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NURS 3514 - Mental Health > Week 8 > Flashcards

Week 8 Flashcards

1
Q

define: mood disorders

A
  • recurrent disturbances or alterations in mood that cause psychological stress and behavioral impairement
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2
Q

what are two exemplars of mood disorders

A
  • unipolar depression (major depressive episode)

- bipolar disorder

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3
Q

describe the continuum of mood disorders

A

mania mild to mod depression –> severe depression

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4
Q

how can we distinguish between grief/sadness and a depressive disorderr?

A
  • length of time they have symptoms
  • degree of symtpoms
  • do they feel hope?
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5
Q

what is the key diagnostic criteria for major depressive disorder (3)

A
  • at least a 2-week history of 5 or more of the symptoms on the upcoming slide
  • symptoms represent a change from baseline
  • symptoms cause significant distress/impairment in functioning
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6
Q

what symptoms are included in the diagnostic criteria for major depressive disorder (9)

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 or increased appetite
  4. Difficulty sleeping (insomnia or hypersomnia) or sleeping day and night
  5. Psychomotor agitation (physical energy or restlessness) or retardation (slow movement)
  6. Fatigue/loss of energy
  7. Feelings of worthlessness or inappropriate guilt despite reassurance from others (cannot get a though out of their head as they are feeling excessively guilty)
  8. Inability to concentrate or indecisiveness
  9. Recurrent thoughts of death/suicide (not every pt will have thoughts of sucide but there are elevated risk)

** at least 1 of either depressed mood or loss of interest/pleasure must be present

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7
Q

disorder qualifiers to describe/define depression (8)

A
  • Major Depressive Disorder (MDD)
  • Mild, moderate, severe
  • Dysthymia
  • Seasonal pattern
  • Psychotic depression
  • Post-partum (onset of sx have to occur within 4 weeks of child birth)
  • Co-occurs with medical conditions
  • Depression in youth and teens
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8
Q

describe symptoms seen in youth/teen depression (5)

A
  • irritable or angry mood
  • “acting out” behaviors
  • unexplained aches and pains
  • extreme senstivity to criticism
  • withdrawing from some, but not all people
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9
Q

untreated depression in youth & teens can lead to (8)

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 ADD, anxiety)
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10
Q

what are some common complaints seen w depression in older adults (5)

A
  • focus on physical health symptoms
  • weight loss
  • poor appetite
  • anhedonia
  • social isolation
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11
Q

what are some less common complaints r/t depression in older adults (2)

A
  • depressed mood/sadness/crying

- weight gain

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12
Q

describe the significance of depression (7)

A
  • WHO cites depression as 3rd in disease burden in the world.
  • Statistics Canada indicates approx. 2-6% of the population at any time are depressed
  • Lifetime prevalence: any age, present in all demographic groups, 25% women, 12% for men
  • Cultural variations
  • Escalating incidence and cost to society
  • Past frequency of episodes is best predictor of future recurrences.
  • Significant suicide risk - 15% die by suicide if not treated.
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13
Q

what factors contribute to depression? (5)(

A
  • biological factors
  • cognitive distortions
  • psychosocial factors
  • early childhood experiences
  • combo of factors
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14
Q

describe how biological factors can contribute to depression (3)

A
  • disruption in the balance of neurotransmitters (ex. serotonin, NE, MOA)
  • genetic vulnerability
  • CNS neurotransmitter abnormalities that result from enviro and medical factors (ex. check thyroid lvl, biochemical factors)
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15
Q

describe how cognitive distortions can contribute to depression (3)

A
  • distorted attitudes
  • learned helplessness
  • irrational beliefs (irrational thoughts leading to a depressive, negative “world view” –> ex. someone in ur past telling you you’re a failure, not letting it go, and incorporating it into your self talk)
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16
Q

describe how psychosocial factors can contribute to depression (3)

A
  • life events, circumstances
  • recent stressors
  • perceptions of helplessness, powerlessness
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17
Q

what are some approaches to treatment/care for depression (10)

