- Characterized by 2+ years of symptoms include an alternating pattern of emotional highs and lows - Highs of cyclothymia characterized hypomanic symptoms, which resemble those of mania, but are less severe - Lows consist of mild or moderate depressive symptoms. - Symptom similar to those of bipolar disorder, but less severe - Usually can function in daily life without social or occupational loss

Week 3: Mood Disorders Flashcards by Mikeala Stacho

What are the two primary mood disorders?

Major depression (MDD)
Bipolar disorder (formerly manic-depressive)

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What is a major depression(MDD)?

2+ weeks of depressed mood, lack of pleasure in life activities
changes in eating habits, hypersomnia/insomia, impaired concentration, decision making, inability to cope, overwhelming fatigue, negative thinking, pessimistic

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What is bipolar disorder (formerly manic-depression)?

-Mood fluctuates to extremes of mania and/or depression

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What is dysthymia? Symptoms?

Depressed mood for most of the days for more days than not
Symptoms: insomnia, hypersomnia, poor appetite or over eating, low energy & self esteem, poor concentration, feelings of hopelessness
*no mania or hypomania episodes, underlying medical causes identified

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What is disruptive mood dysregulation disorder?

Persistent angry/irritable
-Severe, recurring angry outbursts that are not in keeping with the situation or provocation, starting before age 10 at least 3 times per week
Inconsistent with developmental level
Setting is a factor

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What is cyclothymia?

Characterized by 2+ years of symptoms include an alternating pattern of emotional highs and lows
Highs of cyclothymia characterized hypomanic symptoms, which resemble those of mania, but are less severe
Lows consist of mild or moderate depressive symptoms.
Symptom similar to those of bipolar disorder, but less severe
Usually can function in daily life without social or occupational loss

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What is substance-induced depressive or bipolar disorder?

Significant disruption in mood
Direct physiologic consequence of ingested substances such as alcohol, other drugs or toxins
Many medications and substances are known to cause substance-induced depression.
I.E. clonidine, tamoxifen, steroids, triptans, anti depressants etc.

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What is a mood disorder?

Due to a general medical condition - i.e. degenerative neurological condition, i.e. CVA

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What is seasonal affective disorder(SAD)?

2 types:
Winter or Fall Onset = ↑appetite, sleep, carb cravings, weight gain, conflict, irritability, abates with spring and summer

Spring Onset = less common - insomnia, weight loss, poor appetite

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What is postpartum or “maternity” blues? Treatment?

– Within 1-5 days of delivery, brief episodes of labile mood and tearfulness, crying spells, anxiety, peak 3-7 days (mild, predictable ) Treatment: reassurance, time to resolve

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What is postpartum depression? Treatment?

– occurs within 4 wks of delivery and more debilitating than the“blues” - Treatment: medication, psychotherapy

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What is postpartum psychosis?

Needs IMMEDIATE TREATMENT
- rare, follows delivery

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What is pre-menstrual dysphoric disorder?

Recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolve with menstruation
Can cause severe dysfunction in social or occupational functioning

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What is non-suicidal self-injury(self mutilation)?

Involves deliberate, intentional cutting, bruising, burning, scraping, hitting, or interference with wound healing
Persons report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility

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What are the two major chemical messengers implicated in mood disorders?

Serotonin
Norepinephrine

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What is serotonin?

mood, activity, aggressiveness, and irritability, cognition, pain, and neuroendocrine processes( i.e. growth hormone abnormal in depression)

What is norepinephrine?

(catecholamine) Levels may be ↓ in depression and ↑ in mania

What are major depressive disorder treatment?

Medication
Electroconvulsive therapy (ECT)
Psychotherapy

What is the medication MDD?

Tricyclic antidepressants(TCA)
–> oldest medication with the most symptoms
Monoamine oxidase inhibitors(MAOIs)
–> Used least, they can cause a hypertensive crisis if they ingest tyramine rich foods
Selective serotonin reuptake inhibitors(SSRIs)
–> newest and fewest side effects
Atypical antidepressants

What are SSRI medication side effects? Pt teaching?

-For MDD
Side Effects: anxiety, nervousness, sedation agitation, akathisia, nausea, insomnia, sexual dysfunction, dry mouth (Table 17.1 pg 290)
Patient teaching:
Take in the morning or night if sedating
Take with food

What are some examples of SSRIs?

Prozac, Zoloft, Paxil, Celexa, Lexapro

What are the side effects of tricyclic antidepressant drugs(TCAs)? Contraindications?

-For MDD
Side effects: anticholinergic (blurred vision, urinary retention, dry mouth (anticholinergic effects , constipation), orthostatic hypotension, sedation, weight gain, tachycardia, sexual dysfunction

Contraindications: Impaired liver function

What are some examples of tricyclic antidepressant drugs(TCAs)?

