitor for renal toxicity.

• Baseline thyroid studies and then annually to monitor for hypothyroidism.

• Plasma lithium levels every 2-3 days at initiation of treatment and then

every 3-6 months to monitor for lithium effectiveness and lithium toxicity.

• Therapeutic plasma levels: serum trough level of 0.8-1.2mEq/L (may be

higher initially to manage manic episodes)

• Toxic plasma levels: > 1.5mEq/L

See BOX 13.2 for additional points for pt/family teaching R/T Lithium therapy

Anticonvulsants for Mood Stabilization

Stevens Johnson Syndrome (SJS)

• define

• s/s

• intervention

• what med class commonly causes SJS (for the purpose of the class)

a rare, life-threatening skin disorder often triggered by medications that causes painful, blistering rashes, fever, and skin peeling. It affects mucous membranes (eyes, mouth, genitals) and requires immediate hospitalization,