Mood disorders Flashcards
- Tricyclics
- Selective Serotonin Reuptake Inhibitors
- Monoamine Oxidase Inhibitors
Antidepressants
Increase the concentration of norepinephrine, serotonin, and/or dopamine in the body - blocking the reuptake of those neurotransmitters ; also occurs when enzyme - monoamine oxidase (MAO) is inhibited at various sites in the nervous system.
Antidepressants - action
Inactivate norepinephrine , serotonin and dopamine
MAO function
Amitriptyline (Elavil)
Tricyclic antidepressant (TCA)
Doxepin ( Tofranil)
Tricyclic antidepressant (TCA)
- Blurred vision
- Constipation
- Urinary retention
- Orthostatic hypotension
- Reduction of seizure threshold
- Tachycardia , arrhytmias
- Photosensitivity
- Weight gain
side effects of Tricyclic antidepressant (TCA)
Citalopram ( Celexa )
Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants
Fluoxetine ( Prozac)
SSRI antidepressants
Paroxentine ( Paxil )
SSRI antidepressants
Sertaline ( Zoloft )
SSRI antidepressants
Escitalopram ( Lexapro )
SSRI antidepressants
- Insomnia, agitation
- Headache ( analgesics )
- Sexual dysfunction
- Serotonin syndrome
side effects of SSRI antidepressants
- Take dose early in the day
- Avoid caffeine
- Relaxation before bed
Insomnia interventions
- Changes in mental status
- Restlessness
- Hyperreflexia
- Myoclonus (muscle twitching )
- Tachycardia, labile BP
- Diaphoresis, shivering, tremors.
Serotonin syndrome
Cyproheptadine
antihistaminic and antiserotonergic agent; treat symptoms of serotonin syndrome
Phenelzine ( Nardil )
MAOI antidepressant
Tranylcypromine sulfate ( Parnate )
MAOI antidepressant
- Hypertensive crisis
- Weight gain
- Changes in cardiac rhythm
- Hypotension
- Sedation
- Insomnia
side effects of MAOI antidepressants
Occurs if the individual consumes foods containing tyramine while receiving MAOI therapy
Hypertensive crisis
- Severe occipital headache
- Palpitations
- Nausea/vomiting
- Nuchal rigidity (neck stiffness )
- Fever, sweating
- Increase in BP, chest pain, coma
Hypertensive crisis
- Discontinue drug
- Monitor vital signs
- Short-acting antihypertensive medication
- External cooling methods to control hyperpyrexia
TX of hypertensive crisis
Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.
Do not consume while taking MAOIs
Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.
Do not consume while taking MAOIs
- Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
- The therapeutic effect may not bee seen for as long as 4 weeks
- Not drink alcohol - potentiate the effects of each other
Antidepressants - teaching
- Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
- The therapeutic effect may not bee seen for as long as 4 weeks
- Not drink alcohol - potentiate the effects of each other
Antidepressants - teaching
Avoid smoking - it is increases the metabolism of tricyclics
Tricyclic antidepressants - teaching
Avoid smoking - it is increases the metabolism of tricyclics
Tricyclic antidepressants - teaching
5 symptoms have been present during the same 2 -weeks period ; at least one of the symptoms is either - depressed mood or loss of interest or pleasure
Diagnostic criteria for major depressive disorder
- Depressed mood
- Loss of interest or pleasure
- Weight loss / gain
- Insomnia / hypersomnia
- Fatigue/ loss of energy
- Feelings worthlessness / excessive guilt
- Recurrent thoughts of death
Symptoms of major depression disorder
Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy
Bipolar disorders
Lasting one week ( or more if hospitalization is necessary )
- Grandiosity
- Decreased need for sleep
- Talkative
- Racing thoughts
- Distractibility
- Increase in goal-directed activity
- Involvement in pleasurable activities - painful consequences
Diagnostic criteria for manic episode
- Hippocampus
- Amygdala
- Hypothalamus
- Frontal cortex
- Cerebellum
Areas of the brain affected - major depression
memory impairments, feeling of worthlessness , hopelessness and guilt
Hippocampus
anhedonia (no pleasure) , anxiety, reduced motivation
Amygdala
Increased/ decreased sleep and appetite, decreased energy and libido
Hypothalamus
depressed mood, problem concentrating
Frontal cortex
psychomotor retardation/agitation
Cerebellum
- Risk for suicide
- Complicated grieving
- Low-self esteem
- Powerlessness
- Spiritual distress
- Social isolation
- Disturbed though process
- Imbalanced nutrition
- Insomnia
- Self care deficit
Major Depression - nursing diagnoses
- Hypomania - cheerful, ideas of great worth, increased motor activity, inappropriate behaviors (calling President )
- Acute mania - “high” / anger; flight of ideas; hallucinations/delusions; poor impulse control ; days without sleep;
- Delirious mania - labile mood; extremely distractible ; delusions of grandeur or persecution ; purposeless movement .
