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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

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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
Q

how long does it take to see therapeutic effects of anti-depression meds? how long does it take to determine if its effective?

A
  • therapeutic effects: 1-3 weeks

- effective: 3 months

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26
Q

purpose of SSRI/SNRIs

A

inhibit reuptake of serotonin

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27
Q

when are side effects of SSRI/SNRIs most commonly seen

A

first 1-3 weeks of use

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28
Q

common potential SE of SSRIs (9)

A
  • agitation/anxiety
  • sleep disturbance
  • weight change
  • sweating
  • mild nausea
  • loose stools
  • headache
  • sexual dysfunction
  • tremor
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29
Q

first line med for depressive disorders

A

SSRI/SNRI

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30
Q

what meds can you not combine with SSRI/SNRI (2)

A
  • st johns wort

- MAOIs (can produce serotonin syndrome toxic effects)

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31
Q

how long should pts stay on SSRIs

A

6-9 months

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32
Q

SSRI/SNRI meds (12)

A
  • 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)
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33
Q

important teachings for SSRI/SNRI meds (4)

A
  • dont stop taking abrupty
  • assess for serotonin syndrome
  • dont combine with st johns wort/MAOIs
  • dont take with alcohol
34
Q

S+S serotonin syndrome (9)

A
  • agitation
  • diarrhea
  • heavy sweating, fever, shivering
  • mental status changes
  • muscle spasms
  • hyperreflexia
  • tremor
  • ataxia
  • HTN/tachycardia
35
Q

Tx serotonin syndrome (5)

A
  • discontinue med causing it
  • serotonin receptor block
  • benzodiazepines
  • cyproheptadine (periactin)
  • IV fluids/cooling
36
Q

how long to see therapeutic effects and full effectiveness of TCAs

A
  • therapeutic effects: 1-2 weeks

- full effects: 4-8 weeks

37
Q

main drawback side effects of TCAs (5)

A
  • orthostatic hypoTN
  • tachycardia
  • weight gain
  • sedating
  • anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention)
38
Q

what is most hazardous effect of TCAs

A

cardio-toxic

(can be lethal in high doses)s

39
Q

TCA meds (4)

A

Doxepin (sinequan/silenor)
Imipramine (tofranil)
Amitriptyline (elavil)
Notriptyline (pamelor)

40
Q

anti-depression med category to try if poor response to SSRI/SNRIs and TCAs

A

MAOIs

41
Q

pt teaching with MAOIs

A
  • 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
Q

what can occur with MAOIs without dietary restriction

A

hypertensive crisis :

  • increased bp
  • intracranial hemorrhage
  • convulsions
  • coma
43
Q

MAOI meds (3)

A

Phenelzine (nardil)
Isocarboxazid (marplan)
Selegiline (zelapar/eldepryl)

44
Q

Tx other than meds for depression

A

ECT (electroconvulsive therapy)

45
Q

what happens in ECT

A
  • artificial production of seizure (30 secs - 1 min) to pt under anesthesia
  • series of 12 treatments, given 3x/week
46
Q

indications for ECT (4)

A
  • major depression/suicidal when meds aren’t effective
  • acute mania
  • schizophrenia w/ catatonia
  • pregnant women
47
Q

nursing care for ECT (7)

A
  • 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
Q

potential side effects ECT (5)

A
  • headache
  • muscle soreness
  • nausea
  • confusion/disorientation
  • memory loss
49
Q

other physiological Tx options for depression (other than SSRI/SNRIs, TCAs, MAOIs) (6)

A
  • transcranial magnetic stimulation
  • vagus nerve stimulation
  • deep brain stimulation
  • light therapy (for SAD)
  • st johns wort (for mild depression)
  • ECT
50
Q

RF for bipolar disorder (2)

A
  • females

- family h/o

51
Q

disorder characterized by mood swings from profound depression to extreme euphoria/dysphoria with intervening periods of normalcy; may or may not have delusions/hallucinations

A

bipolar disorder

52
Q

2 types of bipolar disorder

A
  • bipolar 1: major depression w/ periods of mania

- bipolar 2: major depression w/ periods of hypomania

53
Q

what is mania

A

extremely elevated and excitable mood

54
Q

disorder: recurrent symptoms of hypomania alternating with MDD

A

cyclothymia

55
Q

differences between hypomania v mania

A
  • 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
Q

DSM 5 criteria for bipolar (at least 3 or more of 7 criteria)

A
  • 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
Q

nursing interventions for manic pts (8)

A
  • 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
Q

meds for bipolar/manic pts (8)

A

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
Q

what 2 med groups are prescribed to pts with bipolar

A

antidepressant + antimanic

60
Q

what pts shouldn’t take antimanic drugs (3)

A
  • pregnant women
  • pts taking diuretics
  • pts taking haldol
61
Q

what should be checked before admin of lithium (2)

A
  • thyroid

- renal function

62
Q

expected side effects lithium (4)

A
  • fine hand tremors
  • polyuria
  • mild thirst/nausea
  • weight gain
63
Q

early S+S toxicity lithium (6)

A
  • coarse hand tremors
  • N/V
  • confusion
  • slurred speech
  • muscle weakness
  • sedation
64
Q

advanced S+S toxicity lithium (7)

A
  • ataxia
  • persistent GI upset
  • stupor
  • incoordination
  • lethargy
  • blurred vision
  • clonic movements
65
Q

Tx lithium overdose/toxicity (3)

A
  • stop drug
  • gastric lavage
  • urea/mannitol/aminophylline
66
Q

client teaching for lithium (3)

A
  • maintain normal diet, salt and fluid intake
  • dont take diuretics
  • take with meals
67
Q

what is the desired range for lithium

A

0.5-1.5

68
Q

what does the acronym LITHIUM stand for

A 
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
Q

what is important to remember with admin of anticonvulsants (3)

A
  • check liver function before
  • check platelet count before
  • blood tests for first 8 weeks
70
Q

triggers for manic phases of bipolar (4)

A
  • stress
  • no sleep
  • drugs
  • missed meds
71
Q

what is 10th leading cause of death in US

A

suicide

72
Q

what % adults who commit suicide have co-morbid psych illness

A

90%

73
Q

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

A

suicidal behavior

74
Q

the thought of killing oneself; can be active or passive

A

suicidal ideation

75
Q

2 types suicide attempts

A
  • direct: ideation/attempt

- indirect: activity is detrimental, pts may deny suicidiality

76
Q

difference between suicide and self-injury goals

A

suicide: goal is to end life

self-injury: goal is to relieve tension/emotion

77
Q

what should you assess for in pts thinking about suicide

A
  • thoughts of suicide? plan?
  • attempts?
  • frequency
  • duration
  • controllability
  • deterrents
  • reasons
78
Q

assessing risk factors for suicide (SAD PERSONS)

A

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
Q

warning signs of suicide (IS PATH WARM)

A

I: ideation
S: substance abuse

P: purposelessness
A: anxiety
T: trapped
H: hopelessness

W: withdrawal, social
A: anger
R: recklessness
M: mood change

80
Q

med options mania/bipolar (5)

A 
anti-anxiety
anti-convulsants
anti-manic
anti-depressant
anti-psychotics
81
Q

nursing interventions for suicidal pt in hospital (5)

A
  • emphasize hope and purpose
  • safe environment
  • suicide precautions
  • facilitate talking about problems
  • explore reasons not to end life
82
Q

suicide precautions in hospital (3)

A
  • never leave pt alone
  • remove potentially dangerous items
  • reassess

mental health/psych (14 decks)

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