{"id":4674,"date":"2019-01-09T19:08:06","date_gmt":"2019-01-10T00:08:06","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4674"},"modified":"2019-05-25T22:38:51","modified_gmt":"2019-05-26T02:38:51","slug":"affective-mood-disorders","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/affective-mood-disorders\/","title":{"rendered":"Affective\/mood Disorders"},"content":{"rendered":"<p>\u2212 Australian prevalence of depression is 1 in 7<\/p>\n<p>\u2212 3<sup>rd<\/sup> highest burden of disease in Australia<\/p>\n<p>\u2212 MDD (Major depressive Disorder) associated with high mortality rate (suicide)<\/p>\n<p>&nbsp;<\/p>\n<p>ArTIOLOGY &amp; rPIDrMIOLOGY<\/p>\n<p>\u2212 Depression affects 1 in 7 (17%) women vs. 1 in 10 (10%) men<\/p>\n<p>\u2212 Genetic factors (2-4 times more likely to develop depression)<\/p>\n<p>\u2212 Multifactorial<\/p>\n<p>\u2212 Neurochemical (serotonin in the brain)\u00a0 \u2212 rnvironment<\/p>\n<p>&nbsp;<\/p>\n<p>RISK FACTORS<\/p>\n<p>\u2212 Family history<\/p>\n<p>\u2212 Personality (e.g. having a low self esteem)<\/p>\n<p>\u2212 Serious medical condition<\/p>\n<p>\u2212 Situational (e.g. adverse life events)<\/p>\n<p>\u2212 Gender<\/p>\n<p>\u2212 Alcohol &amp; Other drug use (AOD)<\/p>\n<p>\u2212 Absence of protective factors (e.g. support network, financial situation, education)<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Suicide-<\/h2>\n<p>\u2212 Suicide is responsible for over 900,00 deaths globally per year<\/p>\n<p>\u2212 Approx. 90% of people who commit suicide meet criteria for one DSM disorder\u00a0 \u2212 35-44 year old have highest suicide rates\u00a0 \u2212 Methods:<\/p>\n<ul>\n<li>Hanging, strangulation, suffocation (54.5%)<\/li>\n<li>Poisoning by drugs (14.5%)<\/li>\n<li>Poisoning by other methods (8.5%)<\/li>\n<li>Firearms (6.8%)<\/li>\n<li>Drowning, jumping, other (15.8%)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>DSM 5 Classification- MDD (Major depressive Disorder)\u00a0 <\/strong><\/p>\n<ul>\n<li><u>5 or more<\/u> <u>of the following symptoms<\/u> for same 2 week period (<u>must<\/u> include at least 1 &amp; 2)\n<ul>\n<li>Depressed mood (dysphoria)<\/li>\n<li>Markedly diminished interest or pleasure in all or most activities most of the day, nearly every day (anhedonia)<\/li>\n<li>Significant weight loss when not dieting, weight gain, decrease\/increase in appetite<\/li>\n<li>Insomnia or hypersomnia nearly every day<\/li>\n<li>Observable psychomotor agitation or retardation nearly every day<\/li>\n<li>Fatigue or loss of energy nearly every day (anergia)<\/li>\n<li>Feelings of worthlessness or excessive or inappropriate guilt nearly every day<\/li>\n<li>Diminished ability to think or concentrate, or indecisiveness nearly every day<\/li>\n<li>Recurrent thoughts of death, suicidal ideation without a specific plan or attempt<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Development &amp; course\u00a0 <\/strong><\/p>\n<ul>\n<li>Likelihood of onset increases with puberty (peaking in 20s)<\/li>\n<li>Chronicity of symptoms increases the likelihood of underlying personality, anxiety, substance use disorders \u00a0 Higher rate of relapse<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Serotonin Syndrome\u00a0 <\/strong><\/p>\n<ul>\n<li>Relatively rare condition but when it does occur it can be fatal (mortality 2-12%)<\/li>\n<li>Care with titration of AD\u2019s when changing<\/li>\n<li>Serotonergic agents such as all other AD\u2019s, pethidine, tramadol, LSD, busiprone, amphetamines, cocaine, ecstasy, lithium &amp; St Johns wort can all cause this syndrome<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Antidepressant Abrupt\/Withdrawal Discontinuation Syndrome\u00a0 <\/strong><\/p>\n<ul>\n<li>May cause withdrawal symptoms<\/li>\n<\/ul>\n<p>\u2212\u00a0 <strong>F<\/strong>lu-like symptoms<\/p>\n<p>\u2212 <strong>I<\/strong>nsomnia<\/p>\n<p>\u2212 <strong>N<\/strong>ausea<\/p>\n<p>\u2212 <strong>I<\/strong>mbalance<\/p>\n<p>\u2212 <strong>S<\/strong>ensory disturbances<\/p>\n<p>\u2212 <strong>H<\/strong>yper arousal (agitation\/anxiety)<\/p>\n<ul>\n<li>Usually short duration &amp; mild<\/li>\n<li>Need for tapering and titration<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Switching Medications (Anti depressants)\u00a0 <\/strong><\/h2>\n<ul>\n<li>Strategies to change medication:<\/li>\n<\/ul>\n<p>\u2212 Direct switch<\/p>\n<p>\u2212 Taper &amp; then immediate switch<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>rlectroconvulsive Therapy (rCT)<\/h3>\n<p>\u2212 Taper &amp; then switch after a washout period<\/p>\n<p>\u2212 Cross titration<\/p>\n<p>&nbsp;<\/p>\n<p>\u2212 Used to treat Major Depressive Disorder (MDD) and Bipolar Disorder and chronic Schizophrenia\u00a0 \u2212 2-3 sessions\/week, for a total of 6-12 sessions<\/p>\n<p>\u2212 Very effective- 90% of patients using it experience improvement<\/p>\n<p>\u2212 Uses general anaesthetic (GA)<\/p>\n<p>\u2212 Induced seizure 70-150 volts via electrodes (bilaterally 1 on each side; unilaterally, both on 1 side)\u00a0 \u2212 Seizures last 30-60 seconds\u00a0 \u2212 Side effects:<\/p>\n<ul>\n<li>Transient short term memory loss<\/li>\n<li>Headache o Confusion o Nausea<\/li>\n<li>Muscles aches<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Trans Magnetic Stimulation (TMS)<\/h3>\n<p>\u2212 Less invasive then rCT<\/p>\n<p>\u2212 Option for patients who cannot tolerate other methods (AD\u2019s, psychotherapeutic interventions)\u00a0 \u2212 40min\/session 5 days\/week<\/p>\n<p>\u2212 Timed variable magnetic field, administered via a coil placed over the scalp, to stimulate brain activity<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Bipolar Affective Disorder I &amp; II (BPAD)<\/h3>\n<p>\u2212 Diagnosis can take 10-20 years<\/p>\n<p>\u2212 Manic episodes are more common as 1<sup>st<\/sup> presentation in mean<\/p>\n<p>\u2212 Depressive episodes are more common as 1<sup>st<\/sup> presentation in women<\/p>\n<p>\u2212 High incidence of non-adherence to Tx<\/p>\n<p>\u2212 High incidence of suicide<\/p>\n<p>\u2212 More than 90% of BPAD sufferers will experience recurrence<\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0AETIOLOGY &amp; EPIDEMIOLOGY OF BPAD <\/strong><\/p>\n<ul>\n<li>Australian lifetime prevalence for BPAD I is up to 1% (no gender variance)<\/li>\n<li>Australian lifetime prevalence for BPAD II is up to 5% (higher rate in women)<\/li>\n<li>rmergence is usually mid-to-late adolescence<\/li>\n<li>More common in high income countries<\/li>\n<\/ul>\n<p><strong>\u00a0 <\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h2><strong>BPADI- Manic Episode\u00a0 <\/strong><\/h2>\n<ul>\n<li>Always has mania<\/li>\n<li>Abnormally elevated, irritable, elevated and expansive mood <u>lasting 1 week &amp; present most of the day<\/u><\/li>\n<li>Highly aroused- difficult to interrupt<\/li>\n<li>Three or more of the following (4 if mood is only irritable):\n<ol>\n<li>Inflated self esteem or grandiosity<\/li>\n<li>Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)<\/li>\n<li>More talkative than usual or pressure to keep talking<\/li>\n<li>Flight of ideas or subjective experience that thoughts are racing<\/li>\n<li>Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed<\/li>\n<li>Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposelessness non-goal-directed activity)<\/li>\n<li>rxcessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h2><strong>BPAD I&amp;II- Hypomanic Episode\u00a0 <\/strong><\/h2>\n<ul>\n<li>\u201cmini mania\u201d no mania episode\/no psychotic features<\/li>\n<li>Distinct period of abnormally elevated, expansive or irritable mood <u>lasting 4 consecutive days<\/u><\/li>\n<li>No