Module 2 Flashcards
1
Q
mood (average affect and activity
A
euthymic
2
Q
Mood disorders are the most common psychiatric diagnoses associated with suicide; …
A
depression is one of the most important risk factors for suicide.
3
Q
CATEGORIES OF MOOD DISORDERS
A
major depressive disorder and bipolar disorder (formerly called manic-depressive illness)
(Book)
4
Q
one or more manic or mixed episodes usually accompanied by major depressive episodes
A
Bipolar 1 disorder
5
Q
one or more major depressive episodes accompanied by at least one hypomanic episode
A
Bipolar 2 disorder
6
Q
is a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable.
A
Mania
7
Q
Other disorders classified with similarities to mood disorders include:
A
•Persistent depressive (dysthymic) disorder
•Disruptive mood dysregulation disorder
•Cyclothymic disorder
•Substance-induced depressive or bipolar disorder
•Seasonal affective disorder (SAD)
•Postpartum or “maternity” blues
•Postpartum depression
•Postpartum psychosis
•Premenstrual dysphoric disorder
•Nonsuicidal self-injury
8
Q
is the most common complication of pregnancy in developed countries. The symptoms are consistent with those of depression (described previously), with onset within 4 weeks of delivery.
A
Postpartum depression
9
Q
has two subtypes. In one, most commonly called winter depression or fall-onset, people experience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities beginning in late autumn and abating in spring and summer. The other subtype, called spring-onset, is less common, with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall. Often treated with light therapy.
A
SAD Seasonal Affective Disorder
10
Q
This has many roles in behavior: mood, activity, aggressiveness and irritability, cognition, pain, biorhythms, and neuroendocrine processes (i.e., growth hormone, cortisol, and prolactin levels are abnormal in depression).
A
Serotonin
11
Q
This may be deficient in depression and increased in mania
A
Norepinephrine levels
12
Q
Emotion focused strategies
A
Deep breathing, guided imagery, distractions, and progressive relaxation.
13
Q
Problem focused strategies
A
Role playing, learn problem solving methods, applying process to identify problems and solutions, improving social skills may help to build relationships.
14
Q
How long does a major depressive episode last?
A
At least 2weeks
15
Q
Onset of postpartum depression?
A
With in 4 keeks of delivery
16
Q
S/S of child with depression
A
Cranky, school, phobia, hyper, active, learning disorders, failing, grades, and antisocial behaviors
17
Q
S/S of Adolescent w/ depression.
A
Abuse of substances, joining a game, risky behavior, underachiever, and dropping out of school.
18
Q
S/S adult depression
A
Substance abuse, eating disorder, compulsive behaviors (workaholic, gambling, and hypochondriac) Cranky and argumentative.
19
Q
What are the major categories of antidepressants?
A
Cyclic antidepressants, monoamine, oxidase, inhibitors(MaIO’s), Selective serotonin reuptake inhibitors(SSRI’s), And atypical antidepressants.
20
Q
What is the rule about discontinuing antidepressant therapy
A
They must be tapered
21
Q
What length of time is proven to show, fear, relapses, and depression, with antidepressant therapy?
A
18-24months
22
Q
Patients who do not respond to antidepressants I have bad side effects candidates for this type of treatment
A
Electroconvulsive therapy(ECT)
23
Q
What is considered the most effective treatment for depressive disorders, and both children and adults?
A
Psychotherapy
24
Q
This may underlie the cycling of mood disorders as well as addiction
A
Kindling
25
These are the oldest antidepressants used
Tricyclic -Because of their anticholinergic side effects, tricyclic antidepressants must be used cautiously in clients who have glaucoma, benign prostatic hypertrophy, urinary retention or obstruction, diabetes mellitus, hyperthyroidism, cardiovascular disease, renal impairment, or respiratory disorders
26
NURSING INTERVENTIONS
For Depression:
Provide for the safety of the client and others.
•Institute suicide precautions if indicated.
•Begin a therapeutic relationship by spending nondemanding time with the client.
•Promote completion of activities of daily living by assisting the client only as necessary.
•Establish adequate nutrition and hydration.
•Promote sleep and rest.
•Engage the client in activities.
•Encourage the client to verbalize and describe emotions.
•Work with the client to manage medications and side effects.
27
True or False we still have to asses mood when taking an antidepressant.
True
28
A salt contained in the body.
Lithium
29
This med stabilizes bipolar disorder by reducing the degree and frequency of cycling or eliminating manic episodes
Lithium
30
periods of euphoria, exuberant activity, grandiosity, and false sense of well-being
Mania
31
NURSING INTERVENTIONS
For Mania:
•Provide for the client’s physical safety and those around.
•Set limits on the client’s behavior when needed.
