mood disorders

Mood Disorders

  • Also known as diagnosing your family and friends.

Overview of Mood Disorders

  • Mood disorders are characterized as disorders that significantly impact one's mood.

Main Categories of Mood Disorders

  • Depression
  • Mania
  • Bipolar Disorder

Depression

  • Defined as both a symptom and a diagnosis.
  • Has a biochemical component that often results in an individual feeling that "everything is down."

Mania

  • In contrast to depression, mania is characterized by an elevated mood, described using the phrase "everything is up."
  • Symptoms include hyperactivity and the potential for a psychotic component, indicating a more severe mood state.

Bipolar Disorder

  • Bipolar disorder involves fluctuations between manic and depressive states.
  • Types of Bipolar Disorder:
    • Bipolar I: Characterized by fluctuations between mania and depression.
    • Bipolar II: Characterized by fluctuations between hypomania (less severe than full mania) and depression.

Differences between Mania and Hypomania

  • Mania is considered more severe and often includes a psychotic component, whereas hypomania is less severe and does not include psychotic features.

Importance of Understanding Depression

  • Recognizing depression is beneficial for nursing, ensuring both safety and effective clinical treatment.

Nursing Considerations for Mood Disorders

  • Nursing Priority: Safety of the patient is paramount.
    • Risk for Suicide: Regular assessments are crucial for evaluating safety measures.

Risk Factors for Suicide

## Individual Risk Factors:

  • Previous attempts at self-harm.

  • Presence of mental illness.

  • Lack of social support.

  • Experiencing legal issues.

  • Facing financial difficulties.

  • Engaging in risky and impulsive behavior.

  • Job loss.

  • Serious medical illnesses.

  • Substance abuse issues.

    Relationship Risk Factors:

  • History of abuse or neglect in childhood.

  • Experiences of bullying.

  • Family history of suicide.

  • Personal relationship issues.

  • Incidents of sexual violence.

    Community Risk Factors:

  • Barriers to accessing health care.

  • Cultural/religious beliefs that may view suicide as a noble resolution to problems.

  • Clusters of suicides within a community.

  • Stigma associated with mental illness or seeking help.

  • Access to means of suicide such as lethal weapons or medications.

  • Media portrayals of suicide, which can influence perceptions and behaviors.

Warning Signs of Possible Suicide

  • Verbal indications of wanting to die or kill themselves.

  • Expressions of feeling hopeless, empty, or without reasons to live.

  • Statements of feeling trapped with no solutions to problems.

  • Assertions of unbearable physical and emotional pain.

  • Feelings of being a burden to others.

    Additional Warning Signs:

  • Social withdrawal from friends and family.

  • Giving away possessions.

  • Bidding farewell to friends and family.

  • Arranging personal affairs as if planning to die.

  • Participating in risky behaviors.

  • Preoccupation with thoughts or discussions about death.

SADPERSONS Assessment

  • An acronym to assess suicide risk:
    • S: Male sex
    • A: Age
    • D: Depression
    • P: Previous attempts
    • E: Ethanol use
    • R: Loss of rational thinking
    • S: Lack of social supports
    • O: Organized plan
    • N: Lack of partner
    • S: Major or chronic sickness

Assessing for Suicide Risk

  • Questions to ask:
    • Do they have ways and means to carry out their plan?
    • Do they have a specific plan?
    • Do they have the intent to follow through on their plan?

Treatments for Mood Disorders

  • Safety Considerations: Immediate risk should prompt inpatient care; otherwise, outpatient care may be viable.
  • Types of treatment include:
    • Inpatient psychotherapy
    • Outpatient psychotherapy

Pharmacological Treatments

## Psychopharmacology:

  • Antidepressants:
    • SSRI/SNRI
    • Tricyclic
    • MAOIs
    • PRNs (as needed)
  • Other areas of focus: Sleep management and anxiety relief.

Non-pharmacological Treatments

  • Common non-pharmacological interventions include:
    • ECT (Electroconvulsive Therapy)
    • CBT (Cognitive Behavioral Therapy)
    • DBT (Dialectical Behavior Therapy)
    • ACT (Acceptance and Commitment Therapy)
    • TMS (Transcranial Magnetic Stimulation)

Bipolar Disorder

  • Fluctuations between mania and depression can be observed in both Bipolar I and Bipolar II.
  • Bipolar I Diagnosis: Involves criteria for mania and depression.
  • Bipolar II Diagnosis: Involves criteria for hypomania and depression.
  • Key point: Cycling between states tends to be gradual.

Symptoms of Mania

  • Common symptoms include:
    • Pressured speech
    • Hyperactivity
    • Insomnia
    • Risky behaviors
    • Poor inhibition
    • Issues with impulse control
    • Disorderly conduct
    • Hypersexuality

Mood Descriptors in Clinical Assessment

  • Common descriptors include:
    • Labile (changing moods)
    • Euthymic (normal mood)
    • Euphoric (extremely happy)
    • Agitated
    • Irritable

Affect Descriptors in Clinical Assessment

  • Categories of affect include:
    • Wide
    • Bright
    • Flat
    • Blunted
    • Appropriate range

General Considerations in Nursing for Mood Disorders

  • Nursing Considerations:
    • Safety
    • Milieu management (creating a safe environment)
    • Ensuring compliance to treatment plans
    • Promoting social interaction

Additional Considerations

  • Related areas impacting mood disorders include:
    • Sleep
    • Nutrition
    • Skin integrity

Inpatient Treatment for Mood Disorders

  • Pharmacological interventions:
    • Mood Stabilizers:
      • Lithium
      • Depakote (Valproic Acid)
      • Tegretol
      • Abilify
      • Latuda

Depakote / Valproic Acid

  • Primary Patient Concerns:
    • Weight gain
    • Sexual dysfunction
    • Available in various forms: pill, liquid, beads (in capsule).
  • Normal Levels for Valproic Acid: 50-100 mcg/mL

Lithium as a Mood Stabilizer

  • Considerations:
    • Effective for stabilizing mood.
    • Risk of kidney damage.
    • Has a narrow therapeutic index, implying a risk for toxicity.

Lithium Toxicity Symptoms

## Mild Symptoms:

  • Fine tremor

  • Nausea/Vomiting

  • Abdominal pain

  • Bloating

    Moderate to Severe Symptoms:

  • Coarse tremors

  • Twitching/jerking movements

  • Altered mental status

  • Ataxia

  • Seizures

Key Considerations for Lithium Use

  • Mild toxic symptoms are expected during the upward tapering of the medication.
  • Do not discontinue medication if lab levels are low.
  • If a patient stops medication, ensure they restart the regimen accordingly.

Lithium Lab Levels

  • Normal range: 0.6-1.2 mEq/L.
  • Ideal level is 1.0 mEq/L.
  • Variations in acceptable levels may occur across facilities; always adhere to institutional policies.