MOOD DISORDERS ( Affective Disorder)

Chapter 15)

• MOOD - is a prolonged emotional state

that influences the person’s whole
personality and life functioning. It
pertains to inner tone of emotion and is
synonymous with the term feeling.
 MOOD DISORDERS or
AFFECTIVE DISORDERS
• - are pervasive alterations in emotions that
are manifested by depression, mania or
both.
• - mood d/o are the most common
psychiatric dx associated with suicide, &
depression is one of the most important
risk factors for it
• Mood d/o interfere with a person’s life,
plaguing him or her w/ drastic & long term
sadness, agitation or elation.
Accompanying self – doubt, guilt, & anger
alter life activities, especially those that
involve self- esteem, occupation &
relationships.
 Models of Causation:
• Genetics: aggression turned in ward;
objects lost; Personality Disorganization:
• Cognitive: Hopelessness; Hopelessness
• Behavioral: Loss of positive reinforcement
• Biological: Decreased serotonin &
Norepinephrine;
• Life Stressors: experiences
Categories of Mood Disorders

• 1. Depressive Disorders
• 2. Manic – Depressive ( Bipolar) Disorder
• 3. Suicidal Behavior
1. Major Depressive disorder – depressive
episode with no manic episodes
1. Major depression, single episode
2. Major depression, recurrent: Repeated
episode of major sadness or depression
separated by long intervals, occurring in
clusters or increasing w/ age
3. Dysthymia: Chronic depressive mood
problems occurring in the absence of a
major depressive or organic or psychotic
diagnosis.
• Differentiation / Category:
• 1. Moderate Depression – crying at night
• Dysthymia – painful depression fro 2 years
• **2. Severe Depression – Crying at early
morning, depression less than 2 weeks
• **3. Major Depression – severe
depression for more than 2 weeks
• ** - both of them have the same
characteristics
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

II. DEPRESSION

DSM-IV-TR DIAGNOSTIC CRITERIA: SYMPTOMS OF MAJOR DEPRESSIVE

DISORDER:
(At least 5 of the following (including 1 of the first two)
must be present most of the day, nearly daily or at least
2x a week):
Affectivee:
1. Early morning Depression (Sad)

2. Anhedonism (decreased attention to and enjoyment

from previously pleasurable activities)

