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Psych Exam 1 > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Lifespan and Cultural Considerations

A
  • life changes in OA increase risk
  • prevalence no different among races
  • expression of mood and culturally determined
  • avoid stereotyping
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2
Q

Role of Stress

A
  • stressful life events precede onset mood disorders, variable thought on degree of influence
  • theory that brain’s biology changes, increases risk of subsequent episodes
  • resilience important in determining impact of stress
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3
Q

Resilience

A

-ability to adapt well to stress, emotional pain and distress experienced

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4
Q

Factors that promote resilience

A
  • caring and supportive relationships
  • capacity to make plans and complete a goal
  • positive view of self
  • communication and problem solving skills
  • ability to manage strong feelings and impulses
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5
Q

Types of Mood Disorders

A
  • adjustment disorder with depressed mood
  • major depressive disorder
  • bipolar disorders
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6
Q

Adjustment Disorder with Depressed Mood

A
  • change in mood and affect following a stressor
  • “situational depression”
  • symptoms begin within 3 months of stressor
  • symptoms do not last beyond 6 months
  • distress out of proportion to the stressor
  • causes impairment in functioning
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7
Q

Clinical Manifestations of Adjustment Disorder with Depressed Mood

A
  • sleep disturbances
  • feeling hopeless and sad
  • loss of self-esteem
  • irritability
  • difficulty concentrating
  • inability to feel pleasure (anhedonia)
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8
Q

Nursing Assessment Adjustment Disorder with Depressed Mood

A
  • precipitating stressor
  • patient symptoms
  • depression risk factors
  • resilience factors
  • currrent coping strategies
  • safety
  • screening tool (beck depression inventory for example)
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9
Q

Adjustment Disorder with Depressed Mood Nursing Diagnosis

A
  • Helplessness
  • Disturbed sleep pattern -Disrupted family processes
  • Situational low self-esteem
  • Ineffective coping
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10
Q

Nursing Plan/Goal for Adjustment Disorder with Depressed Mood may target…

A
  • adequate sleep and rest
  • impulse control
  • daily functioning
  • self-esteem
  • safety
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11
Q

Nursing Interventions for Adjustment Disorder with Depressed Mood

A
  • promote hope
  • identify areas of control
  • encourage belief in themselves
  • assist in problem-solving process
  • identify sources of support
  • encourage family functioning
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12
Q

Collaborative Interventions for Adjustment Disorder with Depressed Mood

A
  • CBT; cognitive behavioral therapy
  • family therapy
  • antidepressant medication
  • antianxiety medication
  • exercise
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13
Q

Major Depressive Disorder

A
  • single episode or recurrent
  • change in emotional state and functioning for 14 days or longer
  • average age onset mid-20s
  • women more affected than med
  • hereditary
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14
Q

Clinical Manifestations of Major Depressive Disorder

A

*Significant decline in ability to function at work, school, or home

  • depressed mood most of the day
  • diminished interest or pleasure
  • weight loss or gain
  • insomnia or hypersomnia
  • fatigue
  • feeling worthless
  • diminished concentration
  • recurrent thoughts of death
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15
Q

Major Depressive Disorder Lifespan Considerations: Children/adolescents

A
  • usually assessed within context of home/school situation
  • decreased school performance
  • problems with parents or teachers
  • irritability
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16
Q

Major Depressive Disorder Lifespan Considerations: OA

A
  • memory problems
  • social withdrawal
  • sleep disturbances
  • appetite
  • delusions/hallucinations
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17
Q

Nursing Assessment for Major Depressive Disorder

A

-symptoms of depression
-difficulty completing simple tasks
-tearfulness
somatic complaints
-withdrawal/social isolation
-differentiate from grief
-co-morbidities
-suicide assessment

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18
Q

Suicide Assessment for Major Depressive Disorder

A

-suicidal ideation (passive vs active, frequency)

-plan
lethality, realistic, available means, intent, past attempts, reasons NOT to complete

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19
Q

Major Depressive Disorder: Suicide Precautions

A
  • nursing suicide assessment
  • documentation
  • patient transport considerations
  • physical environment
  • observation level (q15 or 1:1)
  • restriction (supervised bathroom)
  • contraband
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20
Q

Major Depressive Disorder: Nursing Diagnosis

A
  • risk for self-directed violence
  • chronic low self-esteem
  • hopelessness
  • social isolation
  • ineffective health maintenance
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21
Q

Nursing Plan/Goal for Major Depressive Disorder may target…

A
  • remaining free from self-injury
  • participating in recreational activities
  • knowledge that feeling better follows engaging in activities
  • adherence to tx regimen
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22
Q

Nursing Interventions for Major Depressive Disorder

A
  • develop therapeutic relationship
  • provide distraction from self-focus
  • encourage activities
  • recognize accomplishments
  • set limits on time spent discussing failures
  • teach assertiveness
  • assist in identifying strengths
  • encourage patient to set goals
  • explore various problem-solving strategies
  • help identify resources
  • avoid being overly cheerful and taking on patient’s feelings
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23
Q

Collaborative Interventions for Major Depressive Disorder

A

lab tests

  • thyroid
  • electrolyte
  • urinalysis
  • toxicology
  • LFTs
  • pregnancy test
24
Q

Psychotherapy for Major Depressive Disorder

A

CBT

25
Q

Non-pharm interventions for Major Depressive Disorder

A
  • ECT

- TMS

26
Q

Complementary and Alternative Interventions for Major Depressive Disorder

A
  • exercise
  • supplements
  • acupuncture
  • animal companionship
  • music therapy
27
Q

