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Mood
prolonged emotional tone - most of the day or most of the time. Influences peoples: behaviors, personality, perception of world around them
Affect
Expression of the mood; what one sees
Blunted Affect
not having a full range of expression "Grumpy
Flat affect
having NO expression
Bright affect
whatever the situation, individual is always smiling and/or happy
Inappropriate affect
expression which is opposite of what it is supposed to be
Congruent or Incongruent Mood/Affect
Consistent or Not consistent with pts current mood
Constricted/Restricted
lacking full range of expression
Healthy Mood
Healthy individuals are able to experience the full range of emotions appropriate to the situation. Changes in mood are restored to harmony through adaptation
Problematic Mood
Disrupts quality of life and/or ADLs
Disharmony of moods
stimulus or stressors overwhelms resources leading to maladaption or maladaptive behaviors
Mood Disorders
Diagnosed by DSM - IV TR
Major Depression
must be feeling depressed for at least two weeks everyday; Axis 1 Characterized by depressed mood or loss of interest or pleasure in usual activities with evidence of impaired social and occupational functioning for at least 2 weeks
Bipolar Disorders "Manic Depressive illness"
indicated by moods that swing between two opposite extremes. This individual manifests depression and manic episodes
Manic Episodes
Mood swings, active, aggressive, nothing is wrong, irritable, impulsive (will take s asking), cannot sit stil, euphoric mood, poor judgment, ^ sexual interest, ^ energy less need for sleep, need "finger foods"
Hypomania
"Good worker", has lots of energy but can still be productive, no psychotic features
Mixed Episode
Can occur in both Bipolar 1 & 2. Pt cycles rapidly, can be depressed, euphoric and manic at the same time
Bipolar 1
Pt experiences full syndrome
Acute Mania
Easily distracted, endless energy, affect is labile (ever-changing), changes clothing for every occasion
Delirious Mania
energy + confusion, overwhelms coping resources, cannot control impulses, nursing priority: Safety, DTS, DTO
Hypomania vs. Acute/Delirious Mania
Hypomania has impulse control
Bipolar II Disorder
characterized by recurrent bouts of major depression with the episodic OCCURANCE OF HYPOMANIA. Moderate Manic levels hx of depression or hypomania does not meed criteria for mania or mixed Dx in depressed stage No psychotic features
GAF
Global Assessment of Functioning Key test for Bipolar II
Bipolar I & II
Both may present with our without psychotic featues
If misdiagnosed
If Bipolar Pt Given antidepressants, will become Manic. Need mood stabilizers
Cyclothymia
a chronic mood disturbance involving numerous episodes of hypomania and depressed mood, of insufficient severity or duration to meed criteria for BP I or BP II
Cyclothymia Features
Essential feature is a chronic mood disturbance for at least 2 yrs duration. Involves numerous episodes of hypomania dn depression (not meet BP criteria) Individual never without hypomanic or depressive symptoms for more than 2 months
SAD
Seasonal affective disorder
Cycling
Pts who cycle very rapidly have a poor prognosis
Dysthymic disorder
a depressive neurosis. The symptoms are similar to, if somewhat milder than those ascribed to major depression. No loss of contact with reality, not appreciate full range of emotions or moods that are pleasurable, not depressed but not happy. Mostly bad or grumpy mood
Secondary to General Medical conditions
Anemia, Lupus, Hyponatremia, Hypo/Hypercalcemia, thyroid dysfxn, substance abuse, AIDS, Neurosyphilis, Cancer, mult sclerosis, circadian rhythm de-synchronization.
Postpartum Psychotic Illness
Affects care of child. Pt can have depression or psychosis. Emerges 48-72 hours after birth and lasts 2 wks
Antidepressant treatment
must not be given to BP pts other wise become manic
Mood Stabilizer
given to BP pt
Group & individual therapy
acute or delirious mania will not benefit. Pt needs good coginition
Cognitive therapy
short sessions, helps individual to understand the behavior and the consquences of behaviors.
Adherence to therapy
Denial, Rationalization (creativity will be lost if I take Lithium), Side-effects of Meds, Social stigma/support
Inpatient Care
when pt is unable to fxn, totally out of control, needs close observation, assessing response to meds
Partial Hospitalization
Return to work after each acute phse, transitioning back into community - day treatment, family/social support
Outpatient Management
Handling stress - identifying stressors, Meds monitoring, bldg therapeutic alliances, edu, support group
Attitudes as a part of Therapy
Acceptance Honesty Empathy - not sympathy Patience
ECT Electroconvulsive Therapy
Inducing a generalized seizure if medications do not work or cannot wait for meds to work due to safety (DTS, DTO)
Who Gets ECT
Major depression, Mania, schizophrenia
ECT facts
Absolute Contraindication: INCREASED Intracranial Pressure Can be taken to court for refusal, Pt under conscious dedation (IV - 02 monitor, ABCs)
Ranges of Mood
Euphoric -woohoo Elation - great happiness Euthymic - normal Dysphoric - unhappy Dysthymic - chronic depression does not meet criteria of DSM Depressed - all categories of DSM met
Parts of Brain r/t depression
Hippocampus Amygdala Hypothalamus Limbic Structures Frontal Cortex Cerebellum
ABCs of psych
Affect Behavior Cognition
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