Class 4 Mental Health Flashcards
Criteria for depression
-At least five depressive symptoms present during the same 2-week period
-Most of the day or nearly every day
-Altered from baseline
Bipolar disorder types
-Bipolar I, bipolar II & cyclothymic (rapid cycling)
Bipolar I
One or more manic or mixed episodes accompanied by major depressive episodes
Bipolar II
One or more major depressive episodes accompanied by a hypomanic episode
Cyclothymic (rapid cycling)
At least two years of numerous periods of hypomanic symptoms that do not meet the criteria for a manic episode and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode
Bipolar disorder depression criteria rules
-Five or more of the following symptoms present during the same 2 week period and represent a change from baseline. At least one of the symptoms is depressed mood or loss of interest or pleasure
-Symptoms cause distress or impairment in social, occupational, or other areas of functioning
Bipolar disorder depression criteria
-Daily: Insominia or hypersomnia, fatigue, inability to think or are indecisive
-Daily: Worthlessness/guilt, pyschomotor agitation or retardation
-Reccurent thoughts of death, ideation or attempt
Bipolar disorder depression exclusion criteria
-Not attributed to substance or other medical condition
-Not better explained by any schizophrenia or other psychotic disorders
-Bereavement
Bipolar disorder mania inclusion criteria outline
-1. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and goal-directed activity lasting daily for at least 1 week
-2. Must have 3 of the following symptoms, if the person is already irritable they must have 4
-1. The mood causes impaired social or occupational functioning or necessitates hospitalization
Bipolar disorder mania symptoms
-Inflated self-esteem/grandiose, talkative, flight of ideas, distractibility
-Decreased need for sleep (rested after 3 hours), goal-directed activity or psychomotor agitation
-Excessive involvement in pleasurable activities where there is a high risk for negative consequences
Bipolar disorder hypomania inclusion outline 1&2
-1. A distinct period of abnormally persistently, elevated, expansive, or irritable mood and goal-directed activity lasting at least 4 consecutive days
-2. Must have 3 of the following symptoms, if the person is already irritable they must have 4 (same as mania)
Bipolar disorder hypomania inclusion outline 3, 4,& 5
-3. Episode is associated with definite change in functioning that is way out of character
-4. Others can see the change
-5. Episode is not severe enough to cause impairment of social or occupational functioning and does not necessitate hospitalization. If there are any psychotic features, the episode is by classified as manic
Bipolar disorder hypomania inclusion symptoms (same as mania)
-Inflated self-esteem/grandiose, talkative, flight of ideas, distractibility
-Decreased need for sleep (rested after 3 hours), goal-directed activity or psychomotor agitation
-Excessive involvement in pleasurable activities where there is a high risk for negative consequences
Prevalence of bipolar I
-Onset around 18 years of age, >men
-Likely to include legal problems and violence
-Often begins with a depressive episode
Prevalence of bipolar II
-Onset around 18 years of age, >women
-Most common form of bipolar disorder
-Likely to include substance abuse
-Misdiagnosed as major depressive disorder or personality disorder
Prevalence of cyclothymic disorder
-Onset around early adulthood
Mental health comorbidities
-Panic attacks, alcohol abuse, social phobia, seasonal affective disorder
Physical health concerns with mental health
-Chronic fatigue syndrome, asthma, migraine, chemical sensitivity, hypertension, bronchitis, gastric ulcers
The presence of co-morbidities increases the…
-Complexity of the treatment
-Difficulty for the patient to maintain consistent employment
-Patient’s dependence on others
-Patient’s general health care needs
Biological factors of bipolar disorders
-Strong heritability
-Polygenic disorder
-Irregularities on chromosomes 13 and 15; thought process
Neurobiological factors of bipolar disorder
-Neurotrasnmitters are disrupted (NE, dopamine & serotonin)
-Function of neurotransmitters is linked to hormones
-aReceptor sensitivity
-Prefrontal cortex (impaired executive and cognitive functioning)
-Limbic regions of the brain are most severely affected
Nuerotransmitter review
Page 5
Dopamine
