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Psych - Test 2 > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Depression

A
  • Anger turned inward
  • Cognitive distortions
  • Reaction to distressing experiences
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2
Q

Mania

A

-Defense against depression

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3
Q 
S
I
G
E
C
A
P
S
A
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor retardation
  • Suicidality
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4
Q

What will resolution of Symptoms look like?

A

No complaint of SIGECAPS

  • insomnia resolved
  • appetite improved
  • regular bowel movements
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5
Q

Mood Disorder - Treatment Modalities

Cognitive Behavior Therapy (CBT)

A

Cognitive Behavior Therapy (CBT)

  • Focus on distorted thoughts
    • thoughts influence feelings, behavior, functioning
  • Improve social skills
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6
Q

How does CBT work?

A

Persistent negative thought identified

  • Negative thought is challenged
  • Work to re-frame idea
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7
Q

Mood Disorders - Nursing Diagnoses (2)

A

Altered sensory perception
-HALLUCINATIONS

Altered thought processes
-DELUSIONS

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8
Q 
Nursing Interventions - Depression
Safety needs (2)
A

Safety

  • 15-30 minute checks
  • Monitor for dangerous items (sharps)
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9
Q 
Nursing Interventions - Depression
Activity needs (4)
A
  • Promote some type of movement
  • Monitor for psychomotor retardation
  • Require more time to complete activities
  • Promote socialization
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10
Q

Severe mania

A

> 2 weeks

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11
Q

Hypomania

A

Up to 4 days

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12
Q 
Bipolar Disorder - 
D
I
G
F
A
S
T
A 
Distractibility
Irritability
Grandiosity
Flight of ideas
Activity (increase) - (constant)
Sleep (decrease)
Talkative
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13
Q

Bipolar Disorder - What does it look like?

A 
Disruptive
Invasive
Hypermotor agitation
Flight of ideas
Pressured speech
Illogical thinking
Rapid Fire demands
Confrontational
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14
Q

Bipolar Disorder - Nursing interventions

Safety (5)

A
  • Decreased stimulation
  • Shelter from embarrassment
  • Intervene with “acting out” early on
  • Frequent checks
  • Stay calm
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15
Q

Bipolar Disorder - B52 Injection

A

Benadryl - 100
Haldol - 5-10
Atavan - 2

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16
Q

Least Invasive Intervention…

A

FIRST

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17
Q

Mood Disorders - SAD Treatment (3)

A

Full spectrum lights
Expose to light for 1/2-2 hours per day
Response in 1-4 days

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18
Q 
Mood disorders - Suicide Assessment 
S
A
D
P
E
R
S
O
N
S
A

Sex (male) 1
Age (45) 1
Depression or Hopelessness 2
Previous suicide attempts or psych care 1
Excessive alcohol or drug use 1
Rational thinking loss 2
Separated, divorced or widowed 1
Organized or serious attempt 2
No social supports 1
Stated future intent 2

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19
Q

Who is the priority?

A

A client pacing the hall and experiencing irritability and Flight of ideas

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20
Q

Pharmacology for …

A

Mood Disorders :)

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21
Q

Luvox is used for

A

OCD

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22
Q

Indications for anti-depressants -

A

Caution use with Bipolar

-May cause manic symptoms

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23
Q 
When switching to a 1st generation (i.e.: Nardil) to a
second generation (i.e.: Prozac) there must be a
A

Washout Period

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24
Q

2nd Generation Anti-Depressants

A
  • Usually first choice

- SSRIs

25
Q

Serotonin Reuptake Inhibitor (SSRI)

A

FIRST CHOICE

  • decreased side effects
  • decreased lethal potential
26
Q

Serotonin Reuptake Inhibitor (SSRI)

Details

A
  • Absorption: GI
  • Metabolism: Liver
  • Blocks reuptake of Serotonin at pre-synaptic neuron
  • Peaks 4-6 hr
  • Long half life = once daily dosing

*When treating depression - Usually takes 4 weeks to take effect**

27
Q

Serotonin Reuptake Inhibitor (SSRI)

Names

A
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Luvox (Fluvoxamine)
  • Paxil (paroxetine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Viibryd (vilazodone)
28
Q

Side Effects of Antidepressants -

Anticholinergic Side Effects

A
  • Can’t see
  • Can’t pee
  • Can’t spit
  • Can’t shit
29
Q

Serotonin Syndrome

A
  • Rapid increase in serotonin
  • Too much too fast
  • Begins hours to days after initial dose
  • Potentially lethal
30
Q

Serotonin Syndrome Signs and Symptoms

A

Autonomic instability

  • increased pulse
  • increased BP
  • increased temp
31
Q

Serotonin Syndrome Signs and Symptoms

A
  • Sweating
  • Shivering
  • Change in mental Status
  • Anxiety restlessness
  • Tremors
  • Muscular spasms
  • Decreased coordination
32
Q

Serotonin Syndrome Treatment

A
  • Supportive treatment
  • Antipyretics
  • Cooling measures
  • Temporary withdrawal of drug
  • Antianxiety medication
    • Valium – Spasms
    • Ativan - Restlessness
33
Q

