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Psych > Mood Disorders and Suicide > Flashcards

Mood Disorders and Suicide Flashcards

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1
Q

Dysthymic (Dysthymia)

A

profound sense of dissatisfaction or unease, seen with depression

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2
Q

Mood Disorders

A

also referred to as affective disorders

they are pervasive alterations in emotions that manifest as depression, mania, or both

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3
Q

Mood Disorders: Etiology

A

Theories:

  • genetics
  • neurochemical (Monoamine): serotonin, norepinephrine, dopamine
  • neuroendocrine-hormone (specifically hormone fluctuation w/ depression, correlation between hypothyroidism and depression)
  • psychodynamic theories: Freud (depression is anger turned inwards)

*need to r/o hypothyroidism when someone comes in w/ new onset of depression

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4
Q

Mood Disorders: Cultural Considerations

A

Symptoms of depression in children manifest differently
-more cranky, mood might be a little different

-adolescents present as more withdrawn, changes in academic performance, substance use, more somatization (physical symptoms like migraines) - don’t verbalize as well

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5
Q

Mood Disorders: Related Disorders

A
  • persistent depressive disorder
  • disruptive mood dysregulation disorder
  • cyclothymic disorder
  • seasonal affective disorder (type of depression) MDD w/ seasonal pattern
  • premenstrual dysphoric disorder
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6
Q

Persistent Depressive Disorder

A

depressed mood for most of the day for more days than not for at least 2 YEARS

symptoms don’t effect ADL’s like w/ MDD

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7
Q

Disruptive Mood Dysregulation Disorder

A
  • severe recurrent temper outbursts
  • the outbursts are inconsistent w/ developmental level
  • occur on average three or more times per week
  • mood between outbursts is irritable or angry most of the time
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8
Q

Premenstrual Dysphoric Disorder

A

For most menstrual cycles:

  • marked affective lability
  • marked irritability or anger
  • marked depressed mood, hopelessness, self deprecating thoughts
  • marked anxiety, tension, on edge
  • anhedonia
  • concentration
  • physical symptoms (breast tenderness)
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9
Q

Seasonal Affective Disorder

A

recurrent episodes of major depressive (can be mania or hypomania) w/ seasonal onset

Tx: vitamin D, light therapy, therapy interventions, antidepressants

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10
Q

Major Depressive Disorder (MDD)

A

5 or more symptoms present over a 2-week period

at least one symptoms must be depressed mood or loss of interest or pleasure

SIGECAPS

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11
Q

SIGECAPS

A
  • Sleep (loss or too much)
  • Interest or enjoyment (anhedonia)
  • Guilt or hopelessness
  • Energy (decreased)
  • Concentration (decreased)
  • Appetite (increased or decreased)
  • Psychomotor retardation (slow movement)
  • Suicide
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12
Q

MDD: Clinical Course

A
  • untreated depression can last weeks to months to years
  • depression can occur as a single episode or a recurrent pattern (most experience recurrent episodes)
  • mild/moderate/severe
  • severe depression-psychotic symptoms (20%)
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13
Q

MDD: Presentation

A
  • client may be overwhelmed with their feelings
  • sleep disturbance
  • seclusive to room
  • may be unable to sustain long interactions
  • possible change in self-care (appearance)
  • possible change in self-esteem or confidence
  • lack of sexual desire
  • possible changes in cognitive functioning (slowed activity, ambivalence, decreased concentration)
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14
Q

MDD: Nursing Interventions

A
  • # 1 priority = safety (assess for suicide)
  • encourage conversations (brief interactions multiple x per day)
  • promote ADLs (schedule may be provided for them)
  • engage the client in activities
  • medication education
  • silence (allow them space, don’t need to fill silence)
  • use simple concrete steps if overwhelmed
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15
Q

MDD: Tx

A
  • therapy
  • meds: MAOIs, SSRIs, SNRIs, TCA, Atypicals (buproprion, mirtazapine, vilazodone, trazadone)
  • ECT
  • newer treatments: transcranial magnetic stimulation (TSM - uses magnetic fields for tx resistant depression), Ketamine (nasal spray, IV)

