midterm 2 day 1 Flashcards
Depressive Disorder Therapeutic Management
- Psychological Therapies
- Individual interpersonal therapy (most effective against depressive disorders)
- Behaviour therapy (behavioural analysis, role play, etc.)
- Group therapy & family/marital therapy
- Cognitive therapies (CBT or DBT)
Pharmacotherapy:
- Tricyclics (TCAs)
- (SSRIs)
- Monoamine oxidase inhibitors (MAOIs)
- Atypical’ antidepressants
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
- Serotonin-Dopamine Reuptake Inhibitors (SDRI)
ECT
- Mechanism of action unknown
- Effective treatment for severe depression
- used for Treatment-resistant depression or so severely ill that rapid treatment is required
- Several contraindications
- Appears to be more effecitve in older adults
- S/E: confusion, disorientation, retrograde amnesia
bipolar disorder, types, bio theories
- Bipolar disorders correspond to disorders where persons experience periods of depression coupled with periods of extreme euphoria (mania); including some euthymic periods.
Bipolar Disorders
- Bipolar I: one or more manic episodes with a major depressive occurrence
- Bipolar II: periods of major depression accompanied by at least one incidence of hypomania (no psychotic features)
- Milder form: Cyclothymic disorder (no overt mania, no profound depression)
bio theroies
- Hypothalamic-pituitary-thyroid-adrenal (HPTA) axis – and role with neurotransmitters (NE, dopamine and serotonin)
- Runs in families (7% incidence in families)
bipolar therapeutic managment
lithium, carbapezapine, Lamotirgine, valproic acid
lithium carbonate
- Onset 10-21 days (acute phase = LiCO3 supplemented with antipsychotics, antianxiety, and anticonvulsants)
Narrow therapeutic level (~0.6-1.2 mEq/L)
- toxicity at 1.5 and above – importance of monitoring through blood work
Symptoms of toxicity
- N/V, diarrhea, cardiac arrhythmias, blackouts, tremors, seizures.
Carbamazepine
- Combination with antipsychotic / patients who are aggressive / psychotic
- Liver function
Lamotrigine
- Deadly S/E: Stevens-Johnson syndrome - rash
Valproic acid / divalproex sodium
- drowsiness, dizziness, increase suicidal ideations
- Therapeutic range : 50 – 150 mcg/ml
- Liver function
prioritiation of nsg care
acute, continuation, maintenance
Acute phase
- Medical stabilization
- Maintaining safety
- Self-care needs
Continuation phase
- Maintain medication adherence
- Psychoeducational teaching
- Referrals
Maintenance phase
- Prevent relapse
difference between eating and feeding disorders
Eating disorders are not really about food, but rather a socially acceptable coping mechanism gone wrong
Feeding disorders actually are more often the direct result of food preferences or perceived intolerances.
etiology of eating disorders
- Genetics
- Personality
- Puberty
- Social and cultural factors
- Coping style
- Life stressors
- Family factors
- Epigenetics
anorexia
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. (Severity of AN is based on BMI).
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way one’s body weight or shape is experienced
- influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Subtypes:
- Restricting type (AN-R);
- Binge-eating/purging type (AN-P)
AN medical care, nutritional/ pharmacological, psycotherapy
- Immediate medical stabilization is required if a client has extreme electrolyte imbalances or is below 85% of their ideal weight
- Inpatient medical management required (nutrition therapy) due to refeeding syndrome
- Suicidal ideations (difficulty in establishing a therapeutic relationship)
Pharmacological/Nutritional
- SSRIs are helpful in reducing obsessive-compulsive behavior
- Antipsychotics (chlorpromazine) : delusional or psychomotor agitation
- Atypical antipsychotics (olanzapine): mood & obsessive behaviours
- Food, NG feeds, supplements, etc.
Psychotherapy
CBT: Resolve cognitive distortions
refeeding syndrome
- Caused by rapid refeeding following a long period of fasting (from catabolism to anabolism)
- Usually presents in first four days, but can present up to two weeks
- Symptoms: respiratory depression, hypertension seizures, arrhythmias, heart failure, coma, death
Hypophosphatemia
hypomagnesemia
hypokalemia
thiamine deficiency
water retention → edema
Bulimia Nervosa
- Recurrent episodes of binge eating and recurrent inappropriate compensatory behaviour to prevent weight gain
- Frequency of compensatory behaviours used to specify the level of severity for BN.
- Binge: eating in a discrete amount of time (within 2 hours) an amount that is definitely larger than most would during a similar period of time and under similar circumstances
- Compensatory behaviour: such as self-induced vomiting, misuse of laxatives, diuretics, or other meds, fasting or excessive exercise
BN physical, psyc, pharm
Physical
- Dental erosion & caries
- Changes in pulse/blood pressure
- Electrolyte disturbance
- Dehydration
- Reduces chewing ability
- Esophageal tears
- Abdominal pain
Psychological
- History of anorexia nervosa
- Signs and symptoms of depression and anxiety
- Use of substances
pharm
- antidepressants
Binge Eating Disorder (BED)
- Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances
- Episodes marked by feelings of lack of control
- Behaviour occurs at least once/wk over 3 months
- Frequency of episodes used to specify severity
must include 3 of the following:
Eating very quickly.
Eating regardless of hunger cues.
Eating until uncomfortably/painfully full.
Eating alone due to embarrassment.
Feelings of self-disgust, guilt or depression.
Avoidant/Restrictive Food Intake Disorder (ARFID)
avoidant restrictive food intake disorder
how does it manifest
- Restrictive/inadequate eating not due to medical or psychiatric co-morbidity and not attributed to disturbances in the perception of shape and weight
Three common clinical presentations to ARFID
- Lack interest in food or a blunted response to physiological hunger
- Avoidance of eating d/t dislike of smell, taste, texture, temp, or appearance of food; will only eat a narrow range of foods
- Restricting intake as reaction to an upsetting event such as choking
Manifestations:
- Significant weight loss or lack of appropriate weight gain
- Significant nutritional deficiency (ex. anemia)
- Dependence on nutritional supplements
- Marked interference with psychosocial and/or physical functioning
Pica
- Persistent eating of nonnutritive substances for at least one month
- Behaviour is inappropriate to developmental level
- Behaviour is not a part of a culturally sanctioned practice
- May cause intestinal damage, blockage or laceration