3. feelings of Worthlessness or guilt inappropriate to the

situation ( possibly delusional)
4. Hopelessness; Helplessness
5. Physiological: Unintentional weight
change of 5% or more in a month
6. Cognitive: Inability to concentrate,
think, focus or make decisions
Suicidal
7. Behavioral: Agitation or psychomotor
retardation; Tiredness ( anergia)
• In addition , 4 of the ff symptoms are
present:
• 1. Changes in appetite or weight
• 2. sleep or psychomotor activity
• 3. decreased energy
• 4. feelings of worthlessness or guilt
• 5. difficulty thinking, concentrating or
making decisions
• 6. Recurrent thoughts of death or suicidal
ideation, plans or attempts
• - these symptoms must be present
everyday for 2 weeks & result in.significant
distress or impair social , occupational or
other important areas of functioning. Some
people also have delusions &
hallucinations , the combination is referred
to as psychotic depression
 ADDITIONAL TeRMINOLOGIeS
• Anergia – lack of energy
• Euthymic mood – average affect & activity
• Anhedonia – unable to feel pleasure
• Hypomania – period of abnormally & persistently
elevated , expansive or irritable mood lasting 4 days
• Pressured speech – unrelenting , rapid, often loud
talking without pauses
• Flight of ideas – racing, often unconnected thoughts)
• Lucid – easily understood, completely or comprehensible
intelligible, rational, sane
• ** In a depressed pt; hostility is turned
towards self
• ** in a manic pt; hostility is turned towards
the environment
 Predisposing Factors
• 1. Single, Annulled & Divorced
• 2. Loss of loved one ( situational crisis)
• 3. SAD – Seasonal affective D/O –
common on winter season ( Nov-Feb) or
intimate months
• Seasonal Affective d/o (SAD) –
• Winter depression or fall onset SAD. People experience
increased sleep, appetite & carbohydrate cravings,
weight gain; interpersonal conflict; irritability & heaviness
in the extremities, beginning in late autumn & abating in
spring & summer.
• - Intervention for pt w/ seasonal affective d/o during a
depressed mood includes the use of broad spectrum
light in high activity area. This produces high intensity
color like broad day light. Also instruct the pt. that the
light source must be 3 ft. away from the eye
• 4. Caucasians/ Afro-Americans/ Asians
• 5. Alcoholics/ Drug Addicts ** a 66 y/o
american man, no hobby, no friend, retired
6 yrs ago, no money & has hx of alcohol
abuse is at risk for suicide
• 6. Incurable illness
• 7. Postpartum depression
• 8. Schizophrenia
• Prone : Male
• Age Bracket prone for Suicide:
• #1. Adolescent ( identity crisis)
• 2. Elderly ( ego-despair)
• 3. Middle age men ( 45 y/o above)
• 4. Postpartum depression (7 days /2-4
wks)
 Nursing Interventions for
Depression
• 1. Provide for the safety of the client &
others
• 2. Institute suicide precautions if indicated
• 3. Begin a therapeutic relationship by
spending non demanding time with the
client
• 4. Promote completion of activities of daily
living by assisting the client only as
necessary
• 5. Establish adequate nutrition & hydration
• 6. Promote rest & sleep
• 7. Engage the client in activities
• 8. Encourage the client to verbalize &
describe emotions
• 9. Work with the client to manage
medications & side effects
 Client/ Family Education for
Depression
• 1. Teach about the illness of depression
• 2. Identify early signs of relapse
• 3. Discuss the importance of support
groups & assist in locating resources
• 4. Teach the client & family about the
benefits of therapy & follow-up
appointments
• 5. Encourage participation in support
groups
• 6. Teach the action , side effects & special
instructions regarding medications
• 7. Discuss methods to manage side
effects of medications
 Other Related D/O
• 1. Dysthymic d/o – characterized by at
least 2 yrs of depressed mood for more
days than not w/ some additional , less
severe sx that do not meet the criteria for
a major depressive episode
• 2. Cyclothymic d/o – characterized by 2
yrs of numerous periods of both
hypomanic sx that do not meet the criteria
for bipolar d/o
• 3. Substance Induced Mood d/o –
prominent & persistent disturbance in
mood that is judged to be a direct
physiologic consequence of a medical
condition such as degenerative neurologic
conditions, cerebrovascular dis.. Metabolic
or endocrine cnditios, autoimmune d/o;
HIV.
 2. BIPOLAR DISORDER
• ( formerly called Manic-depressive disorder)
• Is diagnosed when a person’s mood cycles
between extremes of mania & depression
• Bipolar disorder involves extreme mood
swings from episodes of mania to episodes
of depression
• :Mania is a distinct period during which
mood is abnormally & persistently elvated ,
expansive or irritable.
• During manic phases, clients are euphoric
, grandiose, energetic & sleepless. They
have poor judgment & rapid thoughts,
actions & speech.
• During depressed phases, mood, behavior
& thoughts are the same as in people
diagnosed with major depression
• A person with major depression slowly
slides into depression that can last for 6
mos to 2 years,
• the person with bipolar disorder cycles
between depression & normal behavior (
bipolar depressed) or mania & normal
behavior ( bipolar manic)
• A person with bipolar mixed episodes
alternates between major depressive &
manic episodes interspersed with periods
of normal behavior
• Each mood may last for weeks or months
before the pattern begins to descend or
ascend once again.
 Types of Bipolar Disorders
• Bipolar Type 1 – manic episodes with at
least one depressive episode
• Bipolar Type 11 – recurrent depressive
episodes with at least one hypomanic
episode.
• Bipolar Mixed – Cycles alternate between
periods of mania, normal mood,
depression. Normal mood, mania and so
forth
BIPOLAR
• 3. Suicidal Behavior
• = a major depressive episode lasts at least
2 weeks, during which the person
experiences a depressed mood or loss of
pleasure in nearly all activities
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

SUICIDE

Suicide –
Persons with severe mood disturbances must be always be
assessed with potential for suicide. The intensity of anger, guilt
and worthlessness may precipitate suicidal thoughts, feelings or
gestures.

Self-injury is often mistaken for potential suicide. The lethality of

self-injury is low, and persons who self-injure typically want
relief from the tension they feel rather than to kill themselves.

