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w4 Flashcards

1
Q

assessment/screening tools for __________
- zung ________ scale
- patient health questionnaire
- Hamilton _______ rating scale
- geriatric _________ scale
- beck ___________ inventory
- Edinburgh postnatal __________ scale

Primary care screening
- Patients usually seek care from PCP for depression?
- Most seek care from somatic complaints associated with depression?
- Need for consistent depression screening for every patient every visit?

A

depression

Primary care screening
- Patients usually don’t seek care from PCP for depression
- Most seek care from somatic complaints associated with depression
- Need for consistent depression screening for every patient every visit

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2
Q

complication of SRIs: ___________
- can develop within 6 hours of first dose, change in dose, or intentional overdose
- can be fatal

A

serotonin syndrome

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3
Q

Bipolar 2 disorder
- At least 1 major depressive episode
- At least 1 hypomanic episode (no psychosis)
- Impaired functioning in at least 1 area???
- No history of ______ episode!!

A

Bipolar 2 disorder
- At least 1 major depressive episode
- At least 1 hypomanic episode (no psychosis)
- Impaired functioning in at least 1 area???
- No history of manic episode!!

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4
Q

depression: Epidemiology
- _______ more common
- Race
- Seasons
- Socio-economic status

A

Epidemiology
- Women more common
- Race
- Seasons
- Socio-economic status

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5
Q

hypomania vs mania

_______
- lasts 1 week
- severe mood disturbance causes marked impairment
- psychotic features present

_______
- lasts 4 consecutive days
- mood disturbances not severe enough to cause marked impairment
- no psychotic features present

A

mania

hypomania

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6
Q

drug: ____________

indications
- acute mania
- maintenance treatment
- bipolar disorder

contraindications
- CV disease
- Renal disease
- Brain damage
- Thyroid disease
- Pregnant or breastfeeding mothers

A

lithium carbonate

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7
Q

Lamotrigine
anticonvulsant mood stabilizer
- For rapid cycling and depressed phase of bipolar illness
- _______ may be life threatening
- Used as add on therapy in refractory mood disorders

A

Lamotrigine
anticonvulsant mood stabilizer
- For rapid cycling and depressed phase of bipolar illness
- Rash may be life threatening
- Used as add on therapy in refractory mood disorder

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8
Q

expected side effects of all SRIs or serotonin syndrome?
- Dry mouth
- Sex problems
- Tension h/a
- Blurred vision
- Drowsy
- Nausea
- Diarrhea
- Insomnia
- Nervous, agitation, restless
- Dizzy

A

side effects of all SRIs
- Dry mouth*
- Sex problems *
- Tension h/a*
- Blurred vision *
- Drowsy
- Nausea
- Diarrhea
- Insomnia
- Nervous, agitation, restless
- Dizzy

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9
Q

antidepressants:_________

  • May not be as well tolerated compared to SSRIs
  • desvenlafaxine
A

SNRIs – selective serotonin/norepinephrine reuptake inhibitors

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10
Q

Persistent depressive disorder
- AKA dysthymia
- Low level depressive feelings most of the day and majority of the days
- Symptoms last at least 2 years in adults

Must have 2 or more symptoms:
- decreased appetite or overeating
- insomnia or hypersomnia
- low energy
- poor self-esteem
- difficulty thinking
- hopelessness

A

dont focus on it for exam

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11
Q

Meds for depression: children and teens

SSRIs
- Black box warning – increased risk of ___
- Fluoxetine – ___ line treatment
- Venlafaxine (SNaRIs – serotonin noradrenergic reuptake inhibitors) – used off label
- Both have low s/e – h/a, nausea, GI upset
- Improvement in 1-2 weeks, full effect up to 12 weeks

TCAs
- More s/e
- Risk for dysrhythmias
- Risk for lethal ______

A

Meds for depression: children and teens

SSRIs
- Black box warning – increased risk of SI
- Fluoxetine – 1st line treatment
- Venlafaxine (SNaRIs – serotonin noradrenergic reuptake inhibitors) – used off label
- Both have low s/e – h/a, nausea, GI upset
- Improvement in 1-2 weeks, full effect up to 12 weeks

TCAs
- More s/e
- Risk for dysrhythmias and lethal OD

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12
Q

serotonin syndrome treatment:
- stop or reduce meds
- __________ – can help control agitation, seizures, muscle stiffness
- oxygen
- IV fluids – dehydration and fever
- Symptomatic and supportive care
- drugs to treat tachycardia and HTN – esmolol, nitroprusside
- drugs to treat hypotension – phenylephrine and epinephrine
- drugs that block serotonin production (not first line) – serotonin production blocking agents
- Symptoms resolves w/in 24 hours – several weeks

A

treatment:
- stop or reduce meds
- benzodiazepines (diazepam, lorazepam) – can help control agitation, seizures, muscle stiffness
- oxygen
- IV fluids – dehydration and fever
- Symptomatic and supportive care
- drugs to treat tachycardia and HTN – esmolol, nitroprusside
- drugs to treat hypotension – phenylephrine and epinephrine
- drugs that block serotonin production (not first line) – serotonin production blocking agents
- Symptoms resolves w/in 24 hours – several weeks

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13
Q

Lability
Rapid cycling

__________: Rapid shifts or fluctuations in mood state, emotions, or affect.

_________: The occurrence of four or more mood episodes (mania, hypomania, depression) within a 12-month period in bipolar disorder.

A

lability: Rapid shifts or fluctuations in mood state, emotions, or affect.

Rapid cycling: The occurrence of four or more mood episodes (mania, hypomania, depression) within a 12-month period in bipolar disorder.