Manic states
- Risk for injury
- Risk for violence: Self - Directed or Other-Directed
- Imbalanced nutrition less than body requirements
- Disturbed thought process
- Disturbed sensory perception
- Impaired social interaction
- Insomnia
Bipolar Mania - nursing diagnoses
- High protein, high calorie finger foods
- Juice and snacks on unit
- I&O, calorie count, daily weight
- Provide favorite foods
- Supplement with vitamins and minerals
- Sit with client during meals
Imbalanced nutrition interventions
The induction of a generalized seizure through the application of electrical current to the brain (6-12 treatments ; 3 times a week)
Electroconvulsive Therapy
- Major depression - after meds has proved ineffective
- Mania
- Schizophrenia - depression or mania symptoms
Indications for ECT
- Increased intracranial pressure (from brain tumor, cardiovascular accident, cerebrovascular lesion)
- Cardiovascular problems - at risk
- Severe osteoporosis
- Acute and chronic pulmonary disorders
- High-risk or complicated pregnancy
Contraindications - ECT
Most common:
- Temporary memory loss
- Confusion
Side-effects of ECT
2 per 100,000 treatments ; major cause - cardiovascular complications (usually in individuals with previously compromised cardiac status )
Mortality - ECT
- Ensure safety
- Manage client anxiety
- Provide education
- Administer Atropine - decrease secretion to prevent aspiration
Role of the nurse in ECT
- Short-acting anesthetic - thiopental sodium ;
- Muscle relaxant - succinylcholine chloride
- Pure oxygen - resp. muscles paralyzed
- Blood pressure cuff on the lower leg before muscle relaxant to observe seizure activity
- Electrodes placed (bilaterally or unilaterally) on the temples to deliver electrical stimulation
ECT - implementation
ECT is thought to effect a therapeutic response by …
increasing the levels of serotonin , norepinephrine , and dopamine
Lithium Carbonate
Antimanic -
- Drowsiness, dizziness, headache
- Dry mouth, thirst
- GI upset, nausea/vomiting
- Fine hand tremors (decrease dose, propranolol)
- Hypotension, arrhythmias, pulse irregularities
- Polyuria, dehydration
- Weight gain
Side effects of Lithium
The usual ranges of therapeutic serum concentration of Lithium are :
- 0-1.5 mEq/L - for acute mania
0. 6 - 1.2 mEq/L - for maintenance
Serum lithium should be monitored once or twice a week after initial treatment until stable ; then monthly during maintenance therapy
Lithium toxicity > 1.5
- Blurred vision, ataxia , tinnitus , N&V, diarrhea
- Excessive output of dilute urine , tremors, psychomotor retardation, mental confusion
- Coma, MI, cardiovascular collapse
Lithium toxicity > 1.5
Lithium is similar in chemical structure to sodium ; if sodium intake is reduced - - lithium is reabsorbed by the kidneys - toxicity
Adequate records of intake , output, and pts weight should be kept on a daily basis
- Adequate sodium intake
- 2500-3000 mL of fluid
- call doctor - vomiting/ diarrhea
- Risk - pregnancy
Lithium - Teaching
Valproic acid (Depakote)
anticonvulsant (antiepileptic) ; used in treatment of bipolar disorder
- Hypothyroidism
- Impairment of the kidneys ability to concentrate urine
Periodic follow ups required to assess thyroid and renal function
Major long term risks of lithium therapy
When a patient is experiencing a severe manic episode , which bodily system is most at risk for decompensation
Cardiac - death from cardiac collapse
