Mood Disorders Depressive and Bipolar DO

1. Mood DisordersDepressive and Bipolar DO Mary Vercoutere, RN, MSN

2. Introduction • Mood DO • Depressive DO disabling due to effect on thoughts, emotions, behaviors. • Bipolar DO • Coexisting Disorders • Prevalence

3. Topics of Discussion • DSM IV Definition of Mood DO: Major Depression Or Unipolar Disease • Bipolar Disease • Theory of cause: Genetic,Gender, Biological, Psychological, Situational. • Assessing Suicide Potential. • Nursing Interventions.

4. DSM IV Criteria • Major Depression A change in function Clinical distress,impaired social, occupational, or other important areas of functioning. Five or more of the following most days for 2 weeks:

5. Major Depression Depressed Mood,every day Anhedonia Significant weight gain or loss Sleep disturbances Increased / decreased motor activity Anergia (lethargy) Feelings of guilt, helplessness, hopelessness Poor concentration Recurrent thoughts of death/suicide

6. Theory of Cause Presence evaluated on a spectrum. Genetic abnormalities, Activated (Shine) Dormant-normal development The occurrence of stressful events. Difficult ongoing life situations with a depletion of neurotransmitters. Grief-Support and coping skills

7. Genetic Basis • Depression • 20% have one episode only. • An individual with a first-degree relative has up to 40%-50% chance with an 8% vulnerability in the general population. • Multiple genes are involved in Depression, more prevalent in women.

8. Genetic Influence • Bipolar disease • 85% of risk inherited • Multiple genes involved in disease. • Up to 60% chance of having the disease in identical twins. • More prevalent in men.

9. Spectrum of Mood Disorders • Dysthymic • Cyclothymic • Schizoaffective • Post-partum • Co-morbid Disorders

10. Biochemical Basis of Mood DO • The neural networks of the brain and the prefrontal cortex. • Limbic System: the emotional brain. • Altered neurotransmitters: serotonin (5HT), dopamine, norepinephrine, acetylcholine (a critical neurotransmitter in brain plasticity).

11. Neurobiology • Depression and PTSD have shown to damage the hippocampus. • Hypercortisolemia: majority of unipolar and bipolar individuals have elevated cortisol levels. • This causes neurotoxic effects: hippocampal atrophy.

12. Organic Causes • Endocrine disorders: Diabetes, Cushing’s disease • Neurologic diseases: Parkinson’s and Alzheimer’s disease Metabolic disturbances: Hypoxia and hypercalcemia • Cardiovascular diseases: Heart failure, Open Heart OR • Pulmonary disorders:COPD

13. Drugs can cause depression • Antihypertensives • Psychotropics • Antiparkinsonian drugs • Analgesics • Cardiovascular drugs • Steroids • Chemotherapeutic agents • Cimetidine (Tagamet) • Alcohol

14. Symptom Assessment Symptoms: • Client may report feeling “down in the dumps”. • Change in appetite • Sleep disturbances • Difficulty concentrating and easy distractibility • Low self-esteem • Poor coping and problem solving skills

15. Assessment Interview You may notice agitation (wringing hands, restlessness) Or Psychomotor retardation (slow movement) With severe depression persons may have delusions of persecution or guilt.

16. Nursing Assessment and Interventions • Assess for suicidality Stay alert for clues to suicidal thoughts, stay with client. Findings: A preoccupation with death. Previous suicide attempts. Presence of a plan.

17. Assessment Findings Presence of Significant risk factors Profound hopelessness. Concurrent medical illness. Substance abuse. ALERT Mental Health staff!!!!

18. Pharmacological Interventions Antidepressants Prescribed: Variety of antidepressants that alter specific neurotransmitters. Often 4 –6 weeks until a therapeutic result, if none another tried or added to initial medication tried.

19. Non-Pharmacological Therapies • Electroconvulsive Therapy-ECT • Alternative Therapy. • Lifestyle • Nutritional • Herbal: SAMe St. John’s Wort

20. Maintaining a Healthy Brain • A key to activating neuroplasticity: Paying Attention. • Learn something new. • Evoking a mental picture will increase metabolic activity. • Repeated activation strengthens areas of the brain. • Exercise creates new capillaries to the brain.

21. Integrative Medicine • CBT (cognitive behavioral therapy) modifies sensitivity to anxiety. • Family Focused Therapy: problem solving for the family and psychosocial pressures • National Alliance for the Mentally ill NAMI Each client needs to be an involved member of the team.

22. Bipolar Disorders Depression is a low, sad state in which life seems dark and its challenges overwhelming,Bipolar is a pattern of alternating between moods. Mania, the opposite of depression, is a state of breathless euphoria, and a frenzied energy. People have the mistaken belief that the world is theirs.

23. Bipolar I and Bipolar II • Bipolar I is most severe • Patient has manic episodes and major depression. • Bipolar II • Not a severe mania, a milder one such as hypomania/ alternating with major depressive episodes.

24. Incidence • Close to 3 million people have bipolar in the USA. • www.manicdepression.org • Cause • Onset in 20’ and 30’s • Most patients have recurring episodes throughout their lifespan.

25. Genetic Influence • Bipolar Disease has an 85% inheritable risk. • Multiple genes involved. • More prevalent in men.

26. Neurobiology • Bipolar DO: Ventricular enlargement Smaller hippocampus (critical for memory and emotional regulation) amygdala, temporal lobe.

27. Mania Elation, euphoria, agitation or irritability, hyper-excitability, hyperactivity, rapid thought and speech, exaggerated sexuality, decreased sleep. Psychotic symptoms Hypomania:An expansive, elevated, or agitated mood. Similar to mania but is less intense, no psychotic symptoms.

28. Treatment for Bipolar Disorders • Mood Stabilizers. • Anticonvulsants. • Medications combined until therapeutic effect achieved. • Quality of life is always important. • Compliance is always important. • The difficulty in treating women who are pregnant.

29. Treatment • Treatment of bipolar I requires medication • Lithium still a major therapy. • Narrow range of safety as can be toxic (0.5-1mEq/L) • Therapeutic blood levels in 7-10 days. • Risk for Toxicity is high in patients with renal, heart disease, dehydration, salt depletion, on diuretics.

30. Nursing Symptom Assessment • Behavior • Affect • Interpersonal Relationships • Culture • Age-specific considerations • Function • Life-specific considerations

31. Assessment Interview • Rapid speech • Difficulty sitting in a chair. • Physical condition: weight loss, dehydration, poor ADL’s • Evidence of psychosis • Safety interventions

32. Nursing Interventions • During manic phase, provide physical needs, ADL’s. • Ensure safety with minimal stimulation. • Provide emotional support. • Limit setting and staff safety. • Psycho education. • Behavioral therapy re-educates in social skills, with attitude change. • Group therapy.

33. Case Study • Client history • Current problems • Client’s Perception • Your Perception and Assessment: non-emotional, non-judgmental, using inductive reasoning. • Nursing Diagnosis.