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mental health/psych > mood disorders (halter ch 13, 14, 25, [3]) > Flashcards

mood disorders (halter ch 13, 14, 25, [3]) Flashcards

1
Q

2 categories of mood disorders

A

depressive disorders

bipolar disorders

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2
Q

depressive disorder: depressed mood lasting atleast 2 weeks; impaired social and occupational functioning; 5 or more diagnostic criteria behaviors within 2 weeks

A

major depressive disorder (MDD)

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3
Q

depression criteria (9)***

A
  • depressed mood
  • anhedonia
  • weight loss/gain
  • insomnia/hypersomnia
  • psychomotor agitation/retardation
  • fatigue
  • feelings of worthlessness
  • decreased concentration/decision making
  • recurrent thoughts of death/suicide
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4
Q

what is anhedonia

A

diminished interest in things/doing things

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5
Q

tools when assessing for major depressive disorder (4)

A
  • MSE
  • beck depression inventory
  • patient health questionnaire 9
  • suicide assessment
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6
Q

primary risk factors depression (7)

A
  • female gender
  • adverse childhood experiences (learned helplessness, behavioral, cognitive)
  • stressful life events
  • family history
  • neuroticism
  • chronic/disabling medical conditions
  • biologic (serotonin, norepinephrine, hormonal, inflammation)
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7
Q

what is included in patient health questionnaire 9

A
  • little interest/pleasure in doing things
  • feeling down/depressed/hopeless
  • trouble falling or staying asleep/sleeping too much
  • feeling tired/having little energy
  • poor appetite/overeating
  • feeling bad about yourself
  • trouble concentrating on things
  • moving or speaking really slowly/really quickly
  • thoughts you would be better off dead/hurting yourself
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8
Q

nursing interventions for MDD (3)

A
  • safety interventions first (suicide)
  • physiological balance (sleep, appetite, exercise)
  • identify factors and stressors (self esteem, relationships, belonging, spiritual, etc)
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9
Q

important things to remember when working with depressed pt (8)

A
  • patience
  • avoid overaggressive/lighthearted behavior
  • give step by step instructions if having trouble focusing
  • spend time with and encourage expression of feelings
  • monitor self care
  • offer more frequent and smaller meals
  • encourage activity, discourage naps/caffeine later in day
  • help recognize and reframe negative thoughts
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10
Q

what is the kindling effect

A

(with depressive disorders)

  • less stimuli to produce equal response
  • more susceptible to recurrence
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11
Q

depressive disorder: chronically mild depressed mood for more days than not for 2 years

A

persistent depressive disorder (PDD)

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12
Q

depressive disorder: 5 symptoms one week before menses

A

premenstrual dysphoric disorder

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13
Q

S+S premenstrual dysphoric disorder (10)

A
  • mood swings
  • irritability
  • anxiety
  • anhedonia
  • difficulty with concentration
  • lethargy
  • overeating
  • hypersomnia/insomnia
  • feeling overwhelmed
  • physical: breast tenderness, joint/muscle pain, bloating
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14
Q

Tx premenstrual dysphoric disorder (3)

A
  • SSRIs
  • OCP
  • GnRH analogs
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15
Q

depressive disorder: depression during times of shortened daylight, abnormal melatonin production

A

seasonal affective disorder

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16
Q

S+S seasonal affective disorder (4)

A
  • lethargy
  • irritability
  • depressed mood
  • increased appetite
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17
Q

Tx seasonal affective disorder (2)

A
  • SSRIs

- light

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18
Q

3 types postpartum depression

A
  • blues (brief, 1-4 days)
  • depression (2 weeks-12 months)
  • psychosis (2-3 days after delivery)
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19
Q

Tx blues postpartum depression (2)

A
  • reassurance

- support

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20
Q

Tx postpartum depression

A
  • SSRIs

- therapy

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21
Q

Tx postpartum psychosis (2)

A
  • hospitalization

- antipsychotics

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22
Q

types of grief (6)

A
  • normal
  • persistent complex bereavement (beyond 12 months)
  • complicated grieving (functional impairment)
  • disenfranchised grief (“grieving in silence”)
  • anticipatory grief
  • public tragedy
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23
Q

difference between depression and grief

A
  • depression: constant and pervasive, self-loathing, suicidal
  • grieving: gradually gets better, “waves” of sadness, identity intact
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24
Q

S+S grief (3)

