NUR 114 #2 suicide/bipolar/depression

What is bipolar disorder?

Diagnosed when a persons mood fluctuates to extremes of mania &/or depression

What is mania?

Distinct period during which mood is abnormally and persistently elevated, expansive, or irritable (lasts abt a week) may be longer

What do manic episodes manifest?

Inflated self esteem/grandiosity, decreased sleep, excessive and pressured speech (unrelenting, rapid, often loud talking w/o pause), flight of ideas, distractibility, increased activity of psychomotor agitation, and excessive involvement in pleasure seeking or risk raking activities

What is hypomania?

Period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania (doesn’t effects persons ability to function; most likely productive)

What is bipolar 1?

One or more manic or mixed episodes usually accompanied by major depressive episodes

What is bipolar 2?

One or more major depressive episodes accompanied by at least 1 hypnotic episode

What is persistent depressive (dysthymic) disorder?

chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression.

What is disruptive mood dysregulation disorder?

persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or situation, beginning before age 10.

What is cyclothymic disorder?

mild mood swings between hypomania and depression without loss of social or occupational functioning.

What is major depressive disorder?

Typically involves 2 weeks or more of a sad mood or lack of interest in life activities with at least four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision making, self esteem and goals (twice as common in women)

Pharmacological treatments?

MAOIS, SSRIS, and atypical antidepressants

Which class of meds are most common for clients with depression?

SSRIS

Examples of SRRIS?

Fluoxetine, sertraline, paroxetine, citalopram, Escitalopram

SSRI side effects?

Headache, nervousness, anxiety, sedation, tremor, sexual dysfunction, anorexia, constipation, nausea, diarrhea, and weight loss, dry mouth/throat, vomiting, sweating, insomnia, weakness, restlessness

SSRI nursing implications?

Administer in p.m. if client is drowsy. Encourage use of sugar-free beverages or hard candy. Drink adequate fluids. Monitor hyponatremia; report sexual difficulties to physician. Administer with food

Citalopram nursing implications?

Monitor for hyponatremia. Administer with food. Administer the dose at 6 p.m. or later. Promote balanced nutrition and exercise.

Escitalopram nursing implications?

Check orthostatic blood pressure. Assist client in rising slowly from sitting position. Encourage use of sugar-free beverages or hard candy. Administer with food.

Examples of tricyclic antidepressants?

Amitriptyline, imipramine, clomipramine

Tricyclic side effects?

Dizziness, orthostatic hypotension, tachycardia, sedation, headache, tremor, blurred vision, constipation, dry mouth and throat, weight gain, urinary hesitancy, and sweating

Amitriptyline nursing implications?

Assist client in rising slowly from sitting position. Administer at bedtime. Encourage use of sugar-free beverages and hard candy. Ensure adequate fluids and balanced nutrition. Encourage exercise. Monitor cardiac function.

Imipramine nursing implications?

Assist client in rising slowly from sitting or supine position. Ensure adequate fluids and balanced nutrition. Encourage use of sugar-free beverages and hard candy. Encourage exercise.

SSRIS important info?

Take in the morning, reduces side effects → pt more compliant

Tricyclics important info?

Oldest antidepressant, relives symptoms off hopelessness, anhedonia, guilt, takes 6 weeks for full effect, cardiac issues, anticholinergic effects/orthostatic hypotension

Atypicals important info?

Used when SSRIS aren’t working, report signs of suicide, give w food at same time everyday

Example of atypical antidepressants?

Venlataxine, duloxetine

Venlataxine side effects?

Low libido, HTN, tachycardia, anxiety, headache, N/V, fatigue

Examples of MAOIS?

Phenelzine, selegiline, tranylycpromide

MAOIS side effects?

HTN crisis (headache, HTN, N/V, chills, fever, dilated pupils

MAOIS important info?

Use phentolamine for HTN crisis, no tyramine foods (banana, aged cheese, red wine, salami), takes 2-4 weeks to work, no decongestants, 5-6 washout period

What is electro convulsive therapy?

Used to treat depression in select groups, such as clients who do not respond to antidepressants or those who experience intolerable side effects at therapeutic doses (particularly true for older adults). In addition, pregnant women can safely have ECT while many medications are not safe for use during pregnancy. Clients who are actively suicidal may be given ECT if there is a concern for their safety while waiting weeks for the full effects of antidepressant medication. It has also shown a high degree of efficacy for patients with psychotic features and marked psychomotor disturbances (6-15 treatments 3 times a week)

Nursing actions for depression?

• Provide for the safety of the client and others.

• Institute suicide precautions if indicated.

• Begin a therapeutic relationship by spending nondemanding time with the client.

• Promote completion of activities of daily living by assisting the client only as necessary.

• Establish adequate nutrition and hydration.

• Promote sleep and rest.

• Engage the client in activities.

• Encourage the client to verbalize and describe emotions.

• Work with the client to manage medications and side effects.

What is spravato?

A nasal spray Atypical antidepressant that can cause sedation, dissociation, abuse, misuse, SI

What is the treatment for bipolar?

Lithium and anticonvulsants

How does lithium work?

Thought to work in the synapses to hasten the destruction of dopamine and norepinephrine, inhibit neurotransmitter release and decrease the sensitivity of postsynaptic receptors (peaks in 30 mins-4 hours for regular. 4-6 hours for slow release)

When should SSRIS be taken?

In the morning unless sedation is a problem. If forgotten, they can take it up to 8 hours after missed dose

When should cyclics be taken?

At night. If forgotten, take it within 3 hours of missed dose or omit for the day