*OD lethal potential w/ MAOIs, TCAs

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16
Q

Serotonin Syndrome

A

HARM

Hyperthermia
Autonomic instability
Rigidity
Myoclonus

17
Q

Serotonin Discontinuation

A

discontinuation syndrome - feel bad if they come off meds too fast (need to taper off)

18
Q

ECT

A

electroconvulsive therapy

  • tx resistant depression
  • administered as a series of tx/maintenance tx
  • involves application of electrodes to the head to deliver an electrical impulse to the brain which causes seizure
  • theory: the seizure causes changes to the chemical imbalance w/ depression
  • recognize the historical perspectives
19
Q

ECT: Nursing Considerations

A
  • potential for temporary memory loss/confusion
  • NPO after midnight
  • have client void before
20
Q

Catatonia

A

can occur w/ severe MDD

3 or more of the following:

  • stupor
  • catalepsy
  • waxy flexibility
  • mutism
  • negativism
  • posturing
  • mannerism
  • stereotypy
  • agitation
  • grimacing
  • echolalia
  • echopraxia

tx = benzos

ECT may be considered

21
Q

Bipolar Disorders: Types

A

Bipolar I
Bipolar II
Cyclothymia

22
Q

Bipolar I Disorder

A

3 or more symptoms for a total of one week or more

episodes of mania alternating w/ depression

23
Q

Bipolar Disorder: Symptoms

A

DIG FAST

Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity
Sleep (decreased need for it)
Talkativeness (increased)
24
Q

Bipolar II Disorder

A

hallmark sign is hypomania

hypomania is similar but not as severe as mania (doesn’t have the intensity to cause gross dysfunction)

severe episodes of depression (often when people seek tx)

25
Q

Cyclothymia

A

more persistent but less severe version of bipolar disorder

no loss of social or occupational functioning - but symptoms cause clinically significant distress

pattern of the disorder present for two years

26
Q

Features of Bipolar Disorder

A
  • w/ psychotic features
  • w/ catatonia
  • rapid cycling
  • first episode of mania generally in teens, 20s, or 30s
  • risk for suicide
27
Q

Bipolar Disorder: Presentation

A

may have:

  • short attention span
  • pressured, rapid speech
  • labile mood
  • provocative or risky behaviors
  • poor boundaries
28
Q

Bipolar Disorder: Differential Diagnosis

A
  • BPD
  • Substance induced
  • Mania d/t general medical condition (steroid use)
  • Anxiety
  • ADHD
29
Q

Bipolar Disorder: Nursing Interventions

A
  • safety
  • decreasing environmental stimuli (promote rest)
  • speaking clearly w/ simple sentences
  • nutrition (encourage fluids)
  • redirect energy
  • set limits when they cannot do so themselves (you are standing close to me, may you step back two feet, etc)
30
Q

Bipolar Disorder: Tx

A

therapy alone is not considered sufficient w/ bipolar disorder

medications:

  • anticonvulsants
  • antipsychotics
  • antidepressants
  • Lithium
31
Q

Lithium

A
  • therapeutic range
  • serum levels obtained prior to AM dose
  • kidney function (renal disease contraindication)
  • high response rate
  • onset of action: up to 14 days
  • teach clients signs of lithium toxicity (N/V, tremors, ataxia)
32
Q

Acute Mania

A

lithium or valproic acid w/ an antipsychotic

33
Q

Suicide

A
  • intentional act of killing oneself
  • suicidal ideation (SI): thinking about killing oneself
  • passive vs. active
  • attempted (either failed or incomplete, incomplete = person was found or recognized attempt)
  • suicidal thoughts are common in mood disorders, especially depression
  • self-injury
34
Q

Suicide: Risk Factors

A
  • gender (men > risk), 3x rate of women
  • > 65YO
  • separated or divorced
  • hx of suicide attempt
  • family hx of suicide
  • alcohol or substance use
  • access to lethal methods, such as guns
35
Q

Suicide: Protective Factors

A
  • feeling responsible for children or other family
  • religious/spiritual/cultural beliefs
  • overall satisfaction w/ life
  • presence of social support
  • effective coping skills
  • access to medical care
36
Q

Suicide Precautions

A
  • increased supervision

- removal of harmful objects

Psych (18 decks)

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