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Flashcards in Mood disorders Deck (59):
1

1. Tricyclics
2. Selective Serotonin Reuptake Inhibitors
3. Monoamine Oxidase Inhibitors

Antidepressants

2

Increase the concentration of norepinephrine, serotonin, and/or dopamine in the body - blocking the reuptake of those neurotransmitters ; also occurs when enzyme - monoamine oxidase (MAO) is inhibited at various sites in the nervous system.

Antidepressants - action

3

Inactivate norepinephrine , serotonin and dopamine

MAO function

4

Amitriptyline (Elavil)

Tricyclic antidepressant (TCA)

5

Doxepin ( Tofranil)

Tricyclic antidepressant (TCA)

6

1. Blurred vision
2. Constipation
3. Urinary retention
4. Orthostatic hypotension
5. Reduction of seizure threshold
6. Tachycardia , arrhytmias
7. Photosensitivity
8. Weight gain

side effects of Tricyclic antidepressant (TCA)

7

Citalopram ( Celexa )

Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants

8

Fluoxetine ( Prozac)

SSRI antidepressants

9

Paroxentine ( Paxil )

SSRI antidepressants

10

Sertaline ( Zoloft )

SSRI antidepressants

11

Escitalopram ( Lexapro )

SSRI antidepressants

12

1. Insomnia, agitation
2. Headache ( analgesics )
3. Sexual dysfunction
4. Serotonin syndrome

side effects of SSRI antidepressants

13

1. Take dose early in the day
2. Avoid caffeine
3. Relaxation before bed

Insomnia interventions

14

1. Changes in mental status
2. Restlessness
3. Hyperreflexia
4. Myoclonus (muscle twitching )
5. Tachycardia, labile BP
6. Diaphoresis, shivering, tremors.

Serotonin syndrome

15

Cyproheptadine

antihistaminic and antiserotonergic agent; treat symptoms of serotonin syndrome

16

Phenelzine ( Nardil )

MAOI antidepressant

17

Tranylcypromine sulfate ( Parnate )

MAOI antidepressant

18

1. Hypertensive crisis
2. Weight gain
3. Changes in cardiac rhythm
4. Hypotension
5. Sedation
6. Insomnia

side effects of MAOI antidepressants

19

Occurs if the individual consumes foods containing tyramine while receiving MAOI therapy

Hypertensive crisis

20

1. Severe occipital headache
2. Palpitations
3. Nausea/vomiting
4. Nuchal rigidity (neck stiffness )
5. Fever, sweating
6. Increase in BP, chest pain, coma

Hypertensive crisis

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1.Discontinue drug
2. Monitor vital signs
3. Short-acting antihypertensive medication
4. External cooling methods to control hyperpyrexia

TX of hypertensive crisis

22

Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.

Do not consume while taking MAOIs

23

Aged cheese ; wine, beer; chocolate, colas, coffee, tea, sour cream, smoked and processed meats, beef or chicken liver, canned figs, soy sauce , overripe and fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans, cold remedies, diet pills.

Do not consume while taking MAOIs

24

1. Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
2. The therapeutic effect may not bee seen for as long as 4 weeks
3. Not drink alcohol - potentiate the effects of each other

Antidepressants - teaching

25

1. Do not stop taking the drug abruptly - withdrawal symptoms : nausea, vertigo, insomnia, headache, malaise, nightmares.
2. The therapeutic effect may not bee seen for as long as 4 weeks
3. Not drink alcohol - potentiate the effects of each other

Antidepressants - teaching

26

Avoid smoking - it is increases the metabolism of tricyclics

Tricyclic antidepressants - teaching

27

Avoid smoking - it is increases the metabolism of tricyclics

Tricyclic antidepressants - teaching

28

5 symptoms have been present during the same 2 -weeks period ; at least one of the symptoms is either - depressed mood or loss of interest or pleasure

Diagnostic criteria for major depressive disorder

29

1. Depressed mood
2. Loss of interest or pleasure
3. Weight loss / gain
4. Insomnia / hypersomnia
5. Fatigue/ loss of energy
6. Feelings worthlessness / excessive guilt
7. Recurrent thoughts of death

Symptoms of major depression disorder

30

Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy

Bipolar disorders

31

Lasting one week ( or more if hospitalization is necessary )
1. Grandiosity
2. Decreased need for sleep
3. Talkative
4. Racing thoughts
5. Distractibility
6. Increase in goal-directed activity
7. Involvement in pleasurable activities - painful consequences

