MOOD DISORDERS (AFFECTIVE DISORDERS) Flashcards
(148 cards)
1
Q
pervasive alterations in emotions that are manifested by depression or mania or both.
A
MOOD DISORDERS (AFFECTIVE DISORDERS)
2
Q
most common psychiatric diagnoses
associated with suicide.
A
MOOD DISORDERS (AFFECTIVE DISORDERS)
3
Q
Mood disorder most risk factor?
A
suicide
4
Q
They interfere with a person’s life plaguing the client with long term sadness, agitation, or elation.
Accompanying self-doubt, guilt, and anger alter life activities especially those that involve self-esteem, occupation and relationships.
A
MOOD DISORDERS (AFFECTIVE DISORDERS)
5
Q
2 Primary Mood Disorders
A
- Major Depressive Disorder
- Bipolar Disorder ( formerly known as manic depressive illness)
6
Q
formerly known as manic depressive illness
A
Bipolar Disorder
7
Q
Major depressive illness lasts at least
A
2 weeks
8
Q
a person experiences a depressed mood or loss of pleasure in nearly all activities.
A
Major depressive illness
9
Q
Symptoms of Major Depressive Illness
A
- Changes in appetite, weight,sleep or
psychomotor activity - Decreased energy
- Feelings of worthlessness or guilt
- Difficulty thinking, concentrating or makingdecisions or recurrent thoughts of death orsuicidal ideation, plans or attempts.
10
Q
combination of hallucinations,
and delusions is referred
A
psychotic depression
11
Q
it is diagnosed when person’s mood
cycles between extremes of mania and depression.
A
Bipolar disorder
12
Q
distinct period during which mood is
abnormally and persistently elevated, expansive, or irritable.
A
Mania
13
Q
Mania last about how many week/s?
A
1 week
(unless the person is hospitalized and treated sooner) but it maybe longer for some individuals.
14
Q
Accompanying Symptoms of Manic Episode
(at least three of these symptoms)
A
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Pressured speech (unrelenting, rapid, often loud talking without pauses)
• Flight of ideas (racing often unconnected thoughts)
• Distractibility
• Increased involvement in goal directed activity or psychomotor activity
• Excessive involvement in pleasure seeking activities with high potential for painful consequences.
(Some people may exhibit delusions and hallucinations during manic episode)
15
Q
unrelenting, rapid, often loud talking without pauses
A
Pressured speech
16
Q
of abnormally and persistently,
elevated, expansive, or irritable mood lasting 4 days and including three or four of the additional symptoms mentioned earlier.
A
Hypomania
17
Q
Difference of Hypomanic episodes from Manic episodes
A
hypomanic episodes
- do not impair the person’s ability to function (in fact, in fact he or she may be quite productive)
- no psychotic features
(hallucination, delusions).
18
Q
experiences both mania and depression nearly every day for at least 1 week.
A
Mixed episode
19
Q
mixed episode are also called
A
Rapid cycling
20
Q
one or more manic or mixed
episodes usually accompanied by major depressive episodes.
A
Bipolar I disorder
21
Q
one or more major depressive
episodes accompanied by at least one hypomanic episode.
A
Bipolar II disorder
22
Q
People with bipolar disorder may experience normal mood or what we call….
A
euthymic
23
Q
Related Disorders Classified in the DSM IV TR as mood disorders but with symptoms that are less severe or of shorter duration include the following:
A
- Dysthymic disorder
- Cyclothymic disorder
- Substance-induced mood disorder
- Mood disorder due to a general medical condition
24
Q
at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode.
A
Dysthymic disorder
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2 years of numerous periods of both hypomanic symptoms that do not met the criteria for bipolar disorder.
Cyclothymic disorder
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a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequences of ingested substances such as alcohol, other drugs,
or toxins.
