Judith Wikel RN BSN MEd

 ◦ ◦ What is MOOD?

An emotion is a feeling—a nonintellectual responses. Emotions are reactions to various stimuli based on individual points of view.

Your book defines mood as a “prolonged emotional state that influences one’s whole personality and life functioning”.

◦ Think about MOOD! What type of Mood are you in right now?

  Think back to your teenage years!

Were you in a good mood?

  Please refer to page 226 and read the Emotions of Adolescence section.

During our teenage years we are struggling with identity, how to gain control over, and express our emotions.  Moods of adolescents commonly swing from feeling vulnerable to dependent to knowing that they are the smartest on in their family. (remember? I do!)

 ◦ ◦ ◦ Theories Psychoanalytical theories see mood disorders as anger turned inward. Behaviorist or Behavioral theory view depression as a group of learned responses.

Social theorists consider depression the result of faulty social interactions.

 ◦ ◦ Major Depressive Disorder When depression is severe and last more than 2 weeks, it is called a major depressive episode.

Severe depression encompasses one’s whole being—every realm of human functioning.

 ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Behaviors associated with severe depression.

Paralysis to agitation Feelings of worthlessness Guilt Despair expressed in every thought, every movement, every activity Physical appearance declines Eating and sleeping become distasteful chores Poor concentration Inability to follow through on tasks lead to feelings of powerlessness and helplessness.

 ◦ Major Depressive Disorder Persons with major depressive disorders have a high mortality rate.

◦ ◦ Suicide is a risk with Major Depressive Disorder.

Frequent assessment is required and safeguards must be in place to prevent or reduce the risk of suicide.

 ◦ ◦ ◦ Therapeutic Interventions Psychotherapies Electroconvulsive Therapy Antidepressants Read and understand the nursing actions, interventions, patient teaching, and when to notify the physician related to therapies listed above.

 ◦ Daily moderate depression that last for more than 2 years is called?

DYSTHYMIC DISORDER Hint – read and understand all sections in book related to ppt slides.

 ◦ ◦ Seasonal affective disorder Also known as winter depression Levels of mild and moderate depression are experienced during long winter days.

What is the treatment for Seasonal affective disorder?

Read, Read, Read this section in Textbook!

     Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) All other antidepressants ◦ ◦ Mood-stabilizing drugs All above listed medications are discussed on pages 232 & 233 of text book. Don’t get crazy and try to memorize all the drugs be familiar with the drug classes and nursing actions and interventions.

Focus on signs to report to physician.

 ◦ ◦ Bipolar Disorders The hallmark of a depression. bipolar disorder is sudden and dramatic shifts in emotional extremes. Persons with bipolar disorders live in a world that seesaws between the emotional extremes of mania and Thoughts, moods, and behaviors swing from normal to grandiose, to depressed.

 ◦ Hypomania An exaggerated sense of cheerfulness, begins the cycle. Soon cheerfulness progresses to the unstable “high” of mania

 ◦ Behaviors related to Mania Read about Kevin in Case study 21-1 on page 229 and identify his behaviors related to Bipolar disorder.  Confidence   Vigor Unstable  Pressured Think about how he would have looked, spoke, smelled…

 ◦ Trust When needs for food, comfort, safety, and socialization are consistently met, a sense of trust and self-worth develops.

 ◦ Paranoid Personality Disorder Paranoia is a suspicious system of thinking that includes delusions of persecutions and grandeur. ◦ Men are diagnosed more often than women with Paranoia.

 Theories ◦ ◦ Biological theories Psychoanalytical theories ◦ Behavioral theories ◦ Sociocultural theories Read and understand theories on pages 334 & 335.

 ◦ ◦ Psychopaths The hallmark of psychopaths is a lack of conscience.

Psychopaths use charm, manipulation, intimidation, and violence to control others and satisfy their own selfish needs.

 ◦ ◦ Narcissistic Personality Disorder Grandiose, no empathy, needs to be admired, seeks attention.

Look at me!

 ◦ Dependent Personality Disorder This disorder is associated with separation and abandonment. Individuals with this problems carry a deep fear of rejection, which expresses itself as the need to be cared for.

 ◦ ◦ ◦ Schizotypal Personality Disorder Odd, strange, or peculiar actions.

These individuals often have ideas of reference.

Ideas of reference are incorrect perceptions of causal evens as having great or significant meaning.

 ◦ Drugs Used to Treat Personality Disorders Relax! Read through Table 30-2 on page 340 and pay close attention to side effects. No need to memorize specific drugs to specific side effects.

◦ Understand these medications can cause Extrapyramidal side effects (EPSEs).

◦ Understand and be ready to answer questions related to EPSEs.

 ◦ ◦ ◦ ◦ Erratic Cluster Antisocial Borderline Histrionic Narcissistic Tip: Be able to identify the above listed Personality Disorders as erratic.

 ◦ Psychosis The inability to recognize reality, relate to others, or cope with life’s demands.

 ◦ Biological Theories Read the sections on all the different theories of how Schizophrenia develops, and understand most theorist believe different areas of the brain have trouble communicating causing problems with the brain and its activities. ◦ Page 346-347.

 ◦ Schizophrenia Subtypes      Catatonic Disorganized Paranoid Undifferentiated Residual

 ◦ Akathisia An inability to sit still.

 Families of Schizophrenics need treat and support. ◦ Read and understand the nurse’s role in assisting with support of families.

  Use this PowerPoint presentation to guide you along in studying for MH 3.1 exam.

As always, reading the chapters and understanding the objectives is also important.

 Question – a 49y/o nursing instructor is found dancing down her street at 3am, laughing and singing loudly. She is wearing a clown's wig, a tank top, and men’s boxer shorts. She has on bright red lipstick and above her lips as well as on her cheeks. It is 40 degrees outside, and she is barefoot. When the police arrive, she quickly jumps on the younger officer and wraps her legs around his, attempting to kiss him. She slaps his partner when the officer tries to get her off him. She then offers him $2 million to leave her alone. What mood disorder does this woman most likely have? What terms can be used to describe the behaviors that she is displaying?

  Answer This individual is most likely having a manic episode. She is awake in the middle of the night experiencing insomnia and hyperactivity. She is initially euphoric, which is shown by her singing, dancing, and laughing. She exhibits increased motor activity. She is dressed inappropriately in a bizarre outfit, with excessive makeup. She is uninhibited and sexually driven. She becomes easily irrigated with the officer with a brief period of anger. She has grandiose delusions of being a millionaire. Recognize her unstable effect and pressured speech…

 ◦ ◦ ◦ ◦ Question disorder is The chief feature of a paranoid personality A) unwarranted suspicion and mistrust of others.

B) detachment from social relationships C) cognitive and perceptual eccentricities.

D) impulsivity ◦ A-is the correct answer.

 ◦ ◦ ◦ ◦ Question Psychotherapy for clients with schizophrenia is more difficult than for other clients because of: A) family problems associated with schizophrenia B) anxiety problems associated with schizophrenia C) communication problems associated with schizophrenia D)mood problems associated with schizophrenia ◦ Answer is C! But, remember families of schizophrenics need lots of education and support.

 ◦ ◦ ◦ ◦ Question Tardive dyskinesia involves involuntary muscle movements that most often are associated with the: A) mouth, lips, and tongue B) extremities C) trunk D) head

Answer – A –

Hint: review extrapyramidal movements.

    Again, remember the PowerPoint is a study outline.

Read through assigned reading.

Answer objectives.

Study  Do well on the test.

 Judith Wikel RN