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63 Cards in this Set
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All people have normal variations in mood When variation become so severe that they affect function we consider them illness can range from full blown depression to full blown mania |
Mood (Affective Disorders) |
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emotional state that effects the way one views self and world |
Mood |
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How one expresses their mood constricted-not a lot of joy or sorrow blunted- not a lot of emotion flat |
Affect |
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very low mood for specified period of time probably r/t low levels of serotonin and/or adrenalin and dopamine
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Depression |
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pathologically elevated mood, resulting in poor decision making and impulse control problems may last about 1 week
probably r/t excessively high levels of serotonin, adrenalin, and dopamine |
Mania |
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excessively elevated mood |
Hypomania |
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Lack of energy |
Anergia |
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average affect/activity |
Euthymic |
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inability to experience pleasure |
Anhedonia |
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mild but chronic depression |
Dysthymia |
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Poor mood |
Dysphoria |
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Think about same thought over and over, perservate |
Rumination |
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slowed bodily functions r/t autonomic function constipation, lack of energy, decreased sex drive, sleep disturbances, etc |
Neurovegatative signs |
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slowed physical and emotional reactions |
Psychomotor retardation |
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low self esteem, fatigue, excessive guilt, anxiety/worry, pessimism, loss of pleasure
symptoms tend to be worse in the AM |
Psychological symptoms of depression |
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sleep changes, changes in eating, decreased energy, decreased sex drive, constipation, psychomotor retardation |
physiological symptoms of depression |
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slowed thinking, possible psychosis-paranoia, severe somatization, indecisiveness |
cognitive symptoms of depression |
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extreme sadness for 2 weeks (at least), loss of interest in pleasurable activities, insomnia/hypersomnia, fatigue, excessive unjustifiable guilt, low self esteem, decreased concentration, excessive indecisiveness, SI or fixation with death |
Major Depressive Disorder |
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severe mood swings ranging from suicidal depression to extreme mania |
Bipolar Type I |
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milder form, hypomanic, still have full blown depression, probably no psychosis |
Bipolar Type II |
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Energized but not euphoric |
Mixed Manic state |
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Mildest form of bipolar disorders, mood swings range from mild elation to mild depression
usually seen as moody and unpredicatble
No loss of social or occupational function |
Cyclothymic Disorder |
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Significant mood disturbance r/t alcohol, drugs, toxins |
Substance induced depressive or Bipolar disorder |
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chronic low mood and other mild s/s of depression for 2 years
TX: insight, cog, or behavioral therapy or meds |
Dysthymic disorder |
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low mood in winter probably r/t decreased sunlight, less light =less serotonin probably r/t hubernation
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Seasonal Affective Disorder |
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very very severe PMS
TX: meds, SSRI's: Sarafem/Prozac |
Premenstrual Dysphoric DIsorder |
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depression after child birth probably r/t hormonal changes and sudden role change for mother mild and predictable TX: psychosocial support and meds |
Post Partum Depression |
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severe debilitating psychiatric illness after childbirth |
Post Partum psycosis |
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deliberate intentional cutting, burning, etc |
non suicidal self injury |
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probably r/t disregulation of NT (serotonin, adrenalin, and dopamine) possible disregulation of hypothalmic, pituitary, adrenal axis, resulting in over exaggeration of stress response tends to have familial component |
Biological etiology of mood disorders |
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something is either all good or all bad |
Black and white thinking |
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jumping to negative conclusions without sufficient evidence |
arbitrary inference |
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focusing on a single negative detail while ignoring positive details |
specific abstraction |
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forming conclusions based on limited past experience |
overgeneralization |
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believing events are related to oneself |
personalization |
