MOOD DISORDERS AND ASSESSMENT 19 MARCH 2024.pptx

Mental Health Nursing

1. DR MODULA MJ MOOD DISORDERS T: [phone] | E: [email protected] | www.ufs.ac.za

2. Learning Outcomes Conduct a nursing assessment of a client with a mood disorder guided by the mental status examination assessment guidelines. Distinguish between depressive, manic and hypomanic episodes. Compare and contrast similarities and differences between major depressive and bipolar disorders .

3. Learning Outcomes cont … Compile a psychodynamic formulation Identify symptomatology associated with Major depressive and Bipolar disorders guided by DSM-5 Formulate nursing diagnoses and goals of care for a mood disorder.

4. Learning Outcomes cont. … Apply nursing process to the care of clients and families with mood disorders. Identify populations at risk for suicide. Make a thorough suicide assessment of client.

5. Forms of moods Anxious Depressed Dysphoric Angry Irritability Euphoric Elevated Energized Exhausted Agitation Sadness

6. Mood disorders

7. DSM-5 criteria

8. Bipolar disorders Subgroup of affective disorders characterized by at least one episode of manic behaviour with or without episode of depression.

9. Bipolar disorders Characteristics assessment Mood Behaviour Thought processes and speech patterns Thought content Cognitive function

10. Bipolar disorders types

11. Bipolar disorders Bipolar I Bipolar II Episode Single manic Single hypomanic and one major depressive Mortality Suicide Severe depression Comorbidity Panic attacks Social anxiety Specific phobias Anxiety disorders Eating disorders Substance use disorders

12. Main features Mania Hypomania Mood Intense disturbance Persistence elevation Extensiveness Irritability Euphoric Low level Activity Goal directed Extreme energy Excessive energy Period 0ne week Four consecutive days Symptoms Three or more Three Functioning impairment Social or occupational None

13. Major depressive disorder ( Major depression) Mood Persistently depressed Activity Diminished interest Period Minimum of 2 weeks Symptoms Five or more Functioning impairment Social and/or occupational

14. Grieving Depression Normal mourning Pathological grief Reaction to loss Exaggerated reaction to loss Necessary for closure Ineffective coping Functioning level normal Abnormal lack of energy Phases of grief Psychomotor retardation

15. Grief intervention Promote physical health Decrease symptoms Facilitate progress in stages of grief Decrease denial Facilitate expression of feelings Encourage adaptation

16. Depression risk factors

17. Assessment guidelines MDD Risk of harm Medical& neurological examination Psychotic Drugs & alcohol Medical condition Comorbid mental conditions

18. Symptoms of MDD Depressed or irritable mood Pleasure or interest deficit Weight loss/gain Insomnia/hypersomnia Hyperactivity/retardation

19. symptoms cont. .. Fatigue Worthlessness feeling Impaired abstract thinking Recurrent suicidal thoughts

20. Assessment guidelines MDD History of depression and suicide Support systems Family Information Referrals

21. MDD nursing diagnosis Social isolation Risk for direct violence Risk for self directed violence Ineffective coping

22. Cont. … Hopelessness Powerlessness Spiritual distress Chronic low self esteem

23. MDD nursing diagnosis cont. Impaired self care Insomnia Constipation Imbalance nutrition Sexual dysfunction

24. Suicide Risk factor for bipolar and depressive disorders Suicidal ideation - major reason for hospitalization Increased by hopelessness, substance use, recent loss/separation, suicidal attempts.

25. Suicide terms Define: Suicide Suicide ideation Suicide attempt Completed suicide

26. Suicide What are the common harsh and soft methods of suicide?

27. “SAD CHILDREN” assessment S = support systems A = Alcohol & Assault D = Depression & Delusion

28. “SAD CHILDREN” assess cont. C = communication & change in behaviour H = Hostility & history of previous attempts Hallucinations I = Impulsiveness & illness (chronic) L = Lethality

29. “SAD CHILDREN” assess cont. D = Demography R = Reaction to the evaluator E = Events for attempt N = No hope

30. Suicide risk factors Biological Psychological Environmental Cultural Societal

31. How to minimise suicidal behaviour in the ward Use plastic utensils Assign open room Jump and hang proof the rooms Minimal length electric cords Unbreakable glass windows Lock all the rooms

32. cont. Remove harmful objects Check personal belongings Educate visitors on harmful objects Frequent search Check attire

33. Psychodynamic formulation

34. Assessment guidelines

35. Nursing diagnosis for mania

36. Outcome identification

37. Nursing intervention Communication Safe milieu Self-care needs Sleep Hygiene Elimination (Halter, 2022) (Tables: 13.3 and 14.5)

38. Pharmacological intervention

39. Medication aspects

40. Lithium indications Elation, grandiosity Manipulation Anxiety Flight of ideas Self-injurious behaviour Irritability

41. Cont. … Insomnia Psychomotor agitation Aggressive/assaultive Distractibility Hypersexuality Paranoia

42. Patient monitoring Full blood count (FBC) Vital signs Glucose test (HGT) Liver function (LFT) Renal functions Cardiac function 6 months dental check Side effects Compliance

43. Psychotherapy intervention Electroconvulsive (ECT) Support groups Seclusion and restraint Teamwork and safety Health teaching and promotion

44. Education of client and family Knowledge Signs and symptoms Medication Side effects Relapse prevention Emergency contacts

45. Cont. … Over counter use Substance use Good sleep Coping strategies Therapy (group & individual)

46. EMERGENCY CONTACTS Department of Social Development Substance Abuse Line 24hr helpline 0800 12 13 14 SMS 32312 Suicide Crisis Line 0800 567 567 University Of Free State 0800 00 63 63

47. HOMEWORK Identify the similarities between Major depression and bipolar disorders. Distinguish the difference between bipolar and major depressive disorder. Distinguish between warning , risk and protective factors of suicide Discuss patient and family teaching on lithium

48. THE END