Mood Disorders
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| What are 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.
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| What is Mania? | a mood disorder characterized by persistent, abnormal over activity and a euphoric state.
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| What is 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.
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| What is Cyclothymic Disorder? | a pattern that involves repeated mood swings of hypomania and depression but are less intense. There are no periods of normal function with this condition.
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| What is a Hypomanic Episode? | the early phase of a manic episode when symptoms are not severe.
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| What is Major Depressive Disorder (Unipolar Depression)? | repeating, severe depressive episodes lasting more than 2 weeks.
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| What is Bipolar Disorder (Manic-Depressive Disorder)? | sudden shifts of emotional extremes from depression to mania.
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| What is Seasonal Affective Disorder (S.A.D.)? | Depression that comes with shortened daylight in winter and fall and disappears during spring and summer.
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| What is S.A.D. thought to be related to? | abnormal melatonin metabolism
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| What characterizes S.A.D.? | *Hypersomnia *Lethargy and fatigue *Increased anxiety *Irritability *Increased appetite with carbohydrate craving *Weight gain
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| What is there a insufficiency of in people suffering depression? | Norepinephrine and seratonin
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| Fill in the blanks: Genetic studies implicate the transmission of major depression in __________ relatives, who have ______ the risk of developing depression compared with the general population | First-degree, Twice
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| How do Tricyclic antidepressants (TCAs) increase the effects of neurotransmitters? | by blocking their reuptake
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| What is the action of Tricyclic Antidepressants (TCAs)? | *Inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS.
*Increases time that norepinephrine and serotonin are available to the postsynaptic receptors.
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| What are the common adverse reactions of Tricyclic Antidepressants (TCAs)? | *Dry mouth
*Blurred vision
*Tachycardia
*Constipation
*Urinary retention
*Esophageal reflux
*Postural orthostatic hypotension
*Tachycardia
*Sedation
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| What are the most serious adverse effects of Tricyclic Antidepressants (TCAs)? | *Dysrhythmias
*Tachycardia
*Myocardial infarction
*Heart block
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| What are the contraindications for Tricyclic Antidepressants (TCAs)? | *Recentl myocardial infarction or other cardiovascular problem
*Narrow-angle glaucoma
*Hx of seizures
*Pregnant
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| How long can mood elevation from Tricyclic Antidepressants (TCAs) take? | 7 to 28 days
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| How long can the full therapeutic effect from Tricyclic Antidepressants (TCAs) take? | 6 to 8 weeks
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| Drowsiness, dizziness, and hypotension are common INITIAL adverse effects of Tricyclic Antidepressants (TCAs). How long will it take for them to subside? | After first few weeks
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| What can block the effects of Tricyclic Antidepressants (TCAs)? | Alchohol
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| When should Tricyclic Antidepressants (TCAs) be taken so side effects are less experienced? | Full dose at bedtime
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| True or False: To minimize dependance on Tricyclic Antidepressants (TCAs), they should be stopped abruptly so the body is clear of them faster. | False. Suddenly stopping TCAs can cause nausea, altered heartbeat, nightmares, and cold sweats in 2 to 4 days. The patient should call the physician or take one dose of TCA until the physician can be contacted
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| What is the action of Monoamine Oxidase Inhibitors (MAOIs)? | Prevent the breakdown of norepinephrine, serotonin, and dopamine in the brain, thereby increasing the levels of these brain amines and resulting in increased mood
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| Fill in the blanks: People taking MAOIs must restrict their intake of _________ so their blood pressure does not rise to dangerous levels. | Tyramine
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| What foods can interact negatively with MAOIs? | *Avacados
*Soybean
*Figs
*Bananas
*Cheese
*Protein supplements
*Smoked/aged meats (I.E. Jerky)
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| True or False: Due to hormonal imbalances, depressed teens should be treated with a combination of MAOI inhibitors and Trycyclic Antidepressants. | False. Mixing these two drugs can cause a potentially fatal reaction.
