psych mood disorders Flashcards
Major Depressive Disorder - how do you know when it’s depression
it needs to last at least 2 weeks or more, also impairment of functioning.
Major Depressive Disorder - children
could look more like irritatabilty -
Major depressive disorder - symptoms
anhedonia is common. sleep disorders. anergia (lack of energy - affects 97% of ppl) may overeat or anorexia, usually anorexia. usually atypical when ppl eat too much. poor concentration, indecisiveness, brain fog, SI.
Signs and Symptoms of Major Depressive Disorder: (2 things)
Vegetative
Somatic
DSM-5 criteria
vegatative s/sx (veggieBALS)
appetite and weight, sleep, libido, bowel habits.
somatic s/sx
Somatic sxs - could be GI, headache - very common,
types of major depressive disorder
Single episode vs. recurrent
Disruptive Mood Dysregulation Disorder - what ages?
(children) (they thought it was bipolar) between 6-18 ages. constant severe irritability and anger at home and school, with peer. treated w/ therapy, and sometimes med SSRIs, atypical sometimes used.
Persistent Depressive Disorder (formerly called dysthymia) - and how long does it last?
chronic, low grade depression, lasts at least 2 years. can go to school, work, but not thriving. depressed mood. impairment not as severe.
Premenstrual Dysphoric Disorder (aka PMS)
2 weeks before period - luteal phase - mood symptoms. meds - birth control, but BP can backfire on some ppl. antidepressants just during luteal phase. nutrition, coffee sugar can be bad. exercise, sleep. acupuncture. phototherapy.
Substance/Medication Induced Depressive Disorder
alcohol, meds. stimulant binges. antidepressants, antivirals, beta blockers. immune drugs.
Depressive Disorder Due To other Medical Conditions - fetterman
stroke. john fetterman. Parkinson’s. huntingtons, alzheimers. traumatic brain injury. hypothyroidism. lyme disease. toxins. lead. anemia.
MDD with Seasonal Pattern (aka Seasonal Affective Disorder) -
changes in light.
Causative factors – (Apply to all mood/affective disorders) - Genetic/biological - seratonin?
Monozygotic vs. dizygotic twins (50%)
Genetic serotonin deficiency or genetic predisposition for decreased 5HT (this is seratonin)
causative factors - Cognitive/environmental/psychosocial/cultural/societal- learned helplessness
Learned helplessness - chronic stress as a kid, abusive or neglected. therapist might validate. CBT.
is depression treatable?
Depression is very treatable. Studies demonstrating show long-term remission is most likely if psychotherapy is used in conjunction with biological treatments.
vagus nerve- is it invasive?
VNS - vagus nerve - surgical implantation - not used much
integrative approaches -
omega 3, nutrition, exercise.
Meds - how long to stay on them, and how long before they start working
stay on them for at least 6-12 months; many people need to stay on meds indefinitely. Most ADs take at least one month to produce full treatment effects***some ppl longer.
TCAs (tricyclics) - what is the main issue with them? (tricycles are lethal)
not really used anymore bc they have cardiac risks, endocrine risks, sexual side effects, and lethal if OD. used sometimes for migraines, amytripline. sometimes best for severe MDD; cardiac risk; frequently lethal if pt overdoses. know for test*****
MAOIs- what is the issue with them? (mao cheese)
not really used anymore, so many food drug interactions - tyramine reduced diet - smoked, aged, processed - meats, cheeses, sausage, red wine, ripe foods, chocolate. many food/drug interactions (fermented, smoked and cured foods are most dangerous); last med of choice.
SSRI/SNRIs- most common side effect, and what to watch for?
first line treatment; actions & SEs (side effects) more varied from med to med than with TCAs/MAOIs, but SEs generally milder and less dangerous; watch for serotonin syndrome (st. john’s wart and melatonin can cause it) anxious, flushed, cardiac, insomnia headache common at first. most common effect is sexual**in 50% of ppl.
