Comprehensive Notes on Transcript MH exam 3

Emotions and Biology

• Biological causes are explored regarding emotional support, particularly focusing on the heart complex.

• Neurotransmitters and hormones play roles in mood regulation.

• Neurotransmitters facilitate nerve impulses between nerve cells.

• Monoamines are long-acting neurotransmitters modulating neuron sensitivity.

• The pituitary gland regulates hormones, balancing thyroid and adrenal hormones. This is crucial for maintaining overall balance.

• Imbalances in these systems can lead to issues.

• Biological rhythms in depressed individuals differ from those in non-depressed individuals.

• Depression is linked to physical illness, especially chronic conditions.

• Psychoanalytic theory suggests mood disorders arise from anger turned inward.

• Behaviorists view depression as learned responses.

• Social theorists attribute depression to faulty social interactions.

• Healthcare providers generally adopt a holistic approach.

Characteristics of Mood Disorders

• Mood disorders involve disturbances in a person's mood.

• Mania:

  • Characterized by elated, expansive reactions, or irritability.

  • Involves loss of identity, increased activity, and grandiose thoughts/actions.

  • Examples: Overexcited reactions, like impulsively deciding to climb the Grand Canyon while living on the East Coast.

• Depression:

  • Features feelings of sadness, disappointment, and despair.

  • Mild: Short-lived, triggered by life events (e.g., performing poorly on a test).

  • Moderate (Dysthymia): Persists over time, difficult to shake off.

  • Major: Severe, lasts longer than two weeks; symptoms range from paralysis to agitation, with possible suicidal thoughts.

Bipolar Disorder and Related Conditions

• Bipolar Disorder:

  • Involves extremes of mood.

  • Bipolar I: Episodes of depression alternate with episodes of mania; delusions are common during mania, and hallucinations may occur.

  • Bipolar II: Major depressive episodes alternate with periods of hypomania.

    • Often includes 1-2 weeks of severe lethargy, withdrawal, and melancholy, followed by several days of hypomania.

• Cyclothymic Disorder:

  • Repeated mood swings between hypomania and depressive symptoms.

  • Essentially bipolar II, but with an on-and-off cyclical pattern.

• Seasonal Affective Disorder (SAD):

  • Winter depression, typically occurring from October to April.

  • Reduced sunlight exposure is a key factor.

  • Treatment involves daily exposure to sunlight or full-spectrum light.

• Postpartum Depression:

  • Mood disorder occurring after childbirth.

  • Variable symptoms and levels, starting with baby blues (mild, short-term depression), progressing to postpartum depression, and potentially postpartum psychosis.

• Substance-Induced Mood Disorder:

  • Emotional disturbances directly linked to substance use.

Therapeutic Interventions for Mood Disorders

• Treatment Phases:

  • Acute treatment (6-12 weeks).

  • Continuation phase (4-9 months).

  • Maintenance treatment (indefinite).

• Current Standards:

  • Psychotherapy.

  • Pharmacologic therapy.

  • Electroconvulsive therapy (ECT): Requires inpatient setting with anesthesia.

  • Transcranial direct current stimulation: Requires inpatient setting with anesthesia.

    • These electrical therapies aim to regulate nerve impulse transmission in the brain.

Pharmacological Treatments

• Antidepressants:

  • Tricyclics.

  • Nontricyclics.

  • Monoamine Oxidase Inhibitors (MAOIs):

    • MAOIs have many interactions with medications.

    • Nurses must verify medication safety when administering MAOIs.

  • SSRIs and atypical antidepressants:

    • Effects take 2-4 weeks to be noticeable.

• Antimanics:

  • Lithium:

    • Requires monitoring of sodium levels and hydration.

    • Therapeutic blood level: 0.6 to 1.2

    • Lithium is typically discontinued once manic episodes subside.

The Nursing Process & Mood Disorders

• Assessment: Evaluate the level of depression or mania.

• Nursing Diagnosis: Based on client's most distressing problems, including physical issues.

• Therapeutic Interventions:

  • Holistic interventions addressing physical, emotional, social, and spiritual aspects.

Overview of Mood Disorders

• Mood disorders are psychological disorders characterized by severe disturbances in mood and emotions; most often depression, as well as mania and elation.

• It is normal for moods to fluctuate, whereas people with mood disorders have extreme fluctuations which impair their ability to function.

• Mood disorders can be depressive disorders where the defining feature is an extremely negative mood, hopelessness, and regular drives being reduced or eliminated, or bipolar and related disorders where the defining feature is the exact opposite of depression: extremely positive mood where the person is talkative, has grandiose ideas, and behaves recklessly at the same time.

Major Depressive Disorder (MDD)

• Characterized by depressed mood most of the day, nearly every day, and anhedonia (the inability to experience pleasure).

