mh notes
Bipolar Disorder
Definition: Mood disorder with alternating periods of mania and depression, as well as periods of normal functioning.
Types of Bipolar Disorder
Bipolar Type 1: Involves at least one episode of full mania alternating with depression.
Bipolar Type 2: At least one episode of hypomania alternating with depression; higher risk for suicide and self-injury.
Symptoms of Mania
Abnormally elevated mood lasting more than a week.
Hyperactivity, euphoria, rapid speech, distractibility, irritability, agitation, and possible delusions or hallucinations.
Lack of sleep and flight of ideas.
Symptoms of Depression
Feeling sad or hopeless.
Loss of interest in activities.
Unintentional weight loss, slowed behavior, loss of energy.
Risk Factors
Biochemical imbalances, genetics, and brain lesions.
Evaluation
Mental Status Examination (MSE).
Mood Disorder Questionnaire (MDQ): A self-reporting screening tool with 15 questions to identify patients with bipolar disorder.
Treatment Options
Medications:
Anxiolytics, lithium (monitor for toxicity), anticonvulsants, antipsychotics, and antidepressants.
Psychotherapy and Support Groups.
Electroconvulsive therapy.
Nursing Interventions
Provide a safe environment; utilize a 1:1 sitter if safety is a risk.
Redirect hyperactive or aggressive behavior.
Set limits on manipulative behavior.
Promote structured routine; emphasize diet and hydration.
Depression
Definition: Mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest in daily activities.
Symptoms of Major Depressive Disorder
Experience 5 or more symptoms daily for 2 weeks:
Depression or anhedonia.
Sleep disturbances, changes in appetite or weight.
Suicidal thoughts, indecisiveness, inability to concentrate, fatigue.
Treatment Options
Medications:
Antidepressants (SSRIs, SNRIs, TCAs, atypicals, MAOIs).
Psychotherapy and Electroconvulsive therapy.
Types of Depression
Persistent Depressive Disorder (Dysthymia): Lasts at least 2 years in adults, characterized by chronic, mild depression.
Seasonal Affective Disorder: Occurs during seasons with less sunlight, particularly winter.
Premenstrual Dysphoric Disorder: Depression associated with menstruation, occurs in luteal phase.
Nursing Interventions
1:1 observation and safety measures, including removal of harmful items.
Promote a regular daily schedule, encourage socialization, and offer emotional support.
Eating Disorders
Anorexia Nervosa
Symptoms: Severe self-restriction of calories leading to underweight; fear of gaining weight, lack of menstruation, lanugo, cold extremities.
Nursing Interventions:
Gradually increase intake, monitor exercise, and provide nutritional counseling.
Bulimia Nervosa
Symptoms: Binge eating followed by purging; may include tooth erosion, bad breath, parotid swelling.
Nursing Interventions:
Cognitive behavioral therapy, monitoring during meals, weight loss programs.
Binge Eating Disorder
Symptoms: Eating large quantities of food over a short period, secret eating, guilt after eating.
Nursing Interventions: Monitoring weights, trust-building, and encouraging moderate exercise.
Obsessive-Compulsive Disorder (OCD)
Definition: Anxiety disorder marked by repetitive, persistent, unwanted thoughts and compulsions.
Symptoms: Obsessions causing anxiety, leading to compulsive behaviors like hand washing or checking.
Causes/Risk Factors
Neurotransmitter imbalance, particularly serotonin, genetics, and traumatic events.
Treatment Options
Medications: SSRIs and anxiolytics.
Therapies: Cognitive behavioral therapy, exposure, and response prevention therapy.
Nursing Interventions
Set limits on behaviors, maintain a calm environment, positively reinforce good behavior.
Personality Disorders
Definition: Impaired thinking and functioning related to individuals' perception of the world and others.
Types
Cluster A (Odd or Eccentric)
Paranoid: Distrust and suspicion of others.
Schizoid: Social withdrawal and emotional detachment.
Schizotypal: Eccentric behavior and magical thinking.
Cluster B (Dramatic or Emotional)
Antisocial: Disregard for others, lack of empathy.
Borderline: Instability of identity, fear of abandonment.
Histrionic: Attention-seeking behavior.
Narcissistic: Grandiose self-perception.
Cluster C (Anxious or Insecure)
Avoidant: Fear of rejection and social interaction.
Dependent: Extreme dependence on others.
Obsessive-Compulsive: Perfectionism and rigidity.
Treatment Options
Medications: Antidepressants, mood stabilizers, and antipsychotics.
Therapies: Psychotherapy and behavioral therapy.
Nursing Interventions
Prioritize patient safety and provide consistent support.
Post-Traumatic Stress Disorder (PTSD)
Definition: Mental health condition following exposure to traumatic events.
Symptoms
Intrusive memories, avoidance of reminders, negative changes in mood/thoughts, increased arousal.
Risk Factors
Natural disasters, abuse, extreme fear, loss of loved ones.
Treatment Options
Medications: SSRIs, SNRIs, benzodiazepines.
Therapies: Exposure therapy, cognitive therapy, relaxation techniques.
Nursing Interventions
Assess for suicide risk, teach coping strategies, and support emotional expressions.
Schizophrenia
Definition: Break from reality characterized by delusions, hallucinations, and severe emotional disturbances.
Symptoms
Positive: Hallucinations, delusions.
Negative: Lack of motivation, emotional flatness, reduced speech.
Treatment Options
Medications: Antipsychotics.
Nursing Interventions:
Build trust with the patient, maintain safety, provide therapeutic communication.
Substance Abuse Disorders
Definition: Dependency, abuse, or addiction to substances affecting daily life and relationships.
Symptoms of Intoxication and Withdrawal
Alcohol: Memory impairment, slurred speech, coordination issues. Withdrawal can cause hallucinations and seizures.
Stimulants: Euphoria, hyperalertness, paranoia.
Depressants: Respiratory depression, drowsiness.
Treatment Options
Medications vary by substance; include benzodiazepines for alcohol withdrawal.
Address social and psychological aspects through therapy.