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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

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
What is the washout period for fluoxetine? (half-life)?
2 weeks - highest half life of SSRis and most likely to interact
26
Some characteristics of mania?
\*Elevated, energetic, irritable mood \*Grandiosity \*Shorter than depression \*Creativity \*Impulsive sexual behavior \*Lasts at least one week
27
Examples of SNRIs? Risk?
\*venlafaxine \*duloxetine \*desvenlafaxine \*Hypertension
28
Treatments for suicidal clients?
\*Pharmacology \*Psychotherapy \*Cognitive therapy \*ECT
29
What type of side effects do tricyclics tend to have?
\*BLURRED VISION \*ANTICHOLINERGIC \*ORTHOSTATIC HYPOTENSION \*CONSTIPATION \*DRY MOUTH \*URINE RETENTION
30
Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning?
Cyclothymic disorder
31
How is major depressive disorder diagnosed?
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
32
Thinking about and planning one's own death
Suicidal ideation
33
List the 10 Ranges of moods from lowest to highest.
\*severe depression w/psychosis \*severe depression \*Moderate depression \*Mild depression \*Dysthymia \*Normal \*Elation \*Hypomania \*Mania \*Mania w/ psychosis
34
When are tricyclic antidepressants contraindicated?
\*Under 25 and Over 65 \*Liver disease \*Heart conditions \*Thyroid disorder \*Diabetes
35
A period of abnormally and persistently elevated, expansive, or irritable mood. can interfere with ability to be productive.
Mania
36
According to this theory depression is a result of abandonment.
Object-Loss theory
37
Examples of MAOI's
\*Phenlelzine \*Isocarboxazid \*Tranylcypromine
38
Amitriptilyine, doxepin, amoxepine are examples of what?
Tricyclic antidepressants
39
What is the washout period for MAOIs (half-life)?
5 weeks
40
optimal blood concentration for divalproex?
50 to 125mcg/mL
41
Characterizations of a manic episode?
\*Pressured speech \*Combative behavior \*Impaired judgment \*Grandiosity \*Impulsive sexual behavior \*Linked with creativity
42
What increases the possibility of adverse effects during lithium therapy? How can this be avoided?
Heavy perspiration - high fluid diet w/ normal NA levels
43
Nursing considerations for valproate?
\*Liver function test \*Teratogenic \*can cause neural tube defects
44
Is buprorpion considered typical or atypical and why?
Atypical - does not act on serotonin
45
What do MAOIS inhibit the breakdown of in the liver?
Tyramine
46
Etiology of Bipolar disorder?
\*may be inherited /Genetically determine biochem abnormality of brain \*cause unknown \*Some drugs and physical diseases may cause mania
47
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.
Hypomania
48
Adverse reactions for SSRIs?
\*Agitated/anxious \*N/D, GI upset \*Weight loss/gain \*Dry mouth \*Sexual dysfunction \*Dizziness
49
What is the mood change in bipolar called?
switch process
50
Mechanism of action for MAOIs?
prevent breakdown of norepi, serotonin, dopamine - increased levels result in increased mood.
51
The probability that a person will successfully complete suicide
Lethality
52
Primarily recurrent depression with at least one hypomanic episode
Bipolar type ll
53
What are the statistics of suicide for men and women?
Women have more suicide attempts but less lethal means; men are more likely to complete
54
Depression is more common in? What are the statistics?
More common in women (20-25%) than men (7-12%)
55
When a persons mood fluctuates to extremes of mania and/or depression.
Bipolar disorder
56
Contraindications for MAOIs?
\*Severe liver and kidney impairment \*Cardiovascular and cerebrovascular diseases \*HTN
57
What do SNRIs lower?
seizure threshold
58
According to this theory there is considerable evidence that the predisposition to develop depression is inherited.
Biological model/theory
59
Fluoxetine, citalopram, and escitalopram are examples of what?
SSRIs
60
More serious/late signs of lithium toxicity?
seizure and tremors
61
In order to diagnose bipolar, how many symptoms from the DSM-5 need to be present? What are they?
\*3 or more symptoms -DIGFAST \*Distractability \*Indiscretions \*Grandiosity \*Flight of ideas \*Activity increase \*Sleep Deficits \*Talkativeness (pressured speech)
62
According to this theory, depression is a result of anger turned inward.
Psychoanalytic theory
63
therapeutic range for plasma lithium
0.6 – 1.2 mmol/L
64
The two most common comorbid conditions associated with bipolar disorder are?
Anxiety disorder and substance abuse
65
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.
emotional lability
66
Manic individuals may experience the following:
\*Lose touch with reality \*Paranoia/hallucinations \*danger to self/others \*cycle between moods \*recognize own manic behavior (when stable)
67
Lack of energy
Anergia
68
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?
Flight of ideas - usually seen in bipolar disorder
69
What is the mechanism of action for tricyclics?
Blocks activity of norepinephrine and serotonin
70
Mechanism of action for SSRIs
Serotonin reuptake inhibition
71
If symptoms of moderate to severe toxicity to lithium are noted, the nurse should:
\*Withhold medication \*Push fluids \*Aquire blood sample for testing \*Contact HCP
72
According to this theory depression is a result of negative perceptions,
Cognitive theory
73
Signs of serotonin syndrome?
\*Mental status changes - hallucinations, agitation, coma \*Autonomic instability - tachycardia, hyperthermia, change in BP, elevated temp \*Neuromuscular problems - hyperreflexia \*GI disturbances - N/V/D
74
Indications for SSRIs?
\*Major depressive disorder \*Anxiety/Panic disorder \*Bulimia \*Bipolar depression \*OCD \*Treatment resistant depression
75
What should you avoid when taking MAOIs?
OTC meds and foods with tyramine (aged cheeses, cured meats, wine, beer, dried fruit, fermented/pickled foods, chocolate)
76
What kind of medications are used short term for treatment in bipolar?
Benzos and Antipsychotics
77
Some adverse/toxic effects of MAOIs?
\*N/D \*H/A \*Dry mouth \*Dizziness/ Lightheadedness \*Insomnia \*Skin reaction at patch site
78
What is a serious side effect of Carbamazapine?
Agranulocytosis
79
what organ metabolizses lithium?
Kidneys

Nursing 231 - Exam 2 (4 decks)

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