[Exam 3] Chapter 17 - Mood Disorders and Suicide Flashcards
When people feel sad ,low, and tired with the desire to stay in bed, episodes are accompanied by what?
anergia (lack of energy), exhaustion, agitation, noise intolerance, adn slow thinking
The feelings of being “on top of the world” also recedes in a few days to what type of mood?
Authymic (average effect and activity)
What are mood disorders
Affective disorders
Pervcasive laterations in emotions that are manifested by depression or mania or both
What self-esteem changes occur in mood disorders?
Self-doubt, guild, anad anger alter life activites especially those that involve self-esteem, occupation, and relationships
What did King Saul, King Nebuchadnezzar, and Moses suffer from?
overwhelming grief of heart, unclean spirits, and bitterness of soul, which are all signs of depression
What did Abraham Lincoln and Queen Victoria suffer from?
recurrent episodes of depression
Mood disorders are teh most common psychiatric diagnoses associated with what
suicide , and depresion is one of the most important risk factors for it
Clients with schizophrenia, substance use disorder, antialsocial and borderlien personality disorders are at a increased risk for what
suicide and suicide attempts
Categories of Mood Disorders: Primary mood disorders are what?
Major depressive disorder and bipolar disorder
Categories of Mood Disorders: Major depresive episode lasts how long?
2 Weeks
Categories of Mood Disorders - Major Depressive Disorder: What does person experience?
Depressed mood or loss of pleasure in nearly all activites
Categories of Mood Disorders - Major Depressive Disorder: Symtpoms of those?
Changes in eating habits, hypersomnia/insomnia, impaired concentration, inability to dope with daily life, feeling of worthlessness, and thoughts of death
Categories of Mood Disorders - Major Depressive Disorder: Symptoms of this causes impairments of what?
social, occupational, or other important areas of functioning
Categories of Mood Disorders - Bipolar Disorder: Diagnosed when?
A persons mood fluctuates to extremes of mania or depression
Categories of Mood Disorders - Bipolar Disorder: What is mania?
Distinct period during which mood is abnormally and persistently elevated, expansive, or irritable
Categories of Mood Disorders - Bipolar Disorder: How long does mania last
One week but may be sooner
Categories of Mood Disorders - Bipolar Disorder: manic episodes include what?
inflated self-esteem or grandiosity
decreaased sleep
excessive and pressured speech *unrelenting, rapid, often loud talking without pauses)
Flight of ideas
Increased activity
Exessive involvement in please-seeking activites
Categories of Mood Disorders - Bipolar Disorder: Persons mood when manic?
Excessively cheerful, enthusiastic, and expansive or the person may be irritiable especially when they are told no
Categories of Mood Disorders - Bipolar Disorder: How will manic person handle problems?
Denies any problems and places blame on others for difficulities
Categories of Mood Disorders - Bipolar Disorder: What is hypomania?
Period of abnormally and persistently elevated, expansive or orritiable mood and some other milder symptoms of mania
Categories of Mood Disorders - Bipolar Disorder: Difference between manic and hypomania episodes?
Does not impair the person’s ability to function (can be productive) and there are no psychotic features (delusions and hallucinations)
Categories of Mood Disorders - Bipolar Disorder: What is a mixed episode?
Often called manic cycling
When the person experiences both mania and depression nearly everyday for 1 week
Categories of Mood Disorders - Bipolar Disorder: What is Bipolar I?
One or more manic or mixed episodes usually accompanied by major depressive episodes
Categories of Mood Disorders - Bipolar Disorder: What is Bipolar II Disorder?
One or more major depresive episodes accompanied by at least one hypomanic episode
Categories of Mood Disorders - Bipolar Disorder: What do people experience between extreme episodes?
May have a depressed mood swing after a manic episode before rreturning to a euthymic mood
Related Disorders: What is Persistent Depressive (Dysthymic) Disorder?
Chronic, persistent mood disturbance
Related Disorders: What is Persistent Depressive Disorder characterized by?
Insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression
Related Disorders: What is Disruptive Mood Dysregulation Disorder?
Persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or siutation beginning before 10
Related Disorders: What is Cyclothymic Disorder?
Characterized by mild mood swings between hypomania and depression without loss of oscial or occupational functioning
Related Disorders: What is substance-induced depresive or bipolar disorder?
Significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxin s
Related Disorders: What is seasonal-affective disorder (SAD)
Has two subtypes
Winter depression or fall-onset SAD
Spring-onset SAD
Related Disorders: What is Winter depression or fall-onset SAD?
