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Nursing 231 - Exam 2 > Exam 2 - Affective Disorders > Flashcards

Exam 2 - Affective Disorders Flashcards

Major Depressive and Bipolar Disorder/Suicide/Meds

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1
Q

A chronic disorder with persistent mood disturbances that are milder than depression? Occur most days during a two-year period.

A

Dysthymia

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2
Q

A voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death (e.g., taking a sublethal drug)

A

Parasuicide

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3
Q

What could happen to a client on MAOIs that increases level of tyramines?

A

*Hypertensive crisis
*CVA
*Possible death

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4
Q

Mnuemonic that is useful to remember the diagnositc criteria for major depressive disorder?

A

S -sleep changes
I - Interest loss
G - Guilt/worthlessness
E - energy loss/fatigue
C - cognitive/concentration difficulties
A - appetite/weight loss
P - Psychomotor (agitated/never comfortable)
S - suicidal ideation

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5
Q

At least three of the following must be present for a diagnosis of which condition: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

A

Serotonin syndrome

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6
Q

What are early signs of lithium toxicity?

A

*N/V/D

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7
Q

Which tests should be done before administering divalproex sodium?

A

*Liver function test
*CBC w/ platelets

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8
Q

What type of therapy is used for bipolar clients? Goals?

A

*Psychotherapy
-therapeutic relationship w/therapist
*increase med compliance
*Educates client and family

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9
Q

Average affect and activity

A

Euthymic mood

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10
Q

Primarily manic episodes with at least one episode of depression.

A

Bipolar 1 - the more severe/disruptive of the two categories

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11
Q

More than 4 episodes of mania yearly is known as?

A

Rapid cycling

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12
Q

With lithium, you want to minimize the risk of?

A

kidney and thyroid dysfunction

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13
Q

What can lithium do to the thyroid?

A

Causes hypothyroidism

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14
Q

Vulnerable populations for suicide?

A

*Women
*Veterans
*Elderly
*Adolescents
*LGBTQ
*Traumatic Brain injury

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15
Q

First line of treatment for Bipolar? Give some examples.

A

*Mood stabilizers

  • Lithium (gold standard)
  • Valproate
  • Lamotrigine
  • Gabapentin
  • Carbamazapine
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16
Q

Assessment for Bipolar Disorder?

A

*presenting symptoms
*History of mood cycles
*Med compliance
*Mood disorder questionnaire

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17
Q

According to this theory depression is a result of repeated failures.

A

Learned helplessness theory

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18
Q

How long after lithium is taken do you check the plasma lithium levels?

A

12 hours

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19
Q

Bipolar clients are at a higher risk for?

A

suicide

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20
Q

What is an electrolyte imblanace to monitor for with patients taking SSRIs

A

Hyponatremia

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21
Q

Switching from mania to depression without normal periods is known as?

A

Continuous cycling (poorer outcomes)

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22
Q

Unrelenting, rapid, and often loud talking without pauses. What is this seen in?

A

Pressured speech - seen in manic episodes

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23
Q

What creates the greatest risk for serotonin syndrome?

A

SSRIs and MAOI administered in combination

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24
Q

What are some indications for MAOIs?

A

*atypical depression/anxiety
*bulimia
*PTSD
*OCD

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25
Q

What is the washout period for fluoxetine? (half-life)?

A

2 weeks - highest half life of SSRis and most likely to interact

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26
Q

Some characteristics of mania?

A

*Elevated, energetic, irritable mood
*Grandiosity
*Shorter than depression
*Creativity
*Impulsive sexual behavior
*Lasts at least one week

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27
Q

Examples of SNRIs? Risk?

A

*venlafaxine
*duloxetine
*desvenlafaxine

*Hypertension

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28
Q

Treatments for suicidal clients?

A

*Pharmacology
*Psychotherapy
*Cognitive therapy
*ECT

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29
Q

What type of side effects do tricyclics tend to have?

A

*BLURRED VISION

*ANTICHOLINERGIC
*ORTHOSTATIC HYPOTENSION
*CONSTIPATION
*DRY MOUTH
*URINE RETENTION

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30
Q

Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning?

A

Cyclothymic disorder

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31
Q

How is major depressive disorder diagnosed?

A

With 2 weeks or more of sad mood or lack of interest in life activities with at least 4 other symptoms of depression:

*anhedonia
*weight change
*sleep
*energy
*concentration
*decision making
* self-esteem
*goals

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32
Q

Thinking about and planning one’s own death

A

Suicidal ideation

33
Q

List the 10 Ranges of moods from lowest to highest.

A

*severe depression w/psychosis
*severe depression
*Moderate depression
*Mild depression
*Dysthymia
*Normal
*Elation
*Hypomania
*Mania
*Mania w/ psychosis

34
Q

When are tricyclic antidepressants contraindicated?

A

*Under 25 and Over 65
*Liver disease
*Heart conditions
*Thyroid disorder
*Diabetes

35
Q

A period of abnormally and persistently elevated, expansive, or irritable mood. can interfere with ability to be productive.

A

Mania

36
Q

According to this theory depression is a result of abandonment.

A

Object-Loss theory

37
Q

Examples of MAOI’s

A

*Phenlelzine
*Isocarboxazid
*Tranylcypromine

38
Q

Amitriptilyine, doxepin, amoxepine are examples of what?

