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Exam 3 > Affective Disorders (Depression, Suicide, Bipolar) > Flashcards

Affective Disorders (Depression, Suicide, Bipolar) Flashcards

1
Q

Mood:

A

an emotion that influences one’s perception of the world, how one functions, can impair judgment

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2
Q

Affect:

A

emotional expression; provides clues to person’s mood

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3
Q

Affect can be

A

blunted, bright, flat, inappropriate, labile, restricted or constricted

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4
Q

Blunted:

A

reduced intensity of emotional expression

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5
Q

Bright:

A

smiling, projection of a positive attitude

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6
Q

Flat:

A

absent or nearly absent affective expression

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7
Q

Inappropriate:

A

unfitting affective expression accompanying the content of speech or ideation

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8
Q

Labile:

A

varied, rapid, and abrupt shifts in affective expression

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9
Q

Restricted or constricted:

A

mildly reduced in the range and intensity of emotional expression

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10
Q

Depression common mental disorder

Characterized by:

A 
Sadness
Loss of interest or pleasure
Feelings of guilt or low self-worth
Disturbed sleep or appetite
Low energy, poor concentration
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11
Q

Depression can be overwhelming If untreated and cause

A

significant negative effect on quality of life Increases risk of suicide

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12
Q

a patient with Depressive Disorders is at a greater risk for

A

suicide & developing physical health problems

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13
Q

patients with Depressive Disorders experience

A
  1. severe, debilitating depressive episodes

2. lower quality of life

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14
Q

Depressive Disorders are associated with high levels of impairment in

A

occupational, social, and physical functioning

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15
Q

characteristics of Depressive Disorders in Children & Adolescent

A
  1. Psychosis less likely
  2. Anxiety and somatic symptoms more likely
  3. Decreased interaction with peers
  4. irritable rather than sad mood
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16
Q

suicide in teens is ranked

A

Third leading cause of death among teens

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17
Q

characteristics of Depressive Disorder in Older Adults

A
  1. Often undetected and inadequately treated
  2. Commonly associated with chronic illness
  3. Symptoms possibly confused with Bipolar, dementia or stroke
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18
Q

the highest suicide rate in adults are

A

persons over 75 yo.

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19
Q

Treatment of depressive disorders in adults is successful in __________% but response to treatment is _______ than in younger adults

A

60% to 80%, slower

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20
Q

Types of Depressive Disorders

A 
Major depressive disorder
 Persistent depressive (dysthymic)
 Premenstrual dysphoric
 Substance/medication induced
 Disruptive mood dysregulation
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21
Q

what type of disease is Major Depressive Disorder (MDD)

A

progressively recurrent illness

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22
Q

Onset of MDD may occur

A

in puberty, highest onset persons in 20s

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23
Q

Risk relapse in MDD is higher if

A

occur at younger age & have mental disorders

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24
Q

Diagnostic Criteria MDD

A

at least One mood episodes for at least 2 weeks (depressed, loss interest or pleasure)

and

4 of 7 additional symptoms must be present:
Disruption in:
sleep, appetite (or weight), concentration, or energy,
Psychomotor agitation or retardation,
Excessive guilt or feelings of worthlessness,
Suicidal ideation

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25
Q

MDD population statistics in USA

A

10.4% within 12-month, lifetime 20.6%

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26
Q

MDD in Females is higher prevalence than males by

A

(13.4% to 7.2%)

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27
Q

MDD occurs more in which population categories?

A

younger adults, white adults, Native American

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28
Q

MDD episodes usually last

A

more than 6 months

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29
Q

expressions such as “heartbrokenness” means depressed in

A

(Native American, Middle Eastern),

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30
Q

“brain fog” means depressed in

A

(persons from the West Indies),

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31
Q

somatic symptoms describe as “Weakness, tiredness” is common in

A

asians

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32
Q

Risk Factors MDD

A

Prior episode of depression
Family history of depression
Lack of social support
Lack of coping abilities
Presence of life environmental stressors
Current substance use or abuse
Medical and/or mental illness comorbidity

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33
Q

MDD Risk of relapse is higher if

A

initial onset at a young age & additional mental disorders

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34
Q

MDD Often co-occur with other psychiatric disorders, especially

A

substance-related

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35
Q

biologic etiologies of MDD

A

Genetics
Lack of neurotransmitters
Endocrine alterations

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36
Q

psychological etiologies of MDD

A

Lack of love and caring
negative thoughts of self
loss of loved-ones

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37
Q

social etiologies of MDD

A

Family dysfunction

social isolation/deprivation

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38
Q

Family response to MDD

A

all members experience frustration
lack of understanding leads to abuse
depression may be higher in children whose mothers had depression

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39
Q

Dysthymia

A

is low mood occurring for at least two years for adults (1 year for children), along with at least two other symptoms of depression.