• Decreased motivation to engage in activities that used to be enjoyable.

• Diagnosis requires experiencing a total of five related symptoms for at least two weeks.

• Examples of symptoms:
  *Weight and/or appetite disturbances (extreme weight loss or overeating).
  *Sleep disturbances (insomnia or can't even get out of bed).
  *Psychomotor agitation (fidgety and jittery, pacing) or pyschomotor retardation (talking slowly or monotonously, moving slowly).
  *Fatigue or loss of energy.
  *Feelings of worthlessness or guilt.
  *Difficulty concentrating.
  Suicidal ideation, or thoughts of death. This includes planning or attempts at suicide.

• The duration requirement is much shorter than other psychological disorders; symptoms only need to last for two weeks to be considered for diagnosis of major depressive disorder.

• The severity of symptoms can include suicidal ideation, so the duration requirements are reduced. Some subtypes of depression include seasonal pattern depression, peripartum onset depression (or postpartum depression), and persistent depressive disorder, which was previously called dysthymia.

• Persistent depressive disorder is consistent depression lasting at least two years and accompanied by at least two symptoms of major depressive disorder. People with persistent depressive disorder don't meet the criteria for MDD, and these are different diagnoses.

Bipolar Disorder

• A disorder characterized by extreme shifts in mood, from one polar opposite to the other.

• Diagnosis requires manic episodes, but does not require depressive episodes.

• A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy lasting at least one week.

• A person in a manic episode might be extremely talkative with strangers, or extremely irritable or hostile.

• The person may exhibit a flight of ideas, or frequently shifting from talking about one topic to talking about a different, completely unrelated topic.

• Manic episodes may be accompanied with reckless behaviors like quitting jobs.

• There is also a rapid cycling subtype of bipolar disorder in which people experience at least four manic episodes or a combination of four manic and depressive episodes within a single year.

Etiology/Causes of Mood Disorders

• Mood disorders have strong genetic and biological components.

• The twin concordance rate -- the percentage of twins who share major depressive disorder -- is 50% for identical twins and 38% for fraternal twins. 67 and 16% is the difference in twins who share bipolar disorder.

• People with mood disorders tend to have an imbalance of neurotransmitters such as serotonin and norepinephrine.

• The diathesis stress model of psychological disorders suggests that these biological factors (the diathesis) are accompanied by psychological or environmental factors (the stress).

• Cognitive factors also influence the development and perpetuation of mood disorders.

• A person with a mood disorder may experience cognitive distortions in which they view problems as much bigger than they really are, which is called catastrophizing, and ruminate about those problems.

• Learned helplessness is a cognitive theory of depression proposing that negative emotions are accompanied by these negative expectations, leading to depression.

• The expectations tend to be stable (it's always going to be this way) and global (it's going to affect everything).

Cognitive Triad

• The cognitive distortions that I just mentioned a moment ago tend to cluster around thoughts of the self, the world, and the future, and we refer to this as the cognitive triad, which as you'll see connects to hopelessness theory.

• The cognitiive triad is the idea that people have negative thoughts about three different areas of the triad.

• The self -- I'm ugly, I'm worthless, I'm a failure.

• The world -- No one loves me.

• The future -- I feel hopeless.

Medication for Mood Disorders

• When antidepressants don't get an adequate response, mood stabilizers can be added to help resolve the symptoms. Examples of such mood stabilizers include Cervical XR, Ritalopora, and Glutt.

• If depression does not respond to antidepressants, or if there is a family history of bipolar disorder, it is possible your depression may actually be bipolar disorder.

• When most people get on their bipolar meds, they tend to get off of them because they think that they're fine and don't need them.

Diagnosing Bipolar Disorder

• First, there's a physical exam and a thorough medical history, including symptoms.

• Medical tests and blood tests rule for other conditions.

• Then comes a mental health evaluation by a specialist.

• To confirm bipolar disorder, you need to have had at least one episode of mania or hypomania.

• Mental health providers use the DSM to determine its height and severity.

Role of Emotions in Health

• Animals have an evolved stress response mechanism that protects them during times of threat or illness.

• Anxiety and stress can cause a physiologic stress response, which is the fight or flight system, as well as general adaptation syndrome, where biochemical reactions of stress response affect various body systems.

• The immune system is affected by stress levels. You're more likely to get sick when you're highly stressed.

• Physical problems that arise from psychological sources create disorders such as somatoform disorders, psychosomatic disorders, and psychophysical disorders.

Somatoform Disorders

• A disorder which something doesn't have a cause, or there isn't any physical cause.

Psychosomatic Disorder

• A real physical illness that is caused or worsened by emotional or psychological factors.

Disctinctions Between Somatoform and Psychosomatic

*Somatoform: No real physical condition.
*Psychosomatic: Real physical condition.