•Remind the client to respect distances between self and others.
•Use short, simple sentences to communicate.
•Clarify the meaning of the client’s communication.
•Frequently provide finger foods that are high in calories and protein.
•Promote rest and sleep.
•Protect the client’s dignity when inappropriate behavior occurs.
•Channel the client’s need for movement into socially acceptable motor activities.
32
What is not metabolized; rather, it is reabsorbed by the proximal tubule and excreted in the urine?
Lithium
33
When the physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration with which med
Lithium
34
This is an episode Of depression and loss of pleasure in nearly all activities, that lasts at least two weeks.
Major depressive disorder
35
Symptoms of major depressive disorder colon
Changes in eating habits, unplanned, weight loss, or gain, Colorado, hypersomnia, or insomnia, impaired concentration, impaired decision-making, impaired, problem-solving, abilities, and ability to cope with daily life, feelings of worthlessness, hopelessness, guilt, or despair, overwhelming for fatigue, and thoughts of death or suicide
36
What percentage of major depressive disorder, patients experience, delusions, or hallucinations combined with psychotic depression?
20%
37
A significant disturbance in mood that is a direct physiological consequence of ingested substances, such as alcohol, drugs, or toxins
Substance induced depressive, and bipolar disorder
38
This can occur in winter or spring
Seasonal affective disorder
39
Increased sleep, appetite, carb cravings, weight gain irritability.
Fall onset
40
Insomnia, weight loss, poor appetite
Spring onset
41
Mild predictable mood disturbance occurring in the first several days after delivery of a baby
Postpartum or maternity blues
42
Symptoms of postpartum/maternity blues:
Labile mood and affect, crying, spells, sadness, insomnia, anxiety
43
Most common complication of pregnancy in developed countries
Postpartum depression
44
Symptoms of postpartum depression:
Symptoms that are consistent with depression and the onset within four weeks of delivery
45
Severe/debilitating psychiatric illness with acute onset in days following childbirth
Postpartum psychosis
46
Symptoms of postpartum psychosis:
Fatigue, sadness, emotional liability, poor memory, confusion That progresses too delusions, hallucinations poor insight and judgment. This is a medical emergency and requires treatment.
47
Recurrent moderate, psychological and physical symptoms that occur during the week of menses and resolved with menstruation
Premenstrual dysphoric disorder
48
Symptoms of premenstrual, dysphoric disorder:
Labile mood, irritability, increased, interpersonal conflict, difficulty, concentrating, feeling, overwhelmed, or unable to cope, anxiety, tension, or hopelessness
49
Deliberate, intentional, cutting burning, scraping hitting, or interference with wound healing
Non-suicidal self injury
50
Describe: Genetic theory of Major depression
Patience with first-degree relative diagnosed with a major depressive disorder are twice as likely at developing a disorder than others in the population
51
What Neurochemically occurs in people with depression?
There is a deficit of serotonin tryptophan, Or a metabolite of serotonin.
There is also maybe a deficit in Norepinephrine.
There is a dis regulation of acetylcholine and dopamine that is believed to play a role in mood disorders
52
Theory of Neuroendocrine influences on major depression
Hormonal fluctuations (postpartum, or psychosis)
Endocrine d/o thyroid, adrenal, parathyroid, pituitary glands
53
Typically involves 2 weeks or more of a lack of interest in life activities
Major depression
54
Symptoms can vary from mild to severe many people have a single bout in a lifetime about 50 to 60% will have a reoccurrence later in life
Depression
55
Referred to as adjustment disorder
Situational depression
56
Treatment for limiting mild situational depression
Regular exercise, well, balanced, diet, regular, sleeping habits, communicating with friends, or loved ones, joining a support group, Participating in fun activities. Other treatments include meds and therapy.
57
The two neurotransmitters that are believed to be decreased in depression
Norepinephrine and serotonin
58
Types of antidepressants
SSRIs, cyclic, atypical, And MAOI’s
59
This medication produces less sedating, anticholinergic, and CV side effects.
SSRI
60
These are the oldest antidepressant, and should not be given to Liver or in MI patients. Cannot be given W/MAOIs
Cyclic antidepressants
61
Which antidepressant or do you use cautiously and clients with glaucoma BPH, urinary retention DMCV, hypothyroidism, renal impairment, and respiratory disorders?
Cyclic antidepressants
62
These are given when a patient has an inadequate response or has side effects from SSRIs
A typical anti-depressants
Such as bupropion, duloxetine, and venlafaxine
63
This is also used in Parkinson’s disease
MAOIs
64
This antidepressant requires diet restriction includes monitoring of blood, pressure and other medication’s
MAOIs
Isocarboxazid
65
What is the major WARNING sign when taking antidepressants?
