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NURS 3514 > Week 7 Mood Disorders > Flashcards

Week 7 Mood Disorders Flashcards

1
Q

Major Depressive Disorder Key Diagnostic Criteria - DSM-V Criteria

A

At least a 2 week history of 5 or more symptoms listed on the following slide

Symptoms represent a change from baseline

Symptoms cause significant distress/ impairment in functioning

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2
Q

Major Depressive Disorder Key Diagnostic Criteria - DSM-V Criteria Symptoms

A
  1. Depressed mood most of the day, nearly every day**
  2. Markedly diminished interest/pleasure in activities most of the day, nearly every day**
  3. Significant weight loss or weight gain/decreased appetite
  4. Difficulty sleeping (insomnia or hypersomnia)
  5. Psychomotor agitation or retardation
  6. Fatigue/loss of energy
  7. Feelings of worthlessness or inappropriate guilt
  8. Inability to concentrate or indecisiveness
  9. Recurrent thoughts of death/suicide

** At least 1 of either depressed mood or loss of interest/pleasure MUST BE PRESENT

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3
Q

Disorder Qualifiers to Describe/
Define Depression

A

➢ Major Depressive Disorder (MDD)
➢ Mild, moderate, severe
➢ Dysthymia
➢ Seasonal pattern
➢ Psychotic depression
➢ Post-partum
➢ Co-occurs with medical conditions
➢ Depression in youth and teens
* Disruptive Mood Dysregulation Disorder (page 221)

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4
Q

Youth/ Teen depression compared to adults

A

➢ Irritable or Angry Mood
➢ “Acting Out” behaviors
➢ Unexplained aches and pains
➢ Extreme sensitivity to criticism
➢ Withdrawing from some, but not all people

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5
Q

Youth/Teen Depression Untreated: Depression Leads to:

A

➢ Low Self-Esteem
➢ Problems at School/Running Away
➢ Substance Abuse
➢ Eating Disorders
➢ Violence
➢ Self-Injury
➢ Suicide – 15 – 19 years of age – 2nd leading case of death – Indigenous Youth
➢ Comorbid diagnosis – with ADD; Anxiety

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6
Q

Common complaints in depression in older adults

A

➢ Focus on physical health symptoms
➢ Weight loss
➢ Poor appetite
➢ Anhedonia
➢ Social isolation

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7
Q

Less common complaints in depression in older adults

A

➢ Depressed mood/ sadness/ crying
➢ Weight gain

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8
Q

Percentage of those with bipolar disorder that die by suicide if not treated

A

15%

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9
Q

Definition of mood disorders

A

Recurrent disturbances or alterations in mood that cause psychological stress and behavioural impairment

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10
Q

SSRIs

A

Selective serotonin reuptake inhibitors (SSRIs)
➢ Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa)
➢ Safer in overdose; cardiac toxicity decreased
➢ Common side effects
▪ feeling agitated, shaky or anxious.
▪ feeling or being sick.
▪ indigestion.
▪ diarrhea or constipation.
▪ loss of appetite and weight loss.
▪ dizziness.
▪ blurred vision.
▪ dry mouth.

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11
Q

SNRIs

A

Selective serotonin and norepinephrine reuptake inhibitors
➢ Venlafaxine

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12
Q

Atypical antidepressants

A

➢ Trazodone (Desyrel)
➢ Bupropion
➢ Remeron

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13
Q

SSRI discontinuation syndrome

A

➢ Flu-like symptoms
➢ Nausea
➢ “Electric shock” sensations
➢ Headaches
➢ Vertigo - gait instability
➢ Anxiety/ irritability
➢ Insomnia

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14
Q

SSRI serotonin syndrome - excessive serotonin

A

➢ MSE changes (eg. delirium)
➢ Fever
➢ Tachycardia
➢ Hypertension
➢ Tremor
➢ Diarrhea
➢ Neuromuscular symptoms

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15
Q

Older (less frequently used) antidepressants

A

➢ Tricyclic antidepressants (TCAs)
➢ Monoamine oxidase inhibitors (MAOIs)

