Week 3: Mood Disorders Flashcards
What are the two primary mood disorders?
- Major depression (MDD)
- Bipolar disorder (formerly manic-depressive)
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
What is bipolar disorder (formerly manic-depression)?
-Mood fluctuates to extremes of mania and/or depression
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
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
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
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.
What is a mood disorder?
Due to a general medical condition - i.e. degenerative neurological condition, i.e. CVA
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
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
What is postpartum depression? Treatment?
– occurs within 4 wks of delivery and more debilitating than the“blues” - Treatment: medication, psychotherapy
What is postpartum psychosis?
Needs IMMEDIATE TREATMENT
- rare, follows delivery
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
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
What are the two major chemical messengers implicated in mood disorders?
- Serotonin
- Norepinephrine
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?
- Transcranial magnetic simulation (TMS)
- Magnetic seizure therapy(MST)
- Deep brain stimulation (DBS)
- 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?
- Carbamazepine (Tegretol) – used for grand mal seizure
- Valproic Acid (Depakote) – used for simple absence and mixed seizures and mania; check LFT’s
- Gabapentin (Neurontin), Lamotrigine and Topamax – anticonvulsants used for mood stabilizers
- Clonazepam - anticonvulsant and a benzodiazepine used in absence and minor motor seizures, panic disorder and bipolar disorder
- 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