Increased activity improved mood from years of anti-depressants can provide energy for suicidal clients to carry out plans to kill themselves. Must assess the client for suicidal ideation, even when states they feel better after being on man’s.
66
This is a medical treatment reserved for patients who do not respond to antidepressants, or cannot tolerate the side effects.
ECT
67
Name the types of psychotherapy?
Interpersonal therapy(relationships), behavioral therapy(improve social skills), cognitive therapy(how a person thinks about themselves and others)
68
This medical treatment is used for major depression and clients resistant to treatment this is a investigational treatment
TMS (Trans Magnetic stimulation)
69
Anhedonia
Loss of sense of pleasure from activities they formerly enjoyed.
70
Repeatedly going over thoughts
Ruminate
71
Name scales used to write and evaluate depression
Hamilton rating scale, Zhang self rating depression scale, Beck depression inventory
72
What is recommended in therapeutic communication for depression?
Avoid asking yes or no questions try to use open ended questions when attempting to gain information
73
This is the ability to express positive and negative ideas and feelings in an open honest and direct way
Assertive communication
74
List types of nonverbal communication:
Are usually expression, body language, vocal cues, eye, contact, and silence
75
Depression coping strategies
Progressive, relaxation, deep, breathing, guided, imagery, and distractions.
76
Social skills to encourage with depressed patients
Encourage eye contact when speaking, attentive, listening, taking turns with talking, practice empathy, being mindful of body language, verbal and nonverbal. Communication went around others, staying calm, sharing, being kind, respectfulness.
77
This disorder involves extreme mood, swings from mania to depression, moods may last for weeks, pattern of behavior, decisions and ascends.
Bipolar disorder
78
A distinct. During which mood is abnormally or persistently, elevated, expensive, or irritable. This period of time last for one week or more for some individuals.
Mania
79
A period of time where symptoms are not as severe as mania, but the person may have three or more symptoms of bipolar
Hypomania
80
Symptoms of bipolar:
Abnormally, upbeat, jumpy, or wired.
Increase activity, energy or agitation.
Exaggerated sense of well-being and self-confidence(euphoria)
Decreased need for sleep.
Unusual talkativeness.
Racing thoughts.
Distractibility.
Poor decision, making financially or sexually.
81
What would be a purpose for a bipolar patient to stop taking your meds?
Some clients like the way they feel when they are manic they have more energy.
82
Bipolar diagnosis requires a lifetime medication regimen using either:
•Anti-manic agent or lithium
•Anticonvulsant medication
83
Disordered thinking, including delusions, hallucinations, and illusions can occur During an acute stage of mania or depression, patients may be prescribed.
An antipsychotic agent
84
List the maintenance level treatment level and toxic level for lithium
Maintenance level .5 to 1.
Treatment level is .8 to 1.5.
Toxicity level is 1.5+.
85
What is lithium?
It’s a salt… A trace element found in the body. It affects calcium, potassium, magnesium ions glucose metabolism. It is potentially fatal an overdose.
86
This medication is used for a diagnosis of bipolar, panic disorder, seizures
Clonazepam
87
What we need to be monitored when taking the drug carbamazepine?
Drug serum levels, white blood, count, monitor, hypertension, skin, and ability to walk
88
Is it true that Clonazepam is given as a single drug treatment
False, clonazepam cannot be taken alone with a bipolar disorder.
89
This medication is considered an antipsychotic med. The disease is an adjunct other mood stabilizers
Aripiprazole
90
List, three anticonvulsant drugs:
Carbamazepine, Divalproex, And Gabapentin
91
Combined with medication, this therapy can reduce risk of suicide and injury, provide support for client and family, and help client to accept diagnosis and treatment plan.
Psychotherapy
92
If a patient drinks too much water or eats too much salt or are they at risk of where lithium is concerned
Low Lithium levels
93
What Can happen to lithium levels of a patient becomes dehydrated?
Lithium levels can become too high
94
This is the second leading cause of death among 15 to 24-year-old
Suicide
95
What ages is suicide increasing most rapidly among?
45 to 65-year-old
96
This is when a person thanks about, and six ways to commit suicide
Active suicidal ideation
97
The patient is thinking about wanting to die or wishes here she were dead that has no plans to cause his or her self harm
Passive, suicidal ideation
98
What time of year do my suicides occur and why?
Spring, because increased sunlight, and an increase in natural energy is believed to help patients follow through with suicide
99
What questions are involved in a Lethality assessment?
Does the client have a plan? If so, what is it and is the plan specific, are the means available to carry out this plan, if the client carries out the plan, is it likely to be lethal, As the client made preparation for death, where and when.