*Ex: Both people have a stomach ache and see a gastroenterologist. The person with the somatoform disorder has a big workup, and nothing shows up. The doctor can't find anything wrong. For the person with the psychosomatic disorder, they get endoscope and see an ulcer.

*Psychosomatic is called a mind-body connection, where mental distress manifests as physical symptoms even when no underlying medical conditions explain them.

Psychophysical Disorders

*Psychosomatic and psychophysical are essentially the same.

• Ex: Hypertension, high blood pressure increases

• When you go to the doctor's office and get a blood pressure reading, you may get a "white coat reaction." White coat reaction is when you go in for a checkup, and because you're nervous about being in the doctor's office, your blood pressure's high, but when they come back 15 minutes later and check again, your blood pressure is back within normal levels.

Childhood Sources of Stress

• How to perceive or respond to stress in childhood is a learned response.

• Children who have experienced an unstable home environment may react to stress as adults with exaggerated hormonal mechanisms.

• Families who emotionally support and encourage their children to effectively cope with their stresses have few physical

Psychophysical Problems

• Cardiovascular: Migraine headaches, tension headaches, hypertension, angina.

• Musculoskeletal: Rheumatoid arthritis and low back pain.

• Respiratory: Hyperventilation for asthma

• Gastrointestinal: Anorexia nervosa, obesity, peptic ulcer, irritable bowel syndrome, colitis.

• Skin: Neurodermatitis, eczema, psoriasis.

• Genitourinary: Impotence, rigidity, premenstrual syndrome.

• Endocrine: Hyperthyroidism and diabetes.

Stress & Diabetes

*Stress brings on diabetes because when you stress, you tend to eat a lot. If you eat a lot for a long time, you can develop type two diabetes. Stress does not bring on type one

Psychophysical Problems & Stress Response Theory

• Carl jung's theory: Symbolism is attached to a symptom or illness.

• Eric fromm's theory: Certain personality types are prone to develop certain illnesses.

• Organic weakness theory: Every individual has one body system that is more sensitive than the other systems.

Somatoform Disorders

• Somatization: Feeling symptoms in the absence of disease; almost eighty percent of basically healthy people have somatic symptoms in any given week.
  *How to cope? The client can start complaining about a stomach ache to avoid the situation they don't wan't to go to.

• Diagnosis criteria

  • There's no organic medical condition that explains the symptoms.

  • The disorder significantly disrupts or impairs one's level of functioning.

  • The client is unaware of/able to express his or her emotional distress.

Somatization Disorder, Hysteria, & Polysymptomatic Disorder

• It has many signs and symptoms. Both genetic and environmental factors can contribute to the risk of developing a somatization disorder.

• Sometimes they will go to several different physicians because doctor A, B, and C said there's nothing wrong with you.

• Involvement of multiple organ systems suggests a somatization disorder

• The disorder is characterized by early onset and is a chronic condition in which no physical changes occur over time.

Somatiform Disorders

*Signs and symptoms tend to be more in keeping with the individual's ideas of what the problem should be.

Illness Anxiety Disorder (Hypochondria)

• It has an intense fear or pre occupation with having a serious disease or medical condition based on misinterpretation of body signs and symptoms.

• Clients commonly doctor shop. So, again

Fictitious Disorders & Malingering

*Differ from somatoform in that signs and symptoms are produced intentionally.

• Patients will fully produce the signs or symptoms for some form of gain, and usually it's attention. By proxy, which is Munchausen syndrome, involves intentionally producing signs and symptoms in another person
  *Malingering: Individual produces symptoms to meet a recognizable goal.

Goal of Care for Providers

• Rule out the presence of any real disease or dysfunction.

• Develop a trusting relationship.

• Encourage the expression of feelings and emotional states.

• Meet physical needs only when necessary, but encourage entertainments

Anorexia Nervosa

• Individuals who cannot retain normal weight because of an intense fear becomes fat. Ninety nine percent of people with anorexia are female.
  *The are tense, alert, hyperactive, and rigid. And, of course, we just said usually a young woman.

Anorexia Diagnosis

• Body weight when they refuse to maintain a body weight; they use a 15% below normal. intense fear of becoming fat/ distorted significance is placed on body weight and weight in the absence of at least three menstrual cycles in a female.

• Their clinical presentation, their mortality rate is due to the complications of starvation, oftentimes cardiac arrest, and sometimes suicide. It is a far higher death rate than any other mental illness.

• Refeeding syndrome: For anorexic patients, imbalance of foods and electrolytes can lead to cellular dysfunction and life threatening complications.

*Bulimia Nervosa: Often found in young, white, middle class, and upper class women.
*Perfectionism is important with. And it contributes to the maintenance of behaviors.

