QUIZ 1 Flashcards by Langelie Laudato

Are pervasive alterations in emotions that are manifested by depression, mania, or both?

Mood Disorders

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Are the most common psychiatric diagnoses associated with suicide?

Mood Disorders

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the most risk factor

with suicide

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They interfere with a person’s life plaguing the client with long-term

sadness, agitation, or elation

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Biblical personalities who suffered from depression

King Saul, King Nebuchadnezzar and Moses

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Famous personalities

Queen Victoria, Abraham Lincoln, artist Vincent Van Gogh

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Categories of Mood Disorder

Primary Mood disorders

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Primary Mood disorders

Major Depressive Disorder
Bipolar Disorder

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Some people with a combination of hallucinations, and delusions

Psychotic Depression

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diagnosed when a person’s mood cycles between extremes of mania and depression.

Bipolar disorder

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distinct period during which mood is abnormally and persistently elevated, expansive, or irritable. Typically this period lasts about 1 week

Mania

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Accompanying symptoms of a manic episode

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

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period of abnormally and persistently, elevated, expansive, or irritable mood lasting 4 days and including three or four of the additional symptoms

Hypomania

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when the person experiences both mania and depression nearly every day for at least 1 week.

Mixed episode

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Bipolar Disorders are described are follows ( for the purpose of medical diagnoses)

Bipolar I disorder
Bipolar II disorder

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

Bipolar I disorder

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one or more major depressive episodes accompanied by at least one hypomanic episode.

Bipolar II disorder

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Related Disorders Classified in the DSM IV TR as mood disorders

Dysthymic Disorder
Cyclothymic Disorder
Substance-Induced Mood Disorder
Mood Disorder due to a General Medical Condition

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cha by 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.

Dysthymic Disorder

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cha by 2 years of numerous periods of both hypomanic symptoms that do not meet the criteria for bipolar disorder.

Cyclothymic Disorder

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cha by a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins.

Substance-Induced Mood Disorder

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cha by a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of a medical condition

Mood Disorder due to a General Medical Condition

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Other disorders that involve changes in mood

Seasonal Affective Disorder (SAD)
Postpartum or Maternity Blues
Postpartum Depression
Postpartum Psychosis

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Subtypes of SAD & which is the most and less common?

Winter depression or fall onset (most
common)
Spring onset (less common)

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Manifestation of winter depression or fall onset of SAD

Increased sleep Increased appetite Carbohydrate craving, weight gain Interpersonal conflict, irritability Heaviness in the extremities

Symptoms of Spring onset SAD

Insomnia Weight loss Poor appetite

frequent normal experience after delivery of a baby.

Postpartum or maternity blues

Symptoms maternity blues

Labile mood and affect Crying spells Sadness Insomnia Anxiety

meets all the criteria for a major depressive episode with onset within 4 weeks of delivery

Postpartum Depression

psychotic episode developing within 3 weeks 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.

Postpartum Psychosis

Genetic studies implicate transmission of major depression in the 1st-degree relatives who have ______ the risk of developing depression.

twice

implicate transmission of major depression in 1st-degree relatives who have twice the risk of developing depression.

Genetic studies

1st-degree relatives of people with bipolar disorder have ____ risk for developing bipolar disorder compared with ____in the general population.

3% to 8% & 1%

Monozygotic ( identical )twins have a concordance rate ( both twins having the disorder) ______ higher than that of dizygotic (fraternal)twins.

2 to 4 times

two major biogenic amines implicated in mood disorders

serotonin and norepinephrine

Roles of serotonin in behavior

Mood, activity, aggressiveness, and irritability Cognition, pain, biorhythms, and neuroendocrine processes

found in the blood or cerebrospinal fluid occur in people with depression.

Serotonin deficits

Norepinephrine levels may be deficient

Depression

Norepinephrine levels may be increased

Mania

energizes the body to mobilize during stress

catecholamine

process by which seizure activity in a specific area of the brain is initially stimulated

Kindling

inhibit kindling, which may explain their efficacy in the treatment of bipolar disorder.

Anticonvulsants

being studied in relation to mood disorders.

Dysregulation of acetylcholine and dopamine

alter mood ,sleep neuroendocrine function

Cholinergic drugs

seems to be implicated in depression and mania.

acetylcholine

are being studied in relation to depression.

Hormonal fluctuations

How many % of clients with depression have evidence of increased cortisol secretion and elevated glucocorticoid activity associated with the stress response.

40%

How many % of people with depression have thyroid dysfunction

About 5% to 10%

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.

Freud

believed that one’s ego aspired to be ideal

Bibring

compared the state of depression to a situation in which the ego is powerless, helpless child victimized by the superego

Jacobson

viewed depression as a reaction to a distressing life experience such as an event with psychic causality.

Meyer

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

saw depression as resulting from specific cognitive distortions in susceptible people

Beck

depression often appear cranky, have SCHOOL PHOBIA hyperactivity or learning disorders, failing grades, and antisocial behaviors

Children

depression may abuse of substances, JOINING GANGS, engaging in risky behavior underachievers, or dropping out of school.