Elavil, Ascendin, Tofranil, Norpramin, Pamelor, Sinequan

What are atypical antidepressants? Examples?

used when ct has inadequate response or side effects from SSRIs
- For MDD

Effexor : Dual acting, targets serotonin and norepinephrine receptors
–> Side Effects – anxiety, wt. gain, nausea
Wellbutrin (Zyban - for smoking cessation)
Serzone, Cymbalta

What are Monoamine Oxidase Inhibitors (MAOIs)?

- Used infrequently - have potentially fatal side effects & interactions with many medications - lethal in overdose. - for MDD - 2-4 weeks to reach therapeutic levels (d/c 5-6 weeks, before another class of antidepressant is started); not elderly use

What are side effects of Monoamine Oxidase Inhibitors (MAOIs)? Patient teaching?

Side Effects: sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction, - Hypertensive Crisis – most serious from ingesting foods containing tyramine; Tyramine reaction within 20-60 minutes Patient teaching: Follow tyramine-free diet - (avoid aged cheeses – processed ok, aged meats, beer and wine, sauerkraut, soy), use caution when driving

What are some examples of Monoamine Oxidase Inhibitors (MAOIs)?

Marplan, Parnate, Nardil

What is electroconvulsive therapy(ECT)? Side effect?

- shock the brain to induce a seizure to restart brain to correct chemical imbalance of depression - For MDD side effect: short term memory impairment

What is psychotherapy?

- Most effective treatment, talking therapy to help person understand or insight into their problems - Include: behavioural, cognitive, interpersonal

What are some examples of investigational treatments?

1. Transcranial magnetic simulation (TMS) 2. Magnetic seizure therapy(MST) 3. Deep brain stimulation (DBS) 4. Vagal nerve stimulation

What is bipolar disorder?

- aka manic-depressive disorder - extreme mood swings, high ups and low lows - requires 1+ weeks unusually heightened agitated, grandiose mood

What are signs and symptoms for bipolar disorder?

1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to 3 or more of the following symptoms: - Positive mood - Irritability - Inappropriate behaviour - Increased energy - Creativity - Mystical Experiences or psychotic symptoms DSM-V-TR Criteria - Exaggerated self-esteem - Sleeplessness - Pressured speech - Flight of ideas - Reduced ability to filter extraneous stimuli - Distractibility - Increased activities with increased energy - Multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments

What is the treatment for bipolar disorder?

anticonvulsant drugs

What are some examples for anticonvulsants drug?

1. *Carbamazepine (Tegretol)* – used for grand mal seizure 2. *Valproic Acid (Depakote)* – used for simple absence and mixed seizures and mania; check LFT’s 3. *Gabapentin (Neurontin)*, *Lamotrigine* and *Topamax* – anticonvulsants used for mood stabilizers 4. *Clonazepam* - anticonvulsant and a benzodiazepine used in absence and minor motor seizures, panic disorder and bipolar disorder 5. *Abilify* – dopamine system stabilizer/antipsychotic med – use as adjunct to control symptoms; effective in acute and maintenance

What is lithium?

mood stabilizers CAUTION: fine line between therapeutic and toxic levels. Kidneys excrete both lithium and Na, if Na level low lithium will be retained in its place------TOXICITY (must know) - regular monitoring is NEEDED

What is the side effects and patient teaching of lithium?

*Side Effects*: nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, fatigue, weight gain, acne *Patient teaching* - take with food; monthly blood levels drawn 12 hours after last dose Drug interactions*NSAIDS, THIAZIDES,CARBAMAZEPINE,ACE INHIBITORS see med card

Which medication would be most appropriate for the treatment of mania associated with bipolar disorder? A. Lithium B. Fluoxetine C. Citalopram D. Venlafaxine

A. Lithium Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic client with bipolar disorder. Fluoxetine, citalopram, and venlafaxine are antidepressants.

What is the rationale for a person taking lithium to have enough water and salt in his/her diet? A) Salt and water are necessary to dilute lithium to avoid toxicity B) Water and salt convert lithium into a usable solute C) Lithium is metabolized in the liver, necessitating increased water and salt D) Lithium is a salt that has greater affinity for receptor sites than sodium chloride

D. Lithium is a salt that has a greater affinity for receptor sites than sodium chloride.

What are some examples of food that contain tyramine?

Avocados, bananas, beef or chicken liver, yeast, broad beans, caffeine, cheese, meet extracts, overripe fruit, raisins, red wine, beer, sausage, bologna, pepperoni, salami, sour cream, soy sauce, yogurt