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NURS 3514 Mental Health & Illness > Week 7 Mood & affect > Flashcards

Week 7 Mood & affect Flashcards

(94 cards)

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1
Q

What is the continuum of mood disorders ?

A

Mania
Hypomania
Normal/balanced mood/Euthymia
Mild to moderate depression
Severe depression

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2
Q

What is the DSM- 5 Diagnostic criteria for Major depressive disorder?

A
  1. At least a 2 week history of 5 or more symptoms
  2. symptoms are a change from baseline
  3. symptoms cause significant distress/impairment in functioning
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3
Q

What MUST be present for a diagnosis of major depressive disorder?

A
  1. Depressed mood most of the day, nearly everday
    or
  2. markedly diminished interest/pleasure in activities most of the day, nearly everyday
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4
Q

What are the other symptoms of major depressive disorder that can accompany one of the required symtoms?

A
  1. significant weight loss/gain/decreased appetite
  2. hard to sleep
  3. psychomotor agitation or retardation
  4. fatigue/loss of energy
  5. feeling worthless/inappropriate guilt
  6. can’t concentrate/indecisive
  7. recurrent thoughts of suicide/death
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5
Q

How do youth experience depression that is different than adults?

A

-Irritable or angry mood
-“Acting Out” behaviours
-Unexplained aches and pains
-Extreme sensitivity to criticism
-Withdrawing from some, but not all people

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6
Q

What can untreated depression lead to in youth?

A

-Low self-esteem
-Problems at school/running away
-Substance abuse
-Eating disorders
-Violence
-Self-injury
-Suicide: 15-19 years of age - 2nd leading cause of death - Indigenous Youth
-Comorbid diagnosis - with ADHD; Anxiety

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7
Q

What does depression look like in older adults (common)?

A

Focus on physical health symptoms

Weight loss

Poor appetite

Anhedonia

Social isolation

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8
Q

What is anhedonia?

A

not feeling like caring about anything

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9
Q

What are less common complaints of depression in older adults?

A

depressed mood/sadness/crying

weight gain

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10
Q

What is a significant risk of depression?

A

Suicide risk - 15% die by suicide if not treated

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11
Q

What are the causes of depression?

A
  1. Physical - endocrine & illness
  2. Neurotransmitters
    - serotonin, norepi, monoamine oxidase
  3. Cognitive distortions
  4. Genetic vulnerability
  5. psychosocial factors -
  6. ACES (childhood) - trauma & loss
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12
Q

What are the approaches to treatment /care of depression?

A

meds
ECT
TMS (rTMS)
CBT
Pychotherapy
Mindfulness
Psychosocial support
Education
Health promotion
Health & Wellness

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13
Q

What are the antidepressant drug class medications for Depression ?

A

SSRIs
SNRIs
NRIs
NDRIs
SNDIs
TCAs
MAOIs

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14
Q

What does norepinephrine control?

A

Attention
balanced mood
endurance
concentration

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15
Q

What does Dopamine control?

A

Alertness
- clarity
- motivation
- passive working memory
- Appetite

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16
Q

What does serotonin control?

A

Satisfaction
- relaxation / insomnia
- pleasure / anxiety
- learning memory - disability

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17
Q

What are the SSRIs?

A

Selective serotonin reuptake inhibitors (leave more in the synapse)

  • Fluoxetine (prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Sertraline
  • Escitalopram
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18
Q

What meds for depression are used less and why?

A

TCAs
- cardiac issues
- anticholinergic symptoms

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19
Q

What is a SNRI?

A

selective serotonin and norepinephrine reuptake inhibitor

Venlafaxine (Effexor)
Duloxetine

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20
Q

What are atypical antidepressants?

A

Trazadone (Desyrel) - SARI
Buproprion - Wellbutrin - NDRI
Mirtazapine - Remeron- Tetracyclic

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21
Q

What are SSRSs indicated for?

A

Anxiety
Depression
OCD
PTSD

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22
Q

What is the MOA of SSRIs?

A

blocks reuptake of serotonin
so more is left available in synaptic cleft

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23
Q

What do we monitor for in SSRI use?

A

Serotonin syndrome
LFTs
CBC
Renal issues

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24
Q

What are the side effects of SSRIs?