-Fine muscle movement, integration of thoughts and emotions (pleasure and energy), motivation
-Produced in the Substantia nigra
-Dopamine (excitatory) has an inverse relationship with gamma-amino butyric (GABA) (calming)
Dopamine & acetylcholine
Dopamine strives to have a 50:50 balance with acetylcholine
Dopamine excess
Mania (symptoms include psychosis, hallucinations, aggression and anxiety)
Dopamine insufficiency
Depression and Parkinson’s Disease
Norepinephrine
-Converted from dopamine; excess dopamine=excess NE
-Causes changes in mood, attention & arousal/energy
Norepinephrine excess
mania & anxiety
Norepinephrine insufficiency
depression & anhedonia
Serotonin
-Sleep, hunger, mood, pain perception, aggression, & sexual behavior
Serotonin excess & insufficiency
-Excess= anxiety
-Insufficiency= Depression
Neuroendocrine + Bipolar disorder
-Hypothalamic-pituitary-thyroid-adrenal (HPTA) axis
-Hypothyroidism is known to be associated with depressed mood
Gender + Bipolar disorder
-Rate of bipolar disorder is relatively equal between men and women
-Women are more likely to be hospitalized
-Hospitalization most often occurs between the ages of 40-44
Psychological factors: Environmental: Bipolar disorder
-Increased stress: Significant or prolonged
-Once the presentation of bipolar is triggered by a stressful event, the environmental stress is no longer needed to perpetuate the disorder
Psychological factors: SEDoH: Bipolar disorder
-More prevalent in higher socioeconomic classes
-Individuals are over achievers compared to those with unipolar depression
-Creative writers & actors
Stress response
-CNS receives information about the stressor, hypothalamus creates an integrated response, corticotropin releasing factor (CRF) goes to the SNS and anterior & posterior pituitary
Norepinephrine + Stress response
-From peripheral nerve endings
-Increases BP, decreases digestion, dilates pupils & bronchioles
Epinephrine + stress response
-From adrenal medulla
-Increases CO & glucose
Cortisol + stress response
-From adrenal cortex
-Decreases inflammatory response
-Inhibits fibroblast proliferation and function
-Inhibits immunity (prone to sickness)
Vasopressin (ADH) + Stress response
-Increases water retention
MSE: Depression & mania
Pages 8-11
Terms to describe level of goal directed communication
-Circumstantially; over-inclusive, indirect, eventually reaches the goal but is delayed
-Loose association; when the patient’s communication is grossly incoherent
-Tangentiality; responses from the patient are irrelevant, does not reach the goal of the conversation or topic
Additional characteristics of goal directed communication
-Flight of ideas; rapid movement from one idea to another
-Perseveration; inability to interrupt a phrase/task/behavior resulting in pathological repetition
-Clang associations; stringing together of words that rhyme
-Neologism; making up words that do not exist
Mania: Assessment of insight
-Deny experiencing a mental illness
-Minimizes impact of behaviors and consequences
Mania: Assessment of judgement
-Resists being controlled
Mania risk assessment
-Suicide; assess for ideation, plan, intent, means
-Homicide; ask about resentment, anger and disappointment
-Self harm, consider the purpose and consequences of the behavior
-Harm to others, direct or indirect
Physical assessment + Mental health (cardiac) considerations
-Changes in electrolyte function related to nutritional intake & stress response
Physical assessment + Mental health (renal) considerations
-Increased risk for toxicity
-The patient may still be taking medication but could be dehydrated (increased the plasma levels of the medication)
-Dose of medication is increased
-New medications are added
Physical assessment + Mental health (stress response) considerations
-Increases in BP, glucose production and ADH further stress the kidneys
Physical assessment + Mental health (reproductive health) considerations
-Increased risk of STIs
Physical assessment + Mental health (neurological) considerations
-Changes in the balance of:
-Serotonin (impacts circadian rhythm)
-Norepinephrine (impacts mood, attention, and stimulates the SNS to engage the flight or fight response)
-Dopamine (impacts movement, motivation, and thoughts and emotions)
Patient consequences
-Alienation, disrupted relationships
-Additional health problems; STI, pregnancy, addictions
-Legal, impending charges
-Financial, spent all of his/her money
Nursing diagnosis
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