Substance-induced mood disorder
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prominent and persistent disturbance in
mood that is judged to be a direct physiologic consequence of a medical condition such as degenerative neurologic condition, ccerebrovascular disease, metabolic or endocrine
condition
Mood disorder due to a general medical condition
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4 other disorders that involve changes in mood
1. Seasonal Affective Disorder (SAD)
2. Post Partum or Maternity Blues
3. Postpartum Depression
4. Postpartum Psychosis
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2 Subtypes of seasonal Affective Disorder (SAD)
1. Winter depression or fall onset
(most common)
2. Spring onset (less common)
30
5 manifestation of Winter Depression or Fall Onset
• Increased sleep
• Increased appetite
• Carbohydrate craving ,weight gain
• Interpersonal conflict, irritability
• Heaviness in the extremities
( The above symptoms begins in late autumn and abating in spring and summer. )
31
3 Symptoms of Spring Onset SAD
• Insomnia
• Weight loss
• Poor appetite
( Symptoms above lasts from late spring or early summer
until fall )
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frequent normal experience after delivery of a baby.
Post Partum or Maternity Blues
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Characteristics Post Partum or Maternity Blues
• Labile mood and affect
• Crying spells
• Sadness
• Insomnia
• Anxiety
34
Post Partum or Maternity Blues approximately begins and usually peak what day?
begin - 1 day after delivery
peak - 7 days
( disappear rapidly with no
medical treatment )
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meets all the criteria for a major depressive episode with onset within 4 wks of delivery.
Postpartum Depression
36
Postpartum Depression episode onset within
4 weeks after delivery
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a psychotic episode developing within 3 wks of delivery and beginning with fatigue , sadness, emotional lability, poor memory and confusion and
progressing to delusions, hallucinations poor insight, and judgment and loss of contact with reality. This medical emergency requires immediate treatment.
Postpartum Psychosis
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Postpartum Psychosis psychotic episode developing within
3 weeks after delivery
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implicate transmission of major depression in the 1st degree relatives who have twice the risk of developing depression.
Genetic studies
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1st degree relatives of people with bipolar disorder have a __% to__%
risk for developing bipolar disorder
3% to 8%
41
For all mood disorders, monozygotic (identical) twins have a concordance rate (both twins having the disorder)
___ to ___ times higher than that of dizygotic (fraternal) twins.
2 to 4 times
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who are the people with both problems
have a higher rate of mixed and rapid cycling poorer response to lithium, slower rate of recovery and more hospital admissions.
people with early onset bipolar disorder and early onset alcoholism.
43
people with early onset bipolar disorder and early onset alcoholism may responds better to __________________ than to lithium.
anticonvulsants
44
2 major biogenic amines implicated in
mood disorders.
serotonin & norepinephrine
45
Roles of serotonin in behavior:
- mood
- activity
- aggressiveness & irritability
- cognition
- pain
- biorhythms & neuroendocrine processes
(i.e.growth hormone, cortisol, prolactin levels are abnormal in depression)
46
found in the blood or cerebrospinal fluid occur in people with depression.
Serotonin deficits
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Levels of Norepinephrine in client with depression
deficient Norepinephrine levels
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Levels of Norepinephrine in client with mania
increased
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This catecholamine energizes the body to mobilize during stress and immobilize during stress and inhibits Kindling.
Norepinephrine
50
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 amount of electric impulses or chemicals such as cocaine that sensitize nerve cell pathways. These highly
sensitized pathways respond by no longer needing the stimulus to induce seizure activity, which now occur spontaneously.
Kindling
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It is theorized that ________ may underlie the cycling of mood disorders as well as addiction.
kindling
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Medication that inhibits kindling
Anticonvulsants
53
Cholinergic drugs alter mood, sleep
neuroendocrine function and the
electroencephalographic pattern: Therefore _______________ seems to be implicated in depression and mania.
acetylcholine
54
Mood disturbances have been documented in people with endocrine disorders such as
1. thyroid
2. adrenal
3. parathyroid
4. pituitary.
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% of clients with depression that has evidenced of increased cortisol secretion and elevated glucocorticoid activity is associated with stress
response.
40%
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Postpartum hormone alterations precipitate mood disorders such as
- postpartum depression
- psychosis.
