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303 mental health > week 4 mood disorders- depression > Flashcards

week 4 mood disorders- depression Flashcards

1
Q

what are the type of mood disorders?

A
  • Major Depressive Disorder (MDD)
  • Bipolar I Disorder
  • Bipolar II Disorder
  • Persistent Depressive Disorder (Dysthymia)
  • Cyclothymic Disorder
  • Premenstrual Dysphoric Disorder
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2
Q

mood disorders- neurobiology

A

-genes
-psychosocial adversity in childhood
-ongoing or recent psychosocial stress
-norephinephrine
-serotonin
-dopamine

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3
Q

Major Depressive Disorder: Diagnostic Criteria

Diagnostic Criteria: Major Depressive Disorder
The individual must be experiencing five or more symptoms during a 2 week period at at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure in the same 2-week period

A

❑ Depressed mood
❑ Loss of interest/pleasure
❑ Weight loss or gain
❑ Insomnia or hypersomnia
❑ Psychomotor agitation or retardation
❑ Fatigue
❑ Feeling worthless or excessive/inappropriate guilt ❑ Decreased concentration
❑ Thoughts of death/suicide

❑ Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
❑ Episode not attributable to physiological effects of a substance or another medical condition
❑ Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other psychotic disorder
❑ No history of manic or hypomanic episode

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4
Q

Depression: Pharmacotherapeutic Interventions: Antidepressants

A

Increase activity of neurotransmitters in the brain which help to lessen the symptoms of depression

  • Dopamine
  • Norepinephrine * Seratonin
  • Work best when combined with psychotherapy, social support and self care
  • Two in three people with MDD eventually achieve lasting symptom remission with conventional antidepressants and therapy
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5
Q

Depression: Pharmacotherapeutic Interventions: Antidepressants

A
  • Increase activity of neurotransmitters in the brain which help to lessen the symptoms of depression and anxiety
  • Work best when combined with psychotherapy, social support and self care
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6
Q

dopamine

A

-influences decision making
-influences motivation
-influences arousal
-signals pleasure and reward

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7
Q

norepinephrine

A

-influences alertness
-influences motor function
-regulates blood pressure
-regulates heart rate

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8
Q

serotonin

A

-regulates mood
-regulates appetite
-regulates sleep
-regulates social behaviour
-regulates sexual desire

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9
Q

Side Effects of Antidepressant Medications by Class

SSRI

A

Nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation, decrease in sexual desire and response

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10
Q

Side Effects of Antidepressant Medications by Class

SNRI

A

Nausea, drowsiness, dizziness, nervousness, fatigue, loss of appetite, decrease in sexual desire and response, increase in blood pressure

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11
Q

Side Effects of Antidepressant Medications by Class

NON-SELECTIVE CYCLICS

A

Dry mouth, tremors, constipation, sedation, blurred vision, difficulty urinating, weight gain, dizziness,

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12
Q

Side Effects of Antidepressant Medications by Class

MAOI

A

Orthostatic hypotension, insomnia, swelling, weight gain

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13
Q

Side Effects of Antidepressant Medications by Class

NDRI

A

Jitteriness, insomnia

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14
Q

Side Effects of Antidepressant Medications by Class

NaSSA

A

Drowsiness, weight gain

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15
Q

Bipolar
2 TYPES

A

Type 1
* Manic Episodes
* Distinct period(s) elevated mood + energy

Type 2
* Depressive Episodes
* Hypo-Mania

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16
Q

Bipolar I Disorder: Diagnostic Criteria (DSM-5, APA)

A

❑ Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day
❑ During the period of mood disturbance and increased energy or activity 3 or more of the following symptoms
❑ Inflated self-esteem or grandiosity
❑ Decreased need for sleep
❑ More talkative than usual or pressure to keep talking
❑ Flight of ideas or subjective experience that thoughts are racing
❑ Distractibility
❑ Increase in goal-directed activity
❑ Excessive involvement in activities that have a high potential for painful consequences