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14
Q

Depression symptoms in children by age:
0-3
- FTT
- _________ problems
- Lack of playfulness
- Lack of emotional expression
- Delay in speech or motor development

3-5
- Accidents
- Phobias
- Aggressive
- Excessive self-reproach for minor infractions – ______

6-8
- Vague physical complaints
- Aggressive behavior
- Cling to parents
- Avoid new people/challenges
- ________ in social/academic performance

9-12
- Morbid thoughts
- Excessive worrying
- Lack of interest socially
- Believes parents are ________

A

Depression symptoms in children by age:
0-3
- FTT
- Feeding problems
- Lack of playfulness
- Lack of emotional expression
- Delay in speech or motor development

3-5
- Accidents
- Phobias
- Aggressive
- Excessive self-reproach for minor infractions – blaming self, guilt

6-8
- Vague physical complaints
- Aggressive behavior
- Cling to parents
- Avoid new people/challenges
- Behind in social/academic performance

9-12
- Morbid thoughts
- Excessive worrying
- Lack of interest socially
- Believes parents are disappointed

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15
Q

bipolar disorders: medications

benzodiazepines
anticonvulsant mood stabilizers
combination med
antipsychotics
other

__________
- sodium valproate/divalproex sodium/valproic acid
- carbamazepine
- lamotrigine
- gabapentin

________
- lithium carbonate

__________
- symbax (olanzapine: antipsychotic + fluoxetine: SSRI)

_________
- olanzapine
- risperidone
- aripiprazole
- quetiapine

___________
- diazepam
- lorazepam

A

anticonvulsant mood stabilizers
- sodium valproate/divalproex sodium/valproic acid
- carbamazepine
- lamotrigine
- gabapentin

other
- lithium carbonate

combination med
- symbax (olanzapine: antipsychotic + fluoxetine: SSRI)

antipsychotics
- olanzapine
- risperidone
- aripiprazole
- quetiapine
benzodiazepines
- diazepam
- lorazepam

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16
Q

__________ PD (cluster C)
- High need to be taken care of
- Clinging behavior
- Fears of separation and abandonment
- Manipulating others to take responsibilities
- Submissiveness
- Intense anxiety when left alone

A

Dependent

Nursing care: Dependent PD (cluster C)
- Address current stressors
- Set limits
- Be aware of strong countertransference
- Use therapeutic relationship for assertiveness training
- Encourage independence and self-efficacy

worm tail from HP

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17
Q

antidepressant: _________ s/e

Common
- Dry mouth
- n/d
- constipation
- h/a
- drowsy
- insomnia
- dizzy/lightheaded
- skin reaction at patch site

less common
- involuntary muscle jerks
- low BP
- reduced sex function
- weight gain
- urine hesitancy
- muscle cramps
- tingling skin – paresthesia

A

MAOIs

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18
Q

Patient/family Teaching: acute mania
- Chronic and episodic nature of bipolar disorder
- Treatment requires 1+ mood stabilizing agents taken for long time
- s/e and toxic s/e
- relapse s/s
- alcohol, drugs, caffeine, and OTC meds can cause ________
- good sleep hygiene is critical for stability – lack of sleep can be r/t manic episode, sleep meds can avert a manic episode
- coping strategies
- therapy

A
  • Chronic and episodic nature of bipolar disorder
  • Treatment requires 1+ mood stabilizing agents taken for long time
  • s/e and toxic s/e
  • relapse s/s
  • alcohol, drugs, caffeine, and OTC meds can cause relapse
  • good sleep hygiene is critical for stability – lack of sleep can be r/t manic episode, sleep meds can avert a manic episode
  • coping strategies
  • therapy
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19
Q

Mania
D –
I –
G –
F –
A –
S –
T –

A

Mania
D – distractibility
I – indiscretion, impulsive, impaired judgement
G – grandiosity delusions
F – flight of ideas
A – activity increase
S – sleep deficit
T – talkativeness

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20
Q

__________ PD (cluster A)
- Severe social and interpersonal deficits
- Rambles
- Paranoid, suspicious, distrust
- Anxiety
- Odd and eccentric
- Hallucinations/delusions
- Can be made aware of their odd beliefs and magical thinking

A

Schizotypal

Nursing care: Schizotypal PD (cluster A)
- Respect need for social isolation
- Intervene appropriately with pts suspiciousness
- Reinforce social appropriate behavior and dress
- Assess for symptoms that may need intervention – SI

Luna Lovegood from HP

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21
Q

Psychomotor ______ation – visible slowing of physical activity (such as movement or speech), associated with severe depression
- Slow talking
- Long pauses before beginning to talk
- Taking long time to cross room
- Slow food chewing
- Waiting longer than usual between bites

Psychomotor _____ation – increase in activity brought on by mental tension, associated with agitated depression
- Restlessness
- Pacing
- Tapping
- Abruptly starting and stopping tasks
- Meaninglessly moving objects around

A

Psychomotor retardation – visible slowing of physical activity (such as movement or speech), associated with severe depression
- Slow talking
- Long pauses before beginning to talk
- Taking long time to cross room
- Slow food chewing
- Waiting longer than usual between bites

Psychomotor agitation – increase in activity brought on by mental tension, associated with agitated depression
- Restlessness
- Pacing
- Tapping
- Abruptly starting and stopping tasks
- Meaninglessly moving objects around

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22
Q

lithium carbonate

Labs –
- Initially 1-2 times per week
- Monitor creatinine, thyroid, CBC q 6 months

Teaching
- Risk of ____ when lithium is d/c – assess for s/s of _____
- Do not restrict _______
- Hydration
- If sweating hydrate more
- If illness causes loss of fluids – contact MD
- Intermittent blood tests required

A

Labs –
- Initially 1-2 times per week
- Monitor creatinine, thyroid, CBC q 6 months

Teaching
- Risk of SI when lithium is d/c – assess for s/s of depression
- Do not restrict sodium
- Hydration
- If sweating hydrate more
- If illness causes loss of fluids – contact MD
- Intermittent blood tests required

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23
Q

Disruptive mood dysregulation disorder (DMDD)
- Onset must occur before age 10
- More common in males and children

Symptoms –
- Anger
- constant and severe irritability
- verbal/behavioral outbursts at least 3x/week
- temper tantrums in at least 2 settings (home, school, etc.)

