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90 Cards in this Set
- Front
- Back
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Mood
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subjective, inner feelings, tendency towards longer duration
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Affect
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objective, behavioral expression of mood
tendency towards shorter duration |
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Emotional Labiliy
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abrupt, unexpected alterations between moods
most often between euphoric and irritable moods in Mood disorders |
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Mood episode
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is a period of time during which a persons mood is distinctive and different from ones normal "up and down" response to daily events.
Such distinctive moods are pervasive and sustained throughout the period of time. |
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Functional impairment
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is the inability to function successfully at work, home, and or usual social relationships
hospitalization is necessary to prevent harm to self or others |
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Specifier
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is more detailed information about an identified disorder once a diagnosis is made
- assist in choice of treatment and predication of course of prognosis the illness |
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MDE
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major depressive episode
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MDD
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major depressive disorder
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BD
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bipolar disorder
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which gender is MDD more common in?
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women
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what is SIG E CAPS used to diagnose?
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major depressive disorder
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how long must symptoms persist for a patient to be diagnosed with MDD?
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at least 2 weeks
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what is SIG E CAPS?
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S: sleep disturbance
I: loss of interest G: guilt feelings E: loss of energy C: decreased concentration/memory A: loss of appetite P: psychomotor retardation, agitation S: thoughts of suicide, death must confirm distress/impairment rule out bereavement - must have include 4 of the symptoms |
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What is FASTPED used to diagnose?
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Manic episode
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describe FASTPED.
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Bipolar disorder: if behavioral or verbal evidence of elevated, expansive, or irritable mood are present:
F: flight of ideas A: increased goal directed activity S: decreased need for sleep T: more talkative than usual P: self-defeating pleasure E: increased self esteem D: distractible Functional impairment or hospitalization? |
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how many of the FASTPED symptoms must be present for a diagnosis of Bipolar Manic disorder?
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3 or more must be conspicuous and persistent for at least 1 week
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what is a hypomanic disorder?
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period of elevated, expansive, or irritable mood that was distinctively different from his/her usual non-depressed mood that last at least 4 days
- not severe enough to cause functional impairment/hospitalization |
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why do we have an adaptive sense to pain?
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warns of injury or disease
motivates a response |
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what is the significance of pain?
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most common complaint in primary care
affects functioning and well-being some report being more afraid of suffering intractable pain than death itself |
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definition of pain
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pain is unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
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T/F
Pain is a subjective experience. |
True
it is real to the sufferer and not all in one's head |
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describe acute pain
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brief in duration
associated with tissue damage sympathetic arousal associated with anxiety responds to treatment |
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describe chronic pain
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six months or more
no ongoing tissue damage or nociceptive stimulation pain persists over times no sympathetic arousal associated with depression responds poorly to treatment associated with excessive disability and pain |
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what are the goals of acute pain treatment
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to eliminate nociception
to eliminate painful experience |
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what are the goals of chronic pain treatment
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to reduce suffering
to reduce pain behavior to optimize functioning |
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in the assessment of pain, how is the best way to find out about it?
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best way to find out about pain is to ask about it
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what are some descriptive words for sensory-discriminative pain?
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pounding
spreading crushing burning Aching |
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what are some descriptive words of cognitive evaluative pain?
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agonizing
excruciating |
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what are some descriptive words of motivational affective pain?
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exhausting
awful unbearable |
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what did Breecher's work tell us about pain?
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contrasted comparable wounds of civilians versus soliders
32% of war-wounded wanted narcotics compared to 83% of civilian surgical patients intensity of pain depended on significance of pain "ticket to safety" |
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what are some psychosocial influences on pain of pain expression?
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past experience with pain
expectations of pain self-efficacy for pain family influences social and environmental factors |
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what are some psychosocial aspects of pain?
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anxiety
depression attention sleep difficulties fatigue personality traits placebo |
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how does anxiety affect pain?