hospitalisation<\/li>\n<li>The episode is not severe enough to cause impairment<\/li>\n<li>Three or more of the following (4 if mood is only irritable)\n<ol>\n<li>Inflated self esteem or grandiosity<\/li>\n<li>Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)<\/li>\n<li>More talkative than usual or pressure to keep talking<\/li>\n<li>Flight of ideas or subjective experience that thoughts are racing<\/li>\n<li>Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed<\/li>\n<li>Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation<\/li>\n<li>rxcessive involvement in activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Treatment of BPAD\u2019s\u00a0 <\/strong><\/p>\n<ul>\n<li>Antipsychotic medication<\/li>\n<li>Mood stabilising medication<\/li>\n<li>rCT<\/li>\n<li>Counselling<\/li>\n<li>Anxiolytics<\/li>\n<li>Antidepressants (with care)<\/li>\n<\/ul>\n<p><strong>MOOD STABILISERS\u00a0 <\/strong><\/p>\n<h3>\u00a0<strong>MEDICATION\u00a0 DOSAGE\u00a0 SIDE EFFECTS\u00a0 BENEFITS &amp; DISADVANTAGES\u00a0 <\/strong><\/h3>\n<p>Lithium carbonate\u00a0 1800 (a)\u00a0 Nausea, vomiting, diarrhoea, 75% will experience S\/r 900-1200mg (m)\u00a0 weight gain, tremor, fatigue,\u00a0 polydipsia, polyuria\u00a0\u00a0 rfficacy in reducing suicide vs.<\/p>\n<p>other mood symptoms<\/p>\n<p>Sodium Valporate\u00a0\u00a0 400-1500mg\u00a0\u00a0 Weight gain, acne, hair loss, Rapid onset mediation that is<\/p>\n<p>GI upset\u00a0 well tolerated<\/p>\n<p>Carbamazepine\u00a0 200-1600mg\u00a0\u00a0 Drowsiness, dizziness, Less sedating then other<\/p>\n<p>(uncommon)\u00a0\u00a0 headache, fatigue &amp; nausea\u00a0 mood symptoms<\/p>\n<p>Lamotrigine\u00a0 50-200mg\u00a0 Dizziness, drowsiness, rfficacy in managing bipolar<\/p>\n<p>headache, tremor, blurred depression &amp; BPADII<\/p>\n<p>vision, confusion<\/p>\n<p>Observe for rash (life threatening)<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>BPAD Relapse <\/strong><\/p>\n<p>&nbsp;<\/p>\n<h3>Postpartum \u2018Blues\u2019<\/h3>\n<p>\u2212 Common in men &amp; women , 30 days after bitch<\/p>\n<p>\u2212 Transient<\/p>\n<p>\u2212 Mood liability, irritability, tearfulness<\/p>\n<p>\u2212 Feeling of sadness<\/p>\n<p>&nbsp;<\/p>\n<p><strong>DEPRESSION- PERIPARTUM ONSET <\/strong><\/p>\n<p>o Consider impact of unplanned pregnancies, dysfunctional relationships etc. contributing\u00a0 o Prolonged, more serious version of baby blues\u00a0 o May present with over-concern with infant\u00a0 o Can present with psychotic features\u00a0 o 50% of episodes actually begin <em>prior<\/em> to delivery\u00a0 o Symptoms occur within 12 weeks of birth &amp; include: depressed more, severe anxiety, panic attacks<\/p>\n<p>&nbsp;<\/p>\n<p><strong>ASSESSMENT <\/strong><\/p>\n<ul>\n<li>RISK- self, others, vulnerability, spending<\/li>\n<li>MSr<\/li>\n<li>PHYSICAL ASSrSSMrNT- nutrition, sleep, elimination<\/li>\n<\/ul>\n<p>PSYCHOrDUCATION- understanding of illness, mx<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u2212 Australian prevalence of depression is 1 in 7 \u2212 3rd highest burden of disease in Australia \u2212 MDD (Major depressive Disorder) associated with high mortality rate (suicide) &nbsp;&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/affective-mood-disorders\/\">Continue Reading<span> Affective\/mood Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4674"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4674"}],"version-history":[{"count":1,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4674\/revisions"}],"predecessor-version":[{"id":4788,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4674\/revisions\/4788"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4674"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4674"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4674"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}