A

dont focus on it for exam

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24
Q

meds for mania: bipolar d/o

mood stabilizers regimen:
- lithium (______) + antipsychotic
- sodium valproate/divalproex sodium/valproic acid (_______________) + antipsychotic

___________
- olanzapine
- risperidone
- aripiprazole (older than 10 y/o)
- quetiapine
- ziprasidone

____________ – severe agitation, short term use
- diazepam
- lorazepam
- clonazepam

A

meds for mania: bipolar d/o

mood stabilizers regimen:
- lithium (other) + antipsychotic
- sodium valproate/divalproex sodium/valproic acid (anticonvulsant mood stabilizers) + antipsychotic

antipsychotics
- olanzapine
- risperidone
- aripiprazole (older than 10 y/o)
- quetiapine
- ziprasidone

benzodiazepines – severe agitation, short term use
- diazepam
- lorazepam
- clonazepam

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25
substance induced depressive disorder - person only experiences depressive symptoms when using drugs, alcohol, or in withdrawal depressive disorder associated with another medical condition - depressive symptoms result from medical diagnoses or certain medications - not considered major depressive disorder - can be caused by kidney failure, Parkinson’s disease, Alzheimer’s disease
dont focus on it for exam
26
Premenstrual dysphoric disorders - Symptoms appear the week prior to menstruation and decrease significantly/disappear with the onset of menstruation - No meds taken continuously, just for the week of symptom onset Symptoms: - mood swings - irritability - depression - anxiety - feeling overwhelmed - difficulty concentrating - lack of energy - over eating - hypersomnia or insomnia - breast tenderness - aching - bloating - weight gain
dont focus on it for exam
27
meds for mood stabilization: bipolar disorder _____________ - sodium valproate/divalproex sodium/valproic acid - carbamazepine - topiramate - lamotrigine - gabapentin ________ - lithium carbonate ___________ - symbax (olanzapine: antipsychotic + fluoxetine: SSRI) ____________ - olanzapine - risperidone - aripiprazole - quetiapine - lurasidone - ziprasidone
meds for mood stabilization: bipolar disorder anticonvulsant mood stabilizers - sodium valproate/divalproex sodium/valproic acid - carbamazepine - topiramate - lamotrigine - gabapentin other - lithium carbonate combination med - symbax (olanzapine: antipsychotic + fluoxetine: SSRI) antipsychotics - olanzapine - risperidone - aripiprazole - quetiapine - lurasidone - ziprasidone
28
Personality disorder: Cluster ___ – odd, eccentric - Paranoid PD – delusional - Schizoid PD – social withdrawal - Schizotypal PD – unusual, distorted reality Personality disorder: Cluster __ – anxious, fearful - Avoidant - Dependent - Obsessive-compulsive Personality disorder: Cluster ___ – erratic, dramatic - Borderline - Narcissistic - Histrionic - Antisocial
Personality disorder: Cluster A – odd, eccentric - Paranoid PD – delusional - Schizoid PD – social withdrawal - Schizotypal PD – unusual, distorted reality *pAss Personality disorder: Cluster C – anxious, fearful - Avoidant - Dependent - Obsessive-compulsive *C-DOA Personality disorder: Cluster B – erratic, dramatic - Borderline - Narcissistic - Histrionic - Antisocial *B-BAHN
29
Types Bipolar 1 disorder - Most severe form - Highest mortality rate - Involves atleast 1 _______ episode Bipolar 2 disorder - Atleast 1 ______ episode - At least 1 _______ episode major depressive manic hypomanic
Types Bipolar 1 disorder - Most severe form - Highest mortality rate - Involves atleast 1 manic episode Bipolar 2 disorder - Atleast 1 hypomanic episode - At least 1 major depressive episode
30
Bipolar 1 disorder - Involves at least 1 _______ episode!! - Symptoms of alternating manic and depressive episodes and/or hypomanic episodes - Psychotic episodes (delusions/hallucinations) or depressive episodes common - The more manic episodes that occur = the more intense episodes are (why medication adherence is important) - The manic highs mirror lows in intensity
Bipolar 1 disorder - Involves at least 1 manic episode!! - Symptoms of alternating manic and depressive episodes and/or hypomanic episodes - Psychotic episodes (delusions/hallucinations) or depressive episodes common - The more manic episodes that occur = the more intense episodes are (why medication adherence is important) - The manic highs mirror lows in intensity
31
Hypomania vs Mania _________: A period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extreme goal-directed activity or energy lasting at least 1 week. Symptoms are severe enough to cause marked impairment. _________: A low-level, less dramatic mania. Increased activity and energy for at least 4 days with at least 3 manic symptoms, but no psychosis and less impairment than full mania.
Mania: A period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extreme goal-directed activity or energy lasting at least 1 week. Symptoms are severe enough to cause marked impairment. Hypomania: A low-level, less dramatic mania. Increased activity and energy for at least 4 days with at least 3 manic symptoms, but no psychosis and less impairment than full mania.
32
Bipolar ___ disorder - Involves at least 1 manic episode!! - Symptoms of alternating manic and depressive episodes and/or hypomanic episodes - Psychotic episodes (delusions/hallucinations) or depressive episodes common - The more manic episodes that occur = the more intense episodes are (why medication adherence is important) - The manic highs mirror lows in intensity Bipolar ___ disorder - At least 1 major depressive episode (may have psychosis) - At least 1 hypomanic episode (no psychosis) - Impaired functioning in at least 1 area??? - No history of manic episode!!
Bipolar 1 disorder - Involves at least 1 manic episode!! - Symptoms of alternating manic and depressive episodes and/or hypomanic episodes - Psychotic episodes (delusions/hallucinations) or depressive episodes common - The more manic episodes that occur = the more intense episodes are (why medication adherence is important) - The manic highs mirror lows in intensity Bipolar 2 disorder - At least 1 major depressive episode (may have psychosis) - At least 1 hypomanic episode (no psychosis) - Impaired functioning in at least 1 area??? - No history of manic episode!!
