mood disorders chapter 12 and 13. what is bipolar disorder? (bipolar #1) diagnosing and treating...
TRANSCRIPT
Mood Disorders
chapter 12 and 13
• What is Bipolar Disorder? (Bipolar #1)• http://www.youtube.com/watch?v=MBUOoQk0hhU • Diagnosing and Treating Bipolar Disorder (Bipolar #2)• http://www.youtube.com/watch?v=iMMDYZdJBeM• What is Depression? (Depression #1)• http://www.youtube.com/watch?v=IeZCmqePLzM• Treating Depression (Depression #2)• http://www.youtube.com/watch?v=qVEueGutbSs • Clinical Depression• http://www.youtube.com/watch?v=-bru3sJ8yiU
Mood Disorders
• Depression is the oldest and most frequently described psychiatric illness.
• Transient symptoms are normal, healthy responses to everyday disappointments in life.
• Pathological depression occurs when adaptation is ineffective.
Types of Mood Disorders
• Depressive Disorders
• Bipolar Disorders
• Others
Depressive Disorders
• Major Depressive Disorder• Dysthymic Disorder• Premenstrual Dysphoric Disorder• Bipolar Disorders
Other Mood Disorders• Mood disorder due to a general medical condition
• Substance-induced mood disorder
Bipolar Disorders
• Bipolar I Disorder• Bipolar II Disorder• Cyclothymic Disorder
Depression: Predisposing Factors• Biological theories
– Genetics:– Biochemical influences: Neuroendocrine theoriesPhysiological influences– Psychoanalytical theory
• Mourning • Melancholia
Learning theoryObject lossCognitive theory
Depression: Developmental Implications
Childhood Depression• Symptoms:
Adolescence• Symptoms include:• Senescence
Treatment
• Postpartum Depression Treatment
Assessment
• Transient depression• Mild depression• Moderate depression • Severe depression
Nursing Diagnosis
Outcome
Planning/Implementation
Client/Family Education
Evaluation
Treatment Modalities
Antidepressants
Newer-generation antidepressants– Selective serotonin reuptake inhibitors (SSRIs)– Second- and third-generation antidepressants
• Tricyclic antidepressants• Monoamine oxidase inhibitors (MAOIs)
Contraindications/precautions
• Contraindications/precautions– Contraindicated in known hypersensitivity (SSRIs,
MAOIs, tricyclics); acute phase of recovery from myocardial infarction; angle-closure glaucoma (tricyclics); and concomitant with MAOIs (SSRIs and tricyclics).
– Caution with elderly or debilitated clients; clients with hepatic, cardiac, or renal insufficiency; psychotic clients; clients with benign prostatic hypertrophy; and those with history of seizures (tricyclics, MAOIs).
Antidepressants- SSRI
• GenericFluoxetineParoxetineSertralineCitalopramEscitalopramFluvoxamine
• BrandProzacPaxilZoloftCelexaLexaproLuvox
Serotonin Syndrome
• Delirium Agitation• Tachycardia Sweating• Hyperreflexia Muscle spasms• Shivering Coarse tremors More severe cases• Hyperthermia Seizures• Renal failure Rhabdomyolysis• Dysrhythmias DIC
Antidepressants
• Generic Bupropion Mirtzapine Venlafaxine Duloxetine Amitriptyline Imipramine Phenelzine Selegiline
• Brand Wellbutrin Remeron Effexor Cymbalta Elavil Tofranil Nardil Emsam
Monoamine Oxidase Inhibitor
• Nardil• Parnate• Marplan • Selegiline**Available in a patch form called EMSAM
Hypertensive Crisis and Tyramine
Bipolar Disorder (Mania)
AssessmentStage I—HypomaniaStage II—Acute maniaStage III—Delirious mania
Bipolar Disorder (Mania)
Childhood and Adolescence• Lifetime prevalence of pediatric and
adolescent bipolar disorders is estimated at about 1 percent
• Diagnosis is difficult• Guidelines for diagnosis and treatment have
been developed by the Child and Adolescent Bipolar Foundation (CABF)
Nursing Diagnosis
Outcomes
Planning/Implementation
Client/Family Education
Evaluation
Psychopharmacology/Mood Stabilzers
• GenericLithumValproic acidCarbamazepine OxcarbazepineLamotrigineTopiramate
• BrandEskalith, LithobidDepakote, DepakeneTegretol, EquetroTrileptalLamictalTopamax
Planning/Implementation• Blood levels are needed
for Lithium (0.4-1.2mEg/ml)
Depakote (4-12 mEg/ml)
Tegretol (4-12 meg/ml)
• Monitor for side effects of lithium– Drowsiness, dizziness,
headache– Dry mouth; thirst; GI upset;
nausea/vomiting– Fine hand tremors– Hypotension; arrhythmias,
pulse irregularities– Polyuria; dehydration– Weight gain--Potential for toxicitySymbyax is a combination of
Prozac an antidepressant and Zyprexa an atypical major tranquilizer.
Monitor for side effects of anticonvulsants– Nausea and vomiting– Drowsiness; dizziness– Blood dyscrasias– Prolonged bleeding time (with valproic acid)– Risk of severe rash (with lamotrigine)– Decreased efficacy with oral contraceptives (with
topiramate
Planning/Implementation (cont.)• Educate client and family about the
medication
Outcome Criteria/Evaluation