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% of people with depression
have thyroid dysfunction notably an elevated thyroid stimulating hormone. This problem must be corrected with thyroid treatment or treatment for the mood disorder is affected adversely.
5% to 10%
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Psychodynamic Theorist
1. Freud
2. Bibring
3. Jacobson
4. Meyer
5. Horney
6. Beck
59
He looked at the self-appreciation of people with depression and attributed that self- reproach to anger turned inward related to either a real or perceived loss. Feeling abandoned by this loss, people became angry, while both loving and hating the lost object.
Freud
60
He believed that one’s ego aspired to be
ideal (i.e. good and loving, superior or strong) and that to be loved and worthy, one must achieve these high standards. Depression results when in reality the person was not able to achieve these ideals all the time.
Bibring
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He compared the state of depression to
a situation in which the ego is powerless, helpless child victimized by the superego, much like a powerful and sadistic mother who takes delight in torturing the child.
Jacobson
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They view manic episodes as a defense against underlying depression with the id taking over the ego and acting as an undisciplined hedonistic being (child)
Most psychoanalytical theories of mania
63
He viewed depression as a reaction to a
distressing life experience such as an event with psychic causality.
Meyer
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He believed that children raised by
rejecting or unloving parents were prone to feelings of insecurity and loneliness making them susceptible to depression and helplessness.
Horney
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He saw depression as resulting from specific cognitive distortions in susceptible people. Early experiences shaped distorted ways of thinking about oneself, the future and the world; these distortions involve magnification of negative events, traits and expectations and simultaneous minimization of anything positive.
Beck
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Mood disorder or depression is difficult to identify and diagnose in certain age groups.
• Children
• Adolescents
• Adults
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depression often appear cranky,
have school phobia hyperactivity or learning disorders, failing grades and antisocial behaviors
Children with depression
68
depression may abuse substances, join gangs, engage in risky behavior underachievers, or drop out of school.
Adolescents with depression
69
substance abuse, eating disorders,
compulsive behaviors such as workaholism and gambling and hypochondriasis. Older adults
who are cranky and argumentative may actually be depressed.
Adults
70
2 or more weeks of sad mood
or lack of interest in life activities with at least four other symptoms of depression such as anhedonia, and changes in weight, sleep, energy, concentration, decision making, self-esteem and goals.
MAJOR DEPRESSIVE DISORDER
71
twice as common as common in women and has a 1.5 to 3 times greater incidence in 1st degree relatives than in the general population.
MAJOR DEPRESSIVE DISORDER
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TRUE or FALSE
Incidence of depression decreases with age in women and increases with age in men.
TRUE
73
TRUE or FALSE
Single and divorced people have the highest incidence.
In prepubertal boys and girls it occurs at an equal rate.
TRUE
74
Untreated episode of depression can last ________ months before remitting.
6 to 24 months
75
% chance of recurrence after a second episode of depression is
70%
76
% of people with severe depression that have psychotic features
9%
77
Major Categories of Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)
• Cyclic Antidepressants
• Atypical Antidepressants
• Monoamine oxidase inhibitors (MAOI’s)
78
The choice of which antidepressant to use is based on:
✓ Symptoms
✓ Age
✓ Physical health needs
✓ Drugs that have or shave not work in the past or that have work for a blood relative with depression
✓ Other medication that the client is taking
79
levels of neurotransmitters esp. serotonin and norepinephrine in depression
decreased serotonin and norepinephrine
80
medications used in clients who have acute depression with psychotic
features
antipsychotic is used in combination with antidepressant
( Several weeks into the treatment ,
the client is reassessed whether the antipsychotic can be discontinued and maintained only in antidepressant. )
81
Few relapse occur in client who receive antidepressant therapy for how many months?