33
Treatment for anticholinergic s/e associated with what antidepressants? - Dry mouth – sugar free candy/gum - GI upset – take with food - Diarrhea – small frequent meals - Constipation – increase fiber, fluids and exercise - Insomnia – sleep hygiene, change admin time of med - Orthostasis – hydration, get up slow - Sexual s/e – meds - Urinary hesitancy – running water, measure amount
antidepressants: Tricyclic antidepressants - Imipramine - Doxepin - Amitriptyline
34
depression: Medications ________ - Fluoxetine - Paroxetine - Sertraline - Citalopram - Escitalopram _______ - Venlafaxine - Duloxetine _______ - Imipramine - Doxepin - Amitriptyline ________ - Phenelzine - Tranylcypromine - Selegiline ________ - Desvenlafaxine (SNRI) - Trazodone - Bupropion (NDRI) - Mirtazapine (NaSSA)
Medications SSRIs – selective serotonin reuptake inhibitors - Fluoxetine - Paroxetine - Sertraline - Citalopram - Escitalopram SNaRIs – serotonin noradrenergic reuptake inhibitors - Venlafaxine - Duloxetine Tricyclic antidepressants (TCA) - Imipramine - Doxepin - Amitriptyline Monoamine oxidase inhibitors (MAOIs) - Phenelzine - Tranylcypromine - Selegiline Others - Desvenlafaxine (SNRI) - Trazodone - Bupropion (NDRI) - Mirtazapine (NaSSA)
35
antidepressants: _____________ - Phenelzine - Tranylcypromine - Selegiline - 3rd line treatment for depression - Also treats anxiety d/o, panic d/o and bulimia - Effective for unconventional depression - Tyramine restrictions
Monoamine oxidase inhibitors - MAOIs
36
SRIs expected s/e vs symptoms of serotonin syndrome? __________ - agitation - confusion - restless - lethargy - delirium - irritability - dizzy - hallucinations - diaphoresis - flushing - fever - tachycardia - mydriasis – pupils dilate - myoclonus – muscle twitch - hyperreflexia - tremors - n/v/d __________ - Dry mouth* - Sex problems * - Tension h/a* - Blurred vision * - Drowsy - Nausea - Diarrhea - Insomnia - Nervous, agitation, restless - Dizzy
serotonin syndrome - agitation - confusion - restless - lethargy - delirium - irritability - dizzy - hallucinations - diaphoresis - flushing - fever - tachycardia - mydriasis – pupils dilate - myoclonus – muscle twitch - hyperreflexia - tremors - n/v/d side effects of all SRIs - Dry mouth* - Sex problems * - Tension h/a* - Blurred vision * - Drowsy - Nausea - Diarrhea - Insomnia - Nervous, agitation, restless - Dizzy
37
Personality disorder: Cluster C Anxious, fearful 1. 2. 3.
Personality disorder: Cluster C Anxious, fearful 1. Avoidant 2. Dependent 3. Obsessive-compulsive
38
__________ PD (cluster C) - Low self esteem - Shyness increases with age - Inferiority - Reluctant to engage with others - Depression, anxiety, anger - Obsessed with rejection, humiliation, failure
Avoidant Nursing care: Avoidant PD (cluster C) - Friendly, accepting, reassuring - Accept pt fears - Enhance new social skills - Exercises to prevent failure - Assertiveness training charlie brown
39
general Personality disorder: symptoms - Dysfunctions in cognition, impulse control, interpersonal relationships, and _______ PD: General treatment - Psychopharmacology - Indiv. And group Therapy - DBT - Family Education and therapy - Social skills education PD: prognosis - Treatable - Depends on degree of impairment and person’s motivation Etiology/Risk factors - Genetics - Neurobiology - Psychosocial and environmental - Diathesis stress model
general Personality disorder: symptoms - Dysfunctions in cognition, impulse control, interpersonal relationships, and affect PD: General treatment - Psychopharmacology - Indiv. And group Therapy - DBT - Family Education and therapy - Social skills education PD: prognosis - Treatable - Depends on degree of impairment and person’s motivation Etiology/Risk factors - Genetics - Neurobiology - Psychosocial and environmental - Diathesis stress model
40
Nursing care: depression - _______ highest priority Recovery model - Focuses on patients _______ to improve health and reach full potential - ________ developed treatment goals - Unique to ________ personal values and needs - Measurable
Nursing care: depression - Safety highest priority Recovery model - Focuses on patients strengths to improve health and reach full potential - Mutually developed treatment goals - Unique to patient’s personal values and needs - Measurable
41
which antidepressant? SRIs, TCA, MAOI s/e in early treatment - Early morning awakening - Feeling worse in AM - Worry and anxiety Anticholinergic s/e - Hot as a hare – fever - Dry as a bone – dry. Mouth and eyes, urinary retention, constipation - Blind as a bat – dilated pupils, blurred vision - Mad as a hatter – confusion, delirium - Sedation - Weight gain
antidepressants: Tricyclic antidepressants
42
antidepressants: Tricyclic antidepressants Nursing implications - Before giving check: - what organ? - hx of what problem?
Nursing implications - Before giving check: - ECG for cardiac d/o - For hx of seizure d/o
43
lithium carbonate expected side effects or early, advanced, or severe signs of toxicity? - Ataxia - Giddiness - Serious Electroencephalographic changes - Blurred vision - Clonic movements - Large output of diluted urine - Seizures - Stupor - Severe HTN - Coma - Death 2ndary to pulmonary complications
Advanced signs of toxicity: - Ataxia - Giddiness - Serious Electroencephalographic changes - Blurred vision - Clonic movements - Large output of diluted urine - Seizures - Stupor - Severe HTN - Coma - Death 2ndary to pulmonary complications
44
sodium valproate/divalproex sodium/valproic acid anticonvulsant mood stabilizer - Example of Anticonvulsant med that might be prescribed for ___________ - Check serum levels - Broad spectrum of efficacy - Longer periods of mood stabilization
sodium valproate/divalproex sodium/valproic acid anticonvulsant mood stabilizer - Example of Anticonvulsant med that might be prescribed for bipolar disorder - Check serum levels - Broad spectrum of efficacy - Longer periods of mood stabilization
