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M6 13-005

Exam 18: Mood Disorders

Mood A prolonged emotional state that influences the person’s whole personality and life functioning
Depression Exaggerated feelings of sadness, despair, lowered self-esteem, loss of interest in former activities and pessimistic thoughts
Mood Disorders (Affective Disorders): Any of a group of psychotic disorders characterized by severe and inappropriate emotional responses, by prolonged and persistent disturbances of mood and related thought distortions and by other symptoms associated with either depressed or manic states
Mania Persistent, abnormal over activity and a euphoric state
Dysthymic Disorder: Daily moderate depression that lasts more than 2 years. This disorder often ends up as a lifestyle in which the individual can function but does not enjoy life
Cyclothymic Disorder Pattern that involves repeated mood swings of hypomania and depression but are less intense. There are no periods of normal function with this condition
Hypomanic episode The early phase of a manic episode when symptoms are not severe
Major depressive disorder (Unipolar Depression): Repeating, severe depressive episodes lasting more than 2 years
Bipolar disorder (Manic-depressive Disorder): Exhibit sudden shifts of emotional extremes from depression to mania
Mood (Affective Disorders): Characteristics Severe and inappropriate emotional responses. Prolonged and persistent disturbances of mood. Related thought distortions. Other symptoms associated with either depressed or manic states.
Mood defined by DSM-IV-TR: A prolonged emotion that affects a person’s psyche. Extremes in mood range from depression to mania
Hereditary factor’s account for ____ to ___ of mood disorders 60% to 80%
There is an _______ norepinephrine and serotonin in depressed individuals. insufficient
There is an _____ of norepinephrine in manic individuals Excess
Neurotransmitter insufficiency or excess is sometimes the result of what? hereditary and sometimes environmental factors i.e. prolonged stress or brain trauma
Depression: Characteristics Exaggerated feelings of despair. Sadness. Lowered self-esteem. Loss of interest in former activities. Pessimistic thoughts. Found in all races. Women are affected twice as often as men. Can be so severe that they may contemplate suicide.
Unipolar Depression Repeating, severe depressive episodes lasting more than 2 years
Dysthymic Disorder Daily moderate depression that lasts more than 2 years. Often ends up as a lifestyle in which the individual is able to function but not enjoy life
Mania: Persistent, abnormal over activity and a euphoric state.
Mania: Characterisitcs Engaging Outgoing Charming Achieving and successful Has excessive energy and optimism Has potential to accelerate
Are there periods of normal function with cyclothymic disorder? No
Cyclothymic Disorder is thought to be a "____" version of bipolar disorder and can progress to bipolar disorder "muted"
Seasonal Affective and Postpartum Depression Connected with hormonal imbalance Responds well to treatment Treated with phototherapy Clears within days
Medical Treatment for Mood Disorders Anti-depressants. Lithium. Electroconvulsive Therapy. Psychotherapy.
Mood Disorder anti-depressants Fluoxetine (Prozac), trazadone (Desyrel), amitriptyline (Elavil), venlafaxine (Effector)
Nursing Interventions: Depression Encourage expression of feelings. Point out any specific improvement. Reinforce assertive behavior. Recognize and point out manifestations of self-destructive thoughts or behavior to the individual. Discuss alternative ways to respond to stress.
Nursing Interventions: Mania directions specific and simple. Present reality without arguing. Be consistent and keep to the rules. Attempt to provide a focus in the conversation. Interrupt to slow the individual down in conversation. Phrase questions to require a brief answer.
Do not remove ____ from the diet while a patient is on Lithium. salt
Tricyclic Antidepressants (TCAs): Use Inhibit the re-uptake of norepinephrine and serotonin by the presynaptic neurons in the CNS.
Tricyclic Antidepressants (TCAs): Action Increases time that norepinephrine and serotonin are available to the postsynaptic receptors.