18 - 24 months
82
Symptoms of Major Depressive Disorder
✓ Depressed mood
✓ Anhedonism
✓ Unintentional weight change of 5% or more in amonth
✓ Change in sleep pattern
✓ Agitation or psychomotor retardation
✓ Tiredness
✓ Worthlessness or guilt inappropriate to thesituation (possibly delusional)
✓ Difficulty thinking, focusing, or making decisions
✓ Hopelessness, helplessness, and/or suicidal ideation
83
newest category of antidepressants and
effective for most clients with of Major Depressive Disorder
Selective Serotonin Reuptake Inhibitors (SSRI’s)
84
SSRI’s action is specific to
serotonin reuptake inhibition
85
These drug produces few sedating
anticholinergic and cardiovascular side effects which make them safe for use of older adults.
Selective Serotonin Reuptake Inhibitors (SSRI’s)
86
1. Insomnia decreases in ___ to __ days
2. Appetite returns to a more normal state in ___ to ___ days
3. Energy returns in ___ to ___ days
4. Mood, concentration and interest in life returns in ___ to ___ days
1. 3 to 4 days
2. 5 to 7 days
3. 4 to 7 days
4. 7 to 10 days
87
SSRI that produces a slightly higher rate of mild agitation and weight loss but less somnolence. It has a half-life of
more than 7 days which differs from the 25-hour half-life of other SSRI’s.
Prozac or Fluoxetine (Prozac)
88
Cyclic Antidepressant that was introduced for the treatment of
depression in the mid 50’s and the oldest antidepressants.
Tricyclics
89
They relieve the symptoms of hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation and daily mood variation (like cranky in the morning and better in the evening.
Other indication include: panic disorder,
obsessive–compulsive disorder and eating disorder
Cyclic Antidepressant
• Tricyclics
90
tricyclic and heterocyclic take
____ weeks to take full effects.
6 weeks
91
tricyclic and heterocyclic they have a long serum half life there is lag period of ___ to ___ weeks before a steady plasma is reached and the symptoms begins to lessen.
1 to 4 weeks
92
Contraindications of tricyclic antidepressants:
• Severe impairment of liver function, myocardial infarction
• They cannot be given concurrently with MAOI’s because of their anticholinergic side effects
• Be used cautiously in clients with: glaucoma, benign prostatic hypertrophy, urinary obstruction or retention, diabetes mellitus, hyperthyroidism, cardiovascular disease, renal impairment, respiratory disorder.
• Overdosage can cause: confusion, agitation, hallucinations, hyperpyrexia, & increased reflexes.
• Seizures, coma and cardiovascular toxicity can occur with ensuing tachycardia, decreased output, depressed contractility and atrioventricular block.
• Newer types of antidepressant is often used in geriatric population because of fewer side effects and and less drug interaction
93
example of Cyclic Antidepressant
1. tricyclic
2. heterocyclic
94
Example of Tetracyclic Antidepressant
1. Amoxapine (Asendine)
2. Maprotiline (Ludiomil)
95
Tetracyclic Antidepressant that may cause extrapyrimidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome.
• It can create tolerance in 1 to 3 mos .
• It increases appetite and causes weight gainand cravings for sweets
Amoxapine (Asendine)
96
Tetracyclic Antidepressant that
• Carries risk for seizures (esp. in heavy drinkers)
• Severe constipation
• Urinary retention
• Stomatitis
• And other side effects (all this leads to poor compliance)
• The drug is started and withdrawn gradually
• Central nervous system depressants can increase the effects of this drug
Maprotiline (Ludiomil)
97
medication used when the client has an inadequate response to or side effects from SSRI’s
Atypical Antidepressant
98
examples of Atypical Antidepressant
1. Venlafaxine (Effexor)
2. Buropion (Wellbutrin)
3. Nefazodone
4. Mirtazapine (Remeron)
99
Atypical Antidepressant that blocks the reuptake of serotonin, norepinehrine and dopamine (weakly)
Venlafaxine (Effexor)
100
Atypical Antidepressant that modestly inhibits the reuptake of norepinephrine; weakly inhibits the reuptake of dopamine and has no effects on serotonin.
is also marketed as Zyban for smoking cessation
Buropion (Wellbutrin)
101
Atypical Antidepressant that inhibits the reuptake of serotonin and norepinephrine and has few side effects .
half life is 4 hrs and it can be used in clients with kidney and liver disease. It increases the action of certain benzodiazepines( alprazolam, estazolam, and triazolam) and the H2 blocker terfenadine
Nefazodone
102
Atypical Antidepressant that inhibits the reuptake of serotonin and norepinehrine and it has few sexual side effects; however it has a high side effects of weight gain, sedation, and
anticholinergic side effects.
