Week 2 MH Exam 1 (pt 2); Depressive Disorders

Types of Depressive Disorders

• Major Depressive Disorder

• Disruptive Mood Dysregulation Disorder

• Persistent Depressive Disorder

• Premenstrual Dysphoric Disorder

• Substance/medication- induced depressive disorder

• Depressive disorder due to another medical condition

Depression (symptoms and criteria)

• depressed mood (lasting more than 2 weeks)

• Anhedonia

• weight loss or gain

• insomnia or hypersomnia

• psychomotor agitation or retardation

• decreased concentration and decision making

• recurrent though of death, SI

Assessment for Depressive disorders

• suicidality assessment

• behavior/affect

• mood and emotions

• thoughts/perceptions

• comorbidity

Predisposing Factors of Depressive Disorders

• genetics

• biological : neurotransmitters NE, 5HT (serotonin) , hormones, inflammation

• female

Normal Grief

emotional pain, suffering, impairment for a while

Persistent complex bereavement disorder

beyond 12 months (adults)

Complicated Grieving

functional impairment

Disenfranchised Grief

not congruent with socially recognized relationship

Anticipatory Grief

Grieve future loss

Grief vs Depression

• grief: gradually gets better, has “waves” of sadness, identity is intact

• Depression: constant and pervasive, self loathing, suicidal

Seasonal Affective Disorder (sympt)

• shortened daylight

• abnormal melatonin

• recurring

• lethargy

• irritability

• depressed mood

• increase appetite

Seasonal Affective Disorder Treatment

SSRIs and Light

Persistent Depressive Disorder (dysthymia)

• milder than MDD

• low level depressive feelings , at least 2 years in adults and 1 year in children/adolescents

• must have two or more

  • decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self esteem, difficulty thinking and hopelessness

Premenstrual Dysphoric Disorders

symptom cluster in last week before start of a woman’s period and decrease or disappear with the start of a period

• mood swings, irritability, depression, anxiety, feeling overwhelmed, difficulty concentrating, overeating, insomnia, breast tenderness, bloating

Premenstrual Dysphoric Disorders Treatment

SSRIs, GnRH analogs, OCP

Substance - induced depressive disorder

person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal

Serotonin Syndrome

• too much serotonin

• agitation, diarrhea, heavy sweating, fever, mental status changes, muscle spasms, hyperreflexia, shivering, tremor, ataxia, HTN, tachy

• Treatment: stop meds- give Benzo, fluids, cyproheptadine

Electroconvulsive therapy

most effective depression treatment (psychotic illnesses= second most common indication)

• expect temporary memory loss

Electroconvulsive therapy (nursing care)

Pre-treatment

• have crash cart, NPO status, education, consent, labs

• administer anticholinergic, pt in comfy clothes, void immediately before

• suicide assessment

During Procedure

• BP cuff on ankle, pulse Ox, Bite Block (normal for pulse and BP to increase during seizure)

Post procedure

• pt is asleep approx 15 minutes

• monitor side effects : HA, soreness, N, disorientation, memory loss

Repetitive transcranial Magnetic Stimulation

noninvasive (no anesthesia , less effectie)

• uses MRI strength magnetic pulses to stimulate focal areas of the cerebral cortex

• presence of metal is main contraindication

• AE: HA and lightheadedness, no neurological deficits or memory problems, seizures rarely, most are mild and include scalp tingling and discomfort at the administration site

Vagus nerve stimulation

originally used to treat epilepsy

• surgically implanted

• decreases seizures and improves mood

• electrical stimulation boosts the level of neurotransmitters

• side effects (risky); voice alteration (nearly 60%), neck pain, cough, paresthesia, dyspnea

deep brain stimulation

surgically implanted electrodes directly into the brain

• stimulates those regions identified as underactive in depression

• more invasive than vagus nerve stimulation

Light Therapy

first line treatment for seasonal affective disorder

• negative: HA and jitterinesas

Ideation

• passive: “I wish”

• active: “i want to”

Risk factors for suicide

SAD PERSONS

Sex

Age

Depression

Previous attempts

ETOH (alcohol)

Rational thinkening loss

Social supports lacking

Organized plan

No spouse

Sickness

Assess for warning

IS PATH WARM

Ideation

Substance abuse

Purposelessness

Anxiety

Trapped

Hopelessness

Withdrawal, social

Anger

Recklesness

Mood

Schizophrenia

affects 1% of adults

• mostly onsets btwn 15 - 25 y/o (more males)

• may have a higher pain threshold

Schizophrenia- DSM5 criteria

2 or more of the following for most of time for at least 1 month

• delusions, hallucinations, disorganized, incoherent speech, loose associations, negative symptoms, some kind of functional impairment

continuous disturbances for at least 6 months

• rule out substance use or other disorders

First episode of schizophrenia

stress makes schizophrenia worse and schizophrenia causes stress

• appears in young adulthood (15-25 y/o)

Positive symptoms

alterations in reality, adding things that werent there

• delusions

• perception

• hallucination

Negative symptoms

the absence of essential human qualities

• anhedonia

• affective blunting

symptoms of altered mental status

• loose association

• clang association

• neologisms

• echolalia

• thought insertion

• magical thinking

• ideas of reference

Neuroleptic malignant syndrome (NMS)

caused by severe muscle rigidity

• severe muscle rigidity

• reduced or absent speech and movement

• decreased responsiveness

• hyperpyrexia: over 103 F

• delirium, stupor, coma

clozapine

2nd generation antipsychotic

can cause severe neutropenia

Anticholinergic effects

• cant pee

• cant spit

• cant shit

• cant piss

Extrapyramidal symptoms

• muscle rigidity

• tremors

• akathisia (internal restlessness)

• drooling

• shuffling gait

• acute dystonia

EPS treatment

is reversible

• decrease dosage

• administer an anticholinergic or antihistimeine or dopamine agonist

Tardive Dyskinesia

used to be considered permanent

• new treatment: valbenazine

• involuntary mouth movements

• foot tapping

• pill rolling

• use abnormal involuntary movements Assessment to diagnose

abnormal involuntary movements assessment

used to identify tardive dyskinesia

• t

Bipolar disorder

• risk factors: female, trauma, family hx

• significant mood swings: profound depression, not extreme euphoria or dysphoria, periods of normalcy present

• Bipolar 1: 1 or more episodes of major depression + 1 or more. periods of mania

• Bipolar 2: 1 or more periods of Major depression + periods of hypomania

cyclothymic disorder

hypomania alternating with mild depression for at least 2 years (1 y in kids)

• symptoms dont meet criteria for MDD or Bipolar 2

• substance use comorbidity common

• sleep disturbances

Bipolar DSM5 criteria

distinct period of elevated, expansive or irritable mood (1 week mania, 4 days hypomania)

• at least 3 or more:

  • increased self esteem, grandiosity

  • decreased need for seep

  • increased, pressured speech

  • flight of ideas, racing thoughts, distractibility

  • increased activity, agitation, impulsitivity

  • risk taking and pleasurable activities with higher potential for painful consequences

Hypomania v Mania

Hypomania: change in functioning, uncharacteristic

• still functioning socially

• not delusional

Mania

• impairment in social/occupational functioning

• hospitalization needed