A
  • pharmacologic (traditional antidepressants, IV Ketamine)
  • ECT
  • TMS (or rTMS)
  • CBT
  • psychotherapy
  • mindfulness
  • psychosocial
  • education
  • health promotion
  • health and wellness
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18
Q

what are examples of antidepressants (7)

A
  • SSRIs (selective serotonin reuptake inhibitors)
  • SNRIs (serotonin norepinephrine reuptake inhibitors)
  • NRIs (norepinephrine reuptake inhibitors)
  • NDRIs (norepinephrine dopamine reuptake inhibitors)
  • SNDIs (serotonin-norepinephrine disinhibitors)
  • TCAs (tricyclic antidepressants)
  • MAOIs (monoamine oxidase inhibitors)
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19
Q

what are examples of SSRIs

A
  • fluoxetine (prozac)
  • paroxetine (Paxil)
  • Citalopam (Celexa)
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20
Q

describe the use of SSRIs (3)

A
  • safer in overdose
  • cardiac toxicity decreased
  • common side effects (see p. 259, 261, and 262)
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21
Q

what is an exmaple of a SNRI

A
  • venlafaxine (effexor)
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22
Q

what are examples of atypical antidepressants (3)

A
  • trazodone (Desyrel)
  • buproprion (given in low doses, aids w sleep)
  • remeron (also aids w sleep)
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23
Q

what is an important consideration w SSRIs

A
  • should not stop meds abruptly –> risk of discontinuation syndrome
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24
Q

what are symptoms of discontinuation syndrome (7)

A
  • flu-like symptoms
  • nausea
  • electric shock sensations
  • headaches
  • vertigo –> gait instability
  • anxiety/irritability
  • insomnia
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25
Q

what should you assess r/t discontinuation syndrome

A
  • VS
  • MSE
  • lytes
  • serum drug lvls
  • medication use
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26
Q

what is serotonin syndrome

A
  • symptoms due to excessive amt of serotonin in the system
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27
Q

what are symptoms of serotonin syndrome (7)

A
  • MSE changes (ex. delirium)
  • fever
  • tachycardia
  • HTN
  • tremor
  • diarrhea
  • neuromuscular symptoms
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28
Q

how can serotonin syndrome be treated (3)

A
  • hold dose
  • d/c serotonin posting substances
  • symptom management `
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29
Q

what do you want to assess w serotonin syndrome (4)

A
  • vitals
  • mental status
  • med list
  • blood work
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30
Q

what are examples of TCAs (2)

A
  • imipramine

- clomipramine

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31
Q

what are some side effects of TCAs

A
  • very dangerous in overdose (cardiotoxicity)
  • anticholinergic effects (constipation, urinary retention, dry mouth)
  • increased risk of delirium
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32
Q

who are we more concerned w r/t TCAs

A
  • more concerned w older adults due to the other comorbidities going on
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33
Q

what is the last resort drug for depression

A
  • MAOIs
34
Q

what are two examples of MAOIs

A
  • nardil

- parnate

35
Q

what is the action of MAOIs

A
  • inhibits the enzyme that breaks down tyramine
36
Q

what is an important consideration w MAOIs

A
  • individuals need special diet low in tyramine to avoid hypertensive crisis
37
Q

what are some sources of tyramine

A
  • aged cheese
  • protein supplements
  • aged wine
38
Q

describe the onset of antidepressant meds

A
  • typically slow to work –> ~4-6 weeks

- may see improvement in symptoms (ex. insomnia) within 2 weeks

39
Q

what is the danger r/t the improvement of symptoms & the slow onset of antidepressats

A
  • could stop taking or take more than needed

- if hopes too high, could trigger depression

40
Q

what is the role of nursing r/t med admin and adherence for antidepressants

A
  • provide education & assurance
41
Q

what is a danger associated w antidepressant meds

A
  • high risk time for suicide

- meds increase energy to carry out the suicide plan

42
Q

describe the course of IV ketamine

A
  • 8 treatments (2-3x/week), over 50 min

- period monitoring for 2 hrs

43
Q

describe the use of IV ketamine (4)