Increases sleep, appetite, and carbohydrate cravings, weight gain, interpersonal conflict, irritabiility, and heaviness in extremities
Related Disorders: What is spring-onset SAD
less common with symptoms of insomnia, weight losos, and poor appetite lasting from late spring or early summer until early fall
Related Disorders: How is SAD treated?
With light therapy
Related Disorders: What is Postpartum or maternity blues?
Mild, predictable mood disturbance occuring in the first several days after delivery of a baby
Related Disorders: Symptoms of postpartum or maternity blues?
Labile mood and affect, crying spells, sadness, insomnia and anxiety
Related Disorders: Most common complication of pregnanacy?
Postpartum depression
Related Disorders: When does postpartum depression occur?
Within 4 weeks of delivery, consist with symptoms of depression
Related Disorders: What is Postpartum Psychosis?
Severe and debilitating psychiatric illness with acute onset in days following childbirth?
Related Disorders: Postpartum psychosis signs?
Begin with fatigue, sadness, emotional lability, poor memory and confusion
Progress to delusions, hallucinations, poor insight and judgement
Related Disorders: Postpartum psychosis tx?
Requires immediate treatment . Women with history of mental illness are at a higher risk for this
Related Disorders: What is premenstrual dysphoric disorder?
Severe form of premenstrual syndrome and is defined as recurrent , moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation
Related Disorders: signs of premenstrual dysphoric disorder?
Labile mood, irritability, increased inpersonal conflict, difficulty concentraitng, feeling overwhelmed, and feelings of anxiety
Related Disorders: What is nonsuicidal self-injury?
involves deliberate, intentional cutting, burning, scraping, hitting, or intereference with wound healing
Etiology & Genetic Theories: Transmission of major depressision in first degree relatives increases chances by how much?
wice at risk
Etiology & Genetic Theories: First degree relative with bipolar increases risk ny how much?
7x
Etiology & Genetic Theories: There is genetic overlap between early onset bipolar disorder and what?
early-onset alcoholism
Etiology & Genetic Theories: Peole with early onset bipolar and early-onset alcoholism have what responses?
Rapid rate of mixed/rapid cycling, poorer response to lithium, slower rate of recovery and more hospital admissions
Etiology & Neurochemical Theories: This focuses on what?
Serotonin and Norepinephrine.
Etiology & Neurochemical Theories: Serotonin has role in what?
mood, activity, aggressiveness, irritability, congition, pain, and neuroendocrine process (growth hormone, cortisol, and prolactin levels)
Etiology & Neurochemical Theories: Deficits of serotonin, precursor tryptophan or metabolite) found in blood of spinal fluid in people with what
depression
Etiology & Neurochemical Theories: Positron emission tomography demonstrates what in depression?
Reduced metabolism in teh prefrontal cortex
Etiology & Neurochemical Theories: Norepinephrine levels in depression and mania?
Decreased in depression and increased in mania . This energenizes the body to mobilize and inhibits kindling
Etiology & Neurochemical Theories: Wht is kindling?
Process by which seizure activity in a specific area of the rain is initially stimulated by reaching a threshold of the cumulative effects of stress, low amount of electric impulse or chemicals like cocaine. Seizures now occur spontaneously
Etiology & Neurochemical Theories: What drugs inhibit kindling?
anticonvulsants
Etiology & Neurochemical Theories: What do cholinergic drugs alter?
mood, sleep, neuroendorcine functiona dn the electroencephalographic pattern, therefore implicated in depressiona nd mania
Etiology & Neuroendocrine Influences: Elevated glucocorticoid activity is associated with what?
stress response
Etiology & Neuroendocrine Influences: Postpartum hormone alterations precipitate mood disorders such as what?
postpartum depression and psychosis
Etiology & Neuroendocrine Influences: 5-10% of people with depression have thyroid dysfunction, corrected how?
with thyroid treatmetn or tx for the mod disorder affected
Etiology & Psychodynamic Theories: Self-depreciation of people with depressio becomes self-reproach adn anger turned inward. Feeling abandoned by this loss, how do people feel
people are then angry while both loving and hating the lost object
Etiology & Psychodynamic Theories: When does depression results with the persons ego?
When a person is not feeling idea (good and loving, superior or strong)
Etiology & Psychodynamic Theories: How is the ego in depression?
Ego is powerless, helpless child victimized by the superego
Etiology & Psychodynamic Theories: How do most psychoanalytic theoreis of mania view manic episodes?
As a degense against underlying depression, with teh ID taking over the ego
Etiology & Psychodynamic Theories: Children raised by rejecting or unloving parents are prone to feelings of what?
inseucirty and loneliness , making them susceptible to depression and helplessness
Cultural Considerations: How do children with depression appear?