Mirtazapine (Remeron)
103
medications is used infrequently because of potentially fatal side effects and interactions with numerous drugs both prescriptions and over the
counter preparations.
Monoamine Oxidase Inhibitors (MAOIs)
104
most serious side effects of MAOIs
Hypertensive crisis
105
A life threatening condition that results
when a client taking MAOI’s ingest tyramine containing foods and fluids or other medications.
Hypertensive crisis
106
Hypertensive crisis symptoms:
• Occipital headache
• Hypertension
• Nausea
• Vomiting
• Chills
• Sweating
• Restlessness
• Nuchal rigidity
• Dilated pupils
• Fever
• Motor agitation
Above symptoms lead to hyperpyrexia, cerebralhemorrhage, and death.
107
given for hypertensive crises to dilate blood vessels and decrease vascular resistance.
Phentolamine Mesylate
108
lag period before MAOI’s reach therapeutic levels.
2 - 4 weeks
109
Other medical treatments and psychotherapy for major depressive disorder
1. Electroconvulsive Therapy (ECT)
2. Psychotherapy
3. Interpersonal therapy
4. Behavior therapy
5. Cognitive therapy
6. Investigational treatments
110
ECT is used to treat depressed clients in selective cases such as
• Those who do not respond to antidepressant or those who experience intolerable side effects
• Pregnant women can safely have ECT with no harm to the fetus.
• Those who are actively suicidal (because of the concern for their safety) since antidepressant takes weeks to take effect.
• Pt. with psychotic symptoms
111
involves application of electrodes to the head to deliver an electrical impulse to the brain which causes seizures. It is believed that shock stimulates brain chemistry to correct the chemical imbalance of depression
Electroconvulsive Therapy (ECT)
112
after ECT, pt. will experience:
• After ECT the client may be mildly confused or briefly disoriented
• Feel tired and often had a headache. Treated symptomatically.
• Symptoms are just like those of having grand mal seizure
• Client will have some short-term memory impairment
• After the treatment client can eat and usually sleeps for a period.
113
Difference between unilateral and bilateral ECT
• Unilateral ECT results in less memory loss but needs more treatment to see substantial improvement
• Bilateral ECT results in more rapid
improvement but with increased short term memory loss
114
considered the most effective treatment for depressive disorders
combination of psychotherapy and medication
115
The goals of combined psychotherapy and medication therapy are:
• symptoms remission
• Psychosocial restoration
• Prevention of relapse or recurrence
• Reduced secondary consequences such as marital discord or occupational difficulties
• Increasing treatment compliance
116
Interpersonal therapy focuses on difficulties in relationships such as:
• Grief reaction
• Role disputes
• Role transitions
(Ex. A person who as a child never learned how to make friends outside the family structure has difficulty establishing friendships as an adult.
117
seeks to increase the frequency of the
clients positively reinforcing interactions with the environment to decrease negative interactions. It may also focuses on improving social skills.
Behavior therapy
118
focuses on how the person thinks
about the self, others and the future and interprets his or her experiences.
Cognitive therapy
119
Investigational treatments include:
• Transcranial magnetic stimulation (TMS)
• Magnetic seizure therapy
• Deep brain stimulation
• Vagal nerve stimulation
120
Depression Rating Scales
1. Zung-Self Rating Depression Scales
2. Beck depression Inventory
3. Hamilton Rating Scale
121
Self-rating scales of depressive symptoms
1. Zung-Self Rating Depression Scales
2. Beck depression Inventory
122
clinician rated depression scale
1. Hamilton Rating Scale
123
Nursing diagnoses commonly established for the client with depression
• Risk for suicide
• Imbalanced nutrition: less than body
requirements
• Anxiety
• Ineffective coping
• Hopelessness
• Ineffective role performance
• Self-care deficit
• Chronic low self esteem
• Disturb sleep pattern
• Impaired social interaction.
