Affective Disorders (Depression, Suicide, Bipolar) Flashcards
(161 cards)
1
Q
Mood:
A
an emotion that influences one’s perception of the world, how one functions, can impair judgment
2
Q
Affect:
A
emotional expression; provides clues to person’s mood
3
Q
Affect can be
A
blunted, bright, flat, inappropriate, labile, restricted or constricted
4
Q
Blunted:
A
reduced intensity of emotional expression
5
Q
Bright:
A
smiling, projection of a positive attitude
6
Q
Flat:
A
absent or nearly absent affective expression
7
Q
Inappropriate:
A
unfitting affective expression accompanying the content of speech or ideation
8
Q
Labile:
A
varied, rapid, and abrupt shifts in affective expression
9
Q
Restricted or constricted:
A
mildly reduced in the range and intensity of emotional expression
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
11
Q
Depression can be overwhelming If untreated and cause
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significant negative effect on quality of life Increases risk of suicide
12
Q
a patient with Depressive Disorders is at a greater risk for
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suicide & developing physical health problems
13
Q
patients with Depressive Disorders experience
A
- severe, debilitating depressive episodes
2. lower quality of life
14
Q
Depressive Disorders are associated with high levels of impairment in
A
occupational, social, and physical functioning
15
Q
characteristics of Depressive Disorders in Children & Adolescent
A
- Psychosis less likely
- Anxiety and somatic symptoms more likely
- Decreased interaction with peers
- irritable rather than sad mood
16
Q
suicide in teens is ranked
A
Third leading cause of death among teens
17
Q
characteristics of Depressive Disorder in Older Adults
A
- Often undetected and inadequately treated
- Commonly associated with chronic illness
- Symptoms possibly confused with Bipolar, dementia or stroke
18
Q
the highest suicide rate in adults are
A
persons over 75 yo.
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
20
Q
Types of Depressive Disorders
A
Major depressive disorder Persistent depressive (dysthymic) Premenstrual dysphoric Substance/medication induced Disruptive mood dysregulation
21
Q
what type of disease is Major Depressive Disorder (MDD)
A
progressively recurrent illness
22
Q
Onset of MDD may occur
A
in puberty, highest onset persons in 20s
23
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Risk relapse in MDD is higher if
A
occur at younger age & have mental disorders
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
25
MDD population statistics in USA
10.4% within 12-month, lifetime 20.6%
26
MDD in Females is higher prevalence than males by
(13.4% to 7.2%)
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MDD occurs more in which population categories?
younger adults, white adults, Native American
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MDD episodes usually last
more than 6 months
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expressions such as “heartbrokenness” means depressed in
(Native American, Middle Eastern),
30
“brain fog” means depressed in
(persons from the West Indies),
31
somatic symptoms describe as "Weakness, tiredness" is common in
asians
32
Risk Factors MDD
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
33
MDD Risk of relapse is higher if
initial onset at a young age & additional mental disorders
34
MDD Often co-occur with other psychiatric disorders, especially
substance-related
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biologic etiologies of MDD
Genetics
Lack of neurotransmitters
Endocrine alterations
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psychological etiologies of MDD
Lack of love and caring
negative thoughts of self
loss of loved-ones
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social etiologies of MDD
Family dysfunction
| social isolation/deprivation
38
Family response to MDD
all members experience frustration
lack of understanding leads to abuse
depression may be higher in children whose mothers had depression
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Dysthymia
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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Premenstrual Dysphoric Disorder
Recurring mood swings, feelings of sadness, or sensitivity to rejection in the final week before the onset of menses
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Premenstrual Dysphoric Disorder is associated with
Stress, history of interpersonal trauma, and seasonal changes
42
Disruptive Mood Dysregulation Disorder (DMDD)
Severe irritability and outbursts of temper of a child
43
DMDD Onset is
before age 10 when children have verbal rages and/or physically aggressive toward others or property
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physical Assessment of Depressive Disorders
```
Medical + surgical history
Baseline Vitals
Baseline lab test (ECG, CBC)
appetite & weight change
Sleep disturbance
Energy level
```
45
what percentage of patients with Depressive disorders abuse substances?