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| What drugs have fatal interactions with MAOI inhibitors? | *Amphetamines (e.g. Adderall)
*Ephedrine
*Fenfluramine
*Isoproterenol
*Meperidine (Demerol)
*Phenylephrine (Prefrin)
*Phenylpropanolamine
*Pseudoephedrine
*SSRI Antidepressants
*Tricyclic antidepressants
*Tyramine
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| What is the most serious toxic effect of MAOI inhibitors? | Hypertensive crysis
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| What resturants should PTs on MAOI inhibitors avoid due to food content? | Chinese restaurants
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| True or False:Instruct the patient that after the MAOI is stopped, dietary and drug restrictions should be maintained for 14 days | True
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| How long does it take for MAOI inhibitors to reach therapeutic levels? | 2-4 weeks
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| When should MAOI Medications be given? | In morning
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| A PT taking MAOIs should be instructed to do what? | *Rise slowly *Administer in AM *Administer with food *Ensure adequate fluids *Low tyramine diet
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| What is the action of Selective Serotonin Reuptake Inhibitors (SSRIs)? | Selectively block the neuronal uptake of serotonin, thereby leaving more serotonin available at the synaptic site
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| What is the most significant undesireable adverse effect of Selective Serotonin Reuptake Inhibitors (SSRIs) reported by PTs? | Sexual dysfunction (primarily anorgasmia)
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| What potentially life threatening event is associated with Serotonin Reuptake Inhibitors (SSRIs)? | serotonin syndrome
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| What can severe manifestations of seratonin syndrome induce? | Hyperpyrexia (excessively high fever), Cardiovascular shock, Death
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| What are the S/Sx of seratonin syndrome? | *Abdominal pain *Diarrhea *Sweating *Fever *Tachycardia *Elevated blood pressure *Altered mental state (delirium) *Myoclonus (muscle spasms) *Increased motor activity *Irritability *Hostility *Mood change
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| A PT must wait for how long after discontinuing MAOI use before they can take Selective Serotonin Reuptake Inhibitors (SSRIs), and why? | 14 days, due to potentially lethal interactions
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| Fill in the blanks: Inform the patient that insomnia usually decreases in ____ days, appetite returns to a more normal state in ____ days, and energy returns in ____ days. In ____ days, mood, concentration, and interest in life improve | 3-4, 5-7, 4-7, 7-10
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| When are Selective Serotonin Reuptake Inhibitors (SSRIs) administered in the AM | When they are taken for anxiety
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| When are Selective Serotonin Reuptake Inhibitors (SSRIs) administered in the PM | If medication makes PT drowsy
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| What electrolye imbalance must PTs on Selective Serotonin Reuptake Inhibitors (SSRIs) be monitored for? | hyponatremia
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| What is the action of Buproprion (Wellbutrin, Zyban)? | Blocks norepinephrine and dopamine reuptake
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| What is the action of Venlaxafine (Effexor)? | Inhibits reuptake of serotonin and norepinephrine. Inhibits dopamine to a lesser extent.
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| What is the action of Duloxetine (Cymbalta)? | Inhibits reuptake of serotonin and norepinephrine. Inhibits dopamine to a lesser extent
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| What is the action of Mirtazapine (Remeron)? | *Blocks serotonin *An α2- adrenoreceptor *Blocks histamine *Enhances both nonadrenergic and serotonergic transmitters
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| What drugs may help Tx SSRI-induced sexual dysfunction? | Mirtazapine (Remeron), Buproprion (Wellbutrin, Zyban)
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| What is Bipolar I Disorder? | *At least one episode of mania alternating with major depression *Psychosis may accompany the manic episode
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| What is Bipolar II Disorder? | *Hypomanic episode(s) alternating with major depression *Psychosis is not present in bipolar II *The depression tends to put people at particular risk for suicide
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| When do bipolar disorders emerge? | between the ages of 18 and 30
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| What are the first line mood-stabilizing agents use in Tx of Bipolar Disorders? | lithium and divalproex (Depakote)
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| What is lithium? | Lithium is a salt contained in the human body; it is similar to gold, copper, magnesium, manganese, and other trace elements
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| How long does lithium take to reach therapeutic levels? | 7 to 14 days
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| What is the therapeutic level of lithium? | 0.4mEq/L - 1.0mEq/L
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| What are the adverse effects of lithium? | *Fine hand tremor *Polyuria *Mild thirst *Mild nausea and general discomfort *Weight gain
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| What is the mildly toxic serum level of lithium? | 1.5 mEq/L
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| List 5 early S/Sx of lithium toxicity: | *Nausea *Vomiting *Diarrhea *Thirst *Polyuria *Slurred speech *Muscle weakness
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| What should be done if PT demonstrates S/Sx of lithium toxicity? | *Medication should be withheld *Blood lithium levels measured *Dosage reevaluated
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| List 5 S/Sx of advanced lithium toxicity: | *Course hand tremor *Persistent gastrointestinal upset *Mental confusion *Muscle hyperirritability *Electroencephalographic (ECG) changes *Discoordinated
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| What is the severely toxic serum level of lithium? | 2mEq/L - 2.5mEq/L
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| List 5 S/Sx of severe lithium toxicity: | *Ataxia *Serious ECG changes *Blurred vision *Clonic movements *Large output of dilute urine *Tinnitus *Seizures *Stupor *A severe hypotension *Coma *Death is usually secondary to pulmonary complications
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| What is the Tx for severe advanced lithium toxicity? | There is no known antidote for lithium poisoning. The drug is stopped and excretion is hastened with mannitol and aminophylline. Hemodialysis in severe cases.
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| Lithium can lead to what electrolyte imbalance? | Lithium decreases sodium reabsorption in the kidneys, which could lead to hyponatremia
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| A low sodium diet can lead to what in a PT on lithium? | a low sodium intake leads to possible hyponatremia and a relative increase in lithium retention, which could produce toxicity
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| A PT on lithium should be instructed to hold next dose of medication and contact physician if what symptoms occur? | excessive diarrhea, vomiting, or sweating
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| What drug class can be used as mood stabilizers in place of lithium? | Some Anticonvulsants
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| Why is the anticonvulsant Divalproex (Depakote