45
depression: Etiology Biological - Genetic - imbalances – Hormonal, Electrolyte, Cortisol, and neurotransmitters - inflammatory process psychological factors - cognitive theory psychological predisposition - negative and/or unrealistic expectations or environment, self, future - learning theory – learned helplessness _______: diathesis stress model - detachment of primary caregiver - parental separation or divorce - death of loved one, pet - relocation - academic failure - physical illness _______: - conflicts with independence and maturation - role confusion - grief/loss – break up, death __________: - societal attitudes - major stressors – money, life changes, physical illness, grief/loss, decreased function
Etiology Biological - Genetic - imbalances – Hormonal, Electrolyte, Cortisol, Neurotransmitters - inflammatory process psychological factors - cognitive theory psychological predisposition - negative and/or unrealistic expectations or environment, self, future - learning theory – learned helplessness child: diathesis stress model - detachment of primary caregiver - parental separation or divorce - death of loved one, pet - relocation - academic failure - physical illness teens: - conflicts with independence and maturation - role confusion - grief/loss – break up, death older adults: - societal attitudes - major stressors – money, life changes, physical illness, grief/loss, decreased function
46
antidepressants:_________ - Fluoxetine - Paroxetine - Sertraline - Citalopram - Escitalopram - Vortioxetine - vilazodone - 1st line - Rare risk of serotonin syndrome
SSRIs – selective serotonin reuptake inhibitors
47
Other treatment: _________ - Used to subdue severe manic behavior - Useful with treatment resistant mania and rapid cycling - More effective than drugs for treatment resistant bipolar depression - Depressive episodes – severe, catatonic, treatment resistant depression
Other treatment: ECT Electroconvulsive therapy - Used to subdue severe manic behavior - Useful with treatment resistant mania and rapid cycling - More effective than drugs for treatment resistant bipolar depression - Depressive episodes – severe, catatonic, treatment resistant depression
48
Nursing care: _______ - Initial plan of care focuses on exhaustion and nutrition - Managing medications - Decreasing physical activity – walking with nurse ok - Increasing food/fluid intake - Ensure minimum 4-6 hours of sleep per night - Intervene for self-care needs and setting limits on behavior - Injury prevention - Establish quiet environment - Best diet considerations – finger foods high in protein (bananas and peanut butter sandwich)
acute mania
49
bipolar d/o With ________ - 4 or more manic episodes for at least 2 weeks in 12 months - Partial/full remission for 2 months at a time or switch to opposite episode - High risk of recurrence - Resistant to drug therapy - Greater severity of illness - Depressive symptoms predominate
With rapid cycling - 4 or more manic episodes for at least 2 weeks in 12 months - Partial/full remission for 2 months at a time or switch to opposite episode - High risk of recurrence - Resistant to drug therapy - Greater severity of illness - Depressive symptoms predominate
50
nursing implications for MAOIs - dietary restrictions – avoid ________ rich foods to prevent ______ crisis o aged _____ and ______ o overripe ______ o alcohol o beans o condiments - avoid using Demerol – OTC cold meds - rarely used with SSRIs – risk of serotonin syndrome - avoid high consumption of _______ – risk of high BP
nursing implications - dietary restrictions – avoid tyramine rich foods to prevent HTN crisis o ages meats and cheese o overripe fruits/veg o alcohol o beans o condiments - avoid using Demerol – OTC cold meds - rarely used with SSRIs – risk of serotonin syndrome - avoid high consumption of caffeine – risk of high BP
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bipolar d/o With Mixed features – symptoms of both ______ and ______ occur at the same time
bipolar d/o With Mixed features – symptoms of both depression and mania occur at the same time
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Antidepressant meds: general education - ___-___ weeks for symptom improvement - _____logical symptoms improve before _____logical symptoms (increased energy = danger for ___) - Signs of improved sleep – less daytime fatigue and crying, increased frustration tolerance - s/e handled by adjusting ____ or switching meds in same class - d/c meds as soon as you feel better may cause ______ - meds usually needed for 6-9 months past symptom relief and up to 12-24 months - antidepressants are addictive? - abruptly stopping meds will results in _______ – nausea, anxiety, insomnia, flu like symptoms - do not drink ______
Antidepressant meds: general education - 4-6 weeks for symptom improvement - Physiological symptoms improve before psychological symptoms (increased energy = danger for SI) - Signs of improved sleep – less daytime fatigue and crying, increased frustration tolerance - s/e handled by adjusting dose or switching meds in same class - d/c meds as soon as you feel better may cause relapse - meds usually needed for 6-9 months past symptom relief and up to 12-24 months - antidepressants are not addictive - abruptly stopping meds will results in withdrawal – nausea, anxiety, insomnia, flu like symptoms - do not drink alcohol
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Hypomania - changes in functioning uncharacteristic for the individual and noticeable by others? - Episode is severe enough to cause a marked impairment in social or occupational functioning or hospitalization? - psychotic features? - Mood is elevated, expansive, or irritable for at least 4 days?
Hypomania - yes - Episode r/t definite noticeable by others change in functioning uncharacteristic for the individual - no - Episode is not severe enough to cause a marked impairment in social or occupational functioning or hospitalization - No - no psychotic features - yes - Mood is elevated, expansive, or irritable for at least 4 days