A

Tricyclic antidepressants

39
Q

What is the washout period for MAOIs (half-life)?

A

5 weeks

40
Q

optimal blood concentration for divalproex?

A

50 to 125mcg/mL

41
Q

Characterizations of a manic episode?

A

*Pressured speech
*Combative behavior
*Impaired judgment
*Grandiosity
*Impulsive sexual behavior
*Linked with creativity

42
Q

What increases the possibility of adverse effects during lithium therapy? How can this be avoided?

A

Heavy perspiration - high fluid diet w/ normal NA levels

43
Q

Nursing considerations for valproate?

A

*Liver function test
*Teratogenic
*can cause neural tube defects

44
Q

Is buprorpion considered typical or atypical and why?

A

Atypical - does not act on serotonin

45
Q

What do MAOIS inhibit the breakdown of in the liver?

A

Tyramine

46
Q

Etiology of Bipolar disorder?

A

*may be inherited /Genetically determine biochem abnormality of brain
*cause unknown
*Some drugs and physical diseases may cause mania

47
Q

A more mild period of abnormally and persistently elevated, expansive, or irritable mood. This period does not impair a persons ability to function and they can still be productive.

A

Hypomania

48
Q

Adverse reactions for SSRIs?

A

*Agitated/anxious
*N/D, GI upset
*Weight loss/gain
*Dry mouth
*Sexual dysfunction
*Dizziness

49
Q

What is the mood change in bipolar called?

A

switch process

50
Q

Mechanism of action for MAOIs?

A

prevent breakdown of norepi, serotonin, dopamine - increased levels result in increased mood.

51
Q

The probability that a person will successfully complete suicide

A

Lethality

52
Q

Primarily recurrent depression with at least one hypomanic episode

A

Bipolar type ll

53
Q

What are the statistics of suicide for men and women?

A

Women have more suicide attempts but less lethal means; men are more likely to complete

54
Q

Depression is more common in? What are the statistics?

A

More common in women (20-25%) than men (7-12%)

55
Q

When a persons mood fluctuates to extremes of mania and/or depression.

A

Bipolar disorder

56
Q

Contraindications for MAOIs?

A

*Severe liver and kidney impairment
*Cardiovascular and cerebrovascular diseases
*HTN

57
Q

What do SNRIs lower?

A

seizure threshold

58
Q

According to this theory there is considerable evidence that the predisposition to develop depression is inherited.

A

Biological model/theory

59
Q

Fluoxetine, citalopram, and escitalopram are examples of what?

A

SSRIs

60
Q

More serious/late signs of lithium toxicity?

A

seizure and tremors

61
Q

In order to diagnose bipolar, how many symptoms from the DSM-5 need to be present? What are they?

A

*3 or more symptoms -DIGFAST
*Distractability
*Indiscretions
*Grandiosity
*Flight of ideas
*Activity increase
*Sleep Deficits
*Talkativeness (pressured speech)

62
Q

According to this theory, depression is a result of anger turned inward.

A

Psychoanalytic theory

63
Q

therapeutic range for plasma lithium

A

0.6 – 1.2 mmol/L

64
Q

The two most common comorbid conditions associated with bipolar disorder are?

A

Anxiety disorder and substance abuse

65
Q

alterations in moods with little or no change in external events. It is a term used for the rapid shifts in moods that often occur in bipolar disorder.

A

emotional lability

66
Q

Manic individuals may experience the following:

A

*Lose touch with reality
*Paranoia/hallucinations
*danger to self/others
*cycle between moods
*recognize own manic behavior (when stable)

67
Q

Lack of energy

A

Anergia

68
Q

While conducting the assessment, a client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern? What is this a symptom of?

A

Flight of ideas - usually seen in bipolar disorder

69
Q

What is the mechanism of action for tricyclics?

A

Blocks activity of norepinephrine and serotonin

70
Q

Mechanism of action for SSRIs

A

Serotonin reuptake inhibition

71
Q

If symptoms of moderate to severe toxicity to lithium are noted, the nurse should:

A

*Withhold medication
*Push fluids
*Aquire blood sample for testing
*Contact HCP

72
Q

According to this theory depression is a result of negative perceptions,

A

Cognitive theory

73
Q

Signs of serotonin syndrome?

A

*Mental status changes - hallucinations, agitation, coma
*Autonomic instability - tachycardia, hyperthermia, change in BP, elevated temp
*Neuromuscular problems - hyperreflexia
*GI disturbances - N/V/D

74
Q

Indications for SSRIs?

A

*Major depressive disorder
*Anxiety/Panic disorder
*Bulimia
*Bipolar depression
*OCD
*Treatment resistant depression

75
Q

What should you avoid when taking MAOIs?

A

OTC meds and foods with tyramine (aged cheeses, cured meats, wine, beer, dried fruit, fermented/pickled foods, chocolate)

76
Q

What kind of medications are used short term for treatment in bipolar?

A

Benzos and Antipsychotics

77
Q

Some adverse/toxic effects of MAOIs?

A

*N/D
*H/A
*Dry mouth
*Dizziness/ Lightheadedness
*Insomnia
*Skin reaction at patch site

78
Q

What is a serious side effect of Carbamazapine?

A

Agranulocytosis

79
Q

what organ metabolizses lithium?

A

Kidneys

Nursing 231 - Exam 2 (4 decks)

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