A
  • for treatment-resistant depression (off label use)
  • not a comprehensive treatment but used to augment a treatment plan
  • is most cases, meds/boosters will be required to sustain effects
  • admin as an inpt or outpt treatment
44
Q

what is electroconvulsive therapy (ECT) (3)

A
  • one of the most effective acute treatments for depression, but not #1 choice
  • electrical currents passed thru the brain induce a seizure (will be subdued w other meds) resulting in changes in brain chem
  • include bilat and unilat ECT
45
Q

what are some side effects of ECT (5)

A
  • disorientation, confusion
  • short term memory impairment for period surrounding treatment (no permanent injury)
  • muscle aches/pain (most significant after first ECT)
  • HA
  • VS
46
Q

describe the course of treatment of ECT

A
  • 8-12 treatments and resume antidepressive meds or have maintenance ECT
47
Q

what is transcranial magnetic stimulation (TMS)

A
  • an electromagnetic coil is placed on the pt’s scalp
  • electric current running thru the coil generates a magnetic field that stimulates the brain cells thought to be responsible for depression
  • pt is conscious
48
Q

how long does treatment last w TMS

A
  • approx 30 min
49
Q

what are the principles of CBT

A
  • therapeutic alliance and collaboration

- education

50
Q

describe the educational aspect of CBT (3)

A
  • learning about kinds of thoughts (beliefs, automatic thoughts)
  • negative thought patterns are identified, evaluated, and modified/reframed
  • includes homework, reflection
51
Q

what is included in use of a thought record (5)

A

write down:

  • situation
  • initial thought
  • negative thinking
  • evidence to support negative thoughts
  • alternative thinking
52
Q

define: mindfulness

A
  • means paying attention in a particular way; on purpose, in the present moment (being), and nonjudgementally
53
Q

what are the goals for nursing in caring for persons experiencing depression (11)

A
  • develop a therapeutic relationship w the person based on empathy and trust
  • ensure physical health needs are met
  • continually assess for and adress
  • make positive decisions for clients if they are unable to do this for themselves bc 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 w their social and support network
  • ensure effective collaboration w other relevant HCP
  • promote positive health behaviors (consider education, recovery, resources)
  • support & promote self-care activities for families or caregivers
54
Q

define: bipolar I

A
  • at least one episode of mainia alternating w depression/anxiety
55
Q

define: bipolar II

A
  • at least one hypomanic episode AND at least one major depressive episode
56
Q

define: cyclothymia

A
  • numerous periods of hypomanic symptoms alternating w depressive symptoms over at least 2 years
57
Q

what are some specifiers of bipolar disorders (3)

A
  • mixed features (symptoms of both depression & mania/hypomania)
  • psychotic features
  • rapid cycling (four or more episodes within 12 months)
58
Q

how are bipolar disorders distinguished from depressive disorders

A
  • by the occurrence of mania or hypomanic episodes in addition to depressive episodes
59
Q

what are some stats r/t bipolar disorder (10)

A
  • Prevalence ~ 1%
  • Mean Age of Onset ~ 21 to 30 yrs of age
  • Gender - *Women at higher risk for depression and rapid cycling
  • Ethnic and Cultural Differences ~ No difference
  • Comorbidity ~ many (e.g., substance abuse)
  • Secondary mania
  • high recurrence rate
  • 6th leading cause of disability (15-44 yrs. of age) worldwide
  • Often misdiagnosed or undiagnosed
  • Suicide rate ~ 30% attempt/10-15% die by suicide
60
Q

describe the DSM-V diagnostic criteria for manic episode (5)

A

the following symptoms are present for at least 1 week, present most of the day and nearly everyday and represent a change from baseline

  • 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 (above two)):
  • 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 if there are psychotic features.
  • Not caused by substances or another medical condition
61
Q

which symptoms are included in part of the “3 or more of the following symptoms are present (4 if only irritable mood (above two))” of the diagnostic criteria of manic episodes (7)