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can lead to an increased pain
can develop both in response to pain and in anticipation to pain |
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how does depression affect pain?
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pain can be augmented by the presence of depression
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what are the treatment goals of acute pain?
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address of eliminate pain if possible
provide realistic expectations about the course of pain and analgesic relief asses pain; can use rating scale respect the subjective nature of pain encourage use of self management techniques for managing pain |
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what strategies can be used when a patient is going to experience a painful procedure
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provide preparatory information to promote control
offer rest intervals utilize distraction acknowledge persons efforts at coping though empathetic, supportive statement make use of self management techniques |
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what are some pain self management techniques?
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relaxed breathing
relaxation method imagery and visualization positive self statement |
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Bipolar I
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at least one episode of mania or mixed episode
- depressive mood not required |
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Bipolar II
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recurrent bouts of major depression with at least one episode of hypomania
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Cyclothymia
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at least 2 years of cycles of alternating between hypomania, euthymia, dysthymia
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what are anti-depressants used for the treatment of?
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unipolar depressive disorders and can be used in recurring depressed phase of bipolar disorder
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what is the initial treatment of choice for unipolar depression?
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SSRIs and other newer classes are initial treatment of choice due to adverse effects of TCAs and MAOIs
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T/F
antidepressants may trigger a switch from mania in individuals with bipolar disorders |
True
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why must you screen everyone before giving them a prescription for antidepressants?
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may cause:
switch to mania rapid cycling treatment resistance suicidal thoughts |
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what is antidepressant DOC?
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SSRI's
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what is the first SSRI that you would try in a patient?
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Fluoxetine
- it is cheap |
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Name the adverse side effects of SSRIs.
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GI distress
Sexual dysfunction jitteriness, tremor, H/A, Insomnia, akathesia/agitation, sweating, somnolence, fatigue |
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how long does it take to see a clinical response to treatment with SSRIs?
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2-6 weeks of therapy
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are SSRIs nephrotoxic?
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Yes
- reduce dosage in older adults |
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should an SSRI and a MAOI be administered simultaneously?
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NO
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describe discontinuation syndrome of SSRIs
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flu-like symptoms, insomnia, nausea, imbalance, sensory disturbance, hyper arousal
- usually mild. last one- two weeks - more likely with a longer duration of tx and a shorter half-life of the treatment drug - more likely to occur after abrupt stop of at least 4-6 weeks of medication use |
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what are the symptoms of serotonin syndrome?
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changes in mental status
confusion agitation, restlessness weakness tremors, myoclonic jerks N/V, tachycardia tachypnea, hyperthermia, labile BP, Death |
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what are some examples of SNRIs?
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Venlafaxine
Desvenlafaxine Duloxetine |
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what are the adverse side effects of SNRIs?
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headache
Nausea Somnolence weight loss constipation dizziness insomnia sweating ELEVATED BLOOD PRESSURE |
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what type of drug is Bupropion?
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dopamine reuptake inhibitor
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what are adverse side effects of Bupropion (Dopamine RI)
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agitation
SEIZURES Nausea Insomnia |
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should you prescribe Bupropion to a patient who has been treated bulimia nervosa?
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NO
electrolyte imbalance can lead to seizures |
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Trazodone
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Nonselective 5HT-RI
sleep aid commonly used in psychiatry for sleep |
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adverse side effects of Trazodone (Nonselective 5HT RI)
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Priaprism
syncope drowsiness |
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Mirtazapine
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NE and specific 5HT inhibitor
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adverse side effects of Mirtazapine
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WEIGHT GAIN
DYSLIPIDEMIA agranulocytosis somnolence dry mouth constipation flu symptoms dizziness urinary frequency sedation |
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when should a patient take Mirtazapine?
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at night because one of its side effects is sedation
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what do TCAs inhibit?
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non-selective 5HT and NE reuptake inhibitors
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Do blood plasma levels of TCAs need to be monitored?