Common adverse reactions: Anticolinergic Dry mouth Blurred vision Tachycardia Constipation Urinary retention Esophageal reflux
Common adverse reactions: α-adrenergic blockade Postural orthostatic hypotension 2) Tachycardia
Common adverse reactions: Antihistamine Sedation
The most serious effects of the TCAs are Cardiovascular: -Patients who have recently had a myocardial infarction or other cardiovascular problem -Patients with narrow-angle glaucoma -Patients with a history of seizures -Patients who are pregnant
TCA Medications: Amitriptyline (Elavil). Doxepin (Sinequan). Imipramine (Tofranil). Desipramine (Norpramine). Nortriptyline (Pamelor).
Monoamine Oxidase Inhibitors (MAOIs): action Prevent the breakdown of norepinephrine, serotonin and dopamine in the brain, thereby increasing the levels of these brain amines and resulting in increased mood.
Monoamine Oxidase Inhibitors (MAOIs): has demonstrated proven benefits for patients who have not responded to other medication or ECT (Electroconvulsive Therapy).
Monoamine Oxidase Inhibitors (MAOIs) are useful in treating disorders such as panic disorder, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder and bulimia.
Monoamine Oxidase Inhibitors (MAOIs): inhibits breakdown of tyramine in the liver
Drugs that cause potentially fatal interactions with MAOIs Amphetamines (e.g., Adderall). Ephedrine. Fenfluramine. Isoproterenol. Meperidine (Demerol). Phenylephrine (Prefrin). Phenylpropanolamine. Pseudoephedrine (Sudafed). SSRI Antidepressants. Tricyclic antidepressants. Tyramine.
Common adverse reactions to MAOIs Hypotension Sedation, weakness, fatigue Insomnia Changes in cardiac rhythm Muscle cramps Anorgasmia or sexual impotence Urinary hesitancy or constipation Weight gain
Toxic effects of MAOIs Hypertensive crisis (MOST SERIOUS) Severe headache Stiff, sore neck Flushing, cold, clammy skin Tachycardia. Severe nosebleeds, dilated pupils Chest pains, stroke, coma, death Nausea and vomiting
MAOI Medications Isocarboxazid (Marplan). Phenelzine (Nardil). Tranylcypromine (Parnate).
MAOI Medications: Side Effects Drowsiness Dry mouth Over activity Insomnia Nausea Anorexia Constipation Urinary retention Orthostatic hypotension
Selective serotonin re-uptake inhibitors (SSRIs): What do they do? Selectively block the neuronal uptake of serotonin, thereby leaving more serotonin available at the synaptic site
Selective serotonin re-uptake inhibitors (SSRIs): Broad uses Treatment for depressive disorders. Prescribed with success to treat some anxiety disorders, in particular, obsessive-compulsive disorder and panic disorder.
Fluoxtine (Prozac) has been effective in treating some women who suffer from late luteal phase dysphoric disorder and bulimia nervosa
The effect on ______ _______ may be the most significant undesirable outcome reported by patients Sexual Performance
One rare and life-threatening event associated with SSRIs is Serotonin syndrome
serotonin syndrome Thought to be related to over activation of the central serotonin receptors, caused by either too high a dose or interaction with other drugs
SSRI Medications Fluoxetine (Prozac). Sertraline (Zoloft). Paroxetine (Paxil). Citalopram (Celexa). Escitalopram (Lexapro).
Atypical antidepressants Each agent blocks different neurotransmitters and transmitter subtypes, which accounts for their strengths in targeting unique populations of depressed individuals as well as for their efficacy in treating other conditions
Atypical antidepressants Medication Bupropion (Wellbutrin, Zyban). Venlafaxine (Effexor). Duloxetine (Cymbalta). Mirtazapine (Remeron).
Bupropion (Wellbutrin, Zyban): Neurotransmitter affected Blocks norepinephrine and dopamine re-uptake
Bupropion (Wellbutrin, Zyban) may help with ADHD. Chronic fatigue syndrome. Rapid cycling bipolar II disorder. Sexual side effects from use of other antidepressants. Anxiety disorders. Nicotine addiction.
Venlafaxine (Effexor): Neurotransmitter affected Inhibits re-uptake of serotonin and norepinephrine. Inhibits dopamine to a lesser extent.
Venlafaxine (Effexor) may help with Treatment-resistant depression. Chronic depression. Bipolar depression Depression with ADHD. Medical illness and depression. Anxiety. Geriatric depression.