100
Ethnicities with the highest risks of suicide
American Indians, Alaskan natives, and non-Hispanic whites
101
Having a baseline, cognitive impairment, older age & certain medication, Progressive severity of illness are respecters of what cognitive disorder?
Delirium
102
Describe the difference between onset in children and older adults with delirium
Delirium and children comes on fast with a high fever.
Delirium in older adults comes on over hours to days.
103
True or false delirium can be prevented?
True
104
What is the ability to process retain and use information?
Cognition
105
Common causes of delirium
Physiologic/metabolic, infection, or drug related
106
Give examples of physiologic/metabolic causes of delirium
Hypoxemia, electrolyte, imbalance, hypo/hyperglycemia, dehydration, insomnia, head injury, Renal/hepatic failure, brain tumor
107
Give examples of the two types of infections that can cause delirium
Systemic- Sepsis, UTI, pneumonia
Cerebral – meningitis, encephalitis, HIV, syphilis
108
Treatment for delirium And examples
Determine the underlying cause, and then treat.
Deescalate before medicating, using IV fluids, nutrition, or supervision to prevent injury
109
This is a mental disorder involving multiple cognitive deficits, including memory impairment
Dementia
110
Deterioration of language function
Aphasia
111
Impaired motor function
Apraxia
112
Inability to recognize or name objects
Agnosia
113
In ability to think abstractly
Executive functioning
114
Compare delirium in dementia
Delirium: rapid onset, brief duration , LOC impaired/fluctuates, short term memory impairment, speech may be slurred/rambling/irrelevant, temporarily disorganized.
Dementia: gradual onset, progressive Duration, LOC, unaffected, short & then long-term memory impairment, Speech is normal in early stages, and impaired thinking/eventual loss of thinking ability
115
What is the Hallmark sign for Mild dementia?
Forgetfulness
116
What is a moderate clinical sign of dementia?
Confusion along with progressive memory loss
117
A severe sign of dementia
Personality and emotional changes
118
What is the lifespan after a diagnosis of Alzheimer’s?
10 years
119
What is another name for mad cow disease?
Kreutzfeldt – Jakob disease
120
Name a cognitive disease that is hereditary and causes cerebral atrophy
Huntington’s disease
121
Prognosis for dementia
It’s a progressive deterioration of physical and mental abilities until death
122
List populations, ethnicities, and sexes that are at higher risk for Alzheimer’s
African-American, Hispanic Americans, lower education levels, lower socioeconomic status, and women.
123
Is Alzheimer’s a normal part of aging?
No
124
What are the likely causes of Alzheimer’s?
Genetics and environmental factors.
125
What is the most definitive way to diagnose Alzheimer’s?
Autopsy
126
Pathophysiology of Alzheimer’s
Amyloid plaques, Neurofibrillary tangles, loss of connection between neurons, and neuron death
127
What is moderate manifestations of Alzheimer’s?
Personal hygiene is affected, loss of ability to concentrate, agitation & aggression
128
Severe manifestations of Alzheimer’s
Loss of medication, dependent on others, bedridden, and Brainstem death
129
A process by which degenerative mechanisms in dementia, reverse those of normal human development
Retrogenesis theory
130
Mild Stage of Alzheimer’s, developmental age
8yo -adulthood
131
Severe stage of Alzheimer’s, developmental age
1mo-15mo
132
These are twisted fibers of proteins found within neurons
Neurofibrillary tangles
133
Diagnostic studies for Alzheimer’s
CT, MRI, PET
134
This is used to differentiate Alzheimer’s disease from other types of dementia
PET scan
135
What cognitive assessments is used to determine Alzheimer’s?
Mini-cognitive test & Mini-mental state exam
136
What is a mini-cognitive exam?
Give the patient three words that you will have them repeat back to you and draw the face of a clock
137
What is a mini-mental state examination?
Sing the alphabet backwards or counting only even numbers
138
What is observed in an assessment for Alzheimer’s?
Patient history, general appearance, motor behavior, mood, affect, thought process, content, sensorium, intellectual processes, judgment, inside, rolls, responsibilities
139
What exam access is cognitive abilities, such as memory, concentration and abstract processing
MMSE
140
Medication is given for Alzheimer’s
Cholinesterase inhibitors, NMDA, SSRIs, atypical, antidepressants, and antipsychotics
141
List some antipsychotic meds
Haloperidol, risperidone, and olanzapine
142
Why are antipsychotics given?
To manage delusions, hallucinations, paranoia, agitation, or aggression
143
Which medication given, for Alzheimer’s is to slow the progression in moderate to severestages? Example.
NMDA receptor antagonist
(Memantine)
144
Lester drag given to slow the progress of dementia
Donepezil And rivastigmine
145
List two types of medication that can cause/worsen delirium
Benzodiazepines and antidepressants