A
  • Inflated self-esteem or grandiosity (e.g. I just graduated from nursing, and I am going to become the director of shared health next week)
  • Decreased need for sleep (not sleeping and want to accomplish things)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing from topics to topics
  • Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increased goal directed activity or psychomotor agitation (purposeless non-goal-directed activity)
  • Excessive involvement in unrestrained buying sprees, sexual indiscretions, or reckless business investments
62
Q

define hypomania (3)

A
  • elevated behavior that is atypucal 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
63
Q

describe the impact of hypomania

A
  • not severe enough to cause marked impairment to daily, social, or occupational functioning
64
Q

what is included in the etiology of bipolar disorder

A
  • neurobiologic theories

- pyschosocial factors (contribute to the timing of the disorder)

65
Q

describe how neurobiologic factors contribute to bipolar disorder (3)

A
  • neurotransmitter hypotheses
  • structural/functional alterations of the brain
  • genetic factors
66
Q

what are some anti-mania medications (6)

A
  • lithium
  • anticonvulsants
  • antipsychotics
  • antianxiety
  • sedatives/hypnotics
  • antidepressants
67
Q

how long does it take for lithium to reach therapeutic lvls

A

1-2 weeks

- anti-psychotics and sedatives can manage symptoms during the interval

68
Q

what is the therapeutic range of lithium blood lvls

A

0.6-1.2 med/L (narrow, requires close monitoring)

69
Q

list the lithium blood lvls and associated toxicity

A
  • mild side effects –> <1.2 - 1.5 mEq/L
  • moderate toxicity: 1.5-2.0 mEq/L
  • severe toxicity: 2.0 - 2.5 mEq/L
70
Q

lithium toxicity can result in… (2)

A
  • severe kidney damage

- death

71
Q

what can impact lithium lvls (2)

A
  • changes in salt intake

- changes in fluid vol (more hydration = lower lvls, sweating alot = higher lvls)

72
Q

what should the nurse do if the pt is experiencing symptoms of lithium toxicity (3)

A
  • hold the lithium dose
  • notify physician
  • increase fluid intake
73
Q

what are some signs of lithium toxicity (3)

A
  • confusion
  • slurred speech
  • incoordination
74
Q

what are 4 examples of anticonvulsants

A
  • carbamazepine
  • valproate
  • gabapentin
  • topiramate
75
Q

describe the use of antipsychotics (3)

A
  • can directly treat acute mania/psychosis & physiological symptoms (ex. insomnia)
  • for mood & symptom stability
  • may have some effectiveness for stabilization of symptoms over the long term
76
Q

what are some examples of antipsychotics (2)

A
  • quetiapine

- seroquel

77
Q

describe the use of antianxiety (benzos)

A
  • short term for agitation
78
Q

what are 2 examples of sedatives/hypnotics? describe the use

A
  • zopiclone
  • trazodone
  • to promote sleep
79
Q

describe the use of antidepresants

A
  • used for depressed phases

- can trigger manic phase (can be a bad choice for bipolar disorders)

80
Q

describe the holistic nursing assessment for mania (8)

A
  • MSE
  • suicidal ideation
  • substance use (often comorbid)
  • risk behaviors (including violence)
  • physiological changes (sleep, eating, vitals)
  • physical health & medical comordbitities
  • labs
  • pharmacology/med review
81
Q

what are nursing interventions for clients w mania (12)

A
  • acute –> maintain safety and prevent injury w pharmacological interventions when necessary
  • address ADLs
  • speak in calm, supportive tone
  • reduce stimulation where possible
  • have brief convos, dealing w immediate issues, concise explanation
  • give firm, simple directions and comments
  • limit setting may be requieed
  • do not argue or engage in debate about the rules & limits of the ward, simply state the policy and move on
  • avoid value judgments, power struggles and getting caught up in person’s euphoria or unrealistics demands, but act on legitimate complaints
  • redirect energy into more approp or constructive channels
  • use a consistent, team approach
  • maintenance: therapy adherence and goal of preventing relapse
82
Q

describe the continuum of care for mood disorders (6)

A
  • nurses role
  • inpt care
  • outpt programs
  • spectrum of care
  • mental health promotion
  • role of recovery

NURS 3514 - Mental Health (11 decks)

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