It may also be a form of “cry for help” a form of “manipulation” or

as a result of “hallucination”
• - Suicide – is the intentional act of killing oneself.
• 2nd leading cause of death ( after accidents)
among people 15 to 24 years of age
• Men - commits suicide more than women
Women – 4x more likely to attempt suicide
• The higher suicide rates for men are partly the
result of the method chosen ( ex. Shooting,
hanging, jumping from a high place ). Women
are more likely to overdose on medication
Risk factors for Suicide:
• Men, young women, whites, separated, divorced
• Environmental factors that increase
suicide risk:
• 1. isolation
• 2. recent loss
• 3. lack of social support
• 4. unemployment
• 5. critical life events
• 6. family hx of depression or suicide
• A history of previous suicide attempts
increases risk for suicide. The first 2 yrs
after an attempt represent the highest risk
period, especially the first 3 mos. Those w/
a relative who committed suicide are at
increased risk for suicide. The closer the
relationship, the greater the risk.
• Many people w depression who have
suicidal ideation lack the energy to
implement suicide plans. The natural
energy that accompanies increased
sunlight in spring is believed to explain
why most suicides occur in April. Most
suicides happen on Monday mornings,
when most people return to work ( another
energy spurt). Research has shown that
antidepressant tx actually can give clients
w/ depression the energy to act on suicidal
ideation.
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

II. DEPRESSION & SUICIDE

Suicidal Behaviors:
1. Suicide ideation
Thoughts of self-inflicted death either self-reported or reported
to others. The suicidal person may make a statement such
as “will you remember me when I’m gone?”
Active suicidal ideation is when a person thinks about & seek
ways to commit suicide. Passive suicidal ideation thinks about
wanting to die or he or she wishes she were dead but has no
plans to cause his or her death.
• 2. Attempted Suicide - is a suicidal act
that either failed or was incomplete. In an
incomplete suicide attempt, the person did
not finish the act because
• (1.) someone recognized the suicide
attempt as a cry for help & responded &
(2.) the person was discovered & rescued.
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

II. DEPRESSION & SUICIDE

Suicidal Behaviors:

Suicide threat
A direct or indirect warning, either verbal or non-verbal,
that a person is planning to take one’s own life. The suicidal
person may make a statement such as “I’d rather die than….”
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

SUICIDE

Warnings of Suicidal Intent:

1.Early morning awakenings
2.Lifting of depression
3.Lethality Assessment
1. Nurse directly asks possibility of suicide
2. Means – cutting wrist, jumping from a tall building,
shooting self, Strangulation
3. Nurse asks: “How do you think would you kill yourself?”
Possibility of Suicide Increased in Clients With:
Previous attempt Drug use
Recent loss Sex- male common
Age – adolescent, elderly Client who evades rescue
Marital – less in couple than in single client
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

SUICIDE

Nursing Interventions:
1.Close observation – client should be near nurse’s station
2.Nurse visits every 15 minutes but irregular
3.Environment safety
 No sharps, medications locked
 No curtain rods, No spoon & fork
 No plastic spoon & fork
 Provide a “No-suicide contract”
• The nurse NEVER ignores any hint of
suicidal ideation regardless of how trivial
or subtle it seems & the client’s intent or
emotional status.
• Asking clients directly about thoughts of
suicide is important.
 Lethality Assessment
• When a client admits to having a “death
wish” or suicidal thoughts, the next step is
to determine potential lethality.
• Ask the ff questions:
• 1. Does the client have a plan? If so, what
is it? Is the plan specific?
• 2. Are the means available to carry out this
plan? ( Ex. If the person plans to shoot
himself, does he have access to a gun &
ammunition?
• 3. If the client carries out the plan, is it
likely to be lethal? (Ex. A plan to take 10
aspirin is not lethal, while a plan to take a
2 week supply of a tricyclic antidepressant
is)
• 4. Has the client made preparations for
death , such as giving away prized
possession , writing a suicide note, or
talking to friends one last time?
• 5. When and where does the client intend
to carry out the plan?
• 6. Is the intended time a special date or
anniversary that has meaning for the
client?
• -- specific & positive answers to these
questions all increase the client’s
likelihood of committing suicide. It is
important to consider whether or not the
client believes his/her method is lethal
even if it is not.
 Nursing Interventions
• 1. Authoritative Role – ex. A client may
want to be alone in her room to think
privately. This is NOT allowed while she is
at increased risk for suicide.
• 2. Provide a safe environment – for in-
patients, they must not be allowed access
to materials on cleaning carts, their own
medications, sharp scissors, & pen
knives.
• For suicidal clients, staff members shld
remove any items they can use to commit
suicide such as sharp objects, shoelaces,
belts, lighters, matches, pencils, pens, &
even clothing with drawstrings.
• Staff members observe the clients every
10 mins if the lethality is low: For clients w/
high potential lethality, one to one
supervision by a staff person is initiated.
This means that clients are in direct sight
of & no more than 2 to 3 feet away from a
staff member for all activities.
Including going to the bathroom
• No – suicide or no self-harm contracts
– clients agree to keep themselves safe &
to notify staff at the first impulse to harm
themselves ( at home, clients agree to
notify their caregivers; the contract must
identify back up people in case caregivers
are unavailable.
• These contracts are not a guarantee of
safety
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