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40
Q

Premenstrual Dysphoric Disorder

A

Recurring mood swings, feelings of sadness, or sensitivity to rejection in the final week before the onset of menses

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41
Q

Premenstrual Dysphoric Disorder is associated with

A

Stress, history of interpersonal trauma, and seasonal changes

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42
Q

Disruptive Mood Dysregulation Disorder (DMDD)

A

Severe irritability and outbursts of temper of a child

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43
Q

DMDD Onset is

A

before age 10 when children have verbal rages and/or physically aggressive toward others or property

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44
Q

physical Assessment of Depressive Disorders

A 
Medical + surgical history
Baseline Vitals
Baseline lab test (ECG, CBC)
appetite & weight change
Sleep disturbance
Energy level
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45
Q

what percentage of patients with Depressive disorders abuse substances?

A

40-60%

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46
Q

alcohol abuse increases risk of depressive disorders by

A

4 times

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47
Q

psychosocial assessment of a patient

A 
Mental status  (mood & affect, thought processes  & content, cognition, memory & attention).
Coping skills.
Developmental history.
Psychiatric family history.
Patterns of relationships.
Quality of support system.
Education.
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48
Q

Mood and Affect assessment for depressive patients

A

Period of feeling depressed, sad, hopeless
Experience anhedonia, not caring any more, no enjoyment
Decrease of libido
Irritability and anger

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49
Q 
Social withdrawal
Changes occupational
functioning
Increased use of “sick days”
are signs of
A

behavior changes in depressed persons

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50
Q

Impaired ability to think, concentrate, make decisions
Easily distracted, complain of memory difficulties
Older adults: memory difficulties may be chief complaint, may be mistaken for early signs of dementia (pseudo-dementia)
are signs of

A

Cognition and Memory changes in depressed persons

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51
Q

disorganized thought processes , perceptual disturbances (e.g., hallucinations, delusions)
are signs of

A

Thought Content changes in depressed persons

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52
Q

Believe others would be better off if they were dead,
Thoughts of death, or actual specific plans
are signs of

A

Suicide Behavior

changes in depressed persons

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53
Q

Low self-esteem associated with:

A

Obesity
Cardiovascular events
Depression

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54
Q

Assessing self-esteem helps in establishing:

A

Goals and treatments

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55
Q

Positive coping techniques:

A

meditating, talking to love ones

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56
Q

Negative patterns:

A

over-eating, alcohol use, drugs

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57
Q

Commonly used self-report scales:

A 
General Health Questionnaire (GHQ)
Center for Epidemiological Studies Depression Scale (CES-D)
Beck Depression Inventory (BDI)
Zung Self-Rating Depression Scale (SDS)
PRIME-MD
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58
Q

Commonly used clinician-completed rating scales:

A

Hamilton Rating Scale for Depression (HAM-D)
Montgomery-Asberg Depression Rating Scale (MADRS)
National Institute of Mental Health Diagnostic Interview Schedule (DIS)

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59
Q

Teamwork and Collaboration for Patients with Depressive Disorders involves

A

Patient
PCP
Mental health specialist
Family

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60
Q

Goal of Treatment for Patients with Depressive Disorders

A

Reduce or control symptoms
Improve occupational and psychosocial function
Reduce likelihood of relapse
Help patient be as independent as possible
Achieve stability, recovery from major depression

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61
Q

what is the priority of Suicidal Thoughts and Behaviors

A

safety is First Priority

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62
Q

If no suicidal thoughts, focus on:

A 
Lack of sleep
Loss of appetite
Lack of energy
Feelings of hopelessness and low self-esteem
Difficulty making decisions
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63
Q

cognitive-behavioral therapy (CBT) is Effective only when

A

there is partial response to pharmacotherapy in milder depression

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64
Q

Interpersonal Therapy

A

Seeks to recognize, explore, and resolve interpersonal losses, role confusion & transitions, social isolation, deficits in social skills

