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M6 13-005
Exam 18: Mood Disorders
| Term | Definition |
|---|---|
| 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
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