Often appear cranky . May have school phobia, hyperactivitty, learning disorders, and failing grades
Cultural Considerations: What may adolescents with depresion do?
join gangs, engage in risky behavior, or drop out of school
Cultural Considerations: What do adults with depression do?
substance abuse, eating disorders, compulsive behaviors.
Major Depressive Disorder & Onset/Clinical: How long does this last?
2 weeks or more of a sad mood or lack of interest with at least four other symptoms of depresion
Major Depressive Disorder & Onset/Clinical: Untreated episode of depression can last how long?
Few weeks to months, or even years.
Major Depressive Disorder & Psychopharmacology: Categories of antidepressantns include waht?
cyclic antidepressants, MAOIs, SSRIs and atypical antidepressants
Major Depressive Disorder & Psychopharmacology: What neurotransmitters are decreased here?
Norepinephrine and Serotonin
Major Depressive Disorder & Psychopharmacology: Goal of antidepressants neurologic wise?
TO increase the efficacy of available neurotransmitters and the absorption by postsynaptic receptors
Major Depressive Disorder & Psychopharmacology: What is used for a person with acute depression with psychotic features?
An antipsychotic is used in combination with an antidepressants
Major Depressive Disorder & Psychopharmacology: Evidence is increasing that antidepressant theray should continue for how long?
longer than 3-6 months , more ideally 18-24 months
Major Depressive Disorder & Psychopharmacology: How should antidepressants be discontinued?/
Doage should be tapered
Major Depressive Disorder & Psychopharmacology: Most frequently prescribed category of antidepressants?
SSRI.
Major Depressive Disorder & Psychopharmacology: What effects to SSRI produce?
Few sedating, anticholinergic, and cardiovascular side effects. Makes them safe for older adults
Major Depressive Disorder & Psychopharmacology: With SSRIs, how quikcly does insomnia, appetite, energy, and mood,concentration improve?
Insomnia: Decreases in 3-4 days
Appetite: Normal in 5-7 days
Energy: Returns in 4-7 days
Mood: 7-10 days
Major Depressive Disorder & Psychopharmacology: What effects does FLuxetine (Prozac) produce?
Slightly higher rate of mild agtation and weight loss but loss somnolence
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Relieve symptoms of what?
Hopelessness, helplessness, anhedonia, inappropriate guild, suicidal ideation and daily mood variations . Also panic disorder, OCD, and eatind disorders
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Tricyclic antidepressants have a lag period of what
10-14 days before reaching a serum level
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: How long to reach full effect?
6 weeks
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Because they have a long serum half life, there is a lag period of what before steady plasma levels are reachd
1-4 weeks before
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Trycyclic antidepressants are contraindicated in what
severe impairment of liver function and in myocardiac infarction
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Cannot be given concurrently with what
MAOIs
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Because of anticholinergic side effects, used cautiously in clients whohave what
glaucoma, benign prostatic hypertrophy, urinary retention or obstruction, and diabetes
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: Overdosage of this occurs over what time and results in what SE?
Several dadys and results in confusion, agitation, hallucinations, hyperpyrexia and increased reflexes
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: What population is this not reallt used with?
The older adult population
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: What may Amoxapine (Asendin) cause?
extrapyramidal symptoms, (Tardive Dyskinesia, and NMS)
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: What to know tolerance wise and what can Amoxapine (Asendin) cause?
Tolerance in 1-3 months
Increases appetite and causes weight gain and cravings for sweets
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: What risk for Maprotiline (Ludiomil) carry?
RF Seizures , severe constipation and urianry retention, stomatitis, and other side effects
Major Depressive Disorder & Psychopharmacology - Cyclic Antidepressants: What can increase effects of Maprotiline (Ludiomil)?
CNS depressants
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: Used when?
When client has inadequate response to or side effects from SSRIs
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: What drugs included here?
Venlafaxina (Effexor)
Duloxetine (Cymbalta)
Bupropion (Wellbutrin)
Nefazodone (Serzone)
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: What does Venlafaxine block?
The reuptake of serotonin, norepinephrine, and dopamine
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: What does Duloxetine block?
Both serotonin and norepinephrine
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: What does Bupropion inhibit?
reuptake of norepinephrine, dopamine
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: Bupropion is marketed as Zyban for what?
Smoking cessation
Major Depressive Disorder & Psychopharmacology - Atypical Antidepressants: What does Nefazodone inhibit?
reuptake of serotonin and norepinephrine and has few side effects. Can be used in those with liver and kidney disease
Major Depressive Disorder & Psychopharmacology - MAOIs: Why are these infrequently used?