40-60%
46
alcohol abuse increases risk of depressive disorders by
4 times
47
psychosocial assessment of a patient
```
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.
```
48
Mood and Affect assessment for depressive patients
Period of feeling depressed, sad, hopeless
Experience anhedonia, not caring any more, no enjoyment
Decrease of libido
Irritability and anger
49
```
Social withdrawal
Changes occupational
functioning
Increased use of “sick days”
are signs of
```
behavior changes in depressed persons
50
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
Cognition and Memory changes in depressed persons
51
disorganized thought processes , perceptual disturbances (e.g., hallucinations, delusions)
are signs of
Thought Content changes in depressed persons
52
Believe others would be better off if they were dead,
Thoughts of death, or actual specific plans
are signs of
Suicide Behavior
| changes in depressed persons
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Low self-esteem associated with:
Obesity
Cardiovascular events
Depression
54
Assessing self-esteem helps in establishing:
Goals and treatments
55
Positive coping techniques:
meditating, talking to love ones
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Negative patterns:
over-eating, alcohol use, drugs
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Commonly used self-report scales:
```
General Health Questionnaire (GHQ)
Center for Epidemiological Studies Depression Scale (CES-D)
Beck Depression Inventory (BDI)
Zung Self-Rating Depression Scale (SDS)
PRIME-MD
```
58
Commonly used clinician-completed rating scales:
Hamilton Rating Scale for Depression (HAM-D)
Montgomery-Asberg Depression Rating Scale (MADRS)
National Institute of Mental Health Diagnostic Interview Schedule (DIS)
59
Teamwork and Collaboration for Patients with Depressive Disorders involves
Patient
PCP
Mental health specialist
Family
60
Goal of Treatment for Patients with Depressive Disorders
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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what is the priority of Suicidal Thoughts and Behaviors
safety is First Priority
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If no suicidal thoughts, focus on:
```
Lack of sleep
Loss of appetite
Lack of energy
Feelings of hopelessness and low self-esteem
Difficulty making decisions
```
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cognitive-behavioral therapy (CBT) is Effective only when
there is partial response to pharmacotherapy in milder depression
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Interpersonal Therapy
Seeks to recognize, explore, and resolve interpersonal losses, role confusion & transitions, social isolation, deficits in social skills
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primary treatment for patients with depressive disorders
Psychotherapy
+
Medication
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If psychotherapy and Medication is not successful, then other options are:
ECT
Light therapy
TMS
67
(ECT) Electroconvulsive therapy
involves a brief electrical stimulation of the brain while the patient is under anesthesia to treat severe depression
68
Alternative Therapies for depressive disorders
```
Acupuncture
Yoga or tai chi
Meditation
Guided imagery
Massage therapy
Music therapy
Art therapy
```
69
Suicidal Behavior
Occurrence of persistent thought patterns and actions that indicate a person is thinking about, planning, or enacting suicide
70
suicide Risk Factors
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
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MAOIs given when
no response to other antidepressants or cannot tolerate typical antidepressants.
72
Reasons for not taking SSRIs are
GI side effects including diarrhea, cramping, and heartburn.