SUICIDE

Suicidal Behaviors:
Suicide attempt
Any self-directed actions taken by a person that will
lead to death if not stopped
 Treatment
• Major Antidepressants include:
• 1. Cyclic anti depressants
• 2. Monoamine Oxidase Inhibitors
• 3. Selective Serotonin Reuptake Inhibitor
• ( SSRI)
• 4. Atypical antidepressants
• 1. Cyclic antidepressants ( Tricyclic)
• - relieve symptoms hopelessness,
helplessness, anhedonia, inappropriate
guilt, suicidal ideation, & daily mood
variations
• - takes 6 weeks to reach full effect
because they have a long serum half-life.
( there is a lag period of 1 to 4 weeks
before steady plasma levels are reached
and the client’s symptoms begin to lessen.
• Tricyclic antidepressants are
contraindicated in severe impairment of
liver function & in myocardial infarction.
• - cannot be given with MAOi’s bec of their
anticholinergic side effects
• Overdosage of tricyclic antidepressants
occurs over several days & results in
confusion, agitation, hallucination,s,
hyperpyrexia & inceased reflexes,
seizures, coma
• Ex.
• 1. Amitriptylin ( Elavil)
• 2. Amoxapine ( Asendin)
• 3. Doxepin ( Sinequan)
• 4. Imipramine ( Tofranil)
• 5. Desipramine ( Norpramine)
• 6. Nortriptyline ( Pamelor)
• Atypical Antidepressants
• - are used when the client has an
inadequate response to or side effects
from SSRI’s.
• Ex. Venlafaxine ( Effexor)
• Duloxetine ( Cymbalta)
• Bupropion ( Wellbutrin)
• Nefazodone ( Serzone)
• Mirtazapine ( Remeron)
• 2. Monoamine Oxidase Inhibitors,
• - used infrequently because of its fatal side
effects & interactions with numerous drugs.
The most serious side effect is
hypertensive crisis, a life threatening
condition that can result when a client taking
MAOI’s ingests tyramine containing foods.
S/Sx: occipital headache, hypertension,
nausea, vomiting, chills, sweating,
restlessness, nuchal rigidity, dilated pupils,
fever & motor agitation. This can lead to
hyperpyrexia, cerebral hemorrhage & death.
Precaution:
MAOI’s have some serious interactions which can
possibly lead to death w/ certain other medications &
foods. Patients must avoid eating certain tyramine
containing foods like cheeses, pickled foods, & red
wine, alcohol, Na rich foods, condiments,
chocolates while taking theses drugs. Eating these
foods can cause high blood pressure.( hypertensive
) crisis Avoid some non-prescriptive medications
particularly some cold remedies & diet pills.
- Patient must wait for 14 days after stopping
taking MAOI’s before taking another anti depressant
• There is a 2-4 week lag period before
MAOI’s reach therapeutic levels.
• Ex.
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Osocarboxazid (Marplan)
 3. SSRI
• - action is specific to serotonin reuptake
inhibition, these drugs produce few
sedating anticholinergic & cardiovascular
side effects
• Ex.
• Fluoxetine ( Prozac)
• Sertraline ( Zoloft)
• Paroxetine ( Paxil)
• Citalopram ( Celexa)
• Escitalopram ( Lexapro)
Antidepressants – used to reduce anger, irritability, impulsive behavior
& depression
Selective Serotonin Reuptake Inhibitors ( SSRI’s)
1. -It balances certain brain chemicals ( neurotransmitters) that can
worsen symptoms of borderline personality disorder when
unbalanced.
2. It blocks the re-uptake of serotonin
3. Plays an important role in anxiety & mood disorders &
schizophrenia

Side Effects: Anxiety Nausea Sexual Dysfunction

Agitation Insomnia Akathisia (motor
restlessness)

