Chapter 17 Mood Disorders

Question 1

Euthymic

Answer 1

average affect and activity/ normal mood

Question 2

Mania

Answer 2

a distinct period during which mood is abnormally and persistently elevated, expansive, and irritable.

• Typically last about 1 week.
• Many be longer for others.

Question 3

Manic episodes include:

Answer 3

• inflated self esteem or grandiosity
• decreased sleep
• excessive and pressured speech
• flight of ideas
• distractiablitly
• increased activity or psychomotor agitation
• excessive involvment in pleasure-seeking or risking-taking activities.

Question 4

Manic persons moods may be:

Answer 4

• excessively cheerful
• enthusiastic
• expansive
• or irritable
• often denies any problems
• placing blame on others
• also may exhibit delusions and hallucinations during a manic episode

Question 5

Hypomania

Answer 5

period of abnormally and persistenly elevated, expansive, or irritable mood and some other milder symptoms of mania.

Question 6

Difference between Mania and Hypomania

Answer 6

Hypomanic episodes do not impair the persons ability to function. (in fact, he or she may be quite productive) and NO psychotic feautures (delusions or hallucinations)

Question 7

A mixed episode

Answer 7

diagnosed when the person experiences both mania and depression nearly everyday for atleast 1 week.

Question 8

Mixed episodes are often called

Answer 8

rapid cycling

Question 9

Bipolar I Disorder

Answer 9

one or more manic or mixed episodes usually accompanied by major depressive episodes

Question 10

Bipolar II Disorder

Answer 10

one or more major depressive episodes accompanied by atleast one hypomanic episode.

Question 11

Persistent depressive (dysthymic) disorder

Answer 11

a chronic,
persistent mood disturbance characterized by symp-
toms such as insomnia, loss of appetite, decreased
energy, low self-esteem, difficulty concentrating, and
feelings of sadness and hopelessness that are milder
than those of depression.

Question 12

Disruptive mood dysregulation disorder

Answer 12

is a persistent
angry or irritable mood, punctuated by severe, recur-
rent temper outbursts that are not in keeping with the
provocation or situation, beginning before age 10.

Question 13

Cyclothymic disorder

Answer 13

is characterized by mild mood
swings between hypomania and depression without
loss of social or occupational functioning.

Question 14

Substance-induced depressive or bipolar disorder

Answer 14

is
characterized by a significant disturbance in mood that
is a direct physiological consequence of ingested sub-
stances such as alcohol, other drugs, or toxins.

Question 15

Seasonal affective disorder (SAD) has two sub-types. In one, most commonly called winter depression or fall-onset SAD

Answer 15

people experience increased
sleep, appetite, and carbohydrate cravings; weight
gain; interpersonal conflict; irritability; and heaviness
in the extremities beginning in late autumn and abat-
ing in spring and summer. The other subtype, called
spring-onset SAD, is less common, with symptoms of
insomnia, weight loss, and poor appetite lasting from
late spring or early summer until early fall. SAD is often
treated with light therapy

Question 16

Postpartum or “maternity” blues

Answer 16

is a mild, predict-
able mood disturbance occurring in the first several
days after delivery of a baby. Symptoms include la-
bile mood and affect, crying spells, sadness, insom-
nia, and anxiety. The symptoms subside without
treatment, but mothers do benefit from the support
and understanding of friends and family

Question 17

Postpartum depression

Answer 17

is the most common complication of pregnancy in developed countries. The symptoms are consistent with
those of depression (described previously), with onset
within 4 weeks of delivery.

Question 18

Postpartum psychosis

Answer 18

is a severe and debilitating
psychiatric illness, with acute onset in the days following childbirth. Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion
and progress to delusions, hallucinations, poor insight and judgment, and loss of contact with reality.
This medical emergency requires immediate treat
ment. Women who have a history of serious mental
illness are at higher risk for a postpartum relapse
even il they were well during pregnancy

Question 19

Premenstrual dysphoric disorder

Answer 19

is a severe form of
premenstrual syndrome and is defined as recurrent.
moderate psychological and physical symptoms thal
occur during the week before menses and resolving
with menstruation.somatic symptoms that can cause severe dysfunction in
social or occupational functioning, such as labile mood.
irritability, increased interpersonal conflict, difficulty
concentrating, feeling overwhelmed or unable to cope,
and feelings of anxiety, tension, or hopelessness

Question 20

Nonsuicidal self-injury involves ..

