Bipolar and Depression Disorders Flashcards
1
Q
What characteristics do all depressive disorders share ?
A
- sadness
- emptiness
- irritability
- somatic (body) concerns
- impairment of thinking
- impact a person’s ability to function
2
Q
What is Disruptive Mood Dysregulation disorder ?
A
constant and severe irritability and anger in children 6-18 yrs old
- onset before 10 yrs
- introduced in 2013 due to an alarming rate of children and adolescents diagnosed with bipolar
3
Q
What are some S&S of Disruptive Mood Dysregulation Disorder ?
A
- irritability
- anger
- temper tantrums in at least 2 settings (home, school, or with peers)
4
Q
What is Persistent Depressive Disorder ?
A
low level depressive feelings through most of each day, for the majority of days (formerly known as dysthymia)
- at least 2 yrs in adults
- at least 1 yr in children and adolescents
5
Q
What are some S&S of Persistent Depressive Disorder ?
A
- decreased appetite or overeating
- insomnia or hypersomnia
- low energy
- poor self-esteem
- difficulty thinking
- hopelessness
6
Q
What is Premenstrual Dysphoric Disorder ?
A
symptoms of depression before (1 week prior) or during menstruation
- symptoms decrease significantly or disappear with the onset of menstruation
7
Q
What are some S&S of Premenstrual Dysphoric Disorder ?
A
- mood swings
- irritability
- depression
- anxiety
- feeling overwhelmed
- difficult concentrating
8
Q
What is Substance-Induced Depressive Disorder ?
A
person experiences depressive symptoms with the use of drugs or alcohol use or withdrawal
- could also be with the use of certain meds like beta blockers, antivirals, hormones, etc
9
Q
What is Depressive Disorder associated with another medical condition ?
A
symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder
- can be caused by kidney failure, Parkinson’s, & Alzheimer’s
10
Q
What are the qualifying S&S of Major Depressive Disorder (MDD) ?
A
5 or more S&S in 2-week period:
- weight loss and appetite changes
- sleep disturbances
- fatigue
- worthlessness or guilt
- loss of ability to concentrate
- recurrent thoughts of death
PLUS at least 1 symptom is also either:
- depressed mood or
- loss of interest or pleasure (Anhedonia)
11
Q
What is Anhedonia and Anergia ?
A
- Anhedonia: lack of interest
- Anergia: abnormal lack of energy
12
Q
What are additional characteristics of Major Depressive Disorder (MDD) ?
A
- persistent for minimum 2 weeks to 6 months
- chronic: lasting more than 2 yrs
- recurrent episodes common
- symptoms cause distress or impaired function
- episode not attributed to physiological effects
- absence of a manic or hypomanic episode
13
Q
What are some biological factors of MDD ?
A
- genetic disposition
- biochemical: stressful life events
- alterations in hormonal regulation
- inflammatory process
- diathesis-stress model
14
Q
What are some areas to assess for MDD ?
A
- affect
- thought processes
- mood
- feelings
- physical behavior
- communication
- religious beliefs and spirituality
15
Q
What are the different phases of MDD ?
A
- acute: 6-12 wks
- want to see reduction of symptoms
- assess suicide risk, implement safety precautions
- continuation: 4-9 months
- prevention of relapse or prevention of symptoms
- Education, medication, psychotherapies
- maintenance: >1 yr
- want to prevent future episodes of depression
- can last years
16
Q
What are some considerations we have when choosing an antidepressant ?
A
- symptom profile of pt
- side-effect profile (weight gain, sexual dysfunction)
- ease of administration
- hx of past response
- safety and medical considerations
17
Q
What are some characteristics of SSRIs ?
A
increases the serotonin so they don’t feel depressed
- first line therapy
- rare risk of serotonin syndrome (cause manic episode)
- monitor for initial increase in suicidal thoughts (1st 2-4 wks they have energy to attempt)
18
Q
What are some SE for MAOIs ?
A
- hypertensive crisis when eating tyramine foods
- insomnia
- confusion
19
Q
What foods must you avoid with MAOIs ?
A
tyramine foods
- yeast products
- processed meats
- avocados
- aged products: wine, beer, cheese
20
Q
What are some nursing considerations for MAOIs ?
A
- rarely used
- requires close monitoring
- potential fatal drug & food interactions
- OTC interactions
- contraindicated in people taking SSRIs and tyramine-diet
21
Q
What are some examples of foods a pt taking MAOIs can eat ?
A
- most fresh fruit & vegetables
- fresh meat
22
Q
What is the most effective depression treatment ?
A
ECT
23
Q
How does ECT help patients with depression ?
A
helps with the more functional side of depression
- reroutes the neurotransmitters
- safer than meds with certain medical conditions
24
Q
Why may ECT may be used for ?