Because of potentially fatal side effects and interactions with drugs
Major Depressive Disorder & Psychopharmacology - MAOIs: Most serious side effects?
Hypertensive crisis, happens when they ingest tyramine-containing foods
Major Depressive Disorder & Psychopharmacology - MAOIs: Signs of hypertensive crisis?
occipital headache, hypertension, nausea, vomiting, chills, sweating, restlessness, nuchal rigidity, dilated pupils and fever
Major Depressive Disorder & Psychopharmacology - MAOIs: What can hypertensive crisis evantually lead to?
hyperpyrexia, cerebral hemorrhage and death
Major Depressive Disorder & Psychopharmacology - MAOIs: How to tx hypertensive criss?
Transisent antihypertensive agents given to dilate blood vessels and decrease vascular resistance
Major Depressive Disorder & Psychopharmacology - MAOIs: How long to reach therapeutic level?
2-4 weeks
Major Depressive Disorder & Psychopharmacology - MAOIs: Lag period?
5-6 weeks for washout periods
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: What is serotonin syndrome?
Occurs when there is an inadequate washout period between taking MAOIS and SSRIs or when MAOIs are combined with meperidine
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: Mental State changes in Serotonin Syndrome?
Confusion, Agitation
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: Neuromuscular Excitment changes in Serotonin Syndrome?
Muscle rigidity, weaknes, sluggish pupils, shivering, tremors, myoclinic jerks, collapse and muscle paralysis
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: Autonomic abnormalities in serotonin syndrome?
hyperthermia, tachycardia, tachypnea, hypersalivation and diaphoresis
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: How to decrease risk of overdose of MAOI and cyclic Antidepressant/
Depressed or impulsive clients who are taking any antidepressants may need to have refills in limited amounts
Major Depressive Disorder & Psychopharmacology - DRUG ALERT: What drugs interact with MAOI
Amphetamines
Mepheridine
SSRI
Tricylic Antidepressants
Tyramine
Major Depressive Disorder & Other Medical Tx and Psychotherapy: When is Electroconvulsive therapy used?
To treat depression in select groups such as clients who do not respond to antidepressants
Major Depressive Disorder & Other Medical Tx and Psychotherapy: ECT has shown a high degree of efficacy for who?
Patients with psychotic features and marked psychomotor disturbances
Major Depressive Disorder & Other Medical Tx and Psychotherapy: How many txs are giving in ECT?
Six-15 txs. GEnerally minimum of six treatments are needed. Maximum benfift achieved in 12-15 txs
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Steps of performing ECT?
Short acting anesthetic given along with muscle relaxant (suxxinycholine). Thus shocked. Believes that this causes brain to correct the chemical imbalance
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Unilateral ECT results in what?
Less memory loss but more treatments may be needed
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Bilateral ECT results in what?
More rapid movements but with increased short-term memory loss
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Studies report that ECT is as effective as meds for what?
Depression
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Most effective tx for depressive disorders?
Psychotherapy and medication combination
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Goals of combined therapy?
Symptom remission, psychosocial restorration, prevention of relapse or recurrence, reduced secondayr consequences such as marital discord
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Interpersonal therapy focuses on what?
Difficulties in relationships such as grief reactions, role disputes and role transitions
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Behavior therapy seeks to do what?
Increase the frequency of clients positively reinforcing interactions with environment and to decrease negative interactions
Major Depressive Disorder & Other Medical Tx and Psychotherapy: Cognitive therapy focuses on what?
How person thinks about self, others, and the future and interprets his or her experiences
Major Depressive Disorder & History: The nurse asks about behavioral changes, that include what?
When they started, what was happened when it began, their duration, and what client has tried to do about them.
Major Depressive Disorder & General Appearance/Motor: How do they often look?
Sad, ill. Posture slouched with minimal eye contact.
Psuchomotor retardation.
Latency of response seen when clients take up to 30 seconds.
Major Depressive Disorder & General Appearance/Motor: Clients here have psychomotor agitation, which is what?
increased body movements and thoughts
Major Depressive Disorder & Mood/Affect: How will they describe themselves?
As hopeless, helpless, down, or anxious . Easily frustrated and can be angry with others . Experience anhehdonia.
Major Depressive Disorder & Thought Process/Content: How is their thought process?
Slow thinking process, and occurs in slow motion. May not respond verbally to questions. Think negatively and think they will always feel this bad.
Remunate , which is going over same thoughts.
Major Depressive Disorder & Sensorium and Intellectual Processes: How are they with sensorium?
Some may experience difficulty with orientation.
Major Depressive Disorder & Judgement/Insight: Judgement impaired why?
Because they cannot use their cognitive abilites to solve problems or make decisions.
