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125 Cards in this Set
- Front
- Back
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Which mood is the absence of depressed or elevated mood?
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Euthymic
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WHat is Euphoric?
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exaggerated feeling of well-being
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What is expansive?
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Expression of feelings without restraint
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Describe Elated.
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Joy, euphoria, triumph, intense self-satisfaction
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What is dyshoria?
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Feeling of unpleasantness, discomfort. Not full depression
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Define Anxious.
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feeling of apprehension caused by anticipating danger
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What are the 7 ways to describe affect?
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1. blunted
2. flat 3. appropriate 4. inappropriate 5. labile 6. full range 7. restricted or constricted |
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What is meant by a blunted affect?
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severe reduction in intensity of outward expression
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What is a flat affect?
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COMPLETE ABSENCE of outward expression
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what is labile?
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the affect where the pt has a rapid and easily changing outward expression
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What is meant my a full range affect?
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wide range of emotional expression, usually a normal finding.
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What is a restricted or constricted affect?
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reduction in intensity and range of outward expression
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What is the definition of a major depressive episode?
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A serious and clinically significant distress or impairment in social, occupational or other important areas of functioning for at least 2 weeks.
-the mood can manifest as pervasive sadness or irritability, loss of interest or pleasure -cannot be better accounted for by bereavement, drugs or a medical condition |
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For a patient with MDE, what are some common symptoms? How many of these symptoms does a person present on most days?
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1. sig weight loss or gain
2. insomnia/hypersonmia 3. Psychomotor agitation or retardation 4. fatigue 5. feelings of worthlessness or inappropriate guilt 6. decreased ability to think/concentrate 7. recurrent thoughts of death/ suicidal ideation Pt's will have at least 4 of these on most days |
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What type of episode is characterized as persistent elevation in mood, expansive or irritable?
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Manic Episode
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What amount of time must a person show the symptoms of mania to be said to have had an episode?
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1 week
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What are the symptoms of mania?
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1. inflated self-esteem/grandiosity
2. decreased need for sleep 3. more talkative Or pressure to keep talking 4. flight of ideas Or subjective experience that thoughts are racing 5. distractable 6. increase in goal-directed activity/ psychomotor agitation 7. excessive involvement in pleasurable activities that have consequences |
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How many symptoms must a person present with to be said to have a manic episode?
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at least 3 of the symptoms of mania
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What is the criteria for a mixed episode?
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-The criteria for MDE and ME are met nearly everyday for at least 1 week
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What type of episode describes a person who has a lot of energy, but have very black thoughts?
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Mixed episode
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What is the most important thing to monitor for a pt having a mixed episode? Why?
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Monitor for suicidal thoughts, because they are depressed but have the energy to complete the task.
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What is hypomania?
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Similar to mania but does not cause impairment in social or occupational functioning
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If a person is showing signs of mania, but never displays psychotic features, what is their diagnosis?
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Hypomania
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What is the time frame for a hypomanic episode?
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At least 4 days
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What is the only unipolar disorder?
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Major Depressive Disorder
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What are the characteristics of MDD?
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-Presence of 1 or more MDE resulting in difficulty functioning
-Progressive, usually recurrent illness -suicide most serious complication -May exhibit psychotic features |
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Describe the kindling theory.
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The "kindling" theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, a mood episode can start (and become recurrent) by itself.
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What is dysthymic disorder?
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-Milder, more chronic than MDD
-2 years of depressed mood more days than not -often has an early and insidious onset |
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how long must children show symptoms to be diagnosed with dysthymic disorder?
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1 year
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What % of women experience Baby blues? When do symptoms begin and last?
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50-80%
-Symptoms begin approx 1 day after delivery and peak between 3-7 days. |
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What are the characteristics of postpartum depression?
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-Have criteria for MDE w/ onset within 4 weeks of delivery- affects 10-15% of women
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What characterizes postpartum psychosis?
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-Psychotic episode within 3 weeks of delivery
-medical emergency -requires immediate treatment |
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What are the 2 types of seasonal affective disorder?
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1. Winter depression/ fall onset
2. Spring onset (less common: have weight loss) |
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How is SAD treated?