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65
Q

primary treatment for patients with depressive disorders

A

Psychotherapy
+
Medication

66
Q

If psychotherapy and Medication is not successful, then other options are:

A

ECT
Light therapy
TMS

67
Q

(ECT) Electroconvulsive therapy

A

involves a brief electrical stimulation of the brain while the patient is under anesthesia to treat severe depression

68
Q

Alternative Therapies for depressive disorders

A 
Acupuncture
Yoga or tai chi
Meditation
Guided imagery
Massage therapy
Music therapy
Art therapy
69
Q

Suicidal Behavior

A

Occurrence of persistent thought patterns and actions that indicate a person is thinking about, planning, or enacting suicide

70
Q

suicide Risk Factors

A

Lack of and inadequacy of social supports
Family violence: physical or sexual abuse
Passive or active
Past history of suicidal ideation or behavior
Presence of psychosis, substance use or abuse
Decreased ability to control suicidal impulses

71
Q

MAOIs given when

A

no response to other antidepressants or cannot tolerate typical antidepressants.

72
Q

Reasons for not taking SSRIs are

A

GI side effects including diarrhea, cramping, and heartburn.

73
Q

TCAs side effects:

A

sedation
weight gain
decreased memory

and anticholinergic side effects blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia,

74
Q

MAOIs common side effects:

A

headache,
dry mouth
orthostatic hypotension

and throat, constipation, blurred vision,

75
Q

MAOIs adverse side effects:

A

insomnia, weight loss, and postural hypotension, asthenia (lack of energy

76
Q

MAOIs: cannot eat food & substances containing

A

tyramine (e.g., aged cheese, beer, red wine)

77
Q

TCAs: not for patients

A

at risk for suicide

78
Q

Treatment for overdose:

A

induction of emesis, gastric lavage, and cardiorespiratory supportive care

79
Q

ECT is Contraindicated in

A

patients with recent MI, CVA, retinal detachment, pheochromocytoma

80
Q

Light Therapy indicated for

A

For mild-to-moderate seasonal, nonpsychotic, recurrent winter depressive episodes of MDD

81
Q

Repetitive Transcranial Magnetic Stimulation (rTMS)

A

Magnetic head coil releases electrical pulses that stimulate the left cortex to treat mild depression

82
Q

rTMS treatment duration

A

consists of 20 to 30 sessions, lasting 37 minutes for 4-6 weeks

83
Q

Psychosocial Interventions

A

Milieu therapy
Safety
Family interventions
Support groups

84
Q

Psychosocial Interventions

A

Cognitive interventions
Behavioral interventions
Group interventions
Psychoeducation

85
Q

Mania - one of the primary symptoms of

A

bipolar disorders

86
Q

Bipolar mania is Recognized by

A 
elevated, expansive, or irritable mood
Elevated self-esteem 
Speech is pressured
racing thoughts
Need for sleep decreased; energy increased
87
Q

Mood lability in bipolar mania is:

A

alternations in moods with little or no change in external events

88
Q

causes of Bipolar Disorder - Mania

A 
Medical disorders or treatments
Metabolic abnormalities
Neurologic disorders 
CNS tumors
Medications
89
Q

Bipolar mania patients are often hospitalized to

A

prevent self-harm

90
Q

bipolar mania is sometimes associated with

A 
Schizophrenia
Schizoaffective disorder
Anxiety disorders
Some personality disorders
Substance abuse
Adolescent conduct disorders
91
Q

Bipolar 1

A

Classic manic-depressive disorder with mood swings alternating from depressed to manic

92
Q

Bipolar II

A

Mostly depressed; not as easily recognized

93
Q

Hypomania

A

Mild form of mania; characteristic of bipolar

94
Q

Cyclothymic Disorder

A

A mood disorder that causes emotional highs and lows.