Answer 20

deliberate, intentional
cutting, burning, scraping, hitting, or interference with
wound healing. Some persons who engage in self-injury
(sometimes called self-mutilation) report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility.
Others report the influence of peers or the need to “fit
in” as contributing factors

Question 21

Kindling

Answer 21

is the process by which seizure activity in a specific area of the brain is initially stimulated by reaching a
threshold of the cumulative effects of stress, low amounts
of electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways.

Question 22

Major depressive disorder

Answer 22

-typically involves 2 weeks or more
of a sad mood or lack of interest in life activities.
-four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision-making, self-esteem, and goals, hypersomnia or insomnia, feels fatigued, changes in weight, sleep, energy, concentration, self esteem, goals, decision making. May last, weeks,Months or years if untreated
- Major depression is twice
as common in women and has a one-and-a-half to three times
greater incidence in first-degree relatives than in the general population.
-Incidence of depression decreases with age in women and increases with age in men.
-Single and divorced people have the highest incidence.
-Depression in prepubertal boys and girls occurs at an equal rate.

Question 23

psychomotor agitation

Answer 23

(increased body movements and thoughts), which includes pac-

ing, accelerated thinking, and argumentativeness.

Question 24

Ruminate

Answer 24

repeatedly going over the same thoughts

Question 25

The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes hat the client is demonstrating which? a. Aggression b. Anger c. Anxiety d. Psychomotor agitation

Answer 25

d. Psychomotor agitation

Question 26

A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." Which is the best response by the nurse? a. "Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks. b. "It is nothing to worry about unless it continues for the next month." c. "Tremors can be an early sign of toxicity, but we'll keep monitoring your lithium level to make sure you're OK." d. "You can expect tremors with lithium. You seem very concerned about such a small tremor."

Answer 26

a. "Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks.

Question 27

What are the most common types of side effects from SSRIs? a. Dizziness, drowsiness, and dry mouth b. Convulsions and respiratory difficulties c. Diarrhea and weight gain d. Jaundice and agranulocytosis

Answer 27

a. Dizziness, drowsiness, and dry mouth

Question 28

The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client? a. "Do you feel better after talking with others during lunch?" b. "I'm so happy to see you interacting with other clients." C. "I see you were sitting with others at lunch today." d. "You must feel much better than you were a few days ago"

Answer 28

C. "I see you were sitting with others at lunch today."

Question 29

Which term typifies the speech of a person in the acute phase of mania? a. Flight of ideas b. Psychomotor retardation c. Hesitant d. Mutism

Answer 29

a. Flight of ideas

Question 30

What is the rationale for a person taking lithium to have enough water and salt in his or her diet? a. Salt and water are necessary to dilute lithium to avoid toxicity. b. Water and salt convert lithium into a usable solute C. Lithium is metabolized in the liver, necessitating increased water and salt. d. Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

Answer 30

d. Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

Question 31

Identify the serum lithium level for maintenance and safety. a. 0.1 to 1 mEq/L b. 0.5 to 1.5 mEq/L c. 10 to 50 mEg/L d. 50 to 100 mEg/L

Answer 31

b. 0.5 to 1.5 mEq/L

Question 32

A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse? a. "Thank you. I think you are special too" b. "I suspect you want something from me. What is it?" c. "You probably say that to all your nurses." d. "Are you thinking of suicide?"

Answer 32

d. "Are you thinking of suicide?"

Question 33

A client with mania begins dancing around the dayroom. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to a. minimize the client's embarrassment about her present behavior. b. keep her from dancing with other clients. c. avoid embarrassing the male clients who are watching. d. teach her about proper attire and hygiene.

Answer 33

a. minimize the client's embarrassment about her present behavior.

