Mood disorders Flashcards
(24 cards)
What is bipolar disorder?
A life long mental illness that normally commences during early adulthood
Causes unusual shifts in mood, energy and activity levels and challenges the person’s ability to carry out day-to-day tasks
What are the types of bipolar disorder than exist?
Type I
manic episodes that last at least 7 days,
or manic symptoms are so severe that the person needs immediate hospital care.
- Depressive episodes occur as well.
- Person can have depression and manic symptoms at the same time
Type II
defined by a pattern of depressive episodes and hypomanic episodes
ICD10
What is the diagnostic criteria for manic episode?
What is the treatment for acute mania?
Typically in specialised psychiatric care
In acute mania:
- Inpatient unit care
- First goal is to relieve symptoms of mania
- Normalise sleeping pattern
- Suicide risk assessment
- Restrict patient’s behaviour if necessary
-Can include involuntary treatment and nursing interventions
- Electroconvulsive therapy if needed to relieve a severe manic episode
What are the nursing intervention when you encounter a manic patient?
Provide physical safety
Set limit if needed
Remind the patient to respect distance
Use short and simple sentences.
Clarify the meaning of patient’s
communication.
Promote rest and sleep
Promote the patient’s dignity if inappropriate behaviour occurs
Channel the patient’s need for movement in to socially acceptable motor activities
How to manage the potential aggression from a manic patient?
Safewards – Talk down
Unqualified or student nursing are most vulnerable to aggression.
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First stage (delimit): Making environment safe for everyone involved and encouraging a co-opoerative atmosphere, by e.g. activating alarm system to attract aid
Second stage: Clarify: Finding out why the patient is agitation.
- Your thoughts
- Questions
- Important points
https://youtu.be/QE5vO2bP5zY?si=U6etGOzH477YrSmm
What are the ongoing treatment for Bipolar disorder?
- The main focus is preventing symptoms of mania and depression and maintain and improving a person’s ability to function.
- Engagement to the treatment
- Enhancing medication compliance
Psychoeducation
- The main focus and goal is to share information with the patient and their family members.
- Recognizing and preventing symptoms
-Family interventions
-Peer support
What are the medications for ?
- Mood-stabilisers:e.g. lithium, valproic acid, carbamazepine, lamotrigine, topiramate, oxcarbazepine
- Antipsychotics.
- Anxiolytics and sedatives can be used in acute situations
- During episodes of depression a first generation antipsychotics can be used simultaneously with anti-depressants and mood-stabilisers.
- Antidepressants can provoke mania
- Long-term medication is often required
What is depression?
Depression is an alteration in mood that is expressed by a feeling sadness, despair and pessimism.
Has a comprehensive affect on body functions, mood, thoughts and behaviour
What are the symptoms of depression?
- The patient suffers from lowering of mood, reduction of energy, and decrease in activity.
- Capacity for enjoyment, interest, and concentration is reduced
- Tiredness after even minimum effort is common
- Sleep is usually disturbed
- Diminished appetite
- Self-esteem and self-confidence are almost always reduced ideas of guilt or worthlessness are often present.
More symptoms of depression, this time more physical.
The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by physical symptoms:
- loss of interest and pleasurable feelings
- loss of self-esteem and ideas of worthlessness or guilt.
- Waking in the morning several hours before the usual time
- depression worst in the morning
- marked psychomotor retardation
- agitation
- loss of appetite, weight loss
- loss of libido
- BDI
What are types of depressive episodes that exist?
Mild depressive episode (2-4 symptoms)
- Person can usually work or continue with normal activities.
Moderate depressive episode (4 or more symptoms)
- the patient is likely to have great difficulty in continuing with ordinary activities.
Severe depressive episode
- several of the symptoms are marked and distressing.
- typically loss of self-esteem and ideas of worthlessness or guilt.
- suicidal thoughts and acts are common
- a number of physical symptoms are usually present.
What are some characteristics of severe depression?
Severe depression with psychotic symptoms consists of an episode of depression with the presence of , hallucinations, delusions, psychomotor retardation or stupor so severe that ordinary activities are impossible.
There may be danger to life from dehydration or starvation, suicide or murder-suicide
How is depression treated at a primary health care center?
Treatment of mild and moderate episodes of depression.
Identifying in early stage
- (Structured) interviews, for example BDI
Pay attention to possible alcohol or substance abuse problems, anxiety disorder or personality disorder
When is depression treated in a specialized care facility?
Specialized care
- Severe and psychotic depression
- Patients suffering with multiple and severe mental health issues
- Patients with elevated suicide risk
When in the treatment of depression does a patient go to inpatient unit?
A patient has severe problems surviving with every day life (eating, taking care of hygiene, sleeping)
Psychotic symptoms
Acute risk of suicide
What are the general treatments of depression
Supportive nurse-patient relationship and interaction.
Continues assessment, including suicide risk assessment.
Medication to alleviate symptoms of depression, insomnia and anxiety.
-Especially in moderate, severe and psychotic depression
-Electroconvulsive therapy if needed.
Psychotherapy.
- Can be supported by Kela (Social Insurance Institution of Finland)
- Requirements: ability to commit to treatment for at least three month, a referral from psychiatrist
- Main focus to improve quality of life and support person’s ability to study and / or work
When are antidepressants often necessary?
In severe and psychotic episodes of depression.
How long does it take to note results from antidepressants?
Results can be noted in 6-8 weeks.
What is the suicide risk for individuals with multiple episodes of depression?
Suicide risk is elevated and ability to function is reduced if a person has had at least three episodes of depression. Antidepressants can be used to prevent relapse.
How do the effects of antidepressants vary?
Effects are individual.
What are notable side effects of antidepressants?
Impairments of sexual functions, weight gain, sedation, headache, etc.
What are nursing intervention for depression?
Take a note of patient’s strengths and abilities
- Encourage and support independent surviving in a relation of patient’s abilities
- Spend nondemanding time with a patient if needed (inpatient units)
Supporting regular pattern of daily activities
- Adequate nutrition and hydration
- Assist only if needed
Supporting and encouraging physical activity and exercise.
Psychoeducation.
Mood diary
Recognizing distorted and biased thoughts and though patterns increasing self awareness
- Improvement of self confidence
- Relieving feeling of guilt
- Empowerment
Creating and supporting hope
Supporting the feelings of self-efficacy, self control and survival
Peer support.
