mood disorders Flashcards by Alyssa Holland

depression assessment

affective symptoms
psychomotor retardation or agitation 
rumination, negative thinking 
orientation, oncentration 
self-concept/relationships 
anhedonia 
suicidal ideation

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vegetative signs of depression

alterations in activities necessary for PHYSICAL life
sleep disturbance
nutrition changes (anorexia or overeating)
elimination changes (constipation or diarrhea)
decreased libido
chronic pain

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affective symptoms of depression

sad, in despair
helpless, powerless
anxious, overwhelmed
apathetic
poor eye contact, posture
"poor me attitude"
poor hygiene/grooming

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suicidal threats

direct verbal or written expressions of intent to harm self, but no action

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para-suicidal behavior

actions that are intentionally self-injurious such as cutting wrists or taking non-lethal doses of drugs

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suicide risk

lethality of means: guns more lethal than poison
chance of rescue: remote site vs. crowded area
old wounds: scars and ligature marks
previous attempts: the more attempts, the higher the risk

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indications of risk for suicide

impulsivity
labile mood
lack of future plans
Worthlessness/ Hopelessness
verbal clues: “I’m going to put a gun in my mouth and shoot”
maturity level: the more immature, the higher the risk

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suicide assessment

is the client thinking about harming self or ending their life?
does the client have a plan? what is it?
is the method readily available?
has the client given away possessions?
is the suicide to be carried out on a specific day or time?
what has kept them from following through with the plan?
have they attempted suicide in the past?

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desired outcomes for depression

decrease in symptoms
no injury or death
achieving adequate rest and nutrition
increase in self-esteem

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antidepressants

all cause anticholinergic symptoms
all cause orthostatic hypotension

all antidepressants carry a Black Box warning for increase in suicidality in children and adolescents

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4 types of antidepressants

tricyclic
SSRI
MAOI
atypical

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tricylic antidepressants

oldest antidepressant
most side effects.
increase serotonin to relieve symptoms of helplessness, anhedonia, suicidality, inappropriate guilt
-amine, -ine

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amitriptyline (elavil)

tricyclic antidepressant
potentiates serotonin & norepinephrine in CNS
caution with MAOIs & SSRIs
do not use nicotine
avoid if breastfeeding, if have prostatic hyperplasia, pregnancy use only if benefit outweighs risk

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amitriptyline (elavil) adverse effects

orthostatic hypotension
anticholinergic side effects
sedation, toxicity, decreased seizure threshold, excessive sweating, increased appetite, serotonin syndrome
suicidal thoughts may increase at 10-14 days

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amitriptyline (elavil) interventions

monitor BP ↓↑
administer at bedtime
st. john’s wort may decrease effects

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SSRIs

block the neuronal reuptake of serotonin leaving more serotonin available
drug of choice to treat depression
produce fewer side effects

fluoxetine (prozac)

SSRI
caution with St. John’s wort, alcohol, digoxin, warfarin, NSAIDs, aspirin
avoid if pregnant or breastfeeding, with MAOIs
suicidality may increase 10-14 days after start of therapy
full effect takes 4 weeks

fluoxetine (prozac) adverse effects

neuroleptic malignant syndrome
serotonin syndrome
seizures, sexual dysfunction, increased sweating

vortioxetine (brintellix, trintellix)

multimodal antidepressant
SSRI with other effects
caution with lithium, tramadol, fluoxetine, phenytoin, rifampin, aspirin
avoid with pregnancy &amp; breastfeeding
NO MAOIs

vortioxetine (brintellix, trintellix) adverse effects

constipation
nausea
sexual dysfunction
serotonin syndrome

vortioxetine (brintellix, trintellix) interventions

Monitor BP ↓↑
assess sexual side effects
monitor for serotonin syndrome
suicidality increases 10-14 days after start of therapy
increased risk of serotonin syndrome with St. John’s wort

MAOIs

monoamine oxidase inhibitors block the inactivation enzyme to increase serotonin
require special diet

phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam): patch

phenelzine (nardil)

MAOI
inhibits the enzyme monoamine causing an increase in serotonin
treats depression as a last resort
caution with any other medication
avoid with pregnancy, lactation, pheochromocytoma, liver disease

phenelzine (nardil) adverse effects

hypertensive crisis if tyramine free diet not followed
CNS stimulation, orthostatic hypotension, headache
suicidality 10-14 days after start of therapy

phenelzine (nardil) interventions

take no medication, herbal supplement or vitamin without clearing it with treatment team no alcohol monitor BP ↓↑ serious or fatal effects may occur with St. John’s wort

duloxetine (cymbalta)

SNRI caution with digoxin, warfarin, NSAIDs, diazepam, St. John’s wort avoid with pregnancy, breastfeeding, hepatic impairment. NO MAOI NO ALCOHOL

duloxetine (cymbalta) side effects

neuroleptic malignant syndrome, seizures, pancreatitis, Stevens Johnson, serotonin syndrome, hypoglycemia, anticholinergic symptoms

duloxetine (cymbalta) interventions

monitor BP ↓↑ suicidality increases 10-14 days after start of therapy monitor for hypoglycemia increased risk of serotonin syndrome with St. John’s wort

bupropion (wellbutrin)

aminoketone antidepressant decreases neuronal uptake of dopamine in CNS caution with nicotine, digoxin avoid with breastfeeding; use in pregnancy only if benefit outweighs risk

bupropion (wellbutrin) side effects

homicidal thoughts seizures agitation headache

bupropion (wellbutrin) interventions

``` monitor BP ↓↑ suicidality can occur 10-14 days after start of therapy monitor mood changes may impair judgment use two forms birth control ```

st john's wort

herbal OTC medicine avoid with pregnancy & breastfeeding NO alcohol, antidepressants, digoxin, benzodiazepines, oral contraceptives, phenytoin

st john's wort adverse effects

``` dizziness hypertension allergic skin reactions flatulence N/V ```

MAOI diet

avoid: tofu, soy sauce, yeast extract, teriyaki, soybean paste, miso, tamari, tempeh, MSG, aged cheeses, raspberries, bananas, avocado, spinach beef liver, chicken liver, fermented sausages like pepperoni and salami, bacon, hot dogs, corned beef, and luncheon meats caviar, cured fish, dried or pickled herring, shrimp paste. no more than two cans or bottles of beer. no more than 4 oz. wine.