Worksheet for Quiz 1 Flashcards
Affect
outwardly bodily expression of emotions
Mood
a feeling state reported by the client that can vary with internal and external changes
Manic Episode
an elevated, expansive or irritable mood accompanied by hyperactivity, grandiosity, and loss of reality.
Hypomanic
clients may appear happy, agreeable, humorous, and agreeable; not severe enough to cause significant impairment
Flight of Ideas
shifting from one idea to another quickly
Kindling
the creation of electro stress in the brain from stress that results in alteration of neural functioning
Comorbidity
co-occurrence
Anhedonia
loss of interest and pleasure in activities
Persistent Depressive Disorder (Formerly known as Dysthymia)
is chronic low level depression of at least 2 years duration for adults
Cyclothymia
is a chronic mood d/o of at least 2 yrs in adults
1 year in children
-hypomanic episodes alternating with persistent depressive episodes (dysthymia)
Serotonin syndrome
- idiosyncratic medication reaction d/t accumulation of serotonin- SNS: Mental Status changes, fever, elevated Bp, severe could result in death. Nurse intervention d/c med and notify prescribing authority
Apathy
indifference
What are the 2 major neurotransmitters associated with depression and Mania?
Norepinephrine and serotonin
A patient suffering from Bipolar I Disorder is admitted in a manic episode to the Mental Health Inpatient Unit. What should be included in your assessment in addition to suicide?
Amount of sleep, nutritional status, history of aggression, a/v hallucinations, etc…
Valproate
Anticonvulsant
-Action in mood stabilization is unknown - possibly inhibits enzymes involved in GABA catabolism, thereby inhibiting neuronal excitability. increases levels of GABA,
TX: Bipolar Disorder, Seizures, Schizoaffective Disorders, Schizophrenia [acute mania-bipolar mania-prevent of migrane]
Carbamazepine (Tegretol)
Third Generational Anticonvulsants - mood stabilizer (antiepileptic)
TX:mood stablizer - bipolar manic disorders, seizures (bipolar 1)
interactions: grapefruit juice, barbiturates, charcoal, doxycicline, erythromycin, MAOI’s, NMJ blockers [neuromuscular junction], warfarin
Amitriptyline (Elavil)
TCA ( tricyclic antidepressants)( 1st generation antidepressant)
-action in humans is unknown; inhibits the membrane pump mechanism responsible for uptake of NE and serotonin
-Adverse effects: MI & Stroke
Trazodone (Desyrel)
SARI( serotonin antagonist re-uptake inhibitors)
- antidepressant
- act by antagonizing serotonin receptors and inhibiting the re-uptake of serotonin, norepinephrine, and/or dopamine.
Lithium
Mood stabilizer salt
-Tx manic disorders of Bipolar Disorder, schizophrenia and depression
-increases the activity of chemical messengers in the brain- acts on CNS
Maintenance level: 0.4 to 1.3 mEq/L
Early Toxicity: 1.5 mEq/L
Severe Toxicity: 2.0 to 2.5 mEq/L
Fluoxetine (Prozac)
SSRI
-Depressive Disorders, tx of depressive episodes of bipolar 1 disorder, treatment resistant depression, OCD, bulimia, panic disorders, PMDD
interacts with: alcohol, benzos, ED drugs, linezolid, lithium, MAOIs, NSAIDs, TCAs, opiods, serotonergic drugs, thyridezine
In your assessment of a patient who is severely depressed and just started on antidepressants, what would be behavior that would concern you and require further assessment?
Sudden change in mood or behavior.
What symptoms would you expect to find in someone suffering from Major Depression?
- Anhedonia
- sad, down, depressed mood
- changes in appetite (insomnia/hypersomnia)
- change in seep patterns
- psychomotor retardation or psychomotor agitation
- weight changes ( increase or decrease)
- loss of energy
- impaired concentration and impaired decision making
- worthlessness/ excessive guilt
- Suicidality
What are some key points with mood disorders in the Children?
- instead of depressed mood could appear irritable
- unwell- stomach aches
- vague physical complaints
- not going to school
- agression
6 .clinginess
What are some key points with mood disorders in the adolescents?
- sulking
- negative/grouchy
- getting in trouble at school
- feeling misunderstood
- running away
- withdrawing
What are some key points with mood disorders in the elderly?