Major Depressive Disorder & Self-Concept: Self-Esteem here?
Reduced. Often think of themselves as good for nothing or just worthless.
Major Depressive Disorder & Depression Rating Scales: Self rating depression scales include what?
Zung Self-Rating Depression Scale and Beck Depression Inventory
Major Depressive Disorder & Depression Rating Scales: What is the Hamilton Rating Scale for Depression?
Clinician-rated depression scale used like a clinical interview. Rates teh change of client’s behaviors, such as depressed mood, guilt, suicide and insomnia
Major Depressive Disorder & Outcome Identifcation: What are the goals?
Client will not injure themselves
Will indepednetly carry out ADLs
Client will evaluate self-attributes realistically
Will socialize with saff, peers, and family/friends
Major Depressive Disorder & Intervention - Providing for Safety: First priority is to determine what?
Whether client with depression is suicidal
Major Depressive Disorder & Intervention - Providing for Safety: If patient reports suicidial intentions, what happens?
Suicide precautions such as removing harmful items and increased supervision.
Major Depressive Disorder & Intervention - Promoting Therapeutic Relationship: How can silence be important?
Because nurses prescence conveys genuine interest and caring. Silence can conveyr that client sare worthwhile even if they are not listening
Major Depressive Disorder & Intervention - Promoting ADLs and Physical Care: How to assess ability to perform ADLS?
Nurse asks the client to perform a simple task. If they can’t, nurse breaks it down into smaller segments
Major Depressive Disorder & Intervention - Promoting ADLs and Physical Care: What to do if client doesn’t want to do between choosing clothing?
Nurse selects clothing and directs them to put it on
Major Depressive Disorder & Intervention - Promoting ADLs and Physical Care: When does the nurse help client dress?
Only when they cannot perform any of the steps themselves
Major Depressive Disorder & Intervention - Promoting ADLs and Physical Care: What should the nurse do with yes-or-no questions?
Instead of using these, the nurse should say “It’s time to get up now”.
Major Depressive Disorder & Intervention - Therapeutic Communication: It is important for nurse to not fix what?
the client’s difficulties or offer cliches.
Major Depressive Disorder & Intervention - Therapeutic Communication: As clients improve, nurse can help them rediscover what?
More effective coping strategies such as talking to friends, spending leisure time to relax and taking positive steps to deal with stressors.
Major Depressive Disorder & Intervention - Family Advice: They should know that treatment outcomes are best when?
Psychotherapy and antidepressants are combined.
Major Depressive Disorder & Intervention - Family Advice: What does psychotherapy help client do?
Explore anger, dependence, guilt, hopelessness, helplessness, object loss and interpersonal isues.
Bipolar DisordeR: What is this?
Involves extreme mood swings from episodes of mania to episodes of depression.
Bipolar DisordeR: How are clients during manic phase?
euphoric , grandiose, energetic and sleepless. Have poor judgement and rapid thoughts, actions, and speech
Bipolar DisordeR: Diagnoses for this is not made until what
person experiences a manic phase
Bipolar DisordeR: How long can individual moods last?
Weeks or months
Bipolar Disorder & Onset/Clinical: First episode occurs when
person’s teens, 20s or 30s.
Bipolar Disorder & Onset/Clinical: Manic episode typically begin how?
Suddenly with rapid escalation of symptoms over a few days and last few weeks to several months
Bipolar Disorder & Onset/Clinical: Diagnosis of manic episode require what
at least 1 weeks of unusual and incessantly heightened, grandiose, or agitated mood.
Bipolar Disorder & Tx - Psychopharmacology: What medications are used?
Antimanic agent (Lithium) or anticonvulsant meds used as mood stabilizers
Bipolar Disorder & Tx - Psychopharmacology: If client in the acute stage of mania or depression exhibits psychosis, what is given?
Antipsychotic agent
Bipolar Disorder & Psychopharmacology - Lithium: What is lithium?
Salt contained in huhman body.
Bipolar Disorder & Psychopharmacology - Lithium: What can lithium treat?
Stabilize bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes
Bipolar Disorder & Psychopharmacology - Lithium: Lithium action peaks when?
In 30 minutes to 4 hours in regular forms and in 4-6 hours in slow-release forms
Bipolar Disorder & Psychopharmacology - Lithium: Onset of action?
5-14 days. Antipsychotics or antidepressants are used during lag period
Bipolar Disorder & Psychopharmacology - Lithium: Half life of lithium?
20-27 hours
Bipolar Disorder & Psychopharmacology - Anticonvulsant Drug: Facts to know about Carbamazepine (Tegretol)?
