Test 3 Mood disorders Flashcards
- Depressive
- Bipolar
- Mood due to general medicine
- Substance Induced
Mood Disorders
- Neurochemical
- Genetic
- Endocrine
- Psychological
- Multifactorial
Mood disorder etiology
Hypothalamus and pituitary glad disregulation can cause difficulties with thyroid, increased cortisol, and can produce depressive symptoms
Mood disorder endocrine etiology
Major depression is a ______cause of disability in the US, and by 2020 is projected to be ______ cause of disability.
MAJOR cause of disibility, projected to be the MAIN cause by 2020
- Major
- Dysthymic
- Psychotic
- Postpartum
- Seasonal Affective Disorder (SAD)
5 types of depressive disorders
- symptom of disorders that most usually the chief complaint is “I used to really like doing xyz and now I can’t find any pleasure in it”.
- Prevents a person from functioning normally and performing daily tasks
Major Depressive Disorder
- The lows aren’t quite so deep. They don’t function at the optimum and aren’t enjoying things
- Still able to do every day activities, just not as well
Dysthymic Disorder
- Depressive symptoms are so over the top and the valleys are so deep, that psychotic symptoms occur.
- EX: not just no pleasure in eating, but they fear that eating would be dangerous
- Fears that are over the top and not reality based
- Visual or auditory or tactile hallucinations
Psychotic Depression
Fixed false idea
dilusion
- A woman after birth (first months) becomes psychotically depressed and unable to care for the child.
- Ex: Andrea Yates case: Had 5-6 children and a newborn, ended up drowning all of her children in the bathtub. Believed it was the only way to salvage her children’s souls. In a psychiatric hospital for the rest of her life.
Postpartum Depression
- Primarily seen in northern temperate climates in people who don’t get enough vitamin D, don’t see light and sun enough
- Light therapy is effective
Seasonal Affective Disorder
Anhedonia
Don’t derive pleasure from the usual things you derive pleasure from
- Appetite disturbance
- sleep disturbance
- psychomotor retardation
- fatigue
- worthlessness/guilt
- decreased concentration/decreased decision making
- thoughts of death/suicide
Hallmark signs of major depression
Biological Assessment of Depression
- Changes in physical health, fatigue, sleep, appetite, sexual function
- substance abuse
Psychological assessment of depression
- Mental status, decisions, judgement, sadness, irritability
- Hopeless, worthless
- Psychomotor retardation, withdrawal, isolation
Sociocultural assessment of depression
- cultural interpretation
- stigma
Biological screens for depression
Growth hormones and sleep study
Assessing for suicidal risk
- Suicidal thoughts
- plan, lethality of means
- immediacy of threat
- prior attempts
often times ______ can look like dementia, and visa versa
depression
Tend to present with physical symptoms, les on formal mental health services
Latinos and mental health
Depend heavily on family and church support networks and may rely on folk remedies
African American cultural mental health
Delay seeking help due to stigma
Asians and cultural mental health
Mental health interventions will always be based on the ?
Always based on the assessment (evidence)
center your interventions around what first?
Basic needs: nutrition, sleep, and exercise
Nursing interventions for depression
- Increased structure
- Unconditional positive regard
- Therapeutic use of self
- Facilitate expression of feelings
- Build or rebuild self esteem, notice positives
- Education: Stress and coping, life skills, medication teaching and evaluation
- Monitor safety need
- Decrease or promot environmental stimuli
- Pharmacotherapy, effectiveness, problems, and adherance issues
- Phenelzine (Nardil), Isocarboxazid (Marplan), tranylycypromine (Parnate)
- Strict dietary restrictions
- Hypertensive crisis
Monoamine Oxidase Inhibitor (MAOI)
- Amitryptyline (Elavil), nortiptyline (Pamelor)
- Hypotension, dizziness, falls, dryness, lethal in overdose due to cardiac conduction effects, sedation
Tricyclics
- Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro)
- About 2/3 cases respond to initial treatment
- Side effects include anxiety, GI distress, irritability, some evidence of suicidal ideation
- Discontinuation syndrom can be major concern
SSRI-Selective serotonin reuptake inhibitors
other uses for antidepressants
For chronic pain, eating disorders, menopause, migraines, hot flashes, eating disorders
Need to avoid foods contianing tyromine: Aged meats and cheeses, red wine, fava beans, chocolate, bananas
Need to avoid these foods when taking MAOI’s, can produce hypertensive crisis.
- Worked before, and low cost would be two reasons why you would choose which class of antidepressants?