95
Q

Characteristics of Bipolar I

A

Elevated mood
Expansive mood
Irritable mood

96
Q

Elevated mood:

A

euphoria (elevated mood, exaggerated feelings of well-being) or
elation (feeling high, ecstatic)

97
Q

Expansive mood:

A

lack of restraint in expressing feelings; overvalued sense of self-importance; constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions

98
Q

Irritable mood:

A

easily annoyed, provoked to anger; maintaining social relationships difficult

99
Q

Bipolar disorder I Can lead to severe functional impairment such as

A

alienation from family, friends, and coworkers; indebtedness; job loss; divorce; and other problems of living

100
Q

Diagnostic criteria for Bipolar disorder

A

at least one manic episode or mixed episode and a depressive episode

101
Q

symptoms of Bipolar I occur

A

before age 25 years

102
Q

which gender is more prone for depression and faster bipolarity cycles?

A

females

103
Q

which gender is more prone for manic episodes?

A

males

104
Q

Bopilar epidemiology percentage of people?

A
  1. 1% bipolar I;

1. 4% bipolar II

105
Q

most common comorbidities with Bipolar I:

A

Anxiety disorders: panic disorder, social phobia

Substance use: alcohol, marijuana

106
Q

Genetics in Bipolar disorder is

A

highly inheritable

107
Q

bipolar disorder results when

A

interaction exists between the genetic predisposition and psychosocial stress such as abuse or trauma

108
Q

Circadian dysregulation

A

Seasonal changes in light exposure trigger affective episodes in some patients, typically depression in winter and hypomania in the summer

109
Q

Kindling Theory

A

genetically predisposed individuals experience repetitive subthreshold stressors at vulnerable times, mood symptoms of increasing intensity and duration occur

110
Q

Social Rhythm Disruption Theory

A

When patterned social events are disrupted, mood swings are more likely to appear

111
Q

Psychosocial assessment of bipolar disorder includes:

A 
mood
cognition
thought disturbances
stress and coping
suicide risk
112
Q

what is priority during manic episodes?

A

safety!

113
Q

During manic episode:

A

poor judgment and impulsivity lead to risk-taking behaviors

114
Q

After manic episode:

A

may be devastated by consequences of impulsive behavior

115
Q

Interacting With a Person With Mania

A 
Use a calm approach
Be direct and use simple commands 
Avoid open-ended questions
Avoid confrontation 
Limit interaction time
Do not place demands on patient
116
Q

mood-stabilizing drugs, including

A 
lithium carbonate (Lithium), 
divalproex sodium (Depakote), carbamazepine (Tegretol)
amotrigine (Lamictal)
117
Q

Lithium Carbonate class and indication

A

DRUG CLASS: Mood stabilizer

INDICATIONS: Treatment and prevention of manic episodes in bipolar affective disorder.

118
Q

lithium peak effect

A

1-4 hours

119
Q

lithium optimal PO doses

A

600 mg TID

120
Q

divalproex sodium (Depakote) class and indication

A

DRUG CLASS: Antimanic agent

INDICATIONS: Mania, epilepsy, migraine.

121
Q

divalproex sodium (Depakote) peak effect

A

1-4 hours

122
Q

divalproex sodium (Depakote) Doses

A

available in 125 mg - 500 mg capsules

123
Q

carbamazepine (Tegretol) class and indication

A

an anticonvulsant, mood-stabilizing effects.

indication for patients who did not respond to lithium

124
Q

carbamazepine (Tegretol) dose

A

200 mg ID or BID

125
Q

amotrigine (Lamictal) class and indication

A

DRUG CLASS: Antiepileptic

Epilepsy, bipolar disorder (acute mood with standard therapy)

126
Q

amotrigine (Lamictal) half-life

A

32 hours

127
Q

amotrigine (Lamictal) doses

A

25 - 200 mg tablets

128
Q

antipsychotics approved for Bipolar disorder

A 
Aripiprazole (Abilify)
Asenapine (Saphris)
Cariprazine (Vraylar)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
129
Q

what is the main indication for antipsychotics use for Bipolar disorder?