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Light therapy
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What is the average age of onset for MDD?
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32 years old
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Women are ___% more likely to have MDD than men.
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70
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what is the prevalence of MDD in the US?
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> 6.7%
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What is the correlation with race and MDD?
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Blacks are 40% less likely than whites to have MDD
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What are the risk factors for MDD?
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1. family Hx of DD
2. prior episode 3. lack of social support 4. lack of coping abilities 5. presence of life and environment stressors 6. substance abuse 7. medical comorbidity |
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what is the biological etiology of MDD?
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Deficiency of dysregulation in NE, Dopa, Sero: all antidepressants currently available affect these NTs or receptors
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What is the psychological etiology of MDD?
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Feelings of loss, low self-esteem, unlovability, self-hatred, negative, irrational belief structures.
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What are the environmental/sociological etiologies of MDD?
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1. adverse or traumatic life events
2. sexual, physical, psychological abuse 3. maladaptive family interactions 4. reduction in real or perceived rewarding activities an/or increase in unpleasant ones 5. Substance use, medical conditions |
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What medication is the gold standard for MDD?
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SSRIs
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What are all the treatment options for MDD?
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-SSRIs
-atypical antidepressants -TCAs -MAOIs |
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Which medication cannot be taken with tyromine (wine, cheese etc)?
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MAOIs
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What are the psychotherapy options for the Tx of MDD?
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1. CBT
2. Family Therapy 3. Group Therapy 4. Interpersonal Therapy |
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What somatic therapies have been used to Tx MDD?
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1. ECT: only for severe or Tx resistant cases
2. Light therapy: SAD |
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What are the treatment goals for MDD?
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1. reduce, alleviate symptoms
2. Restore functioning 3. prevent relapse |
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What are the priority care issues for MDD?
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1. safety is priority
2. high suicide risk 3. suicide assessment |
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WHat is a very important nursing task on an inpatient unit with MDD?
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Assessing for suicidal behavior/ideation
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What are the nursing diagnoses for MDD?
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1. Risk for suicide
2. imbalanced nutrition 3. self-care deficit 4. decisional conflict 5. fatigue 6. ineffective individual coping 7. ineffective role performance 8. hopelessness 9. low self-esteem 10. disturbed sleep pattern |
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WHat are the 4 nursing interventions for MDD?
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1. SAFETY
2. Nutrition 3. Exercise 4. Sleep hygiene |
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What should be avoided 1 hour prior to sleeping to help with insomnia?
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1. large meals
2. vigorous exercise 3. TV or video games: movies better |
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What makes up the sleep hygiene principles?
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1. Set a Bedtime
2. Lots of sunlight during the day 3. avoid day napping 4. no stimulants or alcohol at night 5. keep bedroom dark 6. use relaxation techniques 7. keep room for sleep and sex |
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why should alcohol be avoided before bedtime?
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it disrupts REM sleep and deep sleep
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What are the second generation Antidepressants?
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1. SSRI's
2. SNRIs 3. Atypical antidepressants |
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What are some examples of SSRIs?
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Prozac, Zoloft, Lexapro, Celexa, Paxil
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Why are the SNRIs not as ideal for use?
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They have more BP effects
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why is cymbalta not beneficial?
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IT is not as effective and can worsen glaucoma
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What are the common SNRIs>
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Effexor, Pristiq, Cymbalta
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What are the first generation antidepressants?
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TCAs and MAOIs
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Which atypical antidepressant is given for sleep?
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Trazadone
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What are the side effects of SSRIs?
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insomnia and activation, headaches, GI upsets, weight gain, sexual side effects
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What are the side effects of SNRIs?
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HTN
Cymbalta can worsen glaucoma |
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Which antidepressant should be avoided in pts with schizophrenia? WHy?
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Bupropion: it can cause psychosis
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What are the side effects of Bupropion?
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Seizures and psychosis
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What is the number one safety check for serotonin based antidepressants?
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Do not give them together! can cause a serotonin syndrome
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What is serotonin syndrome?