73
TCAs side effects:
sedation
weight gain
decreased memory
and anticholinergic side effects blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia,
74
MAOIs common side effects:
headache,
dry mouth
orthostatic hypotension
and throat, constipation, blurred vision,
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MAOIs adverse side effects:
insomnia, weight loss, and postural hypotension, asthenia (lack of energy
76
MAOIs: cannot eat food & substances containing
tyramine (e.g., aged cheese, beer, red wine)
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TCAs: not for patients
at risk for suicide
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Treatment for overdose:
induction of emesis, gastric lavage, and cardiorespiratory supportive care
79
ECT is Contraindicated in
patients with recent MI, CVA, retinal detachment, pheochromocytoma
80
Light Therapy indicated for
For mild-to-moderate seasonal, nonpsychotic, recurrent winter depressive episodes of MDD
81
Repetitive Transcranial Magnetic Stimulation (rTMS)
Magnetic head coil releases electrical pulses that stimulate the left cortex to treat mild depression
82
rTMS treatment duration
consists of 20 to 30 sessions, lasting 37 minutes for 4-6 weeks
83
Psychosocial Interventions
Milieu therapy
Safety
Family interventions
Support groups
84
Psychosocial Interventions
Cognitive interventions
Behavioral interventions
Group interventions
Psychoeducation
85
Mania - one of the primary symptoms of
bipolar disorders
86
Bipolar mania is Recognized by
```
elevated, expansive, or irritable mood
Elevated self-esteem
Speech is pressured
racing thoughts
Need for sleep decreased; energy increased
```
87
Mood lability in bipolar mania is:
alternations in moods with little or no change in external events
88
causes of Bipolar Disorder - Mania
```
Medical disorders or treatments
Metabolic abnormalities
Neurologic disorders
CNS tumors
Medications
```
89
Bipolar mania patients are often hospitalized to
prevent self-harm
90
bipolar mania is sometimes associated with
```
Schizophrenia
Schizoaffective disorder
Anxiety disorders
Some personality disorders
Substance abuse
Adolescent conduct disorders
```
91
Bipolar 1
Classic manic-depressive disorder with mood swings alternating from depressed to manic
92
Bipolar II
Mostly depressed; not as easily recognized
93
Hypomania
Mild form of mania; characteristic of bipolar
94
Cyclothymic Disorder
A mood disorder that causes emotional highs and lows.
95
Characteristics of Bipolar I
Elevated mood
Expansive mood
Irritable mood
96
Elevated mood:
euphoria (elevated mood, exaggerated feelings of well-being) or
elation (feeling high, ecstatic)
97
Expansive mood:
lack of restraint in expressing feelings; overvalued sense of self-importance; constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions
98
Irritable mood:
easily annoyed, provoked to anger; maintaining social relationships difficult
99
Bipolar disorder I Can lead to severe functional impairment such as
alienation from family, friends, and coworkers; indebtedness; job loss; divorce; and other problems of living
100
Diagnostic criteria for Bipolar disorder
at least one manic episode or mixed episode and a depressive episode
101
symptoms of Bipolar I occur
before age 25 years
102
which gender is more prone for depression and faster bipolarity cycles?
females
103
which gender is more prone for manic episodes?
males
104
Bopilar epidemiology percentage of people?
1. 1% bipolar I;
| 1. 4% bipolar II
105
most common comorbidities with Bipolar I:
Anxiety disorders: panic disorder, social phobia
| Substance use: alcohol, marijuana
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Genetics in Bipolar disorder is
highly inheritable
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bipolar disorder results when
interaction exists between the genetic predisposition and psychosocial stress such as abuse or trauma
108
Circadian dysregulation
Seasonal changes in light exposure trigger affective episodes in some patients, typically depression in winter and hypomania in the summer
109
Kindling Theory
genetically predisposed individuals experience repetitive subthreshold stressors at vulnerable times, mood symptoms of increasing intensity and duration occur
110
Social Rhythm Disruption Theory
When patterned social events are disrupted, mood swings are more likely to appear
111
Psychosocial assessment of bipolar disorder includes:
```
mood
cognition
thought disturbances
stress and coping
suicide risk
```
112
what is priority during manic episodes?
safety!
113
During manic episode:
poor judgment and impulsivity lead to risk-taking behaviors
114
After manic episode:
may be devastated by consequences of impulsive behavior
115
Interacting With a Person With Mania
```
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
mood-stabilizing drugs, including
```
lithium carbonate (Lithium),
divalproex sodium (Depakote), carbamazepine (Tegretol)
amotrigine (Lamictal)
```
117
Lithium Carbonate class and indication
DRUG CLASS: Mood stabilizer
| INDICATIONS: Treatment and prevention of manic episodes in bipolar affective disorder.
