MOOD DISORDERS

MOOD DISORDERS

Major Depressive Disorder
Bipolar Disorder

Major Depressive Disorder (MDD)

Definition:
Persistent depressed mood or loss of interest.

Key symptoms:
Think SIGECAPS

S = Sleep changes
I = Interest loss
G = Guilt
E = Energy low
C = Concentration poor
A = Appetite changes
P = Psychomotor changes
S = Suicidal thoughts

Must last:
At least 2 weeks

Depression clinical signs

• hopelessness

• worthlessness

• fatigue

• isolation

• poor hygiene

• flat affect

• slowed speech

Important:
Depression affects:
thoughts, feelings, and function

Depression nursing priorities

Assess:
suicidal thoughts first

Watch:
energy returning before mood improves

Why?
Higher suicide risk when energy comes back.

Big test point.

Antidepressants

SSRIs

Fluoxetine
Sertraline
Escitalopram

First-line

Side effects:

• sexual dysfunction

• GI upset

• insomnia

Teach:
takes 2–6 weeks

SNRIs

Venlafaxine
Duloxetine

Used for:
depression + anxiety

Watch BP.

TCAs

Amitriptyline

Danger:
overdose risk

Anticholinergic effects:
dry mouth
constipation
urinary retention

MAOIs

Phenelzine

Food restrictions:
No tyramine

Avoid:
aged cheese
wine
cured meats

Risk:
hypertensive crisis

Serotonin Syndrome (EMERGENCY)

Serotonin Syndrome

Symptoms:
agitation
fever
diarrhea
tremor
hyperreflexia

Think:
too much serotonin

Stop med immediately.

Bipolar Disorder

Two poles:
mania + depression

Mania (VERY TESTED)

Symptoms:
DIGFAST

D = Distractibility
I = Indiscretion
G = Grandiosity
F = Flight of ideas
A = Activity increase
S = Sleep deficit
T = Talkative

Manic behaviors

• impulsive spending

• risky sex

• rapid speech

• no sleep

• agitation

Priority:
safety

Nursing interventions for mania

Short simple directions

Low stimulation

Set limits

Finger foods

Why finger foods?
Won’t sit to eat.

Monitor fluids.

Mood stabilizers

Lithium

Lithium

Used for bipolar.

Therapeutic:
0.6–1.2

Toxic:

Signs toxicity:
vomiting
tremor
confusion
ataxia

Teach:
hydrate
consistent salt intake

Low sodium = lithium toxicity

VERY testable.

ANXIETY DISORDERS

Generalized Anxiety Disorder
Panic Disorder
Obsessive-Compulsive Disorder

Anxiety levels

Mild

Helpful

Improves focus

Moderate

Narrow focus

Can still learn

Severe

Cannot focus well

Physical symptoms increase

Panic

Loss of control

Priority:
stay with patient

Never leave alone.

Panic attack

Symptoms:
chest pain
shaking
shortness of breath
feeling of doom

Priority:
reduce stimuli
stay calm
stay present

Short simple communication.

Generalized Anxiety Disorder (GAD)

Excessive worry.

Symptoms:
restlessness
fatigue
muscle tension
poor sleep

OCD

Obsessive-Compulsive Disorder

Obsessions = thoughts
Compulsions = behaviors

Example:
obsession = germs
compulsion = washing

Do not stop rituals suddenly.

Gradually reduce.

Anxiety meds

Benzodiazepines

Lorazepam
Alprazolam

Fast acting

Risks:
sedation
dependence

Used short-term.

Buspirone

Buspirone

No dependence

Takes time to work.

Not for acute panic.

Common exam trap.

PTSD

Post-Traumatic Stress Disorder

Caused by trauma.

Examples:
abuse
combat
assault
accidents

Core symptoms:
intrusion
avoidance
mood changes
hyperarousal

PTSD signs

flashbacks

nightmares

hypervigilance

startle response

avoidance

emotional numbness

PTSD nursing care

Promote safety

Build trust

Encourage expression

Identify triggers

Teach grounding techniques

Trauma-informed care

Important:
avoid re-traumatization

Offer choices

Promote control

SUICIDE (VERY HIGH YIELD)

Suicidal Ideation

Always assess directly.

Ask:
“Are you thinking about killing yourself?”

Asking does NOT increase risk.

Big exam point.

Suicide risk factors

Previous attempt (biggest predictor)

Depression

Substance use

Isolation

Chronic illness

Hopelessness

Plan

Means

Intent

Highest-risk statements

“I have a plan.”

“I won’t be a burden much longer.”

Giving away belongings.

Sudden calm after depression.

Can mean decision made.

Suicide assessment

Ask:

Do you have thoughts?

Do you have a plan?

Do you have means?

Do you intend to act?

Plan + means + intent = HIGH RISK

Suicide precautions

1:1 observation

Remove dangerous items

Close monitoring

Safe environment

Document everything

No-suicide contracts

Not reliable.

Do not replace observation.

Common test point.

Priority interventions

High risk:
stay with patient

remove means

get help

Safety first.

Therapeutic communication for suicide

Good:
“Tell me more.”

“What has been hardest lately?”

Bad:
“You have so much to live for.”

Avoid minimizing.

MUST KNOW DIFFERENCES

Depression:
low mood

Mania:
high energy/no sleep

Panic:
loss of control

PTSD:
trauma-based

Suicide:
always assess directly

MEDS TO KNOW

Depression:
SSRIs
SNRIs
TCAs
MAOIs

Bipolar:
Lithium

Anxiety:
Benzo
Buspirone

BIGGEST EXAM TRAPS

Lithium + low sodium = toxicity

MAOI + tyramine = crisis

Buspirone not immediate

Panic = stay with patient

Suicide = ask directly

Depression + energy returning = increased suicide risk

PTSD = triggers/flashbacks