A
- severe malnutrition, exhaustion, and dehydration due to length depression
- delusional depression
- failure of previous medication trials
- schizophrenia with catatonia
25
What is some nursing care for after ECT ?
- Priority #1: physiological stability (breathing, VS stable, eating well)
- reducing disorientation and confusion
- may have short term memory loss or confusion
- do not operate machinery or make important decisions
26
What is Transcranial Magnetic Stimulation ?
uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex
- noninvasive
- presence of metal is the only contraindication
27
What are some adverse reactions for transcranial magnetic stimulation ?
- HA and lightheadedness
- no neurological deficits or memory problems
- seizures rarely
- most are mild and include scalp tingling and discomfort at the administration site
28
What is vagus nerve stimulation ?
sending electrical impulses to the vagus nerve through a invasive lead (like in a EKG)
- electrical stimulation boosts the level of neurotransmitters
- decreases seizures and improved mood
- originally used to treat epilepsy
29
What are some SE of vagus nerve stimulation ?
- voice alteration (60% of pt's)
- neck pain, cough, paresthesia, & dyspnea which tends to decrease with time
30
What is deep brain stimulation ?
surgically implanted electrodes in the brain
- stimulates those regions identified as underactive in depression
- more invasive than VNS since the electrodes placed directly into the brain
31
What is light therapy ?
exposure to an artificial light source
- 1st line tx for seasonal affective disorder (SAD)
- efficacy due to influence of light in melatonin
- effective med for SAD
- (-) effects: HA, and jitteriness
- with bipolar it can trigger a manic episode
32
What is the function for St.John's Wort ?
useful in mild to moderate depression
- thought to increase serotonin, norepinephrine and dopamine in the brain
- flower processed into tea or tablets
- never have them take it with prescription med since its not regulated and we don't know what's in it
33
How does exercise help with depression ?
increases serotonin availability
- biological, social and psychological effects
- more of a maintenance treatment
- not in the beginning because they can't really get out of bed or have suicidal thoughts
34
What are some examples of SSRIs ?
- fluoxetine (Prozac)
- Sertraline (Zoloft)
- paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
35
What is Bipolar 1 Disorder ?
manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care
- most severe
- highest mortality rate
- at least 1 manic episode followed by major depressive episodes
- sudden onset, escalates rapidly
- frequent hospitalization (due to severe manic state)
36
What are some characteristics of Bipolar 1 Disorder ?
- shifts in mood energy and ability to function
- poor judgement and hyperactivity
- interpersonal and occupational difficulties
- psychotic episodes
- mania followed by exhaustion and depression
37
What is the epidemiology of Bipolar 1 Disorder ?
- affects men and women equally
- men more likely to have legal issues and commit acts of violence
- women more likely to abuse alcohol and commit suicide
- childbirth can trigger in women due to hormonal changes and sleep deprivation
38
What is Bipolar 2 disorder ?
pattern of depressive episodes and hypomanic episodes, but not full-blown manic episodes
- at least 1 hypomanic episode
- at least 1 major depressive episode
- no hx of manic episodes
- most common but under or miss diagnosed
39
What are some characteristics of bipolar 2 disorder ?
- mania is less severe than bipolar 1
- verbal and behavioral outburst in adolescents
40
What is Cyclothymia ?
hypomania with dysthymic episodes (symptoms of mild to moderate depression) for at least 2 yrs in adults and 1 yr in children
- rapid cycling possible
41
What are some characteristics of Cyclothymia ?
- not severe enough to meet criteria for Bipolar 1 or 2, but disturbing enough to cause social and occupational impairment
- irritable hypomania
- sleep disturbances
42
What are some risk factors for Bipolar disorder ?
- genetics: runs in family
- neurotransmitters: imbalance of norepinephrine, dopamine and serotonin
- brain structure & function: prefrontal cortical dysfunction (euphoric or aggressive behaviors)
- Neuroendocrine: hypothyroidism
- environment: stress, adverse life events
43
What are some S&S of bipolar mania ?
- elevates/expansive mood "on cloud 9"
- decreased sleep
- inflated sense of self-esteem
- racing thoughts; distractibility
- flamboyant gestures
- increased involvement in pleasurable activities
- delusions or hallucinations
- loud, rapid speech
44
What are some S&S of bipolar depression ?
occurs after the highs of a manic episode
- more withdrawn and poverty of speech
- hopeless
- increase in hypersomnia
- increase in motor retardation
- increased chance of paranoid thoughts and hallucination
45
What are some S&S of hypomania ?
similar to mania but not as severe
- episode is at least 4 days in length
- hospitalization is not required
- notable change from typical behavior
- increase in goal-directed behavior
- decreased need for sleep
46
What is pressured speech ?