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_________ PD (cluster A) - Distrust and suspicion - Reluctant to confide in others - Anxious - Jealous - Controlling as an adult - Unwilling to forgive - Vindictive - Hypervigilant - Quick to anger - Provokes others
paranoid PD (cluster A) Nursing care: paranoid PD (cluster A) - Counteract mistrust - Adhere to schedules and boundaries - Avoid being overly friendly, project neutral and kind affect - Acknowledge feelings - Use simple, direct language Willy Wonka
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_________ PD (cluster B) - Antagonistic behaviors – manipulative, disagreeable - Disinhibited behaviors – impulsive - Lack of empathy, remorse, guilt - "not my fault" - Violates others rights - Conduct disorder (onset before age 15) - Needs to prove superiority - Center of the universe - Irritable - Aggressive - Superficially charming but deceitful - ex: begins cursing when confronted about drug seeking behavior
antisocial Nursing care: antisocial PD (cluster B) - Therapeutic relationship - Identify dysfunctional thinking and develop new problem solving behaviors - Self responsibility - Anger control - Help build new support system - Self awareness walter white from breaking bad
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lithium carbonate expected side effects or toxicity? - n/v, diarrhea - thirst - polyuria - lethargy, sedation - fine hand tremor - risk for renal toxicity/damage – long term use - risk for thyroid disfunction - goiter and hypothyroidism – monitor for dry skin, hair loss, constipation, bradycardia, cold intolerance expected side effects or toxicity? - GI upset - Coarse hand tremor - Confusion, sedation, incoordination - Hyperirritability of muscles - Electroencephalographic changes expected side effects or toxicity? - Ataxia - Giddiness - Serious Electroencephalographic changes - Blurred vision - Clonic movements - Large output of diluted urine - Seizures - Stupor - Severe HTN - Coma - Death 2ndary to pulmonary complications expected side effects or toxicity? - Convulsions - Oliguria - Death
expected side effects: - n/v, diarrhea - thirst - polyuria - lethargy, sedation - fine hand tremor - risk for renal toxicity/damage – long term use - risk for thyroid disfunction - goiter and hypothyroidism – monitor for dry skin, hair loss, constipation, bradycardia, cold intolerance early signs of toxicity: - GI upset - Coarse hand tremor - Confusion, sedation, incoordination - Hyperirritability of muscles - Electroencephalographic changes Advanced signs of toxicity: - Ataxia - Giddiness - Serious Electroencephalographic changes - Blurred vision - Clonic movements - Large output of diluted urine - Seizures - Stupor - Severe HTN - Coma - Death 2ndary to pulmonary complications Severe toxicity: - Convulsions - Oliguria - Death
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bipolar d/o: risk factors biological factors - _________!! - Neurotransmitters (norepinephrine, dopamine, serotonin) - __crease depression/__crease mania - Neurobiological – changes in prefrontal cortex, hippocampus and amygdala - Neuroendocrine – HPTA axis Environmental factors - Stressful family life - Adverse events
risk factors biological factors - genetics!! - Neurotransmitters (norepinephrine, dopamine, serotonin) - decrease depression/increase mania - Neurobiological – changes in prefrontal cortex, hippocampus and amygdala - Neuroendocrine – HPTA axis Environmental factors - Stressful family life - Adverse events
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__________ PD (cluster C) - Rigid, inflexible standards – interefere with project completion - Excessive goal seeking that is self or relationship defeating – workaholic - Unhealthy focus on perfection - Does not interfere greatly with daily functioning
Obsessive-compulsive Nursing care: Obsessive-compulsive PD (cluster C) - Guard against power struggle - Difficulty with unexpected changes - Provide structure - Allow time to complete habitual behaviors - Promote calm, supportive environment Sheldon from big bang theory
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which anticonvulsant mood stabilizers? - sodium valproate/divalproex sodium/valproic acid - carbamazepine - topiramate - lamotrigine - gabapentin Indicated for acute mania, mood stabilization, rapid cycling
gabapentin
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complications r/t antidepressant: ________ HTN crisis symptoms - h/a - palpitations - n/v - HTN - Orthostatic hypotension possible - Dyspnea/SOA - Mental status changes - Blurred vision - Sweating - Neck stiff/sore - Dilated pupils - Photophobia - Tachycardia or bradycardia - Chest pain - Disturbed cardiac rate/rhythm HTN crisis: treatment - Phentolamine – alpha-adrenergic blocker, vasodilator - Sublingual nifedipine – CCB, relaxes cardiac muscles - Symptomatic and supportive
MAOIs
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antidepressants:_________ - Venlafaxine - Duloxetine
SNaRIs – serotonin noradrenergic reuptake inhibitors
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__________ – characteristics and behaviors that comprise a persons unique adjustment to life, including major traits, interests, drives, abilities, values, self-concept, and emotional patterns - Helps determine _______
Personality – characteristics and behaviors that comprise a persons unique adjustment to life, including major traits, interests, drives, abilities, values, self-concept, and emotional patterns - Helps determine behavior
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Other depression medications Antidepressants: Desvenlafaxine (SNRI) Antidepressants: Trazodone - Chemically similar to TCAs - Often give at bedtime for sedative effect as adjunct with another AD Antidepressants: Bupropion (NDRI) - Contraindicated in ____ d/o and hx of seziures - Less sexual s/e - Energizing - Used in smoking cessation Antidepressants: Mirtazapine (NaSSA) - Good for sleep