-The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
❑ The episode is not attributable to the physiological effects of a substance

17
Q

Bipolar II Disorder: Diagnostic Criteria (DSM-5, APA)

A

Criteria have been met for at least one hypomanic episode or at least one major depressive episode
❑ There has never been a manic episode
❑ The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder
❑ The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomanic cause clinically significant distress or impairment in social, occupational or other important areas of functioning

18
Q

Bipolar I and Bipolar II Disorders: Pharmacotherapeutic Interventions: Mood Stabilizers

A

naturally occurring
-Lithium

ANTICONVULSANTS
Carbamazepine (Tegretol)
Divalproex (Epival)
Lamotrigine Lamictal)

ADJUNCTIVE ANTICONVULSANTS
Gabapentin (Neurontin)
Topiramate (Topamax)

19
Q

LITHIUM

A

*Common side effects include Increased thirst and urination, nausea, weight gain, fine trembling of the hands
*Less common side effects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes, slight muscle weakness, thyroid and kidney function changes

20
Q

DIVALPROEX/VALPROIC ACID/VALPROATE

A

*Common side effects include drowsiness, dizziness, nausea and blurred vision
*Lesson common side effects are vomiting, mild ramps, muscle tremor, mild hair loss, weight gain, bruising or bleeding, liver problems , changes in menstrual cycle in people who identify as women

21
Q

CARBAMAZEPINE

A

*Common side effects include dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes and poor coordination
*A rare but dangerous side effect is reduced blood cell counts, soreness of the mouth, gums or throat, mouth ulcers or sores and fever or flu like symptoms can be a side of this effect

22
Q

LAMOTRIGINE

A

Common side effects include fever, dizziness, drowsiness, blurred vision, nausea, vomiting or mild cramps, headache and skin rash
*A rare but dangerous side effect is a severe skin rash

23
Q

Mood Disorders: Non-Pharmacological Interventions

Electroconvulsive Therapy (ECT)

A

An invasive treatment for severe mania, severe depression, treatment refractory depression, catatonia and treatment resistant schizophrenia
* Small electric currents are passed through the brain intentionally triggering a brief seizure while an individual is under anesthetic
* ECT brings about neurophysiological and neurochemical changes in the brain
* The procedure takes about 5 to 10 minutes, with added time for preparation and recovery
* The changes in brain chemistry can result in improvement after as few as 6 treatments

24
Q

Mood Disorders: Non-Pharmacological Interventions

Electroconvulsive Therapy (ECT)

drawbacks and benefits

A

BENEFITS
* Mood stabilizing property is superior to pharmacotherapy for depressive episodes, manic episodes and mixed episodes in bipolar disorder
* Can return to usual activity a few hours after the procedure
* Can result in rapid symptom improvement
* Can be offered for inpatients and outpatients

DRAWBACKS
* Requires sedation with anesthesia in hospital
* May cause low mild transient side effects including confusion, retrograde amnesia, nausea, headache, jaw pain or muscle ache
* May cause medical complications associated with anesthesia
24

25
Q

Mood Disorders: Non-Pharmacological Interventions

Transcranial Magnetic Stimulation (rTMS)

A
  • A non-invasive treatment for treatment refractory
    depression and bipolar disorder
  • Uses targeted magnetic pulses, similar to those used in an MRI machine to activate parts of the brain involved in mood regulation in the dorsolateral prefontal cortext
  • During a session, a helmet containing an electromagnetic coil is placed on the head to stimulate targeted regions of the brain
  • Most people see dramatic improvement in depressive symptoms after four weeks –six weeks
26
Q

Mood Disorders: Non-Pharmacological Interventions

Transcranial Magnetic Stimulation (rTMS)

drawbacks and benefits

A

BENEFITS

  • Well tolerated -not painful or disruptive
  • No hospitalization or anesthesia required
  • No systemic side effects
  • No memory loss