124
OUTCOME IDENTIFICATION
• Client will not injure himself or others
• Client will independently carry out ADL
• Client will establish a balance of rest, sleep and activity
• Client will establish a balance of adequate nutrition, hydration, and elimination
• Client will evaluate self attributes realistically
• Client will socialize with staff, peers, and family and friends
• Client will return to occupation or school activities
• Client will comply with antidepressant regimen
• Client will verbalize symptoms of a recurrence
125
INTERVENTIONS
✓ Providing for safety of client and others
✓ Institute suicide precaution ifindicated
✓ Begin a therapeutic relationship by spending non demanding time with the client
✓ Promote completion of activities of daily living by assisting the client only as necessary
✓ Establish adequate nutrition and hydration
✓ Promote sleep and rest
✓ Engage the client in activities
✓ Encourage the client to verbalize and describe emotions
✓ Work with the client to manage medications and side effects
✓ Providing client and family teaching
126
extreme mood swings from episode of
mania to episode of depression.
BIPOLAR DISORDER
127
During manic phases clients are:
• Euphoria
• Grandiose
• Energetic
• Sleepless
• Poor judgment
• Rapid thoughts, actions and speech
128
ranks 1st as a cause of worldwide disability
major depression
129
ranks 2nd as a cause of worldwide disability
Bipolar disorder
130
The lifetime risk for bipolar disorder is at least ___ with a risk of completed suicide for ___
1.2%
15%
131
A person with bipolar disorder cycles between
depression , normal behavior or mania
132
A person with bipolar mixed episodes alternates between
major depressive and manic episode
interspersed with period of normal behavior
133
TRUE or FALSE
Bipolar disorders occurs almost equally among men and women.
TRUE
134
TRUE or FALSE
Each bipolar mood may last for weeks or months before the patterns begins to descend or ascend.
TRUE
135
TRUE or FALSE
It is more common among highly educated people.
TRUE
136
The mean age for 1st manic episode is
early twenties
137
The diagnosis of manic episodes or mania requires at least 1 week of unusual and incessantly heightened grandiose or agitated mood in addition to three or more of the following symptoms:
- Exaggerated self esteem
- Sleeplessness
- Pressured speech
- Flight of ideas
- Ability to filter extraneous stimuli
- Distractibility
- Increased activities with increased
energy
- Multiple grandiose high-risk activities
involving poor judgment and severe consequences such as spending sprees, sex with strangers, and impulsive investments.
138
used as mood stabilizers
Antimanic agent called lithium or
anticonvulsant
139
medication also used to stabilize bipolar disorder
Lithium
140
Lithium action peaks in ___ to ___ for regular forms and 4 to 6 hours for the slow release form
30min to 4 hours
141
Anticonvulsant Drugs
1. Carbamazepine
2. Valproic acid (Depakote)
3. Gabapentin (Neurontin)
4. Lamotrigine (Lamictal)
5. Topiramate (Topamax)
6. Clonazepam (Klonopin)
142
used for grandmal epilepsy and temporal lobe epilepsy was the 1st anticonvulsant found to have mood stabilizing properties but the threat of agranulocytosis was of great concern.
Carbamazepine
143
Carbamazepine Therapeutic level
4 to 12 ug/ml(microgram/ml)
144
Valproic acid (Depakote) also known as
divalproex sodium or sodium valproate
145
anticonvulsant is used for simple absence and mixed seizures, migraine prophylaxis and mania.
Therapeutic level 50 to 125 ug/ml
Valproic acid (Depakote)
146
Valproic acid (Depakote) therapeutic level
50 to 125 ug/ml
147
drug that is an anticonvulsant
and a benzodiazepine.
Clonazepam (Klonopin)
148
other anticonvulsants used as mood stabilizers but not common as Valproic acid.
Topiramate (Topamax)
