Mood and Affect Flashcards
what is mood
the sustained emotional theme that influcences behaviors and perception
it is subjective
what is affect
outward expression of internal experience
what we observe
what is euthymia
normal healthy fluctuations in mood
what determines severity of mood spectrum disorder
degree of loss of functional status
what are unstable affective states
crying
rage
euphoria
screaming
blunting
what can happen in severe mania/severe melancholy
disabled
acute confusion
hallucinations/delusions
optimal fxn of mood regulatio requires….
coordination and balance of neurons, neurotransmiters, and several parts of the brain
dopamine, norepi, and serotonin regulate
Appetite
Sleep
Thought
Emotion
Learning
Mood
Memory
Motivation
Concentration
how many hours of sleep
6-8
mood regulation in infants
Emotion (smiles, frown, crying) is regulated by the degree of physical comfort and by cues from adults
mood regulation in toddlers
Able to recognize the emotions of others and mimic behaviors. Hugging others in attempt to sooth others in distress
mood regulation in preschool
Observing parents and caregivers, expectations
on how to behave
mood regulation of childhood
Express feelings of sadness or anger to parent more than peers. Understand different emotional states
mood regulation in adolescents
developed skills to regulated emtions (talking w/ parent/friend/coach, listening to music, journal etc)
aware of social circumstances r/t emotional regulation
ex not socially acceptable to throw a tantrum or outburst
more variability in mood state than adults (hormone imbalance or developing emotional regulation)
mood regulation in older adults
Mood regulation is overall consistent
Despite physical and cognitive decline, they report
higher levels of well being than younger adults
Use emotional regulation processes to
compensate for negative stimuli
mood regulation in elderly
Bereavement overload
Increased risk of suicides among elderly
Symptoms of depression often confused with symptoms of neurocognitive disorder (e.g., dementia vs pseudodementia)
what happens when mood cycle is below euthymic range
melancholy (depression)
which gender becomes more depressed
women
where are there higher rates of depression
older adults in nursing or assisted living facilities and those with acute and chronic conditions
etiology on mood and affect disorders
Genetics (twin and adoption studies)
Neurochemical dysfunction (deficiency of norepinephrine, serotonin, and dopamine
has been implicated & excessive cholinergic transmission may also be a factor)
Low birth weight
Early life adversity (ACEs)
Stressful life events
Social factors
Psychological factors (learned helplessness, object loss theory)
Physiological causes (electrolyte disturbances, hormonal disorders, nutritional
deficiencies)
Secondary depression from general medical disorders
Secondary depression from medications (anticholinergics, anticonvulsants,
antihypertensives, antiparkinsonian agents, etc.)
depressive symptoms
Depressed mood
Anhedonia
Change in appetite/weight (high or
low)
Sleep disturbance (high or low)
Fatigue or loss of energy
Neurocognitive dysfunction
Psychomotor agitation or retardation
Feelings of worthlessness or
excessive guilt
Suicidal ideation and/or behavior
what is anhedonia
Loss of pleasure in
interests or activities
neurocognitive dysfxn symptoms
Attention
Concentration
Cognitive flexibility
Executive function
Information processing
speed
Memory
Verbal fluency
Social cognition
what is PHQ-9
patient health questionaire
what is transient depression
life’s everyday disappointments
what is mild depression
normal grief response
what is moderate depression
dysthymia
long lasting
also called persistent depressive disorder
feelings of sadness and emptiness, loss of interest in life
what is severe depression
major depressive disorder
how many symptoms to be diagnosed with depression
5 or more
MDD core symptoms
Sad, irritable or anxious mood
Anhedonia
Impaired concentration and decision
making
Worthlessness and inappropriate guilt
Hopelessness
Fatigue or loss of energy
what is the duration of MDD
> = 2 wks
what does MDD cause
impairment in social and/or occupational fxning
subtypes of MDD
melancholic depression, anxious
depression, atypical depression, psychotic
depression, seasonal depression
adolescent presentation of MDD
est clue that differentiates depression
from normal adolescent behavior: a
visible manifestation of behavioral
change that lasts for several weeks*
Anger, aggressiveness
Running away
Delinquency
Social withdrawal
Sexual acting out
Substance abuse
Restlessness, apathy
what is the 2nd leading cause of death in adolescents
suicide
if SI is present what do you ask
nature of the ideation, intent, plans, available means (e.g., firearms), and actions
prior hx of suicide attempts, comorbid psychiatric and general medical illnesses, and family history of suicide
what is a saftey plan
therapeutic communication, use of soothing or distracting coping skills, and one-to-one monitoring
what are SSRIS
Selectively block reuptake of the neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin
first line for depression
increase energy
side effects of ssris
n/v
headache
wt loss or gain
sexual dysfunction
interactions which ssris
increased risk for bleeding with asprin, NSAIDS, warfarin
other SSRIs
citlopram
esitalopram
fluoxetine
proxetine
sertraline
what are SNRIs
selective norepi and serotonin reuptake inhibitors
selectively block reuptake of norepinephrine and serotonin in the
synaptic space, thereby intensifying the effects of both these NTs.