Pharmacological Interventions for Major Depressive Disorder

A
  • SSRIs
  • SNRIs
  • TCAs and MAOIs
  • Atypical antipsychotics
28
Q

First line med for Major Depressive Disorder

A

SSRIs

  • fluoxetine
  • citalopram
  • sertraline
  • escitaolpram

**increases available serotonin

29
Q

SNRIs

A

**increases serotonin and norepinephrine

  • venlafaxine
  • duloxetine
30
Q

TCAs and MAOIs

A

-older with significant side effects

31
Q

Atypical antipsychotics

A
  • used with SSRI for severe depression
  • aripiprazole
  • risperidone
32
Q

Duration of Medication Treatment: 1st episode/no risk factors

A

-6 months after symptom remission

33
Q

Duration of Medication Treatment: 1st episode with risk factors or 2nd episode

A

1 year after symptom remission

34
Q

Risk Factors for MDD

A
  • dysthymia prior to episode
  • poor recovery between episodes
  • current episode > 2 years
  • onset before age 20 or after 50
  • family hx
  • severe symptoms, psychosis, suicidality
35
Q

Psychotherapy

A
  • most effective when combined with medication

- both effective when used independently

36
Q

CBT

A

Cognitive Behavior Therapy

  • identifies negative thoughts and behaviors
  • replaces disordered thought processes
  • mindfulness training
37
Q

ECT

A

Electroconvulsive Therapy

  • electric current is passed through the brain to induce a sz
  • given under anesthesia (NPO)
  • receive muscle relaxant
  • monitor EEG, EKG, O2 sat, VS
  • short term memory loss expected (usually restores)
  • typically 2-3 times per week for 12 tx
38
Q

TMS

A

Transcranial Magnestic Stimulation

  • magnetic field passes through skull
  • causes cells in cerebral cortex to fire
  • FDA approved
  • target area for depression is left prefrontal cortex
  • rapid onset of improved symptoms (1-2 weeks)
  • as effective for depression WITHOUT psychosis as ECT
39
Q

Inpatient therapeutic strategies for MDD

A
  • many inpatient units use the Recovery Model
  • healing is possible when health care team collaborates with patients
  • focus on patient strengths
  • identify realistic outcome criteria
  • assist with developing criteria
  • assist with developing measurable short term and long term goals
40
Q

Important Strategies for MDD

A
  • recognize that patients with depression often reject support and encouragement
  • recognize unrealistic expectations for self and patient
  • identify feelings that originate with patient
  • understand role of biology and genetics in maintenance of depressed mood
41
Q

Bipolar Disorders

A

-mood alternates between the extremes: depression, mania, interspersed with neutral mood

42
Q

Bipolar 1

A

1 or greater manic episode and 1 or greater MDD epsiode

43
Q

Bipolar 2

A

1 or greater MDD episode and at least 1 hypomanic episode

44
Q

Manic Episode

A

abnormally expansive, elevated or irritable mood

-increased goal directed activity (most of day, everyday….plus 3 or greater of the following factors)

  1. inflated self esteem
  2. decreased need for sleep
  3. more talkative than usual
  4. flight of ideas
  5. distractibility
  6. psychomotor agitation
  7. increased pleasurable activites
45
Q

Manic

A

symptoms last at least 1 week

-mood disturbance causes: marked impairment in functioning, necessitates hospitalization, psychotic features

46
Q

Hypomanic

A
  • symptoms last at least 4 days

- mood disturbance causes: change in functioning, uncharacteristic behavior, observable by others, NO hospitalization

47
Q

Rapid Cycling

A

During a 12 month period:
-four or more illness episodes (mania, hypomania, or depression)

  • at least 2 months between each episode OR alternating episodes (period of mania, followed by depression)
  • more likely: female, earlier onset, tx resistant
48
Q

Biopolar Disorder Nursing Assessment

A
  • changes in thought processes
  • inflated self esteem (delusions)
  • ignoring fatigue, hunger, hygiene
  • distractibility
  • hallucinations
  • surprising sense of well being
  • rapid loud pressured speech**
  • flight of ideas
  • poor judgement/impulse (shopping, drugs, sex)
  • unusual appearance (dress inappropriate)
49
Q

Nursing Plan/Goal for Bipolar disorders may target…

A
  • injury prevention
  • focus
  • making choices
  • appropriate behaviors
  • self-care
  • sleep
50
Q

Nursing interventions for patient with mania

A
  • encourage reality-based thinking
  • acknowledge belief, but share that you see it differently
  • enhance socialization
  • set limits
  • promote improved self-care
  • enhance rest and sleep
  • decrease stimuli
  • remain calm and relaxed
  • firm and matter of fact demeanor (esp with limit setting)
  • use role modeling behavior (offers reassurance)
  • build trusting relationship
  • promote safety
51
Q

Promoting safety with bipolar disorders

A
  • remove smoking and contraband materials
  • safety checks
  • create structured program with rest periods
  • redirect patients who are at doorways (elopement risk)
  • set and enforce limits on unsafe or inappropriate social behaviors
  • prevent escalation (patient self-identifies triggers/calming strategies)
52
Q

Collaborative Interventions for Bipolar disorders

A
  • diagnostic stx
  • pharmacologic: mood stabilizers
  • psychotherapy
  • case management
53
Q

Mood Stabilizers

A
  • antipsychotics
  • lithium
  • anticonvulsants
54
Q

Antipsychotics

A
  • aripiprazole
  • riperidone
  • olanzapine
55
Q

anticonvulsants

A
  • valproic acid
  • lamotrigine
  • carbamazepine
56
Q

Relapse prevention for bipolar disorders

A
  • important to involve family and patient (creating relapse strategies)
  • teach patient and family about course of illness, important to adhering to medication regimen, early warning signs of relapse, community resources (NAMI)

Psych Exam 1 (5 decks)

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