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Mood Disorders

Mood

Major Depressive Disorder

  • Depressed mood or anhedonia + ≥4 symptoms for 2 weeks:
  • SIGECAPS mnemonic:
    • Sleep disturbance (insomnia or hypersomnia)
    • Interest loss (anhedonia)
    • Guilt (worthlessness, hopelessness)
    • Energy loss (fatigue)
    • Concentration difficulty
    • Appetite change (weight loss/gain)
    • Psychomotor changes (agitation or retardation)
    • Suicidal ideation
  • First priority: safety (suicide risk)
  • Suicide risk highest when patient has energy to act on plan
  • Treatment: SSRIs (fluoxetine, sertraline, escitalopram), SNRIs, bupropion, mirtazapine
  • ECT for severe, treatment-resistant depression

Bipolar Disorder

  • Alternating episodes of mania/hypomania and depression
  • Bipolar I: at least one manic episode
  • Bipolar II: hypomanic episodes + major depressive episodes
  • Manic episode: elevated mood, grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, risky behavior
  • DIGFAST mnemonic:
    • Distractibility
    • Indiscretion (risky behavior)
    • Grandiosity
    • Flight of ideas
    • Activity increase
    • Sleep deficit
    • Talkativeness (pressured speech)
  • During mania: slow patient down; prevent exhaustion/injury
  • Treatment: mood stabilizers (lithium, valproate, carbamazepine), atypical antipsychotics
  • Lithium level: 0.6-1.2 mEq/L; toxicity >1.5 mEq/L
  • Lithium toxicity signs: diarrhea, tremors, nausea, muscle weakness, ataxia, confusion
  • Monitor lithium levels monthly; sodium/fluid intake consistent

📝 NCLEX Priority Points

  • Priority: Suicide risk assessment - highest risk when patient has energy to act (as depression starts to lift)
  • Lithium levels: 0.6-1.2 mEq/L therapeutic; toxicity >1.5 mEq/L (tremor, ataxia, confusion)
  • During mania: protect from injury, provide low-stimulus environment, set limits, ensure rest
  • During depression: monitor for self-harm, encourage small achievable goals, provide nutritious meals
  • ECT: monitor for confusion, memory loss; side effects usually temporary

💊 Key Medications

  • SSRIs/SNRIs: fluoxetine, sertraline, venlafaxine - first-line antidepressants; monitor for activation in bipolar (can trigger mania)
  • Lithium: mood stabilizer - monitor levels, hydration, sodium intake; toxicity: diarrhea, tremor, confusion
  • Valproate (Depakote): anticonvulsant mood stabilizer - monitor LFTs, CBC, pregnancy risk
  • Atypical antipsychotics: quetiapine (Seroquel), olanzapine (Zyprexa) - monitor metabolic syndrome: weight gain, glucose, lipids

🩺 Therapeutic Communication Techniques

  • Using silence: Allows patient to organize thoughts and feelings
  • Active listening: Pay attention to both verbal and nonverbal cues
  • Clarifying: "I'm not sure I understand. Tell me more."
  • Focusing: "Let's talk more about that feeling."
  • Restating: "You're saying that you feel alone."
  • Exploring: "What happened before you felt that way?"
  • Validating: "I can see this is difficult for you."

⚠️ Safety Considerations

  • Suicide risk assessment: Ask directly about thoughts, plan, means, intent
  • Remove potential means: belts, shoelaces, sharp objects, medications
  • 1:1 observation for patients at high risk; document every 15 minutes
  • During mania: protect from impulsive decisions, provide safe environment, prevent exhaustion

Source: DSM-5-TR, NCLEX-RN Test Plan. For educational purposes only. Always follow facility protocols and current clinical guidelines.