MAOIs
- Used if a person is having a major sleep difficulty, it’s worked in the past, it’s cheap. Not a go to medicine today
Tricyclics
- Too much serotonin in system
- Life threatening, autonomic dysfunction, confusion, disorientation, mania, agitation, muscle rigidity
Seratonin Syndrome
MAOI antidepressants must be stopped at least two weeks before?
At least two weeks before starting other antidepressants
Class of drugs in the adolescent or child that sees increased risk for suicide?
SSRIs
One difficult side effect: discontinuation syndrom
SSRIs, must taper off. Can cause a whole bunch of flu like symptoms to stop abruptly.
Treatment of serotonin syndrome
- Stop serotonergic drugs, notify prescriber
- Sympromatic treatment- anticonvulsants for seizures, lorazepam for restlessness, fluids
- Venalfaxine (Effexor), Duloxitine (Cymbalta), Desvenlafaxine (Pristiq).
- Very effective for chronic pain
SNRI: selective serotonin and norepinephrine reuptake inhibitors
- Mirtazapine (Remeron), Trazadone (Deseryl)
- Help people sleep well at night.
- Remeron lower dose for sleep, higher dose better for depression control, worse for sleep
- Deseryl: doesn’t work well for decreasing symptoms of depression, but excellent sleeping medication because it’s in and out in 6 hours
Tetracyclic
- Buproprion (Wellbutrin)
- Activating antidepressant: can provide a caffiene kind of feeling
- Used in some children and adolescents to wake up the brain for ADHD in a child where ritalin is not helpful
- Can reduce the seizure threshold: don’t use in pts with eating or seizure disorders
Aminoketone
Alternative medical management of depression therapies
- Electroconvulsant therapy
- Transcranial magnetic Stimulation (TMS)
- Bright light therapy
- herbal approaches
- aromatherapy
- the arts
Bipolar disorders (3)
- Bipolar I: Full manic and depressive episodes
- Bipolar II: hypomanic and depressive episodes
- Cyclothymic Disorders: Hypomanic and dysthymic episodes
Onset of bipolar illness most usually in?
In their early 20s, are seeing children diagnosed in the past 5 or 6 years
- Distinct period in which there is an abnormally and persistently elevated, expansive or iritable mood
- 3 additional symptoms for at least 1 week: Inflated self esteem or grandiosity, pressured speech, flight of ideas, distractibility
- Decreased need for sleep
- Psychomotor agitation
- Excessive involvement in pleasurable activities
Bipolar disorder: Manic Episode
Manic Episodes interventions
- Safety
- Decreased stimulation
- Structure
- Promote basic physical needs (sleep, nutrition, hygiene)
- Education (pt and family)
- Appropriate socialization- stage slowly as tolerated
- Lithium
- Therapeutic level: Adults 0.6-1.2, Geriatric: 0.3-0.8
- Therapeutic level: 7-10 days
Anti-Manic
- May act to stabilize electrical activity in neurons, it is a positively charged ion
- Very narrow therapeutic range
- frequent blood work is important
- may impact kidney and thyroid function with lon term use
- edema, thirst, metallic mouth
Lithium, an anti-manic medication
- Divalproex (Depakote)
- Lamotrigine (Lamictal)
- Carbamazepine (Tegretol)
- Gabapentin (Neurontin)
Anticonvulsants for manic depression
- Aripiprozole (Abilify)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Antipsychotics for manic depression
- Indicated for first line treatment of mania
- Lorazepam (Ativan)
- Diazepam (Valium)
- Clonezepam (Klonopin)
Anxiolytics
- Widely used as first line drug for stabilization and maitenance of mood
- Action is essentially unknown, but thought to increase bioavailability of GABA
- monitor liver function tests, CBC
- Neurontin, Lamictal, Topomax also used frequently for chronic pain, eating disorders
Depakote (anticonvulsants)
- About 20 years old
- Seotonin-dopamine antagonists produced fewer side effects
- Act to reduce negative symptoms as well as positive symptoms
- May improve cognitive function
- increase in blood glucose and weight
- may cause EPS, but less likely
- May cause NMS, but less likely
Atypical Antipsychotics (second generation)
- first, excellent results with few side effects- except for the possibility of neutropenia and potential for agranulocytosis
Clozapine (Clozaril): Atypical antipsychotic
- Work by enhancing GABA, which has an inhibitory effect on neurons in the brain
- Benzodiazepines- clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax)
- Addictive, subject to abuse, avoid other CNS depressants such as ETOH
- Causes sedation, unsteadiness, dependence
Anxiolytics
- active behaviors to decrease
- amount of sleep able to experience
- amount of food intake
Patient outcomes you would look for in Manic patients