Bupropion - what does it do?
inhibits dopamine uptake - so dopamine increases; unique among ADs in action (increases dopamine/norepinephrine) and potential SEs (decreased appetite, decreased desire to smoke, increased sexual desire). usually doesn’t develop until a month into treatment.
Interpersonal psychotherapy
(basic talk therapy) is the oldest tx for MDD and is still effective most of the time, esp for mild-moderate depression
ECT (induction of a grand mal seizure)
half-second jolt produces about a 30 sec seizure - biggest risk is memory loss.
when is ECT used?
Used for drug-resistant and psychotic depression. ECT is rarely a permanent cure. Some pts benefit from maintenance ECT (monthly)
side effects of ECT
Short term memory loss is common and usually transient (warn both patient and family members about this). Re-orient patient and give NSAIDS/acetaminophen prn for HA (headache) and food bc they are NPO
ECT -how often are treatments, and how many?
Usually 6-12 treatments, given 2-3 times/week; can be done outpatient
Safer to use in pregnancy than most ADs (anti-depressants), esp in 1st trimester
Requires surgical permit and general pre- and post-op nursing care
TMS- how often is treatment, and for how long? (TMJ for 6 weeks)
basically uses MRI to stimulate the brain. Transcranial magnetic stimulation.Still uncommonly used. Non-invasive. Usual course is 5-30 min treatments for 6 weeks.
Bipolar I
(most severe one) – at least one episode of full mania, which is a psychotic state. Requires hospitalization
Bipolar II
(dysphoric or depressive, more depression) – at least one episode of hypomania (lesser form of mania), which is not a psychotic state, and at least one episode of severe depression.
Cyclothymia- and how long does it last?
hypomania alternating with minor depression for at least 2 years. (always treated outpatient)
mania is what state?
mania is a psychotic state
rapid cycling- how many times to consider it rapid?
if episodes happen 4 or more times a year, this is considered rapid cycling***sometimes they happen on the same day = this is called a mixed state. the quicker they fluctuate, the harder it is to treat.
S/Sx Bipolar I - men v. women
slightly more common among men, type 2 slightly more common among women
mania - Hyperactivity/sleeplessness
ask patient about their sleep - I’m worried you might get sick if you don’t sleep.
bipolar - Flight of ideas (bipolars fly)
racing thoughts, pressured speech used by client to relieve inner tension. you need to eventually interrupt them - I want to know more about…ask manic ppl about what brought to you the hospital?
bipolar - Grandiosity
delusions. thinks they are better than other ppl.
bipolar - words
Clang associations
bipolar 1 - Cognitive dysfunction is common with
mania (this is why CBT will NOT work during periods of mania. you can use it when they aren’t manic)
anosognsia
Resistance to tx
bipolar - Causative factors - genetics?
More genetic causation likely than with MDD (major depressive disorder) more in higher socioeconomic groups.
Greater incidence in higher socioeconomic groups may be a result of BAD (II) rather than a cause
bipolar - treatments - Lithium and anticonvulsants take how long to work?
2-3 weeks to stabilize client (in the meantime, use benzos and atypical antipsychotics)
Lithium carbonate - what dose?
first drug of choice in United States. Remember: therapeutic range for acute mania is 0.6-1.5 mEq/L tx, can go as low as 0.4-1.2 mEq/L for maintenance.
Anticonvulsants- all can be used for what?
virtually all can be used for mood stabilization, although some are used off-label.
Atypical antipsychotics - what symptoms do they help?
(remember antipsychotics kick in right away) – Used frequently when a patient is manic to decrease agitation and help with sleep. All have mood stabilization properties. Most are now FDA approved as first line tx for mania and as an option for maintenance treatment.