First anticonvulsant found to have mood-stabilizing properties. Agranulocytosis is of great concenr. Need to have drug serum levels checked regularly.
Bipolar Disorder & Psychopharmacology - Anticonvulsant Drug: Facts to know about Valporic Acid (Depakote)?
Therapeutic levels monitored and ongoing liver function tests performed.
Bipolar Disorder & Psychopharmacology - Anticonvulsant Drug: What other drugs are used?
Gabapentin (Neurontin, Lamotrigine (Lamictal) and Topiramate (Topamax)
Bipolar Disorder & Psychopharmacology - Anticonvulsant Drug: What is Clonzaepam used for?
Is an anticonvulsant and benzodiazepine. DEpendence can develop.
Bipolar Disorder & Psychopharmacology - Anticonvulsant Drug: What are the Aripiprazole (Abilify), Brexpiprazole (Rexulti) and Cariprazine (Vraylar) drugs?
Dopamine system stabilizer antipsychotics meds used as adjuncts to other mood-stabilziing drugs
Bipolar Disorder & Psychopharmacology: What class of drugs is most often used to treat bipolar?
Second-generation antipsychotic meds in conjunction with mood stabilizers or antidepressants.
Bipolar Disorder & Psychopharmacology: Which combination meds are the most effective?
Ziprasidone (Geodon) , Lurasidone (Latuda), and Quetiapine (SEroquel).
Bipolar Disorder & History: How is this done?
Difficult. Client jumps form subject to subject , which makes it difficult for nurse to follow
Bipolar & General Appearance/Motor: How do those with mania appear?
Psychomotor agitation. Sitting difficult. Can cause injury or exhaustion
Bipolar & General Appearance/Motor: What clothes do they wear?
Wears clothes that are reflective of elevated mood. Birhg tclothes.
Bipolar & General Appearance/Motor: How is the motor here?
Pressured speech is the hallmark sign. Talk rapidly without pauses.
Bipolar & Mood/Affect: How is the mood?
Periods of euphoria, exuberant activity, grandiosity and false sense of well-being . Mood is labile and they alternate between periods of loud laughter and episodes of tears
Bipolar & Thought Process/Content: How is thinking?
Confused and jumbled with thoughts racing one after another, flught of ideas. Circumstantility and tangentiality also happen.
Bipolar & Thought Process/Content: How do they perform activites?
Start many projects at one time butdo not finish them. Start activities as they occur in thought processes.
Bipolar & Sensorium and Intellectural Processes: What is the problem here?
Not oriented to time.
Bipolar & Sensorium and Intellectural Processes: How is the intellectual process?
Clients claim to have abilities they cannot possses. Also ability to concentrate impaired.
Bipolar & Judgement/Insight: How do they judge others?
Easily angered and irritated and strike back at what they perceive as censorship.
Bipolar & Judgement/Insight: nishgt here?
Impulsive and rarely think before acting or speaking. Also limited because they believe they are fine
Bipolar & Self-Concept: How is sself-esteem?
Exaggerated. They believe they can accomplish anything
Bipolar & Roles/Relationships: Clients have great need to socialize but have little what?
understanding of their excesive, overpowering and confrontional social interaction
Bipolar & Physiological/Self-Care: How do they do with sleep and food?
Can do days without sleep or food and not realize they are hungry or tired.
Bipolar & Intervention - Providing for Safety: Primary nursign responsibility?
Provide a safe environment for clients and others.
Bipolar & Intervention - Providing for Safety: What does the nurse assess?
Clients directly for suicial ideation and plans of hurting themselves.
Bipolar & Intervention - Providing for Safety: What is important for nurse to tell client?
That staff members will help them control their behaviors if clients cannot do so alone
Bipolar & Intervention - Providing for Safety: What to know about setting limits?
Very important to do so because clients do not recognize that they are in others peoples space
Bipolar & Intervention - Meeting Physiological Needs: What is the main problem?
They get little rest and poor nutrition. Provide a quiet environment for stimulation and provide fingering foods that they can eat while moving.
Bipolar & Intervention - Meeting Physiological Needs: What does nurse need to monitor?
Food and fluid intake and hours of sleep until clients routinely meet these needs without difficulty
Bipolar & Intervention - Providing Therapeutic Communication: How does nurse present information?
Using clear, simple sentences when commuicating. Break information into many small segments. Explain purpose of tests .
Bipolar & Intervention - Providing Therapeutic Communication: What to do when client speaks rapidly?
Keep channels of communication open with clients. “Please speak more slowly. I’m having trouble following you.” Puts the difficulty on the nurse instead of client
Bipolar & Intervention - Providing Therapeutic Communication: How does nurse react when speech includes flight of ideas?