A

Acute treatment of manic episodes of Bipolar I

130
Q

Aripiprazole (Abilify) adult dose

A

10–30 mg per day

131
Q

Risperidone (Risperdal) adult dose

A

2–6 mg daily

132
Q

If _____intake is reduced, the body will naturally retain/increase lithium to maintain homeostasis, and vice versa

A

salt

133
Q

its important to lithium Maintain serum level of

A

0.6 to 1.2

134
Q

how frequently should nurse obtain lithium serum levels during acute phase

A

twice a week

135
Q

side effects of lithium toxicity

A

cardiac arrhythmias, blackouts, tremors, seizures

136
Q

treatment of lithium toxicity

A

Withhold dose, obtain blood sample, push fluids if appropriate, contact physician for further direction

137
Q

intervention for lithium side effect of Edema of feet or hands

A

monitor Intake/Output

monitor sodium intake

138
Q

intervention for lithium side effect of muscle weakness and fatigue

A

reassure patient this side effect with pass after a few weeks of treatment

139
Q

intervention for lithium side effect of diarrhea

A

take lithium with meals

replace fluid replacement

140
Q

lithium serum levels of 1.5-2.5 is classified as

A

moderate toxicity

141
Q

lithium serum levels of >2.5 is classified as

A

severe toxicity

142
Q

side effects of severe lithium toxicity

A 
cardiac arrhythmias
Peripheral vascular collapse
Confusion
Seizures
Coma and death
143
Q

ACE inhibitors use with lithium will cause

A

increase lithium levels and toxicity

144
Q

Simple nursing interventions focusing on helping patients establish routines for social cues that impact _______

A

circadian rhythms.

145
Q

COMMON INDICATORS FOR RELAPSE of

Mania

A 
Reading several books at once
Cannot concentrate on one topic
Talking faster than usual
Feeling irritable
Hungry all the time
More energy than usual
146
Q

COMMON INDICATORS FOR RELAPSE of Depression

A 
Quit doing daily chores
Avoid people
Crave foods (e.g., chocolate)
Headaches
Do not care about other people
Sleeping more or restless sleep
147
Q

Relapse emergency plan

A

keep a list of emergency contacts, medications, symptoms, and treatment prefernces

148
Q

During Remission Periods

A

Teach stress management
Practice relaxation techniques
Develop a plan for managing emerging symptoms

149
Q

crisis Occurs when

A

perceived challenge or threat overwhelms capacity of the individual to cope

150
Q

Crisis can have either positive or
negative outcomes

If positive, ________________

If negative, ________________

A

opportunity for growth and new ways of coping learned,

suicide, homelessness, or depression can result

151
Q

Events that Evoke Crisis

A 
Natural disasters (floods, tornadoes, earthquakes)
Human-made disasters (wars, bombings, airplane crashes)
Traumatic experiences (e.g., rape, sexual abuse, assault)
Interpersonal events (marriage, birth)
152
Q

Acute Stress Disorder

A

Individual is significantly distressed or social functioning is impaired.
Has dissociative symptoms and persistently re-experiences the event

153
Q

Types of Crisis

A

Developmental (Maturational) Crisis.

Situational Crisis

154
Q

Developmental (Maturational) Crisis

Describes significant events such as:

A

Leaving home for first time
Completing school
Accepting the responsibility of adulthood

155
Q

Situational Crisis Occurs when

A

stressful events threaten person’s physical and psychosocial integrity resulting in psychological disequilibrium
Events can be:
Internal, e.g. disease process
External, e.g., move to another city, job promotion, graduation

156
Q

Traumatic Crisis

A

Initiated by unexpected, unusual events that affect individuals or a multitude of people.
Individuals face overwhelmingly hazardous events that entail injury, trauma, destruction, or sacrifice

157
Q

examples of traumatic crisis

A 
National disasters (e.g., racial persecutions, riots, war)
Violent crimes (e.g., rape, murder, kidnappings, assault and battery)
Environmental disasters (e.g., earthquakes, floods, forest fires)
158
Q

phases of crisis

A

Problem arises, Anxiety increases, problem solving begins.

problem solving fails, anxiety increases, attempt to restore balance.

attempt is failed, anxiety becomes panic, automatic relief behavior adopted.

when relief behaviors fail, anxiety overwhelms and lead to personality disorganization indicating person is in crisis.

159
Q

crisis nursing care

A 
determine the extent of physical injury or trauma.
Any unusual behaviors 
involvement of person with crisis
Evidence of self-mutilation
Client’s perception of problem
Availability of support for person
160
Q

nursing interventions for crisis self-care

A

Help reestablish healthy diet, sleep hygiene strategies, and attend to personal grooming

161
Q

medications for crisis

A

Cannot resolve crisis but can help reduce its emotional intensity

Exam 3 (6 decks)

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