Depressive Disorders and Bi-Polar Disorder Flashcards
MDD criteria
5 or more in 2 wk period (w/ either 1 or 2 present)
- depressed mood most of day (subjective report or observation)
- considerable decrease in pleasure in activities
- significant weight loss or decrease in appetite every day
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue
- worthlessness, guilt
- dec. concentration or indecisiveness
- recurrent thoughts of death, suicidal ideation
Dysthymic Disorder criteria
at least 2 of the following for at least 2 years
- inc. or dec. in appetite
- insomnia or hypersomnia
- dec. energy/fatigue
- dec. self-esteem
- dec. concentration, difficulty w/ decisions
- feelings of hopelessness
etiology of mood disorders
- genetics
- biochemical
- attachment challenges
- developmental/social factors- bullying, loss, trauma
assess the neurovegetative symptoms of depression and other symptoms of depression
- appetite and weight changes
- sleep disturbance
- decreased energy, tiredness, and fatigue
- loss of interest or pleasure
TCA - amitriptyline (Elavil)
potentiates the effect of serotonin and norepinephrine in the CNS. SE: blurred vision, dry eyes, dry mouth, hypotension, constipation, lethargy, sedation
Concerns with overdose, slow to work, affects muscarinic receptors and led to anticholinergic SE, histaminic receptors led to sedation
SSRI - fluoxetine (Prozac), Celexia (citalopram)
selectively inhibits the reuptake of serotonin in the CNS.
SE: insomnia, anxiety, sexual dysfunction, headache, transient nausea, vomiting/diarrhea, weight gain, cloudy thinking
SNRIs - venlafaxine (Effexor)
inhibits serotonin and norepinephrine reuptake in the CNS, advantages for some with co-occurring depression and anxiety
SE: insomnia, anxiety, sexual dysfunction, headache, nausea, vomiting/diarrhea, weight loss
MAOI - tranylcypromine sulfate (Parnate)
inhibits the enzyme monoamine oxidase (which breaks down neurotransmitters), resulting in an accumulation of various neurotransmitters (dopamine, epi, norepi, serotonin) at the synapse
-high tyramine-containing foods/substances cause hypertensive crisis so you go on a MAOI diet
SE: hypertensive crisis (inc in blood pressure), hepatotoxicity, agranulocytosis, seizures
dietary and drug restrictions for a pt taking an MAOI
high tyramine-containing foods/substances cause hypertensive crisis so you go on a MAOI diet. aged cheeses, overripe fruit, dried meat, alcohol, cough syrup
signs of serotonin syndrome
neuromuscular hyperactivity - akathisia, tremor, clonus, myoclonus, hyperreflexia, rigidity, nystagmus
autonomic hyperactivity - diaphoresis, fever, tachicardia, tachypnea
altered mental status - agitation, excitement, confusion
symptoms of depression SIGECAPS
sleep decreased interest decreased guilt energy decreased concentration difficulties appetite disturbances psychomotor agitation suicide ideation
treatments of depression
drug therapy, ECT, light therapy, exercise and outdoor activity, CBT, mindfullness
age related considerations for depression
child - less likely to present with psychosis, symptoms often expressed somatically as headaches or stomachaches.
older adult - manifest with chronic illnesses, suicide high risk especially men
Indigenous - intergenerational trauma
range of symptoms of bipolar disorder
mania and a MDE -euphoria -grandiosity -expansive mood -pressured speech -flight of ideas -labile mood -excessive energy, dec. need for sleep -delusions of grandeur, persecution, or hallucinations -socially intrusive actions -hoarding -sexual indiscretions -distractibility -irresponsible buying sprees/business deals -bizarre/exaggerated dress/accessories -extreme irritability/demanding reckless impulsivity -poor insight/judgement - decline help/split staff -extra capacity of physical activity/energy -increased "goal direction"
Bipolar I
one or more manic episodes and MDE