Starting/Stopping Antidepressants

A

Taper to start or stop

  • *Never discontinue abruptly**
  • Nausea
  • Lightheaded
  • Dizzy
  • Fatigue
  • Flu-like symptoms
  • Paresthesia
34
Q

Tricyclics also require a

A

Washout Period

35
Q

Tricyclic Side Effects

A

Start low and Go slow

  • Anticholinergic SE’s can be severe
  • Do not use with glaucoma
  • Cardiac arrhythmias
    • *Baseline EKG**
36
Q

MAOI’s

A
  • Nardil (phenelzine)
  • Parnate (tranylcypromine)

Both have dietary restrictions

**If switching to or from an MAOI to or from
an SSRI (i.e.: Prozac) there must be a
washout period**
37
Q

Emsam patch (selequiline)

A
  • Bypasses liver and gut
  • Goes directly into cells
  • No dietary restrictions 6mg or less
38
Q

MAOI Side Effects

A
  • Peripheral edema
  • Muscle Weakness
  • Forgetfulness
  • Hypertensive Crisis
39
Q

MAOI Hypertensive Crisis

A 
Monoamine oxidase (MAO) metabolizes
(breaks down) neurotransmitters
  • Seratonin
  • Norepinephrine
  • Tyramine

“Worst headache of my life!”

40
Q

MAOI Hypertensive Crisis

A

MAOI = Inhibit the breakdown of the
neurotransmitters

Vasoconstrictors build up

Increased vasoconstrictors =
hypertensive crisis

41
Q

MAOI Hypertensive Crisis - Symptoms

A
  • Headache
  • Tachycardia
  • Flushed & Clammy
  • Chest pain
  • Nosebleeds
  • Dilated Pupils
  • Coma
  • Death
42
Q

MAOI Hypertensive Crisis - Treatment

A
  • Procardia 10 mg p.o.
  • Rapid absorption
  • Decrease BP in 10-15”
  • Monitor q 15” until stable
43
Q

if you suspect a hypertensive crisis -

A
  • Hold med
  • Get VS
  • Call MD immediately
44
Q

MAOI Nursing Interventions

A

Drug Interactions:

  • All other Antidepressants
  • Buspar
  • Demerol
  • OTC allergy/cold meds
  • OTC diet meds
  • Stimulants
45
Q

MAOI Nursing Interventions

A

As Energy increases - Suicide Risk increases

  • Do not abruptly discontinue
  • No Alcohol
46
Q

A client is taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructed by the nurse to avoid which food and beverages?

A

Aged cheese and red wine

47
Q

Lithium

A

Fluid Intake Must Remain Steady!

  • HYPOVOLEMIC = INCREASED Lithium level
  • Diarrhea
  • Vomiting
  • Perspiring

HYPERVOLEMIC = DECREASED Lithium level
-Increased fluid intake

48
Q

Lithium Toxicity

A

Potentially Toxic Level: 1.5 - 2.0 mEq/ml

  • Blurred vision
  • Ataxia (lack of voluntary coordination of muscle movements)
  • Tinnitus (ringing in ears)
  • Persistent nausea and vomiting
  • Severe diarrhea

Milder Side Effects
-Reversible 2-10 days after discontinuing med

49
Q

Lithium Therapeutic Range

A

.6 - 1.2

.6 is sub-therapeutic
1.2 is potentially toxic

50
Q

Lithium Workup

A
  • Pregnancy Test
  • Thyroid Function
  • Kidney Function
  • EKG

Know BASELINE!

51
Q

FATAL Lithium Toxicity -

A

Above 3.5 mEq/ml

Sx-

  • Impaired consciousness
  • Nystagmus ( fast, uncontrollable movements of the eyes)
  • Seizures
  • Coma
  • Oliguria/anuria
  • Arrhythmias
  • MI
  • Cardiovascular Collapse
52
Q

Lithium Toxicity - 2.0 - 3.5 mEq/ml

A

2.0 - 3.5 mEq/ml

Excessive output of dilute urine

  • COARSE tremors
  • Muscular irritability
  • Psychomotor retardation
  • Mental confusion
  • Giddiness
53
Q

Do NOT use Lithium with

A
  • Cardiac Conditions

- Kidney Conditions

54
Q

Mood Stabilizers -

Anti-convulsants

A
  • Rapid cyclers (at least 4x / year)

- Clients with Renal or Cardiac Problems

55
Q

Anticonvulsants Lamictal Side Effects

A

Steven Johnson Syndrome

Teach to watch for:

  • Itching
  • Moist, red palms
  • Skin and oral mucosa sores
56
Q

Anticonvulsants Nursing Interventions

A

Teaching

  • Desired Effects
  • Side Effects & how to control
  • Need for regular lab work
  • Do not abruptly stop
  • Do not double-up on missed doses
  • No alcohol
57
Q

A client with bipolar disorder who is taking lithium carbonate is instructed by the nurse on proper use of the drug, side effect and symptoms of lithium toxicity.What statement but the client indicates “additional teaching” is required?

A

When my moods fluctuate, I will increase my Lithium.

58
Q

In a diabetic client - Monitor:

A

Blood Glucose

Continue insulin as always

Psych - Test 2 (4 decks)

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