Duloxetine (Cymbalta): Neurotransmitter affected Inhibits re-uptake of serotonin and norepinephrine. Inhibits dopamine to a lesser extent.
Duloxetine (Cymbalta) may help with Major depression. Geriatric depression.
Mirtazapine (Remeron): Neurotransmitters affected Blocks serotonin. An α2- adrenoreceptor. Blocks histamine. Enhances both nonadrenergic and serotonergic transmitters.
Mirtazapine (Remeron) may help with Sleep disturbances. Poor appetite. Pain. Medical illness with depression. Anxiety. SSRI-induced sexual dysfunction.
Individuals with bipolar disorder often require multiple medications
Antianxiolytics, antipsychotics or even antidepressants may be used for a limited time, but mood stabilizers are considered lifetime maintenance therapy
Most treatment guidelines advocate lithium and divalproex (Depakote) as first-line mood-stabilizing agents
_____ is a salt contained in the human body; it is similar to gold, copper, magnesium, manganese and other trace elements Lithium
Lithium is particularly effective in reducing: Elation, grandiosity and expansiveness. Flight of ideas. Irritability and manipulation. Anxiety.
To a lesser extent, lithium controls Insomnia Psychomotor agitation Threatening or assaultive behavior Distractibility Hyper sexuality Paranoia
Therapeutic Level of Lithium (0.4 to 1 mEq/L)
Early value of lithium level toxicity <1.5 mEq/L
Advanced value of lithium level toxicity 1.5 to 2 mEq/L
Severe value of lithium level toxicity 2 to 2.5 mEq/L
Severe SEVERE Lithium level toxicity >2.5 mEq/L
Anticonvulsants can be also used as mood stabilizers or used for bipolar disorder
What has surpassed lithium as the drug most commonly used to treat bipolar disorder in the United States Divaproex (Depakote)
Anticonvulsant meds Divalproex (Depakote). Carbamazepine (Tegretol). Topiramate (Topamax).
The only anticonvulsant mood stabilizer not associated with weight gain and in fact is associated with weight loss in up to 50% of patients is what? Topiramate (Topamax)
Atypical antipsychotics: examples Aripiprazole (Abilify). Clozapine (Clozaril). Risperidone (Risperdal Consta, M-Tabs). Olanzapine (Zyprexa). Quetiapine (Seroquel). Ziprasidone (Geodon).
Atypical antipsychotics: Becoming more first-line treatments because of the side effect profile and tolerability compared with other mood stabilizers
Benzodiazepines: Examples Alprozolam (Xanax). Clonazepam (Klonopin). Diazepam (Valium). Lorazepam (Ativan).
Benzodiazepines: Facts Allows for rapid induction of sleep with earlier resolution of mania without necessitating high dosage of antipsychotic medications in the acute phase.
Calcium channel blockers: Examples Verapimil (Calan). Nifedipine (Adalat, Porcardia).
Calcium channel blockers: Fact Primarily used when other mood stabilizers have failed. Found to modulate mood by inhibiting calcium channels in the postsynaptic neuron, affecting the noradrenergic neurotransmitter system. Action is similar to that of lithium.
Electroconvulsive therapy (ECT): use Used to subdue severe manic behavior, especially in patients with treatment resistant mania and patients with rapid cycling
Electroconvulsive therapy (ECT): Procedure ECT involves the application of electrodes to the head to deliver an electrical impulse to the brain. Causes seizures. Believed that shock stimulates brain chemistry to correct the chemical imbalance of depression.
ECT is indicated when There is a need for a rapid, definitive response when a patient is suicidal or homicidal. Extreme agitation or stupor. Life-threatening illness because of refusal of foods and fluids. Hx of poor drug response, a history of good ECT response or both.
ECT is NOT necessarily effective in patients with Dysthymic disorder. Atypical depression. Personality disorders Drug dependence. Depression secondary to situational or social difficulties.
The usual course of treatment with ECT for a depressed patient is two or three treatments per week to a total of 6 to 12 treatments
Created by: jtzuetrong