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NURS 3514 Mental Health & Illness > Week 7 Mood & affect > Flashcards

Week 7 Mood & affect Flashcards

1
Q

What is the continuum of mood disorders ?

A

Mania
Hypomania
Normal/balanced mood/Euthymia
Mild to moderate depression
Severe depression

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2
Q

What is the DSM- 5 Diagnostic criteria for Major depressive disorder?

A
  1. At least a 2 week history of 5 or more symptoms
  2. symptoms are a change from baseline
  3. symptoms cause significant distress/impairment in functioning
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3
Q

What MUST be present for a diagnosis of major depressive disorder?

A
  1. Depressed mood most of the day, nearly everday
    or
  2. markedly diminished interest/pleasure in activities most of the day, nearly everyday
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4
Q

What are the other symptoms of major depressive disorder that can accompany one of the required symtoms?

A
  1. significant weight loss/gain/decreased appetite
  2. hard to sleep
  3. psychomotor agitation or retardation
  4. fatigue/loss of energy
  5. feeling worthless/inappropriate guilt
  6. can’t concentrate/indecisive
  7. recurrent thoughts of suicide/death
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5
Q

How do youth experience depression that is different than adults?

A

-Irritable or angry mood
-“Acting Out” behaviours
-Unexplained aches and pains
-Extreme sensitivity to criticism
-Withdrawing from some, but not all people

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6
Q

What can untreated depression lead to in youth?

A

-Low self-esteem
-Problems at school/running away
-Substance abuse
-Eating disorders
-Violence
-Self-injury
-Suicide: 15-19 years of age - 2nd leading cause of death - Indigenous Youth
-Comorbid diagnosis - with ADHD; Anxiety

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7
Q

What does depression look like in older adults (common)?

A

Focus on physical health symptoms

Weight loss

Poor appetite

Anhedonia

Social isolation

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8
Q

What is anhedonia?

A

not feeling like caring about anything

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9
Q

What are less common complaints of depression in older adults?

A

depressed mood/sadness/crying

weight gain

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10
Q

What is a significant risk of depression?

A

Suicide risk - 15% die by suicide if not treated

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11
Q

What are the causes of depression?

A
  1. Physical - endocrine & illness
  2. Neurotransmitters
    - serotonin, norepi, monoamine oxidase
  3. Cognitive distortions
  4. Genetic vulnerability
  5. psychosocial factors -
  6. ACES (childhood) - trauma & loss
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12
Q

What are the approaches to treatment /care of depression?

A

meds
ECT
TMS (rTMS)
CBT
Pychotherapy
Mindfulness
Psychosocial support
Education
Health promotion
Health & Wellness

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13
Q

What are the antidepressant drug class medications for Depression ?

A

SSRIs
SNRIs
NRIs
NDRIs
SNDIs
TCAs
MAOIs

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14
Q

What does norepinephrine control?

A

Attention
balanced mood
endurance
concentration

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15
Q

What does Dopamine control?

A

Alertness
- clarity
- motivation
- passive working memory
- Appetite

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16
Q

What does serotonin control?

A

Satisfaction
- relaxation / insomnia
- pleasure / anxiety
- learning memory - disability

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17
Q

What are the SSRIs?

A

Selective serotonin reuptake inhibitors (leave more in the synapse)

  • Fluoxetine (prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Sertraline
  • Escitalopram
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18
Q

What meds for depression are used less and why?

A

TCAs
- cardiac issues
- anticholinergic symptoms

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19
Q

What is a SNRI?

A

selective serotonin and norepinephrine reuptake inhibitor

Venlafaxine (Effexor)
Duloxetine

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20
Q

What are atypical antidepressants?

A

Trazadone (Desyrel) - SARI
Buproprion - Wellbutrin - NDRI
Mirtazapine - Remeron- Tetracyclic

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21
Q

What are SSRSs indicated for?

A

Anxiety
Depression
OCD
PTSD

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22
Q

What is the MOA of SSRIs?

A

blocks reuptake of serotonin
so more is left available in synaptic cleft

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23
Q

What do we monitor for in SSRI use?

A

Serotonin syndrome
LFTs
CBC
Renal issues

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24
Q

What are the side effects of SSRIs?

A

stomach upset
serotonin syndrome
suicidal thoughts
weight gain
sexual dysfunction
sleep issues
stress

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25
Q

What should someone not take with SSRIs?

A

st john’s wart
Warfarin
Digoxin

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26
Q

What should we educate patients about with SSRIs?

A

insomnia
avoid alcohol
careful with NSAIDs- GI bleed
Change position slowly (BP) - orthostatic hypotension

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27
Q

What are SNRIs indicated for?

A

Anxiety
Depression
Neuropathic pain

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28
Q

Which antidepressants are also good for neuropathic pain?

A

SNRIs
Atypical antidepressants
TCAs

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29
Q

What should we monitor for in someone taking SNRIs?