A
  • insomnia
  • poor appetite
  • depressed mood
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25
how long does it take to see therapeutic effects of anti-depression meds? how long does it take to determine if its effective?
- therapeutic effects: 1-3 weeks | - effective: 3 months
26
purpose of SSRI/SNRIs
inhibit reuptake of serotonin
27
when are side effects of SSRI/SNRIs most commonly seen
first 1-3 weeks of use
28
common potential SE of SSRIs (9)
- agitation/anxiety - sleep disturbance - weight change - sweating - mild nausea - loose stools - headache - sexual dysfunction - tremor
29
first line med for depressive disorders
SSRI/SNRI
30
what meds can you not combine with SSRI/SNRI (2)
- st johns wort | - MAOIs (can produce serotonin syndrome toxic effects)
31
how long should pts stay on SSRIs
6-9 months
32
SSRI/SNRI meds (12)
- Citalopram (celexa) - Escitalopram (lexapro) - Fluoxetine (prozac) - Paroxetine (paxil) - Sertraline (zoloft) - Fluvoxamine (luvox) - Zilazodone (viibryd) - Trazadone (desyrel/oleptro) - Venlafaxine (effexor) - Duloxetine (cymbalta) - Desvenlafaxine (pristiq) - Levomilnacipran (fetzima)
33
important teachings for SSRI/SNRI meds (4)
- dont stop taking abrupty - assess for serotonin syndrome - dont combine with st johns wort/MAOIs - dont take with alcohol
34
S+S serotonin syndrome (9)
- agitation - diarrhea - heavy sweating, fever, shivering - mental status changes - muscle spasms - hyperreflexia - tremor - ataxia - HTN/tachycardia
35
Tx serotonin syndrome (5)
- discontinue med causing it - serotonin receptor block - benzodiazepines - cyproheptadine (periactin) - IV fluids/cooling
36
how long to see therapeutic effects and full effectiveness of TCAs
- therapeutic effects: 1-2 weeks | - full effects: 4-8 weeks
37
main drawback side effects of TCAs (5)
- orthostatic hypoTN - tachycardia - weight gain - sedating - anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention)
38
what is most hazardous effect of TCAs
cardio-toxic | (can be lethal in high doses)s
39
TCA meds (4)
Doxepin (sinequan/silenor) Imipramine (tofranil) Amitriptyline (elavil) Notriptyline (pamelor)
40
anti-depression med category to try if poor response to SSRI/SNRIs and TCAs
MAOIs
41
pt teaching with MAOIs
- dietary changes - avoid: (fermented/aged foods and drinks) sherry, red wine, liquors, MSG, sauerkraut, fermented/smoked meats, beef and chicken liver, cheeses, overly ripe fruit - maintain dietary restrictions for 14 days after stopping MAOIs
42
what can occur with MAOIs without dietary restriction
hypertensive crisis : - increased bp - intracranial hemorrhage - convulsions - coma
43
MAOI meds (3)
Phenelzine (nardil) Isocarboxazid (marplan) Selegiline (zelapar/eldepryl)
44
Tx other than meds for depression
ECT (electroconvulsive therapy)
45
what happens in ECT
- artificial production of seizure (30 secs - 1 min) to pt under anesthesia - series of 12 treatments, given 3x/week
46
indications for ECT (4)
- major depression/suicidal when meds aren't effective - acute mania - schizophrenia w/ catatonia - pregnant women
47
nursing care for ECT (7)
- check pts lab tests - have crash cart with defibrillator available - NPO - IM anticholinergic - void immediately before - bp cuff on ankle or wrist (to monitor seizure activity) - bite block
48
potential side effects ECT (5)
- headache - muscle soreness - nausea - confusion/disorientation - memory loss
49
other physiological Tx options for depression (other than SSRI/SNRIs, TCAs, MAOIs) (6)
- transcranial magnetic stimulation - vagus nerve stimulation - deep brain stimulation - light therapy (for SAD) - st johns wort (for mild depression) - ECT
50
RF for bipolar disorder (2)
- females | - family h/o
51
disorder characterized by mood swings from profound depression to extreme euphoria/dysphoria with intervening periods of normalcy; may or may not have delusions/hallucinations
bipolar disorder
52
2 types of bipolar disorder
- bipolar 1: major depression w/ periods of mania | - bipolar 2: major depression w/ periods of hypomania
53
what is mania
extremely elevated and excitable mood
54
disorder: recurrent symptoms of hypomania alternating with MDD
cyclothymia
55
differences between hypomania v mania