A

stomach upset
serotonin syndrome
suicidal thoughts
weight gain
sexual dysfunction
sleep issues
stress

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25
What should someone not take with SSRIs?
st john's wart Warfarin Digoxin
26
What should we educate patients about with SSRIs?
insomnia avoid alcohol careful with NSAIDs- GI bleed Change position slowly (BP) - orthostatic hypotension
27
What are SNRIs indicated for?
Anxiety Depression Neuropathic pain
28
Which antidepressants are also good for neuropathic pain?
SNRIs Atypical antidepressants TCAs
29
What should we monitor for in someone taking SNRIs?
- serotonin syndrome agitation fever hallucinations diaphoresis tremors
30
What side effects do SNRIs have that SSRIs do not?
-Hypertension d/t norepi increase - Adrenergic effects - Tachycardia (also has all the ones from SSRIs)
31
What do SNRIs interact with?
St. john's wort
32
What are Atypical Antidepressants indicated for?
Depression Neuropathy Fibromyalgia Anxiety Insomnia
33
What is the MOA of atypical antidepressants?
SLOWS (not blocks) rate of reuptake of serotonin and norepi
34
What are the 2 things people can experience if stopping or changing SSRIs suddenly?
Withdrawl symptoms - discontinuation syndrome Serotonin syndrome - excessive serotonin
35
What are discontinuation syndrome symptoms?
flu- like symptoms nausea electric shock in brain headache vertigo anxiety/irritable insomnia
36
What are symptoms of Serotonin syndrome?
MSE changes - delirium Fever Tachycardia Hypertension Tremor Diarrhea Neuromuscular symptoms
37
What drugs can cause Serotonin Syndrome?
SSRIs SNRIs TCAs Buspirone MAOIs Lithium St John's Wort Trazadone LSD, MDMA (ecstacy), cocaine
38
What is the triad of clinical features in Serotonin syndrom?
Mental status changes Neuromuscular abnormalities (muscle rigidity) Autonomic hyperactivities (BP and HR increase)
39
What is the acrynom for Serotonin syndrome?
HARMFUL H- hyperthermia A- agitation, delirium, confusion R - restlessness, increase reflexes M - Myoclonus - twitch/jerk F- Fast heart rate U- Unconsciousness L- Loss of GI control - nausea & diarrhea
40
What is the onset of Serotonin syndrome?
Quick onset (within hours)
41
What two medications do we use to counter serotonin syndrome and why?
benzos- sedation cyproheptadine - block serotonin production
42
What drug class is very dangerous in overdose and why?
TCAs cardiotoxicity
43
What are MAOIs?
TIPS Tranylcypromine Phenelzine Isocarboxazid Selegiline
44
What are MAOIs indicated for?
Depression
45
What is the MOA of MAOIs?
inhibits monoamine oxidase - monoamine neurotrasmitters can't be broken down - stops reuptake of serotonin, melatonin, epinephrine, and norepi
46
What 2 things do we monitor for with MAOIs?
Hypertensive crisis Serotonin syndrome
47
What are the side effects of MAOIs?
Agitation/anxiety Orthostatice hypotension Hypertensive crisis
48
What antidepressants can cause hypertensive crisis?
MAOIs
49
What antidepressants can cause orthostatic hypotension?
Atypical Antidepressants MAOIs TCAs
50
What should we teach patients who are taking MAOIs?
- no foods with tyramine - avoid caffeine -OTC cold medications = hypertension - 2 week washout period needed
51
What is IV ketamine used for?
treatment-resistant depression
52
How long is the treatment of Ketamine?
8 treatments 2-3 x/week
53
What is the MOA of ketamine?
causes excitation of the neurons and neuroplasticity glutamate allows new pathways to be formed in the brain
54
What is one of the most effective treatments for acute depression?
ECT
55
how many hours should someone be NPO before ECT?
6 hours
56
What are the side effects of ECT?
-Disorientation/confusion - STM loss around time of treatment - Muscle aches/pains - headache - N&V
57
What is rTMS/TMS?
transcranial magnetic stimulation - electromagnetic coil on scalp - stimulates brain cells we think relate to depression - 30 min - patient is awake
58
What are the 3 principles of CBT?
1.thoughts create feelings 2. feelings created behaviours 3. behaviours reinforce thoughts it's a cycle
59
What's important for caring for someone with depression?
1. therapeutic relationship 2. meet physical health needs 3. make positive decisions for clients if they are unable to 4. promote coping skills that are empowering to the person 5. Promote problem solving skills 6. positive self regard 7. encourage social support network 8. Support for families or caregivers
60
Which is worse, bipolar I or bipolar II?
Bipolar I
61
What is different between bipolar I and bipolar II?
Bipolar I - at least 1 MANIA (can't function) episode WITH depression/anxiety Bipolar II - at least one HYPOMANIC (function too well) episode AND at least ONE major depressive episode
62