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assist pt in ID early childhood traumas and losses and how they may be similar to current life stressors |
psychodynamic tx for depression |
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assist pt in ID cognitive distortions and irrational thoughts |
cognitive tx for depression |
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address behaviors that are self defeating and develop behaviors that add to life fullfilment |
behavioral tx for depression |
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helps people feel they are not alone in their problem (universality) |
Group therapy |
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addresses conflicts in family groups |
Family therapy |
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first antidepressants-1952 r/t anti-TB drugs Very effective but possible deadly food interactions-Nardil, parnate, iproniazid, selegiline
Not first line of attack because of SE |
MAOIs |
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monoamine oxidase inhibits breakdown of catecholamines (Adrenaline, Dopamine) in synaptic cleft Normally prevent excessive amts of catecholamines and tyramine precursors from being absorbed through digestive tract |
MAIOs |
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to much catcholamines or tyrpamine absorbed can cause _____________ d/t excessive adrenalin and dopamine
adrenaline and dopamine increase BP |
Hypertensive crisis |
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How long is a washout period? |
5-6 weeks (textbook) 2 weeks (powerpoint) |
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second type of antidepressant, mid 60's act by reducing reuptake of adrenaline and serotonin named after 3 ring molecular structure effective but many SE take several weeks to work b/c of receptors relieve: hopelessness, helplessness, anhedonia, inappropriate guilt, suicide, daily mood vari |
TCAs |
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These 2 med classes can not be given together |
MAOIs and TCAs
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anticolinergic-dry mouth, constipation sedation adrenergic receptor blockage tachycardia cardiac abnomralities avoid during pregnancy Lethal in OD |
TCA SE |
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Imipramine, amytriptyline, nortiptyline, desipramine, chlomipramine, amoxipine, etc
will give for sleep, pain control, and anxiety |
Common TCAs |
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1987, selective serotonin reuptake inhibitors selectively reduces reuptake of just serotonin resulting in mood elevation with few SE decreased sex drive and seminal fluid GI upset, n&v Prozac, Zoloft, Paxil, Celexa, Lexapro |
SSRIs |
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can cause agitation in about 10% of users |
Prozac |
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Erection that might not go away SE of Trazadone |
Priapism |
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Effexor |
SSNRI |
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Ludiomil, amoxipine, trazadone, serzone (much sedation), wellbutrin (never use with sz hx), Remeron |
Tetracyclics |
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More prone to suicide in early tx |
antidepressants |
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d/t too much serotonin in synaptic cleft usually from mixing 2 highly serotinergic drugs or herbs (St John's wort) with insufficient washout period Medical emergency s/s: confusion, agitation, disphoresis, hypereflexia, hypo/per-thermia, shivering, tremors, tachycardia, muscle rigidity |
Serotonin Syndrome |
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Mood stabilizers Lithium most effective Salt that probably slows impulse transmission Less release of NT=less mania Narrow therapeutic index (0.5-1.5 mEq/L) |
Treatment of Bipolar |
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mild nausea and vomiting mild diarrhea, mild hand tremors, polydissia, polyurea, lethargy and fatigue, metallic taste in mouth |
Acceptable SE of Lithium |
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>1.5mEq/L: N&V, muscle weakness, slurred speech, hypereflexia, diarrhea, agitation, twitching, rash, incontinence, polydipsia, polyurea, imparied memory >3mEq/L: reduced consciousness, arrhythmias, seizures, cardiovascular collapse, death |
Se of Li >1.5mEq/L |
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competes with salt in the body pt should maintain constant salt level in body salt goes up:concentration goes down=mania pt takes in less salt or sweats excessively concentration goes up possibly displaying toxicity |
Lithium and Salt |
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weight gain, thyroid damage (hypothyroidism), kidney damage (dialysis), polyurea, fatigue, cardiac dysrhythemia, thinning hair |
Long term SE of Lithium |
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Most act on GABA, calming the brain originally for tx of seizures Tegretal (Carbamazepine-decrease WBC/RBC) Depakote-can affect Hct Gabapentin-neurontin Topamax, Klonopin SE: fatigue, ataxia, GI upset, rare: agraunulocytocis |
Other antimania drugs (Anticonvulsants) |
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very effective tx for depression used to treat non-med responding depression, mania, or psychosis electrical impulse to brain via electrodes must have seizure to be effective seizure must last at least 25 seconds up to 90 Prolonged seizure tx with Valium Succinylcholine neuromuscular blocking agent |
Electro-convulsive therapy |
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temporary short term memory loss, mild transient confusion, fatigue, HA, no well documented long term SE |
SE of ECT |
