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Nursing Theory IV B- Anita's Class > Week 3: Mood Disorders > Flashcards

Week 3: Mood Disorders Flashcards

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1
Q

What are the two primary mood disorders?

A
  1. Major depression (MDD)
  2. Bipolar disorder (formerly manic-depressive)
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2
Q

What is a major depression(MDD)?

A
  • 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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3
Q

What is bipolar disorder (formerly manic-depression)?

A

-Mood fluctuates to extremes of mania and/or depression

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4
Q

What is dysthymia? Symptoms?

A

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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5
Q

What is disruptive mood dysregulation disorder?

A
  • 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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6
Q

What is cyclothymia?

A
  • 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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7
Q

What is substance-induced depressive or bipolar disorder?

A
  • 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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8
Q

What is a mood disorder?

A

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

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9
Q

What is seasonal affective disorder(SAD)?

A

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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10
Q

What is postpartum or “maternity” blues? Treatment?

A

– 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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11
Q

What is postpartum depression? Treatment?

A

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

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12
Q

What is postpartum psychosis?

A

Needs IMMEDIATE TREATMENT
- rare, follows delivery

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13
Q

What is pre-menstrual dysphoric disorder?

A
  • 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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14
Q

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

A
  • 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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15
Q

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

A
  1. Serotonin
  2. Norepinephrine
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16
Q

What is serotonin?

A

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

17
Q

What is norepinephrine?

A

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

18
Q

What are major depressive disorder treatment?

A
  1. Medication
  2. Electroconvulsive therapy (ECT)
  3. Psychotherapy
19
Q

What is the medication MDD?

A
  • 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
20
Q

What are SSRI medication side effects? Pt teaching?

A

-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

21
Q

What are some examples of SSRIs?

A

Prozac, Zoloft, Paxil, Celexa, Lexapro

22
Q

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

A

-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

23
Q

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

A

Elavil, Ascendin, Tofranil, Norpramin, Pamelor, Sinequan

24
Q

What are atypical antidepressants? Examples?

A

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
25
Q

What are Monoamine Oxidase Inhibitors (MAOIs)?

A
  • 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
26
Q

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

A

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

27
Q

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

A

Marplan, Parnate, Nardil

28
Q

What is electroconvulsive therapy(ECT)? Side effect?

A
  • shock the brain to induce a seizure to restart brain to correct chemical imbalance of depression
  • For MDD
    side effect: short term memory impairment
29
Q

What is psychotherapy?

A
  • Most effective treatment, talking therapy to help person understand or insight into their problems
  • Include: behavioural, cognitive, interpersonal
30
Q

What are some examples of investigational treatments?

A
  1. Transcranial magnetic simulation (TMS)
  2. Magnetic seizure therapy(MST)
  3. Deep brain stimulation (DBS)
  4. Vagal nerve stimulation
31
Q

What is bipolar disorder?

A
  • aka manic-depressive disorder
  • extreme mood swings, high ups and low lows
  • requires 1+ weeks unusually heightened agitated, grandiose mood
32
Q

What are signs and symptoms for bipolar disorder?

A

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

33
Q

What is the treatment for bipolar disorder?

A

anticonvulsant drugs

34
Q

What are some examples for anticonvulsants drug?

A
  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
35
Q

What is lithium?

A

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

36
Q

What is the side effects and patient teaching of lithium?

A

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

37
Q

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

A

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.

38
Q

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

A

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

39
Q

What are some examples of food that contain tyramine?

A

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

Nursing Theory IV B- Anita's Class (21 decks)

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