Adolescents

substance abuse, eating disorders, compulsive behaviors such as workaholism and gambling, and HYPOCHONDRIASIS.

Adults

who are cranky and ARGUMENTATIVE may actually be depressed.

Older adults

Typically it involves 2 or more weeks of sad mood or lack of interest in life activities with at least four other symptoms of depression

Major Depressive Disorder

symptoms of depression (MDD)

anhedonia, and changes in weight, sleep, energy, concentration, decision-making, self-esteem, and goals.

depression ______ with age in women, and ______ with age in men.

decreases & increases

% of people who have one episode of depression will have another.

50% to 60%

second episode of depression there is ___ chance of recurrence

70%

Some people with severe depression ___% have psychotic features

Treatment and Prognosis (MDD)

Psychopharmacology Major categories of antidepressants

Major categories of antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs) Cyclic Antidepressants Atypical Antidepressants Monoamine Oxidase Inhibitors (MAOIs)

the choice of which antidepressant to use is based on:

symptoms age physical health needs drugs that have or have not work in the past

Symptoms of Major Depressive Disorder according to DSM-IV-TR diagnostic criteria

Depressed mood Anhedonism Unintentional weight change of 5% or more in a month Change in sleep pattern Agitation or psychomotor retardation Tiredness Worthlessness Difficulty thinking, focusing, or making decisions Hopelessness, helplessness, and/or suicidal ideation

newest category of antidepressants and effective for most clients

Selective Serotonin Reuptake Inhibitors(SSRIs)

produces a slightly higher rate of mild agitation and weight loss but less somnolence.

Prozac or Fluoxetine

was introduced for the treatment of depression in the mid-50s and the oldest antidepressant.

Tricyclic

what symptoms are relieved by tricyclic

hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variation

Contraindications of tricyclic antidepressants

Severe impairment of liver function, myocardial infarction They cannot be given concurrently with MAOI’s because of their anticholenergic 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

Tetracyclic Antidepressant

Amoxapine, Maprotiline

may cause extrapyrimidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome

Amoxapine

Amoxapine MAY CAUSE

may cause extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome increases appetite and causes weight gain and cravings for sweets

Maprotiline side effects

carries risk for seizures (esp. in heavy drinkers) severe constipation urinary retention stomatitis

used when the client has an inadequate response to or side effects from SSRIs

Atypical Antidepressant

Venlafaxine Buropion Nefazodone Mirtazapine

blocks the reuptake of serotonin, norepinephrine, and dopamine

Venlafaxine

modestly inhibits the reuptake of norepinephrine; weakly inhibits the reuptake of dopamine and has no effects on serotonin.

Buropion

inhibits the reuptake of serotonin and norepinephrine and has few side effects. Its half-life is 4 hrs and it can be used in clients with kidney and liver disease.

Nefazodone

inhibits the reuptake of serotonin and norepinephrine and it has few sexual side effects

Mirtazapine

used infrequently because of potentially fatal side effects

Monoamine Oxidase Inhibitors ( MAOI’s)

most serious side effects.A life-threatening condition that results when a client taking MAOIs ingests tyramine-containing foods and fluids or other medications.

Hypertensive crisis

Hypertensive crisis symptoms

Occipital headache Hypertension Nausea Vomiting Chills Sweating Restlessness Nuchal rigidity Dilated pupils Fever Motor agitation

Hypertensive crisis symptoms can lead to

hyperpyrexia, cerebral hemorrhage , and death.

The MAOI- Tyramine interaction produces symptoms within ____ after ingestion.

20-60 mins.

given for hypertensive crises to dilate blood vessels and decrease vascular resistance.

Phentolamine Mesylate

Other medical treatments and psychotherapy

Electroconvulsive Therapy (ECT) Psychotherapy Interpersonal Therapy Behavior Therapy Cognitive Therapy Investigational Treatments

used to treat depressed clients I 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.

Electroconvulsive Therapy (ECT)

results in less memory loss but needs more treatment to see substantial improvement

Unilateral ECT

more rapid improvement but with increased short term memory loss

Bilateral ECT

used to prevent relapse in depression

ECT

a combination of psychotherapy and medication is still considered the most effective treatment for depressive

Psychotherapy

focuses on difficulties in relationships

Interpersonal therapy

the goals of combined therapy are

symptoms remission Psychosocial restoration Prevention of relapse or recurrence Reduced secondary consequences such as marital discord or occupational difficulties Increasing treatment compliance

difficulties in relationships such as

Grief reaction Role disputes Role transitions

helps the person to find ways to accomplish this developmental task.

Interpersonal therapy

seeks to increase the frequency of the clients positively reinforcing interactions with the environment to decrease negative interactions.

Behavior Therapy

focuses on how the person thinks about the self , others and the future and interprets his or her experiences.

Cognitive therapy

Investigational treatments includes

Transcranial magnetic stimulation ( TMS) Magnetic seizure therapy Deep brain stimulation Vagal nerve stimulation

closest to approval for clinical use

Transcranial magnetic stimulation ( TMS)