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YES
to keep in safe therapeutic range |
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how are TCA potentially lethal in overdose?
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heart block
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what is a contraindication of a TCA?
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acute phase recovery of an MI
co-administration with an MAOI hepatic failure |
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describe the adverse side effects of TCAs
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anticholinergic: dry mouth, blurred vision, constipation, urinary retention
alpha-1-blockade: orthostatic hypotension, reflex tachycardia, dizziness |
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Name two MAOIs
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Phenelizine
Tranycypromine |
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how do MAOIs work?
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inhibit enzyme that inactivates epinephrine, NE, dopamine, 5-HT
may take 2-4 weeks before therapeutic effects good for atypical depression |
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what are the side effects of MAOIs? (phenelzine/Tranycrpromine)
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daytime drowsiness, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction, HTN CRISIS,
DO NOT administer MAOI with other antidepressants avoid any substance that has high amounts of tyramine |
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when giving a patient an MAOI, why do you tell them to avoid food high in tyramine?
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may cause HTN crisis
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T/F
in patient education of taking an SSRI/SNRI a patient should be informed that once their symptoms have improved, they should stay on the meidication for another 6-12 months |
True
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what is used to treat Bipolar disorder/Mood stabilizing drugs?
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LIthium
Valoprate Carbamazepine Lamotrigine Atypical Antipsychotics |
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what is LIthium contraindicated in?
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CV disease
Renal disease Pregnancy |
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what is Lithium used in the treatment of?
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manic and depressive bipolar disorder
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when may the peak of action take place with Lithium treatment?
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5-14 days
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what are the adverse side effects of LIthium?
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kidney, thyroid, heart
Renal dysfunciton Hypothyroidism Tremor Acne GI distress Increased appetite |
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Is Lithium teratogenic?
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YES
first trimester teratogenic cardiovascular effects - Ebstein's anomaly/tricuspid valve |
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how often should blood levels of lithium be checked?
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check blood levels weekly then every 1-2 months
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in long term use of lithium how often should dosage and organ systems be checked?
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check lithium level q 3-6 months
BUN, Cr, electrolytes q 6-12 months yearly thyroid functions 24 hour urine for volume and GFR only if specific indication EKG every 5 years |
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Depakote
-Divalproex sodium (ER) Valproic Acid (Depakene) |
anticonvulsants used in the treatment of bipolar disorder
- rapid cycling & mixed episodes |
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Are anticonvulsants teratogenic?
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YES
- neural tube defects |
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Tegretol
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anticonvulsant
-Carbamazepine several adverse side effects |
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when treating a patient with Tegretol/Carbamazeipine what should be monitored?
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CBC
CMP |
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Lamotrigine/Lamictal
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anticonvulsant used in treatment in bipolar disorder
- adverse effects: HSR, Neutropenia, Fever, Deposits in IRIS - SJS/fatal rash/ usually develops within 1st 2 months - monitor CBC, CMP - YEARLY EYE EXAM |
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when are antipsychotics indicated in the treatment of mood disorders?
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Indicated in the treatment of mania when psychosis or agitation are present, psychotic depression
- often clinically as a first line agent |
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what drugs for the treatment of mood disorders have a risk of tardive dyskinesia?
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antipsychotics
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what if a patient on a mood stabilizer gets depressed?
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optimize current mood stabilizer
before adding an antidepressant consider adding atypical antipsychotic combining mood stabilizers may be as effective as using an antidepressant - antidepressants can be very useful in bipolar depression IF a mood stabilizer or atypical antipsychotic in place when possible taper off the antidepressant after 3-6 months |
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what is the treatment algorithm for mood stabilizers?
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1. choose a mood stabilizer
2. maximize its dose 3. psychotherapy 4. use antidepressant very cautiously 5. best managed by psychiatrist long term |
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T/F
Persons with bipolar disorder and co-morbid medical conditions as well as some elderly and pregnant patients, ECT may be safer alternative than medication |
True
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