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Fatal side effect that can develop in hours or days after the combination of 2 or more serotonin increasing agents.
WIll see AMS, increase in BP then a fall in BP, neuromuscular abnormalities |
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What are the common side effects of trazadone?
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Sexual dysfunction and priapism
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What is a severe side effect of Nefazodone?
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Can raise hepatic enzymes. Potentially causing liver failure
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What is the most important thing to monitor for pts who's antidepressants have just taken effect?
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Suicidality. they now have the energy to carry it out.
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What are examples of Atypical antidepressants?
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Nefazodone
Trazodone Bupropion Mirtazipine |
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What is the side effect priapism? which antidepressant has this as a possible side effect?
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Erection does not go down.
Trazadone |
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How does Bipolar I differ from II?
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Bipolar I has a combination of full manic episodes and MDE
Bipolar II has hypomanic episodes and MDE |
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Describe rapid cycling?
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Can occur in BP I and II
-is the occurrence of 4 or more mood episodes that meet the criteria for manic, mixed, hypomanic, or depressive episode during prior 12 months |
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What is cyclothymic disorder?
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It is a disorder that is similar to Bipolar and MDD, but does not meet the full criteria of either.
-Mild form of Bipolar -2 years of numerous hypomanic episodes and depressive episodes that do not meet full criteria for a MDE |
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What symptom does elderly patients usually manifest with Bipolar disorder?
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They usually become very confused
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Children with bipolar disorder usually have what symptoms?
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Uncomfortable fits of rage that last 2 or more hours
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What are some of the symptoms seen in a mixed episode>?
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agitation, trouble sleeping, major changes in appetite, and suicidal thinking
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What % of people with Bipolar disorder also use drugs or alcohol?
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40-70%
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What has been thought to be the average length of a manic episode?
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about 13 weeks
but some can have them lasting 10 months or more |
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How does the onset of ME differ from MDE?
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The ME onset is usually much quicker (hours to days)
MDE: days to weeks |
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What is mood?
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Pervasive and sustained emotion that colors one’s perception of the world and how one functions in it.
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What is a mood disorder?
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are recurrent disturbances or alterations in mood that cause psychological distress and behavioral impairment They are characterized by a cluster of signs and symptoms sustained over weeks and months. Most of them recur in a cyclical fashion
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What is the prevalence of SAD?
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1-2% of US population
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Describe the Winter subtype of SAD.
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increased sleep and appetite w/ carb cravings, weight gain, interpersonal conflict, irritability and heaviness in extremities (abates in Spring)
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Describe the SPRING subtype of SAD?
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(less common): insomnia, weight loss, poor appetite
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Describe MDD and children.
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children less likely to experience psychosis, but if they do usually auditory hallucinations more common than delusions. Also they are more likely to have anxiety symptoms, such as stomach aches and headaches. Mood may be irritable rather than sad.
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What is the contribution of cytokines to MDD?
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signal the brain and serve as mediators btn immune and nerve cells. The brain can influence the immune process, and the immunologic response can result in changes in brain activity----could have something to do with the high incidence of depression (perhaps 1 in 3) occurring in people dx w/ HIV.
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What are the lethal doses of TCAs in comparison to the therapeutic dose?
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Lethal is only 3-5 times the therapeutic dose.
More than 1g can be fatal. |
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What are the most common side effects of MAOIs?
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anticholinergic like dry mouth, constipation, urinary retention, etc.
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How do children with bipolar disorder act?
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hallmark of childhood bipolar is intense rage—children may display seemingly unprovoked rage episodes for as long as 2 to 3 hrs.
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Elderly people with bipolar disorder have what symptoms?
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More neurologic abnormalities and cognitive disturbances
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What is the average age of onset for bipolar disorder?
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25 years old
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How do females differ from males with bipolar disorder?
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Females are more at risk for depression and rapid cycling
Males have greater risk for manic episodes |
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What are the most common comorbid conditions with bipolar disorder?
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Anxiety disorders (panic and social phobia)
Substance use (40-70% use drugs or ETOH |
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What are the 3 etiologies for bipolar disorder?
