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44 Cards in this Set

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What is euthymic?
Absence of depressed or elevated mood
What is expansive?
Expression of feelings without restraint
What is dysphoric?
Feelings of unpleasantness, discomfort; depressed
What words are used to describe affect?
Blunted (severe reduction in intensity), flat, inappropriate, labile, restricted or constricted (reduced in intensity)
What is affect?
Outward expression of mood characterized by facial expression and intonation
What are six risk factors associated with Major Depressive Disorder?
1. Prior episode of depression
2. Family history
3. Lack of social support
4. Stressful life event
5. Substance use
6. Medical comorbidity
What are biochemical etiological factors for Major Depressive Disorder?
Serotonin (controls sleep, appetite), norepinephrine (lack of energy, inability to experience pleasure), dopamine
HPA axis (hypersecretion of cortisol)
What is a psychological consequence of chronically high cortisol levels?
Major depressive disorder
How does the DSM describe a Major Depressive Episode?
Depressed mood or loss of interest or pleasure for at least 2 weeks plsu 4 or more of the following:
- weight or appetite changes
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive/inappropriate guilt
- depressed cognitive abilities
- recurrent thoughts of death, suicidal ideation/behavior
What is the clinical course of a Major Depressive Episode?
Usually develops over days or weeks. It lasts a minimum f 2 weeks and can last for six months or more if left untreated. A patient is considered "recovered" after 8 weeks of remission.
How is dysthymic disorder different from depression?
Dysthymic disorder is a chronic sense of milder depression. The onset is generally from childhood to early adulthood. Patients often say "I've always been this way"
How is post partum depression different from post partum (maternity blues)?
Post partum depression meets the criteria for a major depressive episode with onset within 4 weeks of delivery.
Post partum begins approximately 1 day after deliver (but can occur 4-6 weeks after as well), peaks between 3 and 7 days, and then may disappear untreated.
What are some symptoms of post partum psychosis?
Poor memory, confusion, fatigue; poor insight or judgment; loss of reality
What is the difference between winter depression SAD and spring onset SAD?
Winter depression starts in the fall and is characterized by increased sleep and appetite. Spring depression starts in the spring and is characterized by increased insomnia and decreased appetite.
What treatment is often used for SAD?
Light therapy
What are some indicators of depression in children?
Sleep changes and social withdrawal are initial symptoms. Children are more likely to manifest anxiety or somatic symptoms, but less likely to experience psychosis. They may be more bored or irritable than sad.
What are special considerations for elderly patients suffering from depression?
Associated chronic illness and medication side effects.
Coping mechanisms may diminish with age.
Treatment can still be successful, but will be slower.
High risk for being untreated.
What are priority care issues for patients with depression?
Safety, especially high suicide risk
Name 3 important nursing diagnoses for a patient with major depressive disorder
1. Imbalanced nutrition
2. Decisional conflict
3. Fatigue
4. Ineffective individual coping
5. Ineffective role performance
6. Low self-esteem
What are some psychopharmacologic interventions for major depressive disorder?
SSRIs
SNRIs
Atypical antidepressants
TCAs
MAOIs
Name a SSRI
- fluoxetine (Prozac)
- sertraline (Zoloft)
- citalopram (Celexa)
- escitalopram (Lexapro)
Name a SNRI
- venalfaxine (Effexor)
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
Name an atypical antidepressant
- Nefaxodone (Serazone)
- trazodone (Desyrel)
treats insomnia
- buproprion (Wellbutrin)
"activating"
Name a TCA
- desipramine (Norpramin)
- amitriptyline (Elavil)
- nortiptyline (Pamelor)
- imipramine (Tofranil)
Name an MAOI
- phenelzine (Nardil)
- tranylcypromine (Pamate)
- selegeline (Eldepryl)
What psychopharmacologic class can cause lethal ODs?
TCAs; also the oldest drug type
Which psychopharmacologic class of drugs is prescribed for patients with treatment resistant depression or borderline personality disorder?
MAOIs
Which psychopharmacologic class can cause hypertensive crisis?
MAOIs
What is Vagus Nerve Stimulation therapy system?
It's a stimulator device implanted in teh chest that sends electric impulses to left vagus nerve
What is the difference between Bipolar I and Bipolar II diagnoses?
Bipolar I has a combination of manic or mixed episodes and major depressive episodes.
Bipolar II has episodes of major depression and hypomania,
What is cyclothymic disorder?
A mild form of bipolar II characterized by 2 years of numerous periods of hypomanic and relatively mild depressive symptoms.
How does the DSM describe a Manic Episode?
At least 1 week of abnormally and persistently elevated, expansive, or irritable mood. Plus 3 of the following:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual
- distractibility
- increase in goal-directed activity OR psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences
How is a Mixed Episode characterized?
A. The criteria are met both for a manic episode and for a major depressive episode nearly every day for at least a 1-week period
B. The mood disturbance causes dysfunction in life
C. Symptoms are not due to substances
How is a hypomanic episode different from a manic episode?
It lasts at least 4 days.
What is the clinical course of bipolar disorder?
Chronic cyclic disorder that affects interpersonal relationships and occupational functioning.
4 or more episodes within 12 months.
What is the neurotransmitter hypotheses for bipolar disease?
Possible excess of norepinephrine, serotonin and dopamine because of inability to modulate neuronal excitation.
What are the chronobiologic theories of bipolar disorder?
Sleep deprivation can induce mania in some patients. Other patients may be influenced by changes in circadian rhythm.
What are the signs and symptoms of bipolar in children?
Symptoms reflect developmental level of the child. Intense rage episodes for 2-3 hours. Other psychiatric disorders are often also present.
What are the key points of bipolar disorder in the elderly?
Poorer prognosis for late-onset bipolar disorder. Generally occurs in women over 50 and men in their 80s. Often are more neurologic abnormalities and cognitive disturbances.
What are the priority issues for patients with bipolar disorder?
Risk for suicide. Safety risk due to poor judgment and risk-taking behaviors.
Name 3 pertinent nursing interventions for bipolar disorder
-Evaluation of manic and other mood symptoms
-Thought disturbances
-Sleep
-Weight and appetite
-Lab studies (hyperthyroidism)
-Hypersexual, risky behaviors
-Pharmacologic
-Stress and coping factors
-Risk assessment
-Social and occupational changes
-Cultural views of mental illness
Name 3 pertinent nursing diagnoses for bipolar disorder
-Sleep deprivation
-Imbalanced nutrition
-Disturbed sensory perception
-Disturbed thought processes
-Ineffective coping
-Ineffective role performance
-Interrupted family processes
-Impaired social interaction
-Compromised family coping
Name a mood stabilizer prescribed for bipolar disease?
-lithium carbonate
-valprioc acid (Depakote)
-carbamazepine (Tegretol)
-lamotrigine (Lamictal)
-oxcarbazepine (Trileptal)
-gabapentin (Neurontin)
-topiramate (Topamax)
What are other medications used for bipolar disease?
-Antidepressants: added after the patient is stabilized on a mood stabilizer because it can trigger mania
-Antipsychotics: for psychosis, mania, dosage is usually lower
-Benzodiazepines: for short-term for agitation and acute mania, but contraindicated for patients with substance use hx