A
  • serotonin syndrome
    agitation
    fever
    hallucinations
    diaphoresis
    tremors
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30
Q

What side effects do SNRIs have that SSRIs do not?

A

-Hypertension d/t norepi increase
- Adrenergic effects
- Tachycardia

(also has all the ones from SSRIs)

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31
Q

What do SNRIs interact with?

A

St. john’s wort

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32
Q

What are Atypical Antidepressants indicated for?

A

Depression
Neuropathy
Fibromyalgia
Anxiety
Insomnia

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33
Q

What is the MOA of atypical antidepressants?

A

SLOWS (not blocks) rate of reuptake of serotonin and norepi

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34
Q

What are the 2 things people can experience if stopping or changing SSRIs suddenly?

A

Withdrawl symptoms - discontinuation syndrome

Serotonin syndrome - excessive serotonin

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35
Q

What are discontinuation syndrome symptoms?

A

flu- like symptoms
nausea
electric shock in brain
headache
vertigo
anxiety/irritable
insomnia

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36
Q

What are symptoms of Serotonin syndrome?

A

MSE changes - delirium
Fever
Tachycardia
Hypertension
Tremor
Diarrhea
Neuromuscular symptoms

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37
Q

What drugs can cause Serotonin Syndrome?

A

SSRIs
SNRIs
TCAs
Buspirone
MAOIs
Lithium
St John’s Wort
Trazadone
LSD, MDMA (ecstacy), cocaine

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38
Q

What is the triad of clinical features in Serotonin syndrom?

A

Mental status changes
Neuromuscular abnormalities (muscle rigidity)
Autonomic hyperactivities (BP and HR increase)

39
Q

What is the acrynom for Serotonin syndrome?

A

HARMFUL
H- hyperthermia
A- agitation, delirium, confusion
R - restlessness, increase reflexes
M - Myoclonus - twitch/jerk
F- Fast heart rate
U- Unconsciousness
L- Loss of GI control - nausea & diarrhea

40
Q

What is the onset of Serotonin syndrome?

A

Quick onset (within hours)

41
Q

What two medications do we use to counter serotonin syndrome and why?

A

benzos- sedation
cyproheptadine - block serotonin production

42
Q

What drug class is very dangerous in overdose and why?

A

TCAs
cardiotoxicity

43
Q

What are MAOIs?

A

TIPS
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

44
Q

What are MAOIs indicated for?

A

Depression

45
Q

What is the MOA of MAOIs?

A

inhibits monoamine oxidase
- monoamine neurotrasmitters can’t be broken down

  • stops reuptake of serotonin, melatonin, epinephrine, and norepi
46
Q

What 2 things do we monitor for with MAOIs?

A

Hypertensive crisis
Serotonin syndrome

47
Q

What are the side effects of MAOIs?

A

Agitation/anxiety
Orthostatice hypotension
Hypertensive crisis

48
Q

What antidepressants can cause hypertensive crisis?

A

MAOIs

49
Q

What antidepressants can cause orthostatic hypotension?

A

Atypical Antidepressants
MAOIs
TCAs

50
Q

What should we teach patients who are taking MAOIs?

A
  • no foods with tyramine
  • avoid caffeine
    -OTC cold medications = hypertension
  • 2 week washout period needed
51
Q

What is IV ketamine used for?

A

treatment-resistant depression

52
Q

How long is the treatment of Ketamine?

A

8 treatments
2-3 x/week

53
Q

What is the MOA of ketamine?

A

causes excitation of the neurons and neuroplasticity

glutamate allows new pathways to be formed in the brain

54
Q

What is one of the most effective treatments for acute depression?

A

ECT

55
Q

how many hours should someone be NPO before ECT?

A

6 hours

56
Q

What are the side effects of ECT?

A

-Disorientation/confusion
- STM loss around time of treatment
- Muscle aches/pains
- headache
- N&V

57
Q

What is rTMS/TMS?

A

transcranial magnetic stimulation

  • electromagnetic coil on scalp
  • stimulates brain cells we think relate to depression
  • 30 min
  • patient is awake
58
Q

What are the 3 principles of CBT?

A

1.thoughts create feelings
2. feelings created behaviours
3. behaviours reinforce thoughts

it’s a cycle

59
Q

What’s important for caring for someone with depression?

A
  1. therapeutic relationship
  2. meet physical health needs
  3. make positive decisions for clients if they are unable to
  4. promote coping skills that are empowering to the person
  5. Promote problem solving skills
  6. positive self regard
  7. encourage social support network
  8. Support for families or caregivers
60
Q

Which is worse, bipolar I or bipolar II?

A

Bipolar I

61
Q

What is different between bipolar I and bipolar II?

A

Bipolar I - at least 1 MANIA (can’t function) episode
WITH depression/anxiety

Bipolar II - at least one HYPOMANIC (function too well) episode AND at least ONE major depressive episode

62
Q

What is Cyclothymia?

A

numerous periods of hypomanic symptoms
WITH depressive symptoms over at least 2 years

63
Q

What is different between Bipolar II and Cyclothymia?