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-Genetic composition
-Chronobiological Theory -Kindling theory |
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Describe the Chronobiological Theory.
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Sleep deprivation can induce mania. May be from the # of NTs and hormone levels that follow circadian patterns and sleep may precipitate biochemical changes that affect mood
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What are the psychosocial factors for bipolar disorder?
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thought to contribute to the timing of the disorder rather than actually causing the disorder as was once believed.
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What are the priority issues in the Tx of Bipolar disorder?
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1. Risk for suicide
2. Safety from poor judgement and risk-taking behaviors |
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What is the goal of bipolar treatment?
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Minimize and prevent relapse of episodes
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Describe the interpersonal effects of bipolar disorder.
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relationships in all forms can suffer --> marriages, friendships, work relations
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What is the most essential aspect of bipolar treatment?
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Medication
They are essential to control symptoms and prevent relapse |
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What are the medication options for bipolar disorder?
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Lithium, antiseizure meds, antipsychotics, antidepressants
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What are the adjunctive options for the Tx of bipolar?
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Psychoeducation
individual CBT interpersonal therapy substance use Tx programs |
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What are the risk factors for relapse of bipolar episodes?
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1. Noncompliance with med therapy
2. obesity 3. marital conflict 4. separation 5. divorce 6. unemployment 7. underemployment |
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What are the most important nursing assessments for bipolar disorder?
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1. Suicide risk
2. Evaluation of manic and mood symptoms 3. SLEEP 4. weight and appetite 5. check labs: for thyroid fx 6. assess medications 7. asses stressors 8. cultural and personal values r/t mental illness |
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What are the physiological nursing diagnoses related to Bipolar disorder?
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1. sleep deprivation
2. imbalanced nutrition |
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What are the nursing diagnoses related to safety for bipolar disorder?
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1. Risk for suicide
2. Risk for violence |
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What are the nursing diagnoses for bipolar disorder related to psychosis?
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1. Disturbed sensory perception
2. disturbed thought processes |
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What are the nursing diagnoses related to psychosocial aspects of bipolar disorder?
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Ineffective coping
Ineffective role performance Interrupted family processes Impaired social interaction Impaired parenting Compromised family coping |
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What are the common mood stabilizers?
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lithium carbonate
valproic acid (Depakote) carbamazapine (Tegretol) lamotrigine (Lamictal) oxcarbazepine (Trileptal) gabapentin (Neurontin) topiramate (Topamax) |
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What drugs can increase lithium levels?
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NSAIDS, ACE inhibitors, diuretics
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what are the common side effects of lithium?
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-weight gain
-tremor -ataxia -memory problems |
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What is the therapeutic range for lithium?
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0.5-1.2 mEq/L
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Describe lithium toxicity.
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: fatigue, GI upset, impaired memory, agitation, confusion, ataxia, coarse tremors, dysarthria, renal dsfx, cardiovascular changes, muscular fasciculations, myoclonus, tonic-clonic (twitcing) seizures, coma, DEATH
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What labs must be monitored for a person on lithium?
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-the lithium levels
-TSH -renal function tests done every 6 months |
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What are the 2 major long term risk of lithium?
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1. hypothyroidism
2. kidney failure (cannot concentrate urine) |
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What is the most important aspect of a pt's diet who is taking lithium?
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They must not increase or decrease their salt levels!!!
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What drug is considered just as effective as lithium? What are its side effects?
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Depakote
-sedation -tremor -weight gain -pancreatitis |
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What must be monitored when a pt is on Depakote? WHy>?
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Must do pre treatment labs for LFTs and CBC
causes hepatotoxicity and thrombocytopenia |
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Which drug has been known to cause agranulocytosis? who is at the greatest risk for this?
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Tegretol used for bipolar disorder
Asian people most often get this |
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what are the side effects for tegretol?
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sedation and dizziness
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Which new anticonvulsant used for bipolar disorder does not require blood draws?
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Lamictal
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What OTC drugs should bipolar patients and depressive pts stay away from?
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Anything that can cause serotonin syndrome
Ginseng, St. John's Wort, Green tea can lower lithium levels |
