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outwardly bodily expression of emotions



a feeling state reported by the client that can vary with internal and external changes


Manic Episode

an elevated, expansive or irritable mood accompanied by hyperactivity, grandiosity, and loss of reality.



clients may appear happy, agreeable, humorous, and agreeable; not severe enough to cause significant impairment


Flight of Ideas

shifting from one idea to another quickly



the creation of electro stress in the brain from stress that results in alteration of neural functioning






loss of interest and pleasure in activities


Persistent Depressive Disorder (Formerly known as Dysthymia)

is chronic low level depression of at least 2 years duration for adults



is a chronic mood d/o of at least 2 yrs in adults
1 year in children

-hypomanic episodes alternating with persistent depressive episodes (dysthymia)


Serotonin syndrome

1. idiosyncratic medication reaction d/t accumulation of serotonin- SNS: Mental Status changes, fever, elevated Bp, severe could result in death. Nurse intervention d/c med and notify prescribing authority





What are the 2 major neurotransmitters associated with depression and Mania?

Norepinephrine and serotonin


A patient suffering from Bipolar I Disorder is admitted in a manic episode to the Mental Health Inpatient Unit. What should be included in your assessment in addition to suicide?

Amount of sleep, nutritional status, history of aggression, a/v hallucinations, etc…



-Action in mood stabilization is unknown - possibly inhibits enzymes involved in GABA catabolism, thereby inhibiting neuronal excitability. increases levels of GABA,

TX: Bipolar Disorder, Seizures, Schizoaffective Disorders, Schizophrenia [acute mania-bipolar mania-prevent of migrane]


Carbamazepine (Tegretol)

Third Generational Anticonvulsants - mood stabilizer (antiepileptic)

TX:mood stablizer - bipolar manic disorders, seizures (bipolar 1)

interactions: grapefruit juice, barbiturates, charcoal, doxycicline, erythromycin, MAOI's, NMJ blockers [neuromuscular junction], warfarin


Amitriptyline (Elavil)

TCA ( tricyclic antidepressants)( 1st generation antidepressant)
-action in humans is unknown; inhibits the membrane pump mechanism responsible for uptake of NE and serotonin

-Adverse effects: MI & Stroke


Trazodone (Desyrel)

SARI( serotonin antagonist re-uptake inhibitors)

- act by antagonizing serotonin receptors and inhibiting the re-uptake of serotonin, norepinephrine, and/or dopamine.



Mood stabilizer salt
-Tx manic disorders of Bipolar Disorder, schizophrenia and depression

-increases the activity of chemical messengers in the brain- acts on CNS

Maintenance level: 0.4 to 1.3 mEq/L
Early Toxicity: 1.5 mEq/L
Severe Toxicity: 2.0 to 2.5 mEq/L


Fluoxetine (Prozac)

-Depressive Disorders, tx of depressive episodes of bipolar 1 disorder, treatment resistant depression, OCD, bulimia, panic disorders, PMDD

interacts with: alcohol, benzos, ED drugs, linezolid, lithium, MAOIs, NSAIDs, TCAs, opiods, serotonergic drugs, thyridezine


In your assessment of a patient who is severely depressed and just started on antidepressants, what would be behavior that would concern you and require further assessment?

Sudden change in mood or behavior.


What symptoms would you expect to find in someone suffering from Major Depression?

1. Anhedonia
2. sad, down, depressed mood
3.changes in appetite (insomnia/hypersomnia)
4.change in seep patterns
5.psychomotor retardation or psychomotor agitation
6. weight changes ( increase or decrease)
7. loss of energy
8. impaired concentration and impaired decision making
9. worthlessness/ excessive guilt
10. Suicidality


What are some key points with mood disorders in the Children?

1. instead of depressed mood could appear irritable
2. unwell- stomach aches
3. vague physical complaints
4. not going to school
5. agression
6 .clinginess


What are some key points with mood disorders in the adolescents?

1. sulking
3. getting in trouble at school
4. feeling misunderstood
5. running away
6. withdrawing


What are some key points with mood disorders in the elderly?

1. masked depression- masquerading as other medical condition
2. can remain masked, undiagnosed /untreated
- undiagnosed 50% of the time
3. social isolation
4. decrease med adherence
5. those taking SSRIs have more side effects than those take TCAs
6. suicide rate is highest among elderly men than all other age groups


Bipolar 1

1. at least 1 episode of persistent elevated mood (mania) and 1 episode of depression
2. anxious distress
3. rapid cycling
4. melancholic (pensive sadness, typically with no obvious cause) features
-Atypical features
- peri-partum onset


Bipolar 2

1. severe and prolonged periods of depression that alternate with brief periods of hypomanic episodes



less severe, less intense form of mania - may only last 4 consecutive days in most cases

inflated self-esteem


what are SSRIs

Selective Serotonin re-uptake inhibitor

-First line for Depression
( also used for anxiety, PTSD, and OCD)

-Mechanism of action- blocks Serotonin re-uptake so there will be a higher level of serotonin in the synaptic space to attache to receptors and help your mood

(because low serotonin=depression)

#1 most serious adverse effect (rare)- serotonin syndrome
- do not want to take with other SSRIs

- do not take for bipolar can induce manic episodes

- absorbed almost completely after oral adm., highly protein bound

- sometimes used for eating disorders, panic disorders, personality disorders

- less dx interactions than TCAs, however competitively inhibit liver enxymes responsible for oxidation of other drugs

- SSRIs and MAOIs together = potentially fatal


What are Tricyclic Antidepressants?

Similar to SSRIs but are named after their molecular structure, rather than what they do (most MH drugs are name based on their action)

- used for ADHD, OCD, diabetic neuropathy and enuresis (children under 6 y/o)

- helpful when used with a mood stabilizer in treating acute depression in treating those with BP1 disorder

- interact with amphetamines, arbituates,

-They block the transmitters of Norepinephrine and serotonin- in turn blocking their re-uptake so it increases their concentration in the synaptic space.

-broad mechanism of action

-more side effects than SSRIs

-easy to overdose on
-long half lives
-extremely fat soluble and accounts for their wide distribution throughout the body, slow excretion and long half-life

- they also block acetylcholine and histamine receptors

- Nursing process - check EKG, mood changes for effectiveness, assess for low BP and