DRAWBACKS

  • Common side effects may include headache, scalp discomfort at the site of stimulation, tingling and light headedness spasms of facial muscles and
  • Uncommon side effects can include seizures and mania in people with bipolar disorder
  • Treatment may not be effective for
    everyone
27
Q

Mood Disorders: Non-Pharmacological Interventions

  • Ketamine Infusion
A

An invasive treatment for treatment resistant resistant depression that stimulates a rapid increase in glutamate
* Glutamate helps strengthen and restore vital neural connections and pathways in the regions of the brain that are most impaired by depression
* New connections help induce beneficial changes in brain circuit function
* Ketamine is administered IV in subanesthetic doses (0.5mg/kg over 40 min) in an anesthetic care unit under medical supervision

28
Q

Mood Disorders: Non-Pharmacological Interventions
* Ketamine Infusion

drawbacks and benefits

A

BENEFITS
* Offers fast acting symptom relieve. (within hours)
* Has anti-suicidal properties
* Well tolerated and safe

`DRAWBACKS
* Requires access to operating theatre
* Common side effects may include high blood pressure and slowed breathing
* Uncommon side effects inxclude
* Serial influsions may be required to maintain treatment effect

29
Q

Mood Disorders: Non-Pharmacological Interventions
* Esketamine Treatment

A

A rnon-invasive treatment for individuals with treatment resistant depression who have failed two antidepressant trials of adequate dosages and durations
* Esketamine Increases connections/synapses between brain cells
* Administered intranasally in an outpatient setting under medical supervision
* Provides a rapid acting anti-depressive response that can last 3-14 days

30
Q

Mood Disorders: Non-Pharmacological Interventions
* Esketamine Treatment

drawbacks/benefits

A

benefits
produces rapid acting anti- depressive response
* Has anti-suicidal properties
* Antidepressive response lasts an average of 3-14 days

DRAWBACKS
* Common side effects include temporary sedation, trouble with attention, judgment and thinking
* Initial treatment involves 6 influsions spread out of 3 weeks
* May require repeated treatments to maintain anti- depressive and anti- suicidal effects in continuation phase of treatment

31
Q

Mood Disorders: Non-Pharmacotherapeutic Interventions: Psychotherapy

A

Cognitive Therapy-Short-term-Focused on changing negative thought patterns(cognitive distortions) that contribute to depression

Behavioral Therapy-Short-term- focused on changing behaviours that contribute to depression

Cognitive Behavioral therapy-Short-term-Focused on addressing negative thought patterns and behaviors that contribute to depression

Psychodynamic therapy-Longer term-Focused on exploring unconscious conflicts often originating from childhood and the impact they have on depression

32
Q

12 common cognitive distortions

A
  1. mind reading- when you assume you know what others are thinking/feeling
  2. negative focus- when you ignore positive aspect and only see the negative ones
  3. catastrophizing- when you expect the worse case scenario to happen to you
  4. labelling- when you label yourself or someone negatively
  5. should-thinking- when you have rules or expectations how things or people should be/act
  6. overgeneralizing-when a single negative event occurs and you believe its a pattern
  7. emotional reasoning- when you believe that how you feel is evidence or reflects reality
  8. fortune telling- when you think the future is set in stone and the outcome is true
  9. personalization- when you feel personally responsible or guilty for things you can’t control
  10. owning the truth- when you are certain you are right and your opinion is the truth
  11. just world-thinking- when you assume that everything in the world will be balanced fairly
  12. control fallacy- when you assume you can control everything that happens in your life
33
Q

Mood Disorders: Nursing Interventions

A

Psychoeducation
Family support & education
Skill Teaching- illness self- management
Supportive Counselling
Facilitating Individual psychotherapy
Facilitating Group psychotherapy
Resource matching & referral
Individual & system level advocacy
Crisis prevention & intervention
Monitoring Service Delivery
Medication monitoring, management & Administration

303 mental health (8 decks)

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