Question 34

Cultural Considerations in children

Answer 34

cranky, school phobia, learning disabilities, anti social, failing grades

Question 35

Cultural Considerations in adolescents

Answer 35

Risky behavior, join gangs, school dropouts, abuse substances

Question 36

ECT (electro convulsive therapy) is used when

Answer 36

drug therapy fails

Question 37

_________ is said to be best in combination with medication

Answer 37

Psychotherapy

Question 38

Data Analysis to Determine Priorities

Answer 38

Risk for suicide (safety is the first-priority) •If suicidal, what is the plan and is it lethal, place on suicide precautions •Imbalanced nutrition: less than body requirements •Anxiety •Ineffective Coping and role performance •Self-Care Deficit •Chronic low self esteem •disturbed sleep pattern •Impaired social interaction •Hopelessnes

Question 39

Desired outcomes for client with psychomotor retardation form of depression may include:

Answer 39

The client will: •Not injure him or herself•Independently carry out ADLs •Establish a balance of rest, sleep and activity •Evaluate self-attributes realistically •Socialize with staff, peers, family/friends •Return to occupation or school activities •Will comply with an antidepressant regimen •Verbalize symptoms of reoccurrence

Question 40

Client and family education for Depression

Answer 40

-Teach them that it is an illness •Teach early signs of relapse •Teach the importance of support groups •Teach med compliance, therapy compliance and the importance of follow up appointments

Question 41

Lethality Assessments

Answer 41

Is there a plan? •Is the plan possible? •Is the plan specific? •Is the plan lethal

Question 42

Selective serotonin reuptake inhibitors (SSRIs)

Answer 42

``` Fluoxetine Paroxetine Sertraline Citalopram Escitalopram ```

Question 43

Tricyclic antidepressants

Answer 43

Amitriptyline Imipramine Mirtazapine

Question 44

Monoamine oxidase inhibitors (MAO inhibitors)

Answer 44

Phenelzine | Tranylcypromine

Question 45

``` Selective serotonin reuptake inhibitors (SSRIs) Adverse reactions. Fluoxetine Paroxetine Sertraline Citalopram Escitalopram ```

Answer 45

``` Common s/e: Anxiety, insomnia, sedation, akathisia, sexual dysfunction. Increased risk of suicide Serotonin syndrome (agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, confusion, ?coma and death) ```

Question 46

``` Tricyclic antidepressants: Amitriptyline Imipramine Tetracyclic antidepressant: Mirtazapine Adverse reactions ```

Answer 46

Tricyclic antidepressants: Weight gain Anticholinergic s/e such as dry mouth, urinary retention, constipation, vision changes. Tetracyclic antidepressant: Serious: agranulocytosis, serotonin syndrome, orthostatic hypotension, seizures, akathisia, torsades de points, Stevens-Johnson syndrome (fever, flu-like s/s, rash, blisters, peeling of skin), rhabdomyolysis Common: somnolence, xerostomia, increased appetite, weight gain, elevated lipids, elevated ALT, AST, photosensitivity

Question 47

Monoamine oxidase inhibitors (MAO inhibitors) Adverse reactions. Phenelzine Tranylcypromine

Answer 47

Sedation, insomnia, weight gain, dry mouth, orthostatic hypotension, sexual dysfunction. HTN crisis due to tyramine ingestion

Question 48

The most serious side effect of MAOIs is

Answer 48

hypertensive crisis: life threatening conditon that can result when a client taking MAOIs ingests tyramine-containing foods and other fluids or other medications

Question 49

Hypertensive crisis symptoms

Answer 49

occipital headache, hypertension, nausea, vomiting, chills, sweating, restlessness, nuchal rigidity, dilated pupils, fever, motor agitation

Question 50

Bipolar disorder

Answer 50

involves extreme mood swings from episodes of mania to episodes of depression. (Bipolar disorder was formerly known as manic-depressive illness.) During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor judgment and rapid thoughts,actions, and speech. During depressed phases, mood, behavior, and thoughts are the same as in people diagnosed with major depression (see previous discussion). In fact, if a person's first episode of bipolar illness is a depressed phase, he or she might be diagnosed with major depression; a diagnosis of bipolar disorder may not be made until the person experiences a manic episode.

Question 51

Medication for bipolar disorders

Answer 51

Lithium

Question 52

Lithium levels

Answer 52

Maintence levels: 0.5- 1 Treatment levels: 0.8-1.5 Toxic levels: 1.5 and above