Anxiolytics (benzos)
Important for anxiety, sleep and psychomotor agitation while mood stabilizers are taking effect. Lorazepam and clonazepam are drugs of choice.
bipolar - nursing treatment - ADL (what do they need the most?)
especially sleeping, PO intake and grooming.
bipolar - how to give instructions
Keep instructions firm, simple and brief.
bipolar - set limits
on abusive language and redirect as needed, but then ignore inappropriate verbalization (e.g. cursing at staff) as much as possible. sometimes you just have to ignore them. This behavior will diminish as meds take effect.
mood disorders - causative factors- hormones
Hormonal regulation - women most likely during adolescence, pituitary and hypothalamus issues.
mood disorders - causative factors- inflammation
Inflammatory processes - chronic inflammation, 1/3 have elevated c-reactive, and interlukins (cytokines), BDNF (miracle grow for the brain, helps neurons grow and reconnect) - low. exercise is best for BDNF.
mood disorders - causative factors- HIV
Immune dysfunction - HIV, not enough immunoglobulins.
causative factors- Cognitive (depression) rigidity
Cognitive rigidity - very common. black and white thinking. catastrophizing. validate first.
Diathesis Stress Model -
Trauma - childhood or anytime in life.
primary risk factors for depression (male or female?)
female, poverty, unmarried
meds - one of the first symptoms to start improving?
One of the 1st symptoms to improve is anergia.
meds - symptoms slower to resolve
Hopelessness and SI are slower to resolve. Starting doses in the elderly should be half the lowest adult dose
If a patient has a full-blown manic episode, s/he is
no longer BAD II. Instead, s/he is forever after diagnosed as BAD I.
hypomania- description - no what?
no grandiose delusions, no voices, a lot of energy but will sleep some.
bipolar causative factors - biological (hormones, etc)
Biological: hormonal changes, thyroid dysfunction (both hyper and hypo), circadian rhythm disruption, antidepressant use trigger, etc.
sleep deprivation
signs of lithium toxicity?
if coarse tremor is visible at rest, it’s likely toxicity
common side effects of lithium
mild nausea & diarrhea,S/Es, which increase in toxic range, eventually leading to renal failure, seizures and death, thyroid, and cardiac. ***has a narrow therauptic range. renal failure is the main concern.
what labs to assess before starting lithium?
Renal/thyroid/cardiac functions need to be assessed before starting.
common anticonvulsant
VPA (valproic acid aka (Depakote)
valproic acid is good for which patients? (val is good for the mix)
good for mixed presentation or rapid cycling. is a first line treatment now in Europe and the US. Better than Li+ for rapid cyclers and mixed episode subtypes
primary risk factors for depression (gene)
history of loss or trauma, family history of depression, poor coping,
primary risk factors for depression - illness?
medical illness, chronic illness, isolated,
primary risk factors for depression
poor social support, substance use disorder.
signs of early lithium toxicity
muscle weakness and diahrrea
bipolar 1 - more common in women or men?
men
neurotransmitters -(4) Depression
Dopamine (Decrease), Norepinephrine (Decrease), Serotonin (Decrease), Acetylcholine (Increase)
neurotransmitter - anxiety
Norepinephrine (Increase)
neurotransmitter - schiz/psychosis/mania
Dopamine (Increase), Norepinephrine (Increase)
neurotransmitter –Alzhemier’s Disease
A decrease in Acetylcholine
anhedonia
one of the most common signs of depression - things you used to enjoy are not pleasurable anymore.
how often to assess for SI?
every shift, if that’s what brought someone into the hospital
where is ECT done?
in the OR, place electrodes on head
ECT works for how many ppl who try it?
90%
bipolar type II more characterized by
depression
substance use disorder and bipolar
very common, 60-70%, marijuana and stimulants particularily hard to manage
2 main catagories of meds for bipolar
lithium and anticonvulsants
what level of lithium is starting to get toxic?
over 1.5
other side effects that are common w/ lithium
wt. gain and thirst are common
when to use restraints?
if the person is an imminent threat to self or others
write down thoughts on piece of paper - for who?
bipolars
how long for DBT?
1 year
how long to get CBT?
short term, 6 months
DBT for borderline and what else?
anxiety and eating disorders
