Ramona Smith NP Essentials

          Nurse Practitioner MSN, NP-C     

Mood Class Notes

The Brain:

“The Brain is the hardware of the soul.” ~Dr. Daniel Amen

1.     Pre-frontal Cortex:  Controls attention and impulse control.  It is in the front of the brain and deals with focus control of impulse, good and bad decisions.  When underactive, there are problems with attention, organization and follow through. We can learn to activate the pre-frontal cortex for better internal supervision.

2.     Temporal Lobes (right and left): Under the temples and behind the eyes.  Deal with memory and language understanding, facial recognition and temper control.  When there are problems in the left temporal lobe, there is anger, rapid mood shifts and memory and learning problems.

3.     Deep Limbic System:  In the deep and primal area of the brain. It is the area of mood and bonding and can be associated with moodiness, depression and negativity.  It is also the area of good memories triggered by smells and clear thinking.  We can soothe this part of the brain by being with positive people.  Essential oils soothe the limbic system and central nervous system when aromatically inhaled. (Structures of the limbic system include the hippocampus, hypothalamus, and thalamus)

4.     Basal Ganglia: Deep within the brain. Controls the idle speed.  When it works too hard, it creases anxiety, panic, fear and conflict avoidance. If underactive, can have concentration and fine motor skills dysfunction.

5.     Cingulate:  gear shifter, runs through the middle of the frontal lobes and allow the attention from thought to thought; and thought to behavior to be regulated

All of theses areas function in an intricate interaction with each other.

 

Anxiety

What is anxiety?

DSM IV-TR Criteria for Generalized Anxiety Disorder
Excessive anxiety about a number of events or activities, occurring more days than not, for at least 6 months. The person finds it difficult to control the worry. The anxiety and worry are associated with at least three of the following six symptoms (with at least some symptoms present for more days than not, for the past 6 months):

  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance

The focus of the anxiety and worry is not confined to features of an Axis I disorder, being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social or occupational functioning. The disturbance does not occur exclusively during a mood disorder, a psychotic disorder, pervasive developmental disorder, substance use, or general medical condition.

 

Depression

 What is depression?

 Signs and Symptoms of a Major Depressive Episode

Depressed or sad mood*

Markedly diminished interest or pleasure in all or almost all activities, especially those the individual normally enjoys*

Sleep disturbance (insomnia or hypersomnia)

Feeling of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick, but rather a firmly held conviction that might in some instances be considered delusional)

Fatigue or loss of energy

Indecisiveness or diminished ability to think or concentrate

A change in appetite (typically decreased, but can be increased in atypical depression), or a significant weight change (>5% of body weight) when not intentionally trying to lose or gain weight

Psychomotor agitation or retardation nearly every day

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a specific plan for committing suicide, or a suicide attempt

*One or the other of these must be present for a diagnosis of major depressive episode.
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC, American Psychiatric Association, 2000.

 

Mnemonic Used for Diagnosis of Major Depressive Episode: SIG: E CAPS*

SSleep disturbance. Typically, difficulty staying asleep; less often, difficulty falling asleep

IInterest, pleasure, or enthusiasm for usual activities is diminished

GGuilt, self-doubt, or loss of self-esteem that is excessive or unwarranted

EEnergy level is diminished

CConcentration (or attention) span is poor or worse than usual

AAppetite is impaired. Typically it is diminished and associated with weight loss, but in some cases the patient overeats and gains weight

PPsychomotor activity is abnormal. Typically the patient moves and thinks more slowly; some patients, especially the elderly, can be more restless, explosive, or agitated

SSuicidal  thoughts, hopelessness, or thoughts that the patient (and often others) would be better off if the patient were dead

TOOL BOX FOR DEPRESSION AND ANXIETY

What do depression and anxiety do to us?  Everyone is different and each day can be different.

What can we do to care for ourselves? We can take a holistic approach and use all the

tools we can find! 

 

BODY:  Our physical being.

Approach: nutritional with removing power drinks and soda from your diet, eat organic when you can, vitamins D and B-complex, omega 3, detoxification, exercise, walking, yoga, aromatherapy, prescriptions medications, meditation/prayer, progressive muscle relaxation, stress reduction, magnesium, epsom salt baths.  

and____________________________________________________________________________________________

MIND: The complex of cognitive faculties that enables consciousness, thinking, reasoning, perception, and judgment.

Approach:  sleep hygiene, lumosity (web based brain function enhancers), . to assist with insomnia, exercise, nutrition, deep breathing, light therapy, antidepressants (prozac, zoloft, pristiq, wellbutrin, etc), anxiolytics (lorazepam, clonazepam, aprazolam, etc) , atypical antipsychotics (abilify, seroequel, etc), .                           

and____________________________________________________________________________________________  

SOUL:  The spiritual principle embodied in human beings, our essence.

Approach:  support groups, community activity, volunteer work, meditation/prayer, help others, deep breathing (the word for breath in Latin is spirit), faith groups.

and____________________________________________________________________________________________

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