Nurse asks clients to explain relationships, because the conversation quikcly moves to different subjects
Bipolar & Intervention - Promoting Appropriate Behaviors: How can nurses direct their needs for movement?
Makes them socially acceptable, large motor activites. Like arranging chairs for a community meeting or walking.
Bipolar & Intervention - Promoting Appropriate Behaviors: Problem with those who have few restrictions on themselves?
They act out impulsive thoughts, have inflated and grandiose perceptions of their abilities, are demanding, and need immediate gratification
Bipolar & Intervention - Promoting Appropriate Behaviors: Problems with clients and sex?
Lose sexual inhibitions. They are revealing and engage in unprotected sex with virtual strangers. Will ask everyone for sex and describe sexual acts.
Bipolar & Intervention - Managing Medications: How is Lithium handled in body?
Reabsorbed by the proximal tubule and excreted in the urine.
Bipolar & Intervention - Managing Medications: Maintenance level of Lithium?
0.5-1
Bipolar & Intervention - Managing Medications: Treatment level of lithium?
0.8-1.5
Bipolar & Intervention - Managing Medications: Toxic levels of lithium?
1.5 or above
Bipolar & Intervention - Managing Medications: Symptoms when Lithium is at 1.5-2?
N/V, Diarrhea, Reduced Cooridnation, Drowsiness, Slurred Speech
Bipolar & Intervention - Managing Medications: Symptoms whn Lithium is 2-3?
Ataxia, Agitation, blurrerd vision, tinnitus, giddiness, muscle fasciculation, hyperreflexia, hypertonic muscles
Bipolar & Intervention - Managing Medications: Interventions when lithium is at 1.5-2?
Without next dose
Bipolar & Intervention - Managing Medications: Interventions when lithium is at 2-3?
Withhold future doses, call physicial . Gastric lavage may be used.
Bipolar & Intervention - Managing Medications: Symptoms when Lithium is 3+?
Cardiac arrhythmia, hypotension, peripheral vascular collapse, reduced levels of consciousness.
Bipolar & Intervention - Managing Medications: Water and Lithium?
SHould drink 2L/day and have usual amount of dietary salt. Too much salt reduces receptor available for lithium
Bipolar & Intervention - Managing Medications: Lithium and if too much water ingested?
Lithium dilued and lithium level will be low.
Bipolar & Intervention - Managing Medications: Lithium and if too little water digested?
Increases lithium level and results in toxicity
Bipolar & Intervention - Managing Medications: How to monitor fluid balance with lithium?
Monitor daily weights and the balance between intake and output and checking for dependent edema.
Bipolar & Intervention - Managing Medications: How often are thyroid function tests ordered with lithium?
Baseline and every 6 months during tx. In 6-18 months, 1/3 clients taking lithium have increased level of TSH causing anxiety and labile emotions
Bipolar & Intervention - Managing Medications: Lithium contraindicated in what peopple?
Those with compromised renal function or urinary retnetion and those taking low-salt diets or diuretics
Bipolar & Intervention - Providing Fam/Client Education: What is important to teach family memebrs?
Education about cause of bipolar, medication managemen, ways to deal with behaviors, and potential problems that manic people can encounter is important
Bipolar & Intervention - Providing Fam/Client Education: Education reduces what in family?
Guilt, blame, and shame that accompany mental illness. Increases client safety and enlarges the support system for clients.
Bipolar & Evaluation: What does this include?
Safety issues, comparsion of mood and affect between start of tx and present, and adherence to tx regimen of medication and psychotherapy
Suicide: What is this?
Intentional act of killing oneself.
Suicide: How many suicides happen?
45,000 each year. `
Suicide: Chonic medical illnesses associated with increased RF suicide include what?
Cancer, HIV, diabetes, cerebrovascular accidents and head/spinl cord injury.
Suicide: Envionmental factors that increase suicie include what
isolation, recent loss, lack of social support, unemployment, critical life events and family history
Suicide: behavioral factors that increase risk include what
impulsivity, erratic or unexmplained changes
Suicide: What is suicidal ideation?
Means thinking about killing oneself
Suicide: what is active suicidal ideation?
when a person thinks about and seeks ways to commit suicide
Suicide: what is passive suicidal ideation?
when person thinking about wanting to die or wishes or she were dead but has no plans to cause their death
Suicide: What does suicide involve?
Ambivalence. Its impossible to know if person who drove into telephone pole did this on person
Suicide & Assessment: Highest risk period for this?
First 2 years after attempt, especially the first 3 months
Suicide & Assessment: When are suicides most likely to occur?
