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Mood Disorders

Mood Disorders. 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.

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Mood Disorders

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  1. Mood Disorders

  2. 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.

  3. Types of Mood Disorders • Depressive Disorders • Bipolar Disorders • Others

  4. 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

  5. Bipolar Disorders • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder

  6. Depression: Predisposing Factors • Biological theories • Genetics: • Biochemical influences: Neuroendocrine theories Physiological influences • Psychoanalytical theory • Mourning • Melancholia Learning theory Object loss Cognitive theory

  7. Depression: Developmental Implications Childhood Depression • Symptoms: Adolescence • Symptoms include: • Senescence Treatment • Postpartum Depression Treatment

  8. Assessment • Transient depression • Mild depression • Moderate depression • Severe depression

  9. Nursing Diagnosis

  10. Outcome

  11. Planning/Implementation

  12. Client/Family Education

  13. Evaluation

  14. Treatment Modalities

  15. Antidepressants Newer-generation antidepressants • Selective serotonin reuptake inhibitors (SSRIs) • Second- and third-generation antidepressants • Tricyclic antidepressants • Monoamine oxidase inhibitors (MAOIs)

  16. 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).

  17. Antidepressants- SSRI • Generic Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine • Brand Prozac Paxil Zoloft Celexa Lexapro Luvox

  18. Serotonin Syndrome • Delirium Agitation • Tachycardia Sweating • Hyperreflexia Muscle spasms • Shivering Coarse tremors More severe cases • Hyperthermia Seizures • Renal failure Rhabdomyolysis • Dysrhythmias DIC

  19. Antidepressants • Generic Bupropion Mirtzapine Venlafaxine Duloxetine Amitriptyline Imipramine Phenelzine Selegiline • Brand Wellbutrin Remeron Effexor Cymbalta Elavil Tofranil Nardil Emsam

  20. Monoamine Oxidase Inhibitor • Nardil • Parnate • Marplan • Selegiline* *Available in a patch form called EMSAM Hypertensive Crisis and Tyramine

  21. Bipolar Disorder (Mania) Assessment Stage I—Hypomania Stage II—Acute mania Stage III—Delirious mania

  22. 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)

  23. Nursing Diagnosis

  24. Outcomes

  25. Planning/Implementation

  26. Client/Family Education

  27. Evaluation

  28. Psychopharmacology/Mood Stabilzers • Generic Lithum Valproic acid Carbamazepine Oxcarbazepine Lamotrigine Topiramate • Brand Eskalith, Lithobid Depakote, Depakene Tegretol, Equetro Trileptal Lamictal Topamax

  29. 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 toxicity Symbyax is a combination of Prozac an antidepressant and Zyprexa an atypical major tranquilizer.

  30. 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

  31. Planning/Implementation(cont.) • Educate client and family about the medication Outcome Criteria/Evaluation

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