Others Antidepressants: Desvenlafaxine (SNRI) Antidepressants: Trazodone - Chemically similar to TCAs - Often give at bedtime for sedative effect as adjunct with another AD Antidepressants: Bupropion (NDRI) - Contraindicated in ED and hx of seziures - Less sexual s/e - Energizing - Used in smoking cessation Antidepressants: Mirtazapine (NaSSA) - Good for sleep
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________ PD (Cluster A) - Loner - Poor academic performance - Disordered family life - Avoids close relationships - Depersonalization, detachment, cold, distant
Schizoid Nursing care: Schizoid PD (Cluster A) - Avoid being overly friendly - Don’t try to increase socialization - Assess for symptoms, patient reluctant to discuss - Protect from group ridicule - Respect personal space
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lithium carbonate expected side effects or early, advanced, or severe signs of toxicity? - n/v, diarrhea - thirst - polyuria - lethargy, sedation - fine hand tremor - risk for renal toxicity/damage – long term use - risk for thyroid disfunction - goiter and hypothyroidism – monitor for dry skin, hair loss, constipation, bradycardia, cold intolerance
expected side effects
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Nursing implications: all SRIs - Effective in __-__ weeks - s/e diminish in 4-6 weeks - monitor SI, extreme agitation, fever, increased blood pressure, manic symptoms - sleep hygiene - avoid caffeine if anxious - teach relaxation - abrupt d/c may be mild or severe- electrical surges, _____ shivers, pins and needles, blackouts, short term memory loss, unconsciousness
Nursing implications: - Effective in 4-8 weeks - s/e diminish in 4-6 weeks - monitor SI, extreme agitation, fever, increased blood pressure, manic symptoms - sleep hygiene - avoid caffeine if anxious - teach relaxation - abrupt d/c may be mild or severe- electrical surges, brain shivers, pins and needles, blackouts, short term memory loss, unconsciousness
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s/s mania - __________ – extreme, rapid mood swings, irritability or sudden outburst of misplaced rage - Quick to _______ - Feels misunderstood - Low or high frustration tolerance? - Pacing - Dramatic mannerisms - Uses jokes, puns - __________ dress
s/s mania - Mood liability – extreme, rapid mood swings, irritability or sudden outburst of misplaced rage - Quick to anger - Feels misunderstood - Low frustration tolerance - Pacing - Dramatic mannerisms - Uses jokes, puns - Flamboyant or sexual dress
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Personality disorder: Cluster B Erratic, dramatic 1. 2. 3. 4.
Personality disorder: Cluster B Erratic, dramatic 1. Borderline 2. Narcissistic 3. Histrionic 4. Antisocial
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____________ A specific notable pattern of thinking, feeling and behaving that is: - Persistent, inflexible - Pervasive – across a broad range of situations - Involves inner experience and externa behavior - Differs significantly from individual’s culture - Involves 2 or more areas of functioning – thinking, feeling, interpersonal functioning, impulse control - Leads to significant distress/impairment – social, legal, work, money, safety, etc. - Not better accounted for by another mental health condition, direct effect of a substance, or medical condition
Personality disorder
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Personality disorder: Cluster A odd/eccentric 1. 2. 3.
Personality disorder: Cluster A odd/eccentric 1. Paranoid PD – delusional 2. Schizoid PD – avoid, social withdrawal 3. Schizotypal PD – unusual, distorted reality
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major depressive disorder (MDD) - persistent and/or chronic? - recurrent episodes common? - causes distress and/or impaired function? - episodes attributed to physiological function? - manic or hypomanic episode present?
major depressive disorder (MDD) - can be persistent and chronic - recurrent episodes common - causes distress or impaired function - episodes not attributed to physiological function - NO manic or hypomanic episode
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life threatening rash associated with which 2 anticonvulsant mood stabilizers? - sodium valproate/divalproex sodium/valproic acid - carbamazepine - topiramate - lamotrigine - gabapentin treatment for rash: __________ o Is an allergic reaction o Can advance to toxic epidermal necrosis o Can advance to steven johnson syndrome (w/in first few weeks) o Flu like symptoms – sore throat, fever, chills, blisters, burning eyes
- carbamazepine - lamotrigine treatment for rash: Stop meds immediately o Is an allergic reaction o Can advance to toxic epidermal necrosis o Can advance to steven johnson syndrome (w/in first few weeks) o Flu like symptoms – sore throat, fever, chills, blisters, burning eyes
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SRIs expected s/e or symptoms of serotonin syndrome? - agitation - confusion - restless - lethargy - delirium - irritability - dizzy - hallucinations - diaphoresis - flushing - fever - tachycardia - mydriasis – pupils dilate - myoclonus – muscle twitch - hyperreflexia - tremors - n/v/d
serotonin syndrome symptoms If med is not d/c symptoms may progress to: - worsening myoclonus - HTN - Rigor - Acidosis - Respiratory failure - Rhabdomyolysis
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________ disorder symptoms 5 or more are present daily in a 2 week period: - wight and appetite changes - sleep disturbances - fatigue - psychomotor agitation or retardation - worthlessness or guilt - loss of ability to concentrate - recurrent thoughts of death + 1 of these must occur: - depressed mood - anhedonia – loss of interest/pleasure
major depressive disorder (MDD)
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carbamazepine anticonvulsant mood stabilizer - Risk of low ______ – check serum levels - Check ______ and ________ function - Effective in pts who have no response to lithium or with 2ndary mania - _______ may be life threatening