Four Other Types of Eating Disorders

• Eating of items such as clay, cornstarch, insects, leaves, pebbles
  *Regurgitation and the tink of food
  *The plants are helped to replace distorted body image and thought problem solving skills.

Importance of Problem Solving Skills

*We need problem solving skills because we don't want stress to happen and then all of a sudden to reverse back into anorexia.

Sleep Wak Disorders

*Normal sleep: bodily functions and metabolic rate is slow, muscles relax, body conserves energy, renewable and repair of cells and tissues.
Dreaming allows humans to gain insight, solve problems, work through emotional reactions, and prepare for the future.
*Dream in REM sleep

• A sleep disorder is a problem that repeatedly disrupts an individual's pattern of sleep. general ages and need for sleep. so Adults should be getting seven to nine hours a night. And you see children vary as they get older, starting off with newborns fourteen to seventeen hours.

• Sleep disturbances: insomnia is a disorder of falling asleep or maintaining a sound sleep.
  *Primary hypersomnia: Excessive sleepiness that can begin between 15 and 30 years of age.
  *Narcolepsy: An individual has repeated attacks of sleep, so they may experience cataplexy and inappropriate rapid eye movement.
  *Obstructive sleep apnea syndrome: A lot of people have periods of apnea, and it can be so bad that they wake it wakes them up.
  *Circadian rhythm sleep disorder: Pattern of sleep disruption that results from a mismatch between personal body rhythms and environmental demands
  *Restless leg syndrome: A tingling and itching that occurs when someone is trying to fall asleep or they are asleep, and their legs are really giving them a problem.

Parasomnias

*Sleep nightmares where you have frequent really frightening nightmares and wake up abruptly
*Sleep terrors where children suffer from this with panicky symptoms
*Sleepwalking disorder: Complex motor movement during sleep. People with sleepwalking disorder literally are asleep. They do not know that they are up and moving around and doing
*Nocturnal sleep related eating disorder. So that's when you wake up, you're still asleep, and you're in the refrigerator
*Sleeping problems frequently occur during substance use or period of of withdrawal.

Sleep Provoking Interventions

*Maintain a regular routine.
*Provoke comfort Make sure you have a nice comfy space.
*Control physical disturbances. Turn off the TV.
*Shut off the phone, and maintain a quiet, restful environment.

Dissociative Disorders

• Self-concept: All the attitudes, notion, beliefs, that think of a person's self knowledge that goes into what you you how you would describe yourself, how you think you are. Low self comp concept results in maladaptive behavioral responses.
  *Influenced by culture, society, attitudes, beliefs of parents, siblings, and other significant people, and experiences.

• Dissociation is an attempt to cope with deep seated emotional anxiety or distress. Low self esteem is the most common component of many mental health problems. Identity diffusion is failure to bring various childhood identifications into an effective adult personality

Dissociative Disorders

• Come from two sources: Amnesia or food vie, a problem loss with memory or consciousness and dissociative identity disorder and where the problem is with one's own identity.
  *Depersonalization or derealization disorder is a response to severe anxiety associated with blocking awareness and fading of reality.

• Derealization involves the detachment and feelings of unreality in relation to one's surroundings, and it's commonly associated with other mental disorders.

Dissociative Amnesia

*Loss of memory. It's the inability to remember personal information that that cannot be explained by ordinary forgetfulness. Most of these memory lapses are related to extremely stressful events.

• Dissociative food: Is sudden unexpected travel with an inability to recall the past. Every it occurs in response to an overwhelmingly stressful or traumatic event. Slight in its biggest form. Dissociative fugue which just pack your bags and just go.

Dissociative Trans Disorder

Cultural trances are entered into voluntarily and cause no distress or harm to the individual. During trances, individuals do not lose their identity. Will clinically significantly distress or significant distress or functional impairment.

Dissociative Identity Disorder

*Multiple personality disorder. The presence of two or more identities of personalities that repeatedly take control of an individual's behavior
The presence of other personalities within one individual. Each personality is unique and represents the individual at different developmental stages

Treatment for Dissociative Disorders

*Is a long term therapy process usually in an outpatient setting. They only require hospitalization if there's anger, aggression, or violence directly towards self or others or if they present a danger to people in their immediate environment.
*Medications must be evaluated and adjusted regularly. Treatments and therapies include assessment, stabilization, revisiting, and reworking past traumas, trying to identify what is at the core of this.
*Pharmacologic therapy, treatment is often based on symptoms. All medications are prescribed only for short periods.
*In the nursing process, your assessment should describe their behavior, how they communicate their anxiety, depression, and social functioning along with the presence of any amnesia.

*Care treatment with of individuals with associated problems are complex, time consuming, and challenging
Health care providers are challenged with the twin cast of accepting and understanding the messages sent by Treatment of clients with backgrounds of trauma is often frustrating, but can be extremely rewarding.