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lithium peak effect
1-4 hours
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lithium optimal PO doses
600 mg TID
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divalproex sodium (Depakote) class and indication
DRUG CLASS: Antimanic agent
| INDICATIONS: Mania, epilepsy, migraine.
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divalproex sodium (Depakote) peak effect
1-4 hours
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divalproex sodium (Depakote) Doses
available in 125 mg - 500 mg capsules
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carbamazepine (Tegretol) class and indication
an anticonvulsant, mood-stabilizing effects.
| indication for patients who did not respond to lithium
124
carbamazepine (Tegretol) dose
200 mg ID or BID
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amotrigine (Lamictal) class and indication
DRUG CLASS: Antiepileptic
| Epilepsy, bipolar disorder (acute mood with standard therapy)
126
amotrigine (Lamictal) half-life
32 hours
127
amotrigine (Lamictal) doses
25 - 200 mg tablets
128
antipsychotics approved for Bipolar disorder
```
Aripiprazole (Abilify)
Asenapine (Saphris)
Cariprazine (Vraylar)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
```
129
what is the main indication for antipsychotics use for Bipolar disorder?
Acute treatment of manic episodes of Bipolar I
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Aripiprazole (Abilify) adult dose
10–30 mg per day
131
Risperidone (Risperdal) adult dose
2–6 mg daily
132
If _____intake is reduced, the body will naturally retain/increase lithium to maintain homeostasis, and vice versa
salt
133
its important to lithium Maintain serum level of
0.6 to 1.2
134
how frequently should nurse obtain lithium serum levels during acute phase
twice a week
135
side effects of lithium toxicity
cardiac arrhythmias, blackouts, tremors, seizures
136
treatment of lithium toxicity
Withhold dose, obtain blood sample, push fluids if appropriate, contact physician for further direction
137
intervention for lithium side effect of Edema of feet or hands
monitor Intake/Output
| monitor sodium intake
138
intervention for lithium side effect of muscle weakness and fatigue
reassure patient this side effect with pass after a few weeks of treatment
139
intervention for lithium side effect of diarrhea
take lithium with meals
| replace fluid replacement
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lithium serum levels of 1.5-2.5 is classified as
moderate toxicity
141
lithium serum levels of >2.5 is classified as
severe toxicity
142
side effects of severe lithium toxicity
```
cardiac arrhythmias
Peripheral vascular collapse
Confusion
Seizures
Coma and death
```
143
ACE inhibitors use with lithium will cause
increase lithium levels and toxicity
144
Simple nursing interventions focusing on helping patients establish routines for social cues that impact _______
circadian rhythms.
145
COMMON INDICATORS FOR RELAPSE of
| Mania
```
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
COMMON INDICATORS FOR RELAPSE of Depression
```
Quit doing daily chores
Avoid people
Crave foods (e.g., chocolate)
Headaches
Do not care about other people
Sleeping more or restless sleep
```
147
Relapse emergency plan
keep a list of emergency contacts, medications, symptoms, and treatment prefernces
148
During Remission Periods
Teach stress management
Practice relaxation techniques
Develop a plan for managing emerging symptoms
149
crisis Occurs when
perceived challenge or threat overwhelms capacity of the individual to cope
150
Crisis can have either positive or
negative outcomes
If positive, ________________
If negative, ________________
opportunity for growth and new ways of coping learned,
| suicide, homelessness, or depression can result
151
Events that Evoke Crisis
```
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
Acute Stress Disorder
Individual is significantly distressed or social functioning is impaired.
Has dissociative symptoms and persistently re-experiences the event
153
Types of Crisis
Developmental (Maturational) Crisis.
| Situational Crisis
154
Developmental (Maturational) Crisis
| Describes significant events such as:
Leaving home for first time
Completing school
Accepting the responsibility of adulthood
155
Situational Crisis Occurs when
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
Traumatic Crisis
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
examples of traumatic crisis
```
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
phases of crisis
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
crisis nursing care
```
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
nursing interventions for crisis self-care
Help reestablish healthy diet, sleep hygiene strategies, and attend to personal grooming
161
medications for crisis
Cannot resolve crisis but can help reduce its emotional intensity