urgent or intense speech; reluctance to allow comments from others
- their brain thinks faster then they can speak
- stumble over their words
47
What is circumstantial speech ?
including unnecessary and often tedious details in conversation but eventually reaching the point
48
What is tangential speech ?
wandering off topic or going off on tangents and never reaching the point
49
What does loose associations mean ?
thoughts are loosely connected to each other by a word or topic in the person's conversation
50
What does flight of ideas mean ?
moving rapidly from one thought to the next, often making it difficult for others to follow the conversation
51
What is clang associations
stringing together words because of their rhyming sounds, without regard to their meaning
52
What are grandiose delusions ?
they believe they are something greater than they actually are
- believing you are god or Taylor Swift's songwriter
53
What are persecutory delusions ?
where the patient feels persecuted or that they are going to be got in someway
- Ex.) the CIA is watching me and they tapped my phone, they are always listening
54
What occurs in the acute, continuation, and maintenance phase of bipolar disorder ?
- acute: prevent injury and reduction of mania
- continuation: relapse prevention thru meds, education or psychotherapies
- maintenance: limit severity and duration of future episodes
55
What are some interventions to implement for Bipolar Disorder ?
- safety is #1 priority
- set limits and be consistent with approach
- give clear, concise directions
- increasing foods and fluid with finger foods that are high calorie & protein
- redirect into more healthy activity (distraction)
- one-on-one supervision for uncontrolled behaviors
- reinforce reality as needed
- decrease physical activity
- 4-6 hrs of sleep at least
- reduce environmental stimuli
- maintain structure & routine
- intervene so self-care needs are met
- respond to legit complains
56
What is the first-line med for bipolar disorder ?
Lithium
- mood stabilizers often require lifetime med management
57
Why may Olanzapine (Zyprexa) be used ?
used to treat mania and bring hyperactivity under control
- atypical anti-psychotics
58
Why may anticonvulsants be used ?
to bring rapidly changing moods under control
59
What meds may potentiate mania ?
antidepressants, stimulants, steroids, & anticholinergics
60
What is Lithium used for ?
to treat acute mania, refractory unipolar depression & bipolar maintenance
- has a specific anti-suicide effect
61
What are some characteristics of Lithium ?
- 10-21 day response time
- take with meals to decrease nausea
- high teratogenicity: not recommended for women of child bearing age
- contraindicated in pt's with cardiovascular or renal disease
- use in caution in elderly pt's: monitor closely
62
What are some SE's and nursing considerations for Lithium ?
- SE: nausea, fine hand tremors, polyuria (can cause dehydration), confusion
- monitor blood levels on a regular basis & 12 hrs after last dose
- q 6-12 months monitor TSH, SCr, Na, CBC, & lithium levels
- can cause dehydration: interferes with regulation of Na & H2O
- maintain normal fluid intake
- interacts with NSAIDs, ACE inhibitors, Thiazide diuretics
63
What are the therapeutic & toxic levels of Lithium ?
- Therapeutic: 0.6 to 1.4
- Toxic: 1.5 and above
- Adverse effects: diaphoresis, weakness, severe nausea
64
What is the use for Valproate (Depakote) ?
Anticonvulsants
- very effective for acute mania & mania secondary to a general medical condition
- used in conjunction with atypical antipsychotics to stop manic attacks or as a first-line agent for mixed episodes
65
What are additional characteristics of Valproate (Depakote) ?
- normalize & stabilize neuronal activity
- rapid onset
- generally well-tolerated
- SE: transient hair loss, weight gain, GI disturbances, tremor & thrombocytopenia (Low RBCs)
- black box warning: pancreatitis, hepatitis, teratogen (all anticonvulsants you don't give to someone pregnant)
66
What are some adverse effects of Carbamazepine (Tegretol) ?
- nausea
- anorexia
- sedation & drowsiness
- anemia
- rarely thrombocytopenia
67
What are some considerations for Carbamazepine ?
- doesn't respond to lithium or valproates
- rapid cycling
- therapeutic range 4-12
- use with SSRIs can cause toxic effect: weekly CBC: taper slowly
68
What are some adverse effects of Lamotrigine (Lamictal) ?
- dizziness
- HA
- nausea
- black box for Steves-Johnson syndrome and toxic epiderman necrolysis
69
What are some considerations for Lamotrigine ?
- effective with bipolar depression
- long term maintenance
- taper slowly
70
What is the first-line Bipolar med for pregnant pt's ?
antipsychotics
- lithium is the last choice
- anticonvulsants are never used
71
What are some examples of affective symptoms ?
- dysphoria
- depression
- hopelessness
- suicidality
72
What are some examples of cognitive symptoms ?
- concrete thinking
- impaired memory
- impaired attention
- impaired executive functioning (problem solving & decision making)
- illogical thinking
- impaired judgement