- hypomania: uncharacteristic when not symptomatic, not delusional, normal functioning, no need for hospitalization - mania: impairment in social/occupational functioning, hospitalization usually needed, psychotic features
56
DSM 5 criteria for bipolar (at least 3 or more of 7 criteria)
- increased self esteem - decreased need for sleep - increased, pressured speech - flight of ideas, racing thoughts - distractibility - increased activity, agitation - excessive involvement in pleasurable activities (w/ high potential for painful consequences)
57
nursing interventions for manic pts (8)
- at risk for injury (safety precautions) - provide physical exercise outlet (and rest periods) - firm, calm approach, consistency - remain neutral and avoid power struggles - decrease environmental stimuli when possible - high calorie fluids and food (monitor I&Os) - redirect agitation - teach relaxation as tolerated
58
meds for bipolar/manic pts (8)
ANTIMANIC DRUGS: - Carbamazepine (equetro/tegretol) - Gabapentin (tegretol) - Lamotrigine (lamictal) - Lithium (eskalith/lithobid) - Oxcarbazepine (trileptal) - Divalproex/valproic acid/valproate (depakene/depakote) ANTICONVULSANTS: - depakote (valproic acid) - tegretol (carbamazepine)
59
what 2 med groups are prescribed to pts with bipolar
antidepressant + antimanic
60
what pts shouldn't take antimanic drugs (3)
- pregnant women - pts taking diuretics - pts taking haldol
61
what should be checked before admin of lithium (2)
- thyroid | - renal function
62
expected side effects lithium (4)
- fine hand tremors - polyuria - mild thirst/nausea - weight gain
63
early S+S toxicity lithium (6)
- coarse hand tremors - N/V - confusion - slurred speech - muscle weakness - sedation
64
advanced S+S toxicity lithium (7)
- ataxia - persistent GI upset - stupor - incoordination - lethargy - blurred vision - clonic movements
65
Tx lithium overdose/toxicity (3)
- stop drug - gastric lavage - urea/mannitol/aminophylline
66
client teaching for lithium (3)
- maintain normal diet, salt and fluid intake - dont take diuretics - take with meals
67
what is the desired range for lithium
0.5-1.5
68
what does the acronym LITHIUM stand for
``` L: level 0.5-1.5 I: increase fluids T: toxicity (know S+S) H: hyponatremia (maintain salt intake) I: interactions (diuretics, haldol) U: upsets stomach (take w food) M: monitor levels weekly x4, 3 months, 6 months ```
69
what is important to remember with admin of anticonvulsants (3)
- check liver function before - check platelet count before - blood tests for first 8 weeks
70
triggers for manic phases of bipolar (4)
- stress - no sleep - drugs - missed meds
71
what is 10th leading cause of death in US
suicide
72
what % adults who commit suicide have co-morbid psych illness
90%
73
any form of behavior where the intent is death, and the person is aware of the desired outcome. Includes ideation, attempts, gestures, and fatal suicides
suicidal behavior
74
the thought of killing oneself; can be active or passive
suicidal ideation
75
2 types suicide attempts
- direct: ideation/attempt | - indirect: activity is detrimental, pts may deny suicidiality
76
difference between suicide and self-injury goals
suicide: goal is to end life | self-injury: goal is to relieve tension/emotion
77
what should you assess for in pts thinking about suicide
- thoughts of suicide? plan? - attempts? - frequency - duration - controllability - deterrents - reasons
78
assessing risk factors for suicide (SAD PERSONS)
S: sex (male) A: age (10-35, 65+) D: depression ``` P: previous attempts E: ETOH (alcohol) R: rational thinking loss S: social supports lacking O: organized plan N: no spouse S: sickness ```
79
warning signs of suicide (IS PATH WARM)
I: ideation S: substance abuse P: purposelessness A: anxiety T: trapped H: hopelessness W: withdrawal, social A: anger R: recklessness M: mood change
80
med options mania/bipolar (5)
``` anti-anxiety anti-convulsants anti-manic anti-depressant anti-psychotics ```
81
nursing interventions for suicidal pt in hospital (5)
- emphasize hope and purpose - safe environment - suicide precautions - facilitate talking about problems - explore reasons not to end life
82
suicide precautions in hospital (3)
- never leave pt alone - remove potentially dangerous items - reassess

mental health/psych (14 decks)

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