Test 3

Disturbances in the regulation of mood, emotional expression, behavior and affect

Anxiety disorders

• Altered neurotransmission
• Neuroendocrine dysregulation of the limbic hypothalamic-pituitary-adrenal axis
• Genetic transmission
• Hypothyroidism

• Elevated, expansive, irritable mood
• Goal-directed activity or energy
• Inflated self-esteem/grandiosity
• Talkative, distractible, flight of ideas
• Risk taking
• Psychotic features possible

• Same symptoms as mania, just less severe.
• Does not markedly impair social/occupational functioning or require hospitalization
• Also no psychosis present

Individual that usually only has depressive disorders & very rarely only mania.

Periods of depression that alternate with periods of elevated mood, impulsivity & hyperactivity (mania)

• Develop as a result of any type of identifiable stressor
• Can be acute (occurs within 3 months following the stressor) or chronic (lasting over 6 months following the stressor, but starts within 3 months of trigger.)
• Marked distress that is out of proportion to the severity or intensity of the stressor
• Significant impairment in social, occupational, or other areas of functioning

Persistent and Dysthymic Depressive Disorder

• Feeling depressed the majority of the time for at least 2 years.
• Chronic depressed mood with periods of major depressive mood without incidence of mania.
• Less severe symptoms than MDD.
• Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
• Most experience 1 or more MDD episodes (higher suicide rate)

• Situational
• Atypical
• Postpartum
• Seasonal Affective Disorder (SAD)

• Sadness, hopelessness, emptiness, worthlessness, inappropriate guilt
• Diminished pleasure and interest in all or almost all activities, anhedonia
• Fatigue
• Recurrent thoughts of death
• Diminished ability to think/concentrate/make decisions
• Significant impairment in social, occupational, or other important area of functioning
• Lasts for more than 2 weeks

• Characterized by psychotic features:
• Delusions, usually of persecution
• Hallucinations

• A 21-question multiple-choice self-report inventory for depression.
• Composed of items relating to symptoms of depression.

• Take in AM, with or without food
• Monitor for weight loss, nausea, GI pain
• Avoid alcohol (depressant)
• Report development of a rash or itching

Ask them what time they take their meds, may need to take them in AM to avoid insomnia.

• Citalopram (Celexa)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

2-4 weeks

2-4 weeks, when drug reaches full therapeutic level.

• Serotonin Norepinephrine Reuptake Inhibitors
• Considered second line choice

• Duloxetine (Cymbalta)
• Venlafaxine (Effexor, Effexor XR)

• Bupropion (Wellbutrin)
• Nefazodone (Serzone)
• Trazodone (Desyrel)
• Mirtazapine (Remeron)

• Many adverse side effects, not used first line.
• Inhibits the reuptake of norepinephrine, serotonin, and dopamine

• Amitriptyline (Elavil)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)

• Monitor BP, orthostatic hypotension
• Monitor liver fxn & CBC
• Monitor for ↑ S/S suicide
• Not advised for those with a hx of angle-closure glaucoma or seizure disorder.
• Avoid driving & hazardous machinery if drowsy

• Monoamine oxidase inhibitors
• May be used for atypical depression
• Has a high risk for adverse effects & dangerous interactions with foods & medications (anything that has or converts to tyrosine can cause HTN crisis)

Bad headache

• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

• Not to ingest foods/beverages containing tyrosine, caffeine, or tryptophan
• Can cause HTN crisis
• BP monitored q 2 - 4 h during initial therapy
• No meperidine (Demerol), epinephrine, local anesthetics, decongestants, cough meds, diet pills

• St. John's Wort
• Should not be combined with prescription antidepressants
• SAMe
• Helps produce dopamine, 5-HT serotonin, norepinephrine
• Vitamin B
• Necessary for production of dopamine, 5-HT serotonin, norepinephrine
• Many antidepressants deplete vitamin B
• Omega-3 Fatty Acids
• Abnormally low levels found in people with depression
• Melatonin
• Effective in inducing sleep w/o side effects
• Dehydroepiandrosterone (DHEA)
• Corticosteroid
• May assist in mood regulation & sense of well-being

• Electroconvulsive therapy
• Electrical current applied to a patient's brain through electrodes placed on the scalp above the temples

Used for treatment of severe depression when medications & psychotherapy haven't been effective, or when there is an immediate risk of suicide

• MD orders for pt fasting typically 6-8 h prior
• Consent signed
• All metal objects & prosthesis removed from the body
• Oral bite block
• Electronic monitor for EEG tracing, ECG, SvO2

• Atropine or glycopyrolate (decreases stomach acids & secretions)
• Short-acting general anesthetic
• Muscle relaxant
• Oxygen

• Patient remains in recovery for 1 to 3 hours until VS stable
• Patient regains alertness, can converse, ambulate
• Nursing role is to also reassure and orient patient to surroundings and event
• Monitor VS

• Communication
• Structure & socialization
• Self-help suggestions
• Medication education

• Proven benefits within 24 hours.
• Awake for at least 36 hours
• Improves dopamine & 5-HT serotonin balance

• Exposure to full-spectrum fluorescent lamps for 30 minutes/day
• clinical improvement in 3-5 days
• Improves circadian rhythm by suppressing melatonin production

• Can improve mild-moderate depression within weeks
• Needs to be either regular vigorous aerobic or longer sessions of non-aerobic (yoga)
• ↑ levels of dopamine, 5-HT serotonin & norepinephrine
• (NT related to mood, feelings of reward, motivation & attention)

• Aromatherapy
• Acupuncture (raises endorphin levels)
• Animal-Assisted
• Music

Extreme mood swings between mania & depression with normal range of mood expressions returning between.

20-30 years old

Mixed manic and depressive episodes

4 or more episodes of extreme fluctuations in mood in a 12 month period

• By the time you get the medication titrated they are in a different mood state.
• They don't want to lose the mania state

• Hx of numerous hypomanic episodes with numerous depressive episodes, lasting at least 2 years
• Periods of normal mood lasting less than 2 months in the 2 year period

• Lithium
• Valproic acid (Depakote)
• Carbamazapine (Tegretol)
• Antidepressants (rarely)

• SAFETY
• Physical outlets for increased psychomotor energy
• Frequent high calorie finger foods
• Encourage hygiene
• Encourage short naps and rest periods
• Low stimuli environment
• Keep hydrated
• Create boundaries

• Assist with ADLs, staying with them
• Encourage high fiber foods, fluids, smaller meals
• Physical activity