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15
Q

Tricyclic antidepressants (TCAs)

A

➢ Imipramine, clomipramine
➢ Very dangerous in overdose - cardiotoxicity
➢ Anticholinergic effects
➢ Delirium

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16
Q

Monoamine oxidase inhibitors (MAOIs)

A

➢ Nardil, Parnate
➢ Inhibits the enzyme that breaks down tyramine
➢ Individuals need special diet low in tyramine to avoid hypertensive crises

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16
Q

Note about antidepressant medications

A

➢ Typically, slow to work (may take 4-6 weeks before anti-depressant effect seen)
➢ May see improvement in some symptoms (e.g., insomnia) within 2 weeks

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17
Q

IV ketamine

A

➢ For treatment-resistant depression (off label use)
➢ Not a comprehensive treatment but used to augment a treatment plan
➢ In most cases medications/”boosters” will be required to sustain the effects
➢ Administered as an inpatient or as an outpatient
➢ Course is 8 treatments (2-3x/week)

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18
Q

Electroconvulsive Therapy (ECT)

A

➢ One of the most effective acute treatments for depression
➢ Electrical currents passed through the brain induce a seizure resulting in changes in brain chemistry
➢ Bilateral or unilateral ECT
➢ Given as inpatient or day patient

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19
Q

ECT pre-session

A

➢ BP cuff placed
➢ Oximetry placed
➢ ECG to monitor heart rates
➢ Patient would have already had a physical exam, routine blood tests, a heart tracing, and chest x-ray if indicated
➢ They should have nothing to eat or drink at least 6 hours prior to treatment
➢ Anesthetist come to ensure patient is fit for anesthetic

20
Q

ECT side effects

A

➢ Disorientation/ confusion
➢ Short term memory impairment for period surrounding treatment
➢ Muscle aches/ pains
➢ Headache
➢ Nausea/ vomiting

21
Q

How many treatments of ECT?

A

Usually given twice a week and the number of sessions is usually 6-8

21
Q

ECT: The patient is given a _____ to induce sleep and a ______ to prevent ______.

A

The patient is given a general anesthetic to induce sleep and a suxamethonium to prevent full-blown fit after the seizure.

22
Q

What is TMS?

A

Transcranial Magnetic Stimulation (TMS)
➢ An electromagnetic coil is placed on the patient’s scalp. Electric current running through the coil generates a magnetic field that stimulates the brain cells thought to be responsible for depression.
➢ Patient is conscious
➢ Treatment takes approximately 30 minutes
➢ Repetitive Transcranial Magnetic Stimulation (rTMS) is offered at St. Boniface Hospital

23
Q

What are the principles of Cognitive Behaviour Therapy?

A

➢ Thoughts create feelings
➢ Feelings create behaviours
➢ Behaviours reinforce thoughts

24
Q

List the goals for nursing in caring for persons experiencing depression

A

➢ Develop a therapeutic relationship with the person based on empathy and trust – what about where the client is withdrawn and isolated?
➢ Ensure physical health needs are met
➢ Continually assess for and address . . .
➢ Make positive decisions for clients if they are unable to do this for themselves because of their severe depression
➢ Promote effective coping skills in a way that is empowering to the person
➢ Promote effective problem solving skills in a way that is
empowering to the person
➢ Promote the person’s sense of positive self-regard
➢ Promote the person’s engagement with their social and support network
➢ Ensure effective collaboration with other relevant health care providers
➢ Promote positive health behaviors – consider education around the illness/medications, recovery, resources, etc.
➢ Support and promote self-care activities for families or caregivers

25
Q

Describe the continuum of mood disorders

A
26
Q

What is bipolar I?

A

at least one episode of mania
alternating with depression/anxiety

27
Q

What is bipolar II?

A

at least one hypomanic
episode AND at least one major depressive episode

28
Q

What is cyclothymia?