- masked depression- masquerading as other medical condition
- can remain masked, undiagnosed /untreated
- undiagnosed 50% of the time - social isolation
- decrease med adherence
- those taking SSRIs have more side effects than those take TCAs
- suicide rate is highest among elderly men than all other age groups
Bipolar 1
- at least 1 episode of persistent elevated mood (mania) and 1 episode of depression
- anxious distress
- rapid cycling
- melancholic (pensive sadness, typically with no obvious cause) features
- Atypical features
- peri-partum onset
Bipolar 2
- severe and prolonged periods of depression that alternate with brief periods of hypomanic episodes
hypomania
less severe, less intense form of mania - may only last 4 consecutive days in most cases
inflated self-esteem
what are SSRIs
Selective Serotonin re-uptake inhibitor
-First line for Depression
( also used for anxiety, PTSD, and OCD)
-Mechanism of action- blocks Serotonin re-uptake so there will be a higher level of serotonin in the synaptic space to attache to receptors and help your mood
(because low serotonin=depression)
#1 most serious adverse effect (rare)- serotonin syndrome - do not want to take with other SSRIs
- do not take for bipolar can induce manic episodes
- absorbed almost completely after oral adm., highly protein bound
- sometimes used for eating disorders, panic disorders, personality disorders
- less dx interactions than TCAs, however competitively inhibit liver enxymes responsible for oxidation of other drugs
- SSRIs and MAOIs together = potentially fatal
What are Tricyclic Antidepressants?
Similar to SSRIs but are named after their molecular structure, rather than what they do (most MH drugs are name based on their action)
- used for ADHD, OCD, diabetic neuropathy and enuresis (children under 6 y/o)
- helpful when used with a mood stabilizer in treating acute depression in treating those with BP1 disorder
- interact with amphetamines, arbituates,
- They block the transmitters of Norepinephrine and serotonin- in turn blocking their re-uptake so it increases their concentration in the synaptic space.
- broad mechanism of action
- more side effects than SSRIs
- easy to overdose on
- long half lives
- extremely fat soluble and accounts for their wide distribution throughout the body, slow excretion and long half-life
- they also block acetylcholine and histamine receptors
- Nursing process - check EKG, mood changes for effectiveness, assess for low BP and
What are MAOIs
- 2 classifications - hydrozines and non-hydrozines
- absorbed rapidly and completely in the GI tract and
- inhibit MAO, enzyme which metabolizes MA NT
- makes more monoamines available to the receptors, therefore decreasing depression symptoms
-
Monoamine NT
epinephrine, norepinephrine, serotonin, dopamine
What are SARIs
- Serotonin antagonist reuptake inhibitor
Lymbic System
- The “Emotional Brain”
- thalamus, hypothalamus, amygdala, hippocampus
GABA
- Gamma Amino Beuteric Acid
- most abundant inhibitory NT
- amino acid classified as a neurotransmitter
- helps promote relaxation and sleep
- inhibits over excitation - balances the brain
- contributes to motor control, vision, anxiety
- higher levels = less anxiety
- barbituates and benzodiezepimes act on GABA
- too little GABA/decreased GABA firing = anxiety, insomnia, opposite of “calm body and mind”
- gl
Histrionic Personality Disorder
Histrionic personality disorder is characterized by constant attention-seeking, emotional overreaction, and suggestibility. A person with this condition tends to over-dramatize situations, which may impair relationships and lead to depression.
Catatonic
-abnormality of movement (psychomotor retardation) and behavior arise from a disturbed mental state
- grimacing
- echopraxia (mimicking movements of others)
- echolalia (repeating words and sounds- mimicking)
- posturing
- stereotype movements
- waxy flexibility
- agitation
- mutisim ( not speaking)
dysthymic
persistent depressive disorder (must have sx two years or more)
-chronic, low level depression
-depressed mood fluctuates with your ‘normal mood’
more days than not for >2 years
atypical
subtype of major depressive disorder
- increased appetite
- hypersomnia
- leaden paralysis (feeling heaving, like you’re walking through mud)
- moods that are strongly reactive to environmental circumstance
- rejection sensitivity
- profound fatigue
- personality and anxiety disorders are co-occuring)
- mood may brighten in the presence of positive events
cyclothmic
demonstrates a range of mood changes between moderate depression and hypo-mania
Must be:
1 year in kids
2 years in adults
transient depression
everyday sadness, disappointments
psychotic depression
depression + psychotic features
- delusions
- auditory hallucinations
(more common in bipolar disorder)
risk factor for suicide
Trileptal
produce blockade of voltage sensitive sodium channels, resulting in stabilization of hyper excited neuro-membranes stops repetitive neuron firing
TX:
NURSING NOTES: monitor serum sodium levels b4 and during treatment- serious hyponatremia can occur; naeusa headach milase lethargy and confusion should be reported; dont stop . abruptly, not for use during prego, do not crush or chew, avoid alcohol, wear medical alert tag, report unusual bleeding, report SI
