Ch. 16 - Emotional, Mood, and Behavioral Disorders Flashcards
To be diagnosed with bipolar disorder, what must happen?
Manic symptoms must persist for at least 1 week
A depressed affect that lasts for a minimum of two weeks and is present for most of the day, every day, or almost everyday in addition to 5 other symptoms
Major depressive disorder
Difficulty sleeping or sleeping too much
Extremely tired; without energy
Abnormal eating patterns
Vague physical symptoms
Obsession with death
Avoidance of psychosocial and interpersonal interactions
Lack of interest in personal appearance or sex
Delusions or hallucinations
Inability to concentrate or make decisions
Feelings of despair, guilt, misery; lack of self-worth
Intense mood changes associated with hormonal changes after giving birth
Postpartum depression
Enhanced release of melatonin due to lower natural light levels
Seasonal Affective Disorder (SAD)
Intense mood shifts; unusual behaviors
Psychotic depression
Severe depressive illness generally requires what?
Interpersonal and cognitive-behavioral
Psychodynamic therapies
Focus on the patient’s disturbed personal relationships that both cause and exacerbate the depression
Interpersonal therapies
Helps patients change the negative styles of thought and behavior often associated with their depression
Cognitive behavioral therapy
Focus on resolving the patient’s internal conflicts
Psychodynamic therapies
For patients with serious and life-threatening mood disorders who are unresponsive to pharmacotherapy and psychotherapy
Electroconvulsive therapy (ECT)
Inhibit the reuptake of neurotransmitters (norepinephrine and serotonin) into the presynaptic nerve terminals
TCAs & SNRIs
Inhibit MAO enzyme activity inside the presynaptic nerve terminals
MAOIs
Have an effect of enhanced catecholamine release
MAOIs
Block the reuptake of serotonin into presynaptic nerve terminals
SSRIs
Enzymes that terminate the action of norepinephrine
MAO & COMT
Classes of Antidepressant Drugs
SSRIs
SNRIs and other atypical antidepressants
TCAs
MAOIs
Ex. citalopram (Celexa)
fluoxetine (Prozac)
paroxitine (Paxil)
Selective Serotonin Reuptake Inhibitors (SSRI)
Ex. Bupropion (Wellbutrin)
duloxetine (Cymbalta)
venlafaxine (Effexor)
Atypical antidepressants, including serotonin-norepinephrine reuptake inhibitors (SNRI)
Ex. amitriptyline (Elavil)
imipramine (Tofranil)
Tricyclic antidepressants (TCA)
Ex. phenelzine (Nardil)
Monoamine Oxidase Inhibitors (MAOI)
Characterized by episodes of depression alternating with episodes of mania
Bipolar disorder (manic-depression)
Lack of energy
sleep disturbances
abnormal eating patterns
Feelings of despair
guilt
hopelessness
Depressive symptoms
Inflated self-esteem or grandiosity
Decreased need for sleep
Increased talkativeness
Flight of ideas; subjective feeling that thoughts are racing
Distractibility
Increased goal-directed activity
Excessive involvement in pleasurable activities that have high potential for painful consequences
manic symptoms
Work by moderating extreme shifts in emotions between mania and depression.
mood stabilizers
Why should Bipolar disorder never be treated with antidepressants alone?
it will cause the patient to have manic cycles
Mood Stabilizer main drug
lithium (Eskalith)
lithium (Eskalith) MOA
affects sodium transport across cell membranes
Acts like sodium in the body: so adverse effects are similar to those of hyponatremia
lithium (Eskalith)
Why does lithium (Eskalith) require frequent blood draws
To check serum levels b/c lithium (Eskalith) has a narrow therapeutic range
How often do you check serum levels for the patient taking lithium (Eskalith)?
Every 4-5 days, after any change of dose, or initiation of therapy
Therapeutic concentrations of lithium (Eskalith)
range from 0.6 to 1.5 mEq/L
Persistent GI upset (nausea, vomiting, abdominal pain), increased urination, and confusion
Early signs of lithium toxicity
Nystagmus, convulsions, ataxia, coma
Late signs of lithium toxicity
Drugs for the treatment of bipolar disorder
antiseizure drugs:
atypical antipsychotic drugs
Valproic acid (Depakene, Depakote)
cabamazapine (Tegretol)
lamotrigine (Lamictal)
antiseizure drugs used for treatment of bipolar disorder
heart block
aplastic anemia
respiratory depression
SJS
toxic epidermal necrolysis
coma
death (overdose)
liver failure
pancreatitis
exfoliative dermatitis
serious adverse effects of antiseizure drugs
Dizziness
ataxia
somnolence
headache
nausea
diplopia
blurred vision
sedation
drowsiness
nausea
vomiting
prolonged bleeding time
side effects of antiseizure drugs
Risperidone (Risperdal)
aripiprazole (Abilify)
Seroquel
Zyprexa
Atypical antipsychotics used for bipolar disorder
tachycardia
parkinsonism
transient fever
akathisia
insomnia
sedation
dizziness
nausea
vomiting
constipation
Side effects of atypical antipsychotics used for treatment of bipolar disorder
agranulocytosis
increased risk of death in older adults with demential-related psychosis
neuroleptic malignant syndrome (rare)
Serious adverse effects of atypical antipsychotics used for the treatment of bipolar disorder
Neurodevelopmental/Behavioral disorder
ADHD
Easy distractibility
Failure to receive or follow instructions
Inability to focus on one task at a time
Difficulty remembering
Frequent loss or misplacement of personal items
Excessive talking; interrupting
Inability to sit still
Impulsiveness
Sleep disturbance
Symptoms of ADHD/Developmentally inappropriate behaviors
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin)
Adderall
Vyvanse
CNS Stimulants
CNS stimulants MOA
heightens awareness, increases focus
insomnia
nervousness
anorexia
weight loss
irritability
palpitations
Side effects of CNS stimulants
Psychological dependence
circulatory collapse
sudden death (reported in children with structural cardiac abnormalities)
Serious adverse effects of CNS stimulants
To reduce the risk of dependence and evaluate need, the nurse should educate their patient to do what when taking CNS stimulants.
take drug-free “holidays”
Similar efficacy to stimulants with reduced risk of dependence.
Non-stimulants for ADHD treatment
Can be used as monotherapy or adjuvant
Non-stimulants for ADHD treatment
atomoxetine (Strattera)
clonidine
guanfacine (Intuniv)
Non-stimulants for ADHD treatment
headache
insomnia
decreased appetite
dry mouth
vomiting
upper abdominal pain
severe liver injury
Adverse effects of Nonstimulants for the treatment of ADHD
Black Box Warning for atomoxetine (Strattera)
suicidal ideation
Nervousness
Anxiety
GI Upset
Fatigue
side effects for only SSRIs
Increased BP & HR
Sweating
Agitation
Tremor
Vomiting
Increased Appetite
side effects for only SNRIs
Sedation
Mydriasis - dilation of the eye
Side effects for only TCAs
Dry mouth
Sexual Dysfunction
Side effects for:
SSRIs
SNRIs
TCAs
MAOIs
Headache
Somnolence
Side effects for:
SSRIs
SNRIs
Urinary retention
Side effects for:
TCAs
MAOIs
Nausea
Insomnia
Side effects for:
SSRIs
SNRIs
MAOIs
Dizziness
Side effects for:
SSRIs
SNRIs
TCAs
Constipation
Blurred Vision
Drowsiness
Orthostatic hypotension
Side effects for:
SNRIs
TCAs
MAOIs