Diagnostic criteria for manic episode

32

1. Hippocampus
2. Amygdala
3. Hypothalamus
4. Frontal cortex
5. Cerebellum

Areas of the brain affected - major depression

33

memory impairments, feeling of worthlessness , hopelessness and guilt

Hippocampus

34

anhedonia (no pleasure) , anxiety, reduced motivation

Amygdala

35

Increased/ decreased sleep and appetite, decreased energy and libido

Hypothalamus

36

depressed mood, problem concentrating

Frontal cortex

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psychomotor retardation/agitation

Cerebellum

38

1. Risk for suicide
2. Complicated grieving
3. Low-self esteem
4. Powerlessness
5. Spiritual distress
6. Social isolation
7. Disturbed though process
8. Imbalanced nutrition
9. Insomnia
10. Self care deficit

Major Depression - nursing diagnoses

39

1. Hypomania - cheerful, ideas of great worth, increased motor activity, inappropriate behaviors (calling President )
2. Acute mania - "high" / anger; flight of ideas; hallucinations/delusions; poor impulse control ; days without sleep;
3. Delirious mania - labile mood; extremely distractible ; delusions of grandeur or persecution ; purposeless movement .

Manic states

40

1. Risk for injury
2. Risk for violence: Self - Directed or Other-Directed
3. Imbalanced nutrition less than body requirements
4. Disturbed thought process
5. Disturbed sensory perception
6. Impaired social interaction
7. Insomnia

Bipolar Mania - nursing diagnoses

41

1. High protein, high calorie finger foods
2. Juice and snacks on unit
3. I&O, calorie count, daily weight
4. Provide favorite foods
5. Supplement with vitamins and minerals
6. Sit with client during meals

Imbalanced nutrition interventions

42

The induction of a generalized seizure through the application of electrical current to the brain (6-12 treatments ; 3 times a week)

Electroconvulsive Therapy

43

1. Major depression - after meds has proved ineffective
2. Mania
3. Schizophrenia - depression or mania symptoms

Indications for ECT

44

1. Increased intracranial pressure (from brain tumor, cardiovascular accident, cerebrovascular lesion)
2. Cardiovascular problems - at risk
3. Severe osteoporosis
4. Acute and chronic pulmonary disorders
5. High-risk or complicated pregnancy

Contraindications - ECT

45

Most common:
1. Temporary memory loss
2. Confusion

Side-effects of ECT

46

2 per 100,000 treatments ; major cause - cardiovascular complications (usually in individuals with previously compromised cardiac status )

Mortality - ECT

47

1. Ensure safety
2. Manage client anxiety
3. Provide education
4. Administer Atropine - decrease secretion to prevent aspiration

Role of the nurse in ECT

48

1. Short-acting anesthetic - thiopental sodium ;
2. Muscle relaxant - succinylcholine chloride
3. Pure oxygen - resp. muscles paralyzed
4. Blood pressure cuff on the lower leg before muscle relaxant to observe seizure activity
5. Electrodes placed (bilaterally or unilaterally) on the temples to deliver electrical stimulation

ECT - implementation

49

ECT is thought to effect a therapeutic response by ...

increasing the levels of serotonin , norepinephrine , and dopamine

50

Lithium Carbonate

Antimanic -

51

1. Drowsiness, dizziness, headache
2. Dry mouth, thirst
3. GI upset, nausea/vomiting
4. Fine hand tremors (decrease dose, propranolol)
5. Hypotension, arrhythmias, pulse irregularities
6. Polyuria, dehydration
7. Weight gain

Side effects of Lithium

52

The usual ranges of therapeutic serum concentration of Lithium are :

1.0-1.5 mEq/L - for acute mania
0.6 - 1.2 mEq/L - for maintenance

53

Serum lithium should be monitored once or twice a week after initial treatment until stable ; then monthly during maintenance therapy

Lithium toxicity > 1.5

54

1. Blurred vision, ataxia , tinnitus , N&V, diarrhea
2. Excessive output of dilute urine , tremors, psychomotor retardation, mental confusion
3. Coma, MI, cardiovascular collapse

Lithium toxicity > 1.5

55

Lithium is similar in chemical structure to sodium ; if sodium intake is reduced - - lithium is reabsorbed by the kidneys - toxicity

Adequate records of intake , output, and pts weight should be kept on a daily basis

56

1. Adequate sodium intake
2. 2500-3000 mL of fluid
3. call doctor - vomiting/ diarrhea
4. Risk - pregnancy

Lithium - Teaching

57

Valproic acid (Depakote)

anticonvulsant (antiepileptic) ; used in treatment of bipolar disorder

58

1. Hypothyroidism
2. Impairment of the kidneys ability to concentrate urine
Periodic follow ups required to assess thyroid and renal function

Major long term risks of lithium therapy

59

When a patient is experiencing a severe manic episode , which bodily system is most at risk for decompensation

Cardiac - death from cardiac collapse