carbamazepine anticonvulsant mood stabilizer - Risk of low WBC – check serum levels - Check hepatic and renal function - Effective in pts who have no response to lithium or with 2ndary mania - Rash may be life threatening
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_________ PD (cluster B) - Suicidal behavior or self-mutilating behavior - Affective instability - Mood swings - Identity disturbance - Intense anger, uncontrollable - Paranoid - Severe dissociation - Feeling empty, dysphoria, bored - Avoids abandonment (real or imagined) - Unstable interpersonal relationships - Impulsivity – spending, sex, substance use - Views self as victim - Splitting – defense mechanism, unable to accept both positive and negative feelings, people/self/life are either all good or all bad
Borderline Nursing care: Borderline PD (cluster B) - Assessment – risks and emotional triggers - Build trust, therapeutic relationship - Teach coping strategies for emotional regulation - Set boundaries and conflict resolution - Safety Rebecca Bunch (Crazy Ex-Girlfriend)
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_________ PD (cluster B) - Excitable, dramatic, excessive emotions, smothering - High functioning - Bold, provocative, attention seeking - Self centered - Low frustration level - Limited relationships - Considers relationships more intimate than they are
histrionic Nursing care: histrionic PD (cluster B) - Seductive behavior is a response to stress - Ignore flirtations - Keep interactions professional, set boundaries - Help pt clarify feelings - Teach role model assertiveness - Assess for SI the kardashians
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Mania vs hypomania vs both? - characterized by elevated mood and increased energy levels - more severe, with symptoms lasting at least one week and causing significant impairment in daily functioning. - It often involves psychotic features like delusions or hallucinations. - less extreme and does not lead to marked impairment, though others may notice changes in behavior. - episodes are shorter, lasting at least four days. - associated with Bipolar I Disorder - seen in Bipolar II Disorder - requires immediate intervention due to its acute nature and potential for harmful consequences.
Mania vs hypomania - both characterized by elevated mood and increased energy levels - Mania is more severe, with symptoms lasting at least one week and causing significant impairment in daily functioning. - mania often involves psychotic features like delusions or hallucinations. - Hypomania, on the other hand, is less extreme and does not lead to marked impairment, though others may notice changes in behavior. - Hypomanic episodes are shorter, lasting at least four days. - Mania is associated with Bipolar I Disorder - hypomania is seen in Bipolar II Disorder - mania requires immediate intervention due to its acute nature and potential for harmful consequences.
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________ PD (cluster B) - Entitlement, self importance - Lack of empathy - Exploits others - Low self esteem - Hypersensitivity - Constant need for admiration "I don't care about your problems" "I deserve to get my way b/c I am better than other people" "If I flatter my boss, even though he is incompetent, I will get a promotion"
Narcissistic Nursing care: Narcissistic PD (cluster B) - Remain neutral - Promote strong pt self-identity - Avoid power struggles or becoming defensive - Role model empathy voldemort from HP
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lithium carbonate expected side effects or early, advanced, or severe signs of toxicity? - GI upset - Coarse hand tremor - Confusion, sedation, incoordination - Hyperirritability of muscles - Electroencephalographic changes
early signs of toxicity: - GI upset - Coarse hand tremor - Confusion, sedation, incoordination - Hyperirritability of muscles - Electroencephalographic changes
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antidepressants: ___________ - Imipramine - Doxepin - Amitriptyline - 2nd line treatment for depression - Increased danger of death by OD - Anticholinergic adverse reactions - Increased potentially fatal CNS depression with ETOH and other CNS antidepressants - TCAs less expensive
TCA antidepressants: Tricyclic antidepressants
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other symptoms of MDD in children/teens: - frequent, ________ physical complaints - frequent absence or poor school performance - boredom - SUD - Anger or hostility - Reckless
other symptoms of MDD iin children/teens: - frequent, vague physical complaints - frequent absence or poor school performance - boredom - SUD - Anger or hostility - Reckless
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epidemiology - ___________ and undiagnosed bipolar disorder may occur together - can begin at any age - bipolar 1 – more common in males - bipolar 2 – more common in females - cyclothymia – onset common in adolescence or early adulthood
epidemiology - depression and undiagnosed bipolar disorder may occur together - can begin at any age - bipolar 1 – more common in males - bipolar 2 – more common in females - cyclothymia – onset common in adolescence or early adulthood
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key concepts with meds bipolar d/o: lithium = (2) carbamazepine = (1) lamotrigine = (1) depression: SRIs = (1) SRIs for kids = (1) TCA = (1) TCAs for kids = (2) MAOIs = (2)
key concepts with meds bipolar d/o: lithium = toxicity, don't restrict sodium carbamazepine = life threatening rash lamotrigine = life threatening rash depression: SRIs = serotonin syndrome, treat with beznos SRIs for kids = Black box warning – increased risk of SI TCA = anticholinergic s/e TCAs for kids = Risk for dysrhythmias and lethal OD MAOIs = avoid tyramine (aged meat/cheese/fruit/veg, alcohol, etc), risk for HTN crisis
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lithium carbonate expected side effects or early, advanced, or severe signs of toxicity? - Convulsions - Oliguria - Death
Severe toxicity: - Convulsions - Oliguria - Death

sav nur 329 exam 2 (2 decks)

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