What is Cyclothymia?
numerous periods of hypomanic symptoms WITH depressive symptoms over at least 2 years
63
What is different between Bipolar II and Cyclothymia?
Cyclothymia: time- must be at least over 2 years frequency- numerous hypomanic symptoms
64
How do we distinguish Bipolar from depressive disorders?
the occurance of mania or hypomania (mild manic) IN ADDITION to Depressive episodes
65
what is the onset age of bipolar?
21-30 years old
66
What is rapid cycling?
4 or more episodes in 12 months
67
What is secondary mania?
it's caused by something else like a tumour "Mania secondary to tumour"
68
What is hypomania?
elated behaviour that is atypical for the person over at least 4 consecutive days, most of the day, nearly everyday
69
Which progresses into psychosis, Mania or hypomania?
Mania only
70
Does hypomania cause marked impairment to daily, social, or occupational functioning?
No - that's mania
71
How long do symptoms of Mania have to be present according to the DSM 5?
at least 1 week present most of the day, nearly everyday represents a change for the person
72
What symptoms must be present for a mania diagnosis?
- persistent elevated (euphoric), expansive or irritable mood - very goal directed activity/energy - 3 or more of the other symptoms (or 4 if there is only irritable mood)
73
What are the other symptoms of Mania that go along with the required two for diagnosis according to DSM 5?
- inflated self-esteem or grandiosity - don't need sleep - pressured speech - talkative - flight of ideas - racing thoughts - distracted to external stimuli - purposeless non-goal directed activity / psychomotor agitation - Excessive buying sprees, sexual indiscretions, reckless business investments
74
What is different between schizophrenia from bipolar in the common symptoms?
schizophrenia- when they sleep delusions go away bipolar - sleep doesn't make things better
75
How does lithium toxicity differ from serotonin syndrome?
lithium toxicity - more of a tremor and rigidity until they become unconscious - think of G4 guy with what looked like seizures but very random and he was unconscious
76
What medications are used first line for bipolar?
*Anti-psychotics - quetiapine - Seroquel *Sedatives/Hypnotics - zoplicone - trazadone (for sleep) Antianxiety - benzos (short term) Antidepressants
77
What medication is used after first line meds have been tried for bipolar?
Lithium
78
What can lithium toxicity result in ?
severe kidney damage (check urine and creat/urea!) death
79
What affects lithium levels and how?
salt too much salt makes lithium not work well too little salt can allow lithium to become toxic dehydration or N&V can cause toxicity
80
What is lithium indicated for?
acute mania - bipolar long term management of bipolar
81
What is the MOA of lithium?
acts on CNS strengthen nerve connections in the brain - mood, thinking, behaviour
82
What bloodwork do we monitor with lithium?
Creatinine/BUN Lithium levels - 12 hrs after last dose Na
83
What are the side effects of lithium?
nephrotoxicity - kidney harm polyuria - pee a lot increased thirst fine hand tremors hypothyroid electrolyte changes leukocytosis (high white blood cells)
84
what should we teach someone on Lithium?
no diuretics no NSAIDS careful Na intake careful fluid intake careful when sweating, dehydrated, diarrhea, illness no preggers or breastfeeding
85
What are some clinical symptoms of lithium toxicity?
confusion slurred speech incoordination
86
What do we do if we suspect someone has lithium toxicity?
activated charcoal or pump stomach bolus with fluid (likely dehydrated or not enough salt) sometimes hemodialysis
87
What drug classes are used for bipolar?
Mood stabilizers - lithium Anticonvulsants - -carbamazepine - valproate - gabapentin - topiramate
88
What are anticonvulsants indicated for?
acute mania maintenance of bipolar disorder
89
What is the MOA of anticonvulsants?
carbamazepine - decreases synaptic transmissions in CNS Valproic acid - increases GABA (inhibitory behaviour and mania decrease)
90
what do we monitor with carbamezapine?
"my love of CARBS is in my blood - cbc" LFTs, CBC leukopenia & aplastic anemia
91
What do we monitor in valproate?
(if you VALue your liver) *LFT *PLATELETS drowsiness mood ideations
92
What do we educate people about with carbamazepine?
fever or sore throat (leukopenia) lowers effectiveness of most hormonal BC
93
What do we educate about valproate?
not for preggers maybe jaundice watch for bleeding
94
What are the goals of care for ACUTE mania?
safety prevent injury with drugs when needed ADLs Calm voice Short convos Reduce stimulation

NURS 3514 Mental Health & Illness (7 decks)

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