A

numerous periods of hypomanic symptoms alternating with depressive symptoms over at least 2 years

29
Q

Specifiers of cyclothymia

A

➢ Mixed features (symptoms of both depression and mania/hypomania
➢ Psychotic features
➢ Rapid cycling – four or more episodes within 12 months

30
Q

How are bipolar disorders are distinguished from depressive disorders?

A

by the occurrence of mania or hypomanic (i.e., mildly manic) episodes in addition to depressive episodes

31
Q

What is the prevalence of bipolar disorder?

A

~1%

32
Q

Mean onset of bipolar disorder

A

~ 21 to 30 years of age

33
Q

Gender of bipolar disease

A

Women at higher risk for depression and rapid cycling

34
Q

Bipolar has a ______ recurrence rate

A

High

35
Q

Bipolar disorder is the _____ leading cause of disability (15-44 yrs of age) worldwide

A

6th

36
Q

Suicide rate of bipolar disorder

A

~ 30% attempt; 10-15% die by suicide

37
Q

Bipolar disorder hypomania

A

➢ Elevated behavior that is atypical for the individual over at least 4 consecutive days, most of the day, nearly every day
➢ Same symptoms as mania but NOT as intense
➢ Does NOT progress into psychosis
➢ Hypomania is NOT severe enough to cause marked impairment to daily, social or occupational functioning

38
Q

Manic episode (DSM-V)

A

The following symptoms are present for at least 1 week, present most of the day and nearly every day and represent a change:
➢ Persistent elevated, expansive or irritable mood
➢ Increased goal-directed activity/energy
➢ 3 or more of the following symptoms are present (4 if only irritable mood)

39
Q

Symptoms of manic episode

A

3 or more of the following symptoms are present (4 if only irritable mood)
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increased goal directed activity or psychomotor agitation (purposeless non-goal-directed activity)
7. Excessive involvement in unrestrained buying sprees, sexual indiscretions, or reckless business investments

40
Q

Mood stabilizers: Anti-mania medications

A

(Anti-mania medications)
Lithium
➢ 1 - 2 weeks to reach therapeutic levels
▪ Anti-psychotics and sedatives can manage symptoms during the interval
➢ Lithium Blood Levels – narrow therapeutic range (0.6 – 1.2 meq/L)
➢ Lithium Blood Levels and Associated Toxicity
▪ Mild Side Effects - < 1.5 mEq/L
▪ Moderate Toxicity - 1.5 - 2.0 mEq/L
▪ Severe Toxicity - > 2.0 - 2.5 mEq/L
Toxicity can result in severe kidney damage, death (VERY dangerous in OD)
▪ Changes in salt intake can affect lithium levels
▪ Changes in fluid volume can affect lithium levels

41
Q

Signs of lithium toxicity

A

➢ severe nausea and vomiting
➢ severe hand tremors
➢ confusion
➢ vision changes
➢ unsteadiness while standing or walking

42
Q

Mood stabilizers: anticonvulsants

A

➢ Used as a mood stabilizer
➢ Carbamazepine and Valproate most commonly used
▪ See common side effects
➢ Newer/Other anticonvulsants
▪ Gabapentin
▪ Topiramate

43
Q

Antipsychotics

A

▪ Can directly treat acute mania/psychosis as well as the physiological symptoms (insomnia etc.)
* Quetiapine, Seroquel most often used
▪ For mood and symptom stability
▪ May have some effectiveness for stabilization of symptoms over the long term

44
Q

Antianxiety – Benzodiazepines

A

Short-term for agitation

45
Q

Sedatives/Hypnotics

A

Zopiclone, Trazodone to promote sleep

46
Q

Antidepressants

A

▪ Used during depressed phases
▪ Can trigger manic phase

47
Q

Holistic Nursing Assessment
(Inpatient focus)

A

➢Mental Status Exam:
▪ Mood, behavior, speech, cognition, etc.
➢ Suicidal ideation
➢ Substance use (often comorbid)
➢ Risk behaviours – including violence
➢ Physiological changes: sleep, eating, vitals
➢ Physical health & medical comorbidities
➢ Labs
➢ Pharmacology/Medication review

NURS 3514 (6 decks)

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