Common agents for depression
Adverse effects are usually mild and go away after the first few weeks of
treatment. Take with food to avoid nausea
adverse effects of SNRIs
Nausea, sweating, insomnia, tremors, sexual dysfunction
SNRIs
desvenlafaxine
duloxetine
levomilnacipran
venlafaxine
what are atypical antidepressants
change the levels of one or more neurotransmitters, dopamine, serotonin
or norepinephrine
Because atypicals work in different ways, each has their own characteristics and different possible side effects
ex of atypical antidepressants
bupropian
mirtazapine
nefazodnoe
trazodone
vilazodone
vortioxetine
what is bupropion
Low risk of sexual side effects and weight gain, can increase anxiety, lowers seizure threshold, contraindicated with hx of head injury, seizure, or eating disorder
what is mirtazapine
Increases appetite, can be beneficial for elderly or those with poor intake, Adverse effects: weight gain, fatigue, elevated cholesterol
what is trazodone
Used in combination with SSRI to treat insomnia, side effects
of sedation and rare priapism (prolonged erection of penis)
adverse effects of TCAs
Anticholinergic effects
Orthostatic hypotension
Sedation
Cardiac arrhythmias, tachycardia
Lethal toxicity in OD
Excessive sweating
Increased appetite/weight gain
Sexual dysfunction
contraindications in TCAs
seizure disorder
CAD, diabetes, urinary retention
Highly toxic, assess OD risk, may increase suicide risk
examples of TCAS
Amitriptyline
Amoxapine
Desipramine (Norpramin)
Doxepin
Nortriptyline (Pamelor)
what are TCAs
Used to treat conditions other than depression, e.g. obsessive-compulsive
disorder, anxiety disorders, nerve-related (neuropathic) pain
Take at bedtime, causes sedation, amitriptyline, doxepin, imipramine, and
trimipramine
Cause weight gain, amitriptyline, doxepin, imipramine, and trimipramine
Nortriptyline and desipramine are tolerated better than other TCAs
what are monoamine oxidase inhibitors
Increase norepinephrine, dopamine, and serotonin in brain
Risk for hypertensive crisis; must avoid tyramine in diet
Orthostatic hypotension
Required 14-day “washout” period if switching meds
interactions with MAOIs
SSRIs
TCAs
OTC decongestants, etc.
Antihypertensives
Amphetamines, caffeine
HF, CVD, renal disease, pheochromocytoma (tumor on adrenal gland, irregular secretion of epinephrine and norepinephrine – increases bp,
palpitations, and HA)
examples of MAOis
isocarboxazid
phenelzine
selegiline
tranylcypromine
what is serotonin syndrome
rare
Most often occurs when 2 medication that raise the level of serotonin are
combined
Other antidepressants
Some pain or headache medications
Herbal supplement, St. John’s wort
s/s of serotonin syndrome
Anxiety
Agitation
High fever
Sweating
Confusion
Tremors
Restlessness
Lack of coordination
Major changes in BP
Tachycardia
Pupil Dilation
nonpharm treatments
Electroconvulsive therapy (ECT)
Light therapy
Tanscranial magnetic stimulation (TMS)
Vagal nerve stimulation
Deep brain stimulation
Peer support
Exercise
Complementary medicine: St. John’s Wort
-Not regulated by FDA
-Photosensitivity
-Risk for serotonin syndrome if taken with Rx agents
mechanism of action with ECT
Thought to increase levels of biogenic amines (i.e., neurotransmitters)
side effects of ECT
temp memory loss and confusion
risks of ECT
mortality
permanent memory loss
post procedure ECT
monitor ABCs and vitals
recovery period of ECT
rest, quiet environment, falls prevention