With natural energy from spring in Apil
Or monday mornings, when people return to work
Suicide & Warnings of Suicidal Intent: What must we do as a nurse?
Never ignore any hint of suicidal ideation regardless of how trivial or subtle it seems
Suicide & Warnings of Suicidal Intent: How does nurse repsond to “I just want to go to sleep and not think anymore”
“Specifically just how are you planning to sleep and not think anymore?
Suicide & Warnings of Suicidal Intent: Nurses response to “I want it to eb all over”
“What is it you specifically want to be over?”
Suicide & Warnings of Suicidal Intent: Nurse response to “IT will just be the end of the story”
“Are you planning to end your life”
Suicide & Warnings of Suicidal Intent: Nurses response to “You have been a good friend”
“You sound as if you are saying goodbye. Are you?”
Suicide & Warnings of Suicidal Intent: Nurses response to “If there is any need for anyone to know this, my will and insurance appers are in the top drawer of my dresser”
“I appreciate your trust. However, I think there is an important message you are giving me. Are you thinking of ending your life”?
Suicide & Risky Behaviors: What kind of risky behaviors may an individual perform?
Speeding in blinding rainstorm or when intoxicated .Carrires a high risk of harm to clients and innocent bystanders
Suicide & DRUG ALERT & ANTIDEPRESSANTS: Why may they have a continued or increased risk for suicide?
They may experience an increase in energy from the antidepressant but remain depressed. May make them more likely to act on suicidal ideas.
Suicide & Lethality Assessment: What questions are asked if clients admit to having a death wisk or suicidal thoughts?
Does the client have a plan?
Are the means availble to carry out the plan?
If client carries out the plan, is it likely ot be lethal?
Has client made preparations for death?
Suicide & Internvetion & Using an Authoritaive role: What role does nurse use?
This authoritative role to keep client safe. Nurse lets client know that their safety is the primary concern and takes precendence over othere needs or wishes.
Suicide & Internvetion & Providing Safe Environment: What objects may staff remove from patient?
Sharp objects, shoelaces, belts, lighters, matches, pencils, pens and even clothing
Suicide & Internvetion & Providing Safe Environment: How often are patients chekced on if lethality low?
Every 10 minutes
Suicide & Internvetion & Providing Safe Environment: What is done is high lethality possible?
Clients observed on a one-on-one supervision. Client in direct sight and no more than 2-3 feet away.
Suicide & Internvetion & Providing Safe Environment: What are no-suicide or no-self-harm contracts?
/Clients agree to keep themselves safe and notify staff at their first impulse to harm themselves.
Suicide & Internvetion & Creating a support system list: What support system list will eb created?
Mental health clinics, hotlines, psychiatric emergency evaluations services, student health services, church groups and self-help groups
Suicide & Internvetion & Nurses Response: How must nurse respond to this?
Must indicate unconditional positive regard not for the act for but the person adn their desperation . Must convey belief that person can be helped and can grow and change
Suicide & Lethal and Ethical Considerations: Who is Dr. Jack Kevorikian?
A doctor who participated in numerous assited suicides. They are lobbying for changes in laws that would allow health care profesionals and family members to assit with suicide attempts
Suicide & Community-Based Care: What changes may individuals notice first?
Difficulty eating and sleeping, thinking, complaints of being tired all the time, sadnes, and agitation.
Suicide & Community-Based Care: People with depressionc an be treated successfully in the community by who?
pschiatrists, psychiatric advanced practice nurses , and primary care physicians.
Suicide & Community-Based Care: People with bipolar disorder should be referred to who?
Psychiatrist or psychiatric advanced practice nurse.
Mental Health Disorderes and Mental Health Promotion: What do programs that use an education approach focus on?
Increasing self-esteem and reducing loneliness and hopelessness
Mental Health Disorderes and Mental Health Promotion: Efforts to improve primary care tx of depression have built upon a chornic illness care model that includes what
improved screening and diagnosis in primary care settings, use of evidence-based protocols for tx and patient self-management
Antidepressants: Which have fewest side effects?
SSRIs
Antidepressants: Which are oldest and have longer lag period before reaching adequate serum level?
Tricryclic Antidepressants, are chespest
Antidepressants: MAOIS used least why
because clients are at ris k for hyptertensive crisis if they ingest tyramine-rich foods an fluids while taking these drugs.
People with bipolar disorder cycle between what
mania, normalcy and depression.
Lithium is how effects?
75% of clients, but has a narrow range of safety.
Conducting a suicide lethality assessments involves determinign what??
the degree to which the person has planned his or her death including time, method, tools, place, person to find the body, reason and funeral plans