A

Cyclothymia:
time- must be at least over 2 years

frequency- numerous hypomanic symptoms

64
Q

How do we distinguish Bipolar from depressive disorders?

A

the occurance of mania or hypomania (mild manic)

IN ADDITION to

Depressive episodes

65
Q

what is the onset age of bipolar?

A

21-30 years old

66
Q

What is rapid cycling?

A

4 or more episodes in 12 months

67
Q

What is secondary mania?

A

it’s caused by something else like a tumour

“Mania secondary to tumour”

68
Q

What is hypomania?

A

elated behaviour that is atypical for the person

over at least 4 consecutive days, most of the day, nearly everyday

69
Q

Which progresses into psychosis, Mania or hypomania?

A

Mania only

70
Q

Does hypomania cause marked impairment to daily, social, or occupational functioning?

A

No - that’s mania

71
Q

How long do symptoms of Mania have to be present according to the DSM 5?

A

at least 1 week
present most of the day, nearly everyday
represents a change for the person

72
Q

What symptoms must be present for a mania diagnosis?

A
  • persistent elevated (euphoric), expansive or irritable mood
  • very goal directed activity/energy
  • 3 or more of the other symptoms (or 4 if there is only irritable mood)
73
Q

What are the other symptoms of Mania that go along with the required two for diagnosis according to DSM 5?

A
  • inflated self-esteem or grandiosity
  • don’t need sleep
  • pressured speech - talkative
  • flight of ideas - racing thoughts
  • distracted to external stimuli
  • purposeless non-goal directed activity / psychomotor agitation
  • Excessive buying sprees, sexual indiscretions, reckless business investments
74
Q

What is different between schizophrenia from bipolar in the common symptoms?

A

schizophrenia- when they sleep delusions go away

bipolar - sleep doesn’t make things better

75
Q

How does lithium toxicity differ from serotonin syndrome?

A

lithium toxicity - more of a tremor and rigidity until they become unconscious

  • think of G4 guy with what looked like seizures but very random and he was unconscious
76
Q

What medications are used first line for bipolar?

A

*Anti-psychotics
- quetiapine
- Seroquel

*Sedatives/Hypnotics
- zoplicone
- trazadone (for sleep)

Antianxiety - benzos (short term)

Antidepressants

77
Q

What medication is used after first line meds have been tried for bipolar?

A

Lithium

78
Q

What can lithium toxicity result in ?

A

severe kidney damage (check urine and creat/urea!)

death

79
Q

What affects lithium levels and how?

A

salt

too much salt makes lithium not work well

too little salt can allow lithium to become toxic
dehydration or N&V can cause toxicity

80
Q

What is lithium indicated for?

A

acute mania - bipolar

long term management of bipolar

81
Q

What is the MOA of lithium?

A

acts on CNS

strengthen nerve connections in the brain - mood, thinking, behaviour

82
Q

What bloodwork do we monitor with lithium?

A

Creatinine/BUN
Lithium levels - 12 hrs after last dose
Na

83
Q

What are the side effects of lithium?

A

nephrotoxicity - kidney harm
polyuria - pee a lot
increased thirst
fine hand tremors
hypothyroid
electrolyte changes
leukocytosis (high white blood cells)

84
Q

what should we teach someone on Lithium?

A

no diuretics
no NSAIDS
careful Na intake
careful fluid intake
careful when sweating, dehydrated, diarrhea, illness
no preggers or breastfeeding

85
Q

What are some clinical symptoms of lithium toxicity?

A

confusion
slurred speech
incoordination

86
Q

What do we do if we suspect someone has lithium toxicity?

A

activated charcoal or pump stomach

bolus with fluid (likely dehydrated or not enough salt)

sometimes hemodialysis

87
Q

What drug classes are used for bipolar?

A

Mood stabilizers - lithium
Anticonvulsants -
-carbamazepine
- valproate
- gabapentin
- topiramate

88
Q

What are anticonvulsants indicated for?

A

acute mania
maintenance of bipolar disorder

89
Q

What is the MOA of anticonvulsants?

A

carbamazepine - decreases synaptic transmissions in CNS

Valproic acid - increases GABA (inhibitory behaviour and mania decrease)

90
Q

what do we monitor with carbamezapine?

A

“my love of CARBS is in my blood - cbc”

LFTs, CBC
leukopenia & aplastic anemia

91
Q

What do we monitor in valproate?

A

(if you VALue your liver)
*LFT
*PLATELETS
drowsiness
mood
ideations

92
Q

What do we educate people about with carbamazepine?

A

fever or sore throat (leukopenia)

lowers effectiveness of most hormonal BC

93
Q

What do we educate about valproate?

A

not for preggers
maybe jaundice
watch for bleeding

94
Q

What are the goals of care for ACUTE mania?

A

safety
prevent injury with drugs when needed

ADLs

Calm voice

Short convos

Reduce stimulation

NURS 3514 Mental Health & Illness (7 decks)

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