Precaution: Avoid sudden stop in taking antidepressants. The use of any

antidepressants should be tapered slowly & only under the supervision of a
doctor. Abruptly stopping antidepressant medications can cause negative side
effects or a relapse of symptoms of borderline personality disorder
• 4. Atypical Antidepressants
• - are used when the client has an
inadequate response to or side effects
from SSRI’s.
• Ex. Venlafaxine ( Effexor)
• Duloxetine ( Cymbalta)
• Bupropion ( Wellbutrin)
• Nefazodone ( Serzone)
• Mirtazapine ( Remeron)
 Other Medical Treatments
• ECT
• - for clients who do not respond to
antidepressants or those who experience
intolerable side effects at therapeutic
doses.
• Involves application of electrodes to the
head of the client to deliver an impulse to
the brain
• Pts usually are given 6 to 15 treatments
scheduled 3x a week .
• Generally, a minimum of 6 tx is needed to
see sustained improvements in depressive
sx. Maximumbenefit is achieved in 12 to
15 tx.
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

. MANIA

- Is a distinct period during which mood is abnormally &

persistently elevated , expansive or irritable.
The essential feature of mania is a distinct period of intense
psychophysiological activation. The predominant mood is
elevated or irritable accompanied by one or more of the
following symptoms: hyperactivity, pressured speech (
unrelenting, rapid, often loud talking without pauses, flight of
ideas ( racing, often unconnected thoughts), distractibility,
inflated self-esteem or (grandiosity) and hypersexuality,
decreased need for sleep,
Typically, this period lasts 1 week or more
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

III. MANIA

= Mood that is elevated, expansive or irritable

In contrast with depressed patients, manic patients are

extremely self-confident with an ego that knows no bounds.
But accompanying this supreme self-esteem is lack of guilt
and shame.

In contrast with depressed patients, manic patients have

abundant energy and heightened sexual appetite
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

III. MANIA

Behaviors Commonly Associated with Mania

Cognitive Physiological Behavioral
Ambitiousness Dehydration Aggressiveness
Denial of realistic Inadequate Excessive spending
danger nutrition Grandiose act
Easily distracted
Has flight of ideas
Little need of Hyperactivity
Affective sleep Increased motor activity
Elation or euphoria Weight loss Irresponsibility
Humorousness Thoughts of Irritable and argumentative
Inflated self-esteem grandiosity Poor personal grooming
Intolerance of Has illusions Sexual overactivity
criticism Lack of judgment
Lack of shame and Loose
guilt associations
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

III. MANIA

Diagnostic Criteria for Manic Episodes

At least three of the following must be present to a significant
degree at least 1x a week: unusual & incessantly heightened.
Grandiose or agitated mood.( over self woth; inflated self-
esteem) R!! Defense to mask feelings of depression &
inadequacies. In addition, 3 or more of the ff sx:
1. Decreased need for sleep; Insomnia
2. Pressured speech
3. Flight of ideas – talkative / pressured speech/ pressure to
keep talking
** Tell manic pt. to speak slowly to make a sense if he keeps
on moving one subject to another
4. Distractibility
 C. EMOTIONAL RESPONSES and MOOD DISORDERS

III. MANIA

Diagnostic Criteria for Manic Episodes

5. Exaggerated self-esteem
6.Excessive involvement in pleasurable activities without
regard for negative consequences
7. Poor impulsive control
8. Violent/ Aggressive/ hypersexual
9. Manuipulative
10 Easily agitated
• Nursing Diagnosis:
• 1. Risk/Potential for Injury directed to
others
• 2. Fluid & Electrolyte Imbalances
• 3. Fluid Volume Deficit
Nursing Interventions for Mania
• 1. Accept the client; reject the behavior
• 2. Provide for client’s physical safety & those
around
• 2. Set limits on client’s behavior when needed
• 3. Remind the client to respect distances
between self & others
• 4. Use short, simple sentences to communicate
• 5. Clarify the meaning of client’s communication
• 6. Frequently provide finger foods that are high in
calories & protein
• 7. Promote rest & sleep
• 8. Protect the client’s dignity when inappropriate
behavior occurs
• 9. Channel client’s need for movement into socially
acceptable motor activities.
• 10.
 Client/Family Education for
Mania
• 1. Teach about bipolar illness & ways to manage
the disorder
• 2. Teach about medication management,
including the need for periodic blood work & mx
of side effects.
• 3. For clients taking lithium, teach about the
need for adequate salt & fluid intake
• 4. Teach the client & family about signs Of
toxicity & the need to seek medical attention
immediately.
• 5. Educate the client & family about riak-
taking behavior & how to avoid it
• 6. Teach about behavioral signs of relapse
& how to seek treatment in early stages
 Mood Stabilizers ( Anti-Manic
Drugs) Lithium
• - salt contained in the human body
• Helpful for bipolar mania/ > bipolar depression
• Response rate of bipolar mania to lithium
therapy is 70% to 80%
• - mechanism of action is unknown but is thought
to work in the synapses to hasten destruction of
catecholamines (dopamine, NE), inhibit
neurotransmitter release, decrease the
sensitivity of postsynaptic receptors.
• Lithium’s action peak in 30 mins to 4 hrs
for regular forms & in 4-6 hrs for the slow
released form. It crosses the blood brain
barrier & placenta & is distributed in sweat,
& breast milk. ( not recommended during
pregnancy)
• Onset of action is 5 to 14 days, with this
lag period, antipsychotic or antidepressant
agents are used carefully in combination
with lithium to reduce sx in acutely manic
or acutely depressed clients.
• Half-life of lithium is 20 to 27 hours.
• Lithium is effective in about 75% of people
w/ bipolar illness.
• Lithium is not metabolized, rather it is
reabsorbed by the proximal tubule &
excreted in urine . Periodic serum lithium
levels are used to monitor the client’s
safety & to ensure that the dose given has
increased the serum lithium to a treatment
level or reduced it to a maintenance level.
There is a narrow range of safety among
maintenance level ( 0.5 to 1 mEq/L)
Treatment levels ( 0.8 to 1.4 mEq/L) and
Toxic levels ( 1.5 mEq/L & above).
- It is imp to assess for signs of toxicity & to ensure that
clients & their families have this info before discharge.
- Clients should drink adequate water ( approx 2L/day) &
continue w/ the usual amount of dietary table salt. Having
too much salt in the diet bec of unusually salty foods or the
ingestion of salt-containing antacids can reduce receptor
availability for lithium & increase lithium excretion, so the
lithium level will be too low. If there is too much water ,
lithium is diluted & the lithium level will be too low
Mood Stabilizers:
2. Lithium
L – evel 0.6 -1.2 mEq/L or 0.5 – 1.5 mEq/L
I - ncrease urination (polyuria)
Side Effects:
T – remors - polyuria
H – ydration ( 2-3L ) - Na+ increase
( hypernatremia)
I – ncrease salt -N&V
U –u - diarrhea
M – outh ( dry )
 Anticonvulsants used as Mood
Stabilizers
• 1. Carbamazepine ( Tegretol)
• SE. dizziness, hypotension, ataxia,
sedation, blurred vision, leukopenia,
rashes
• 2. Divalproex (Depakote)
• SE ataxia, drowsiness, weakness, fatigue,
menstrual changes, dyspepsia, nausea,
vomiting, weight gain, hair loss
• 3. Gabapentin ( Neurontin)
• SE dizziness, hypotension, ataxia,
coordination
• 4. Lamotrigine ( Lamictal)
• SE dizziness, hypotension , headache
weakness
• 5. Topiramate ( Topamax)
• 6. Oxcarbazepine ( Trileptal)
 Sx & Interventions of Lithium
Toxicity
• Serum Lithium Level = .5-2 mEq/L
• Sx of lithium toxicity – N&V, diarrhea,
reduced coordination, drowsiness, slurred
speech, muscle weakness
• Interventions: Withhold next dose, call
physician, serum lithium levels work ups,
doses of lithium are usually suspended for
a few days or the dose is reduced
• serum lithium level of 2 – 3 mEq
• Sx. Of lithium toxicity = ataxia, agitation,
blurred vision, tinnitus, giddiness,
choreoathenoid movements, confusion,
hyperreflexia, hypertonic muscles,
myoclonic twitches, pruritus,
maculopapular rash, movement of limbs,
slurred speech, large output of dilute urine,
incontinence of bowel & bladder, vertigo
• Interventions: withhold future doses, call
physician, stat serum lithium levels, gastric
lavage may be used for oral lithium, IV
containing saline & electrolytes used to
ensure fluid & electrolytes function &
maintain renal function.
• Serum Lithium level of = 3.0 mEq/L &
above
• Sx of Lithium Toxicity:
• Cardiac arrythmias, hyppotension,
peripheral vascular collapse,focal or
generalized siezures, reduced levels of
consciousness, from stupor to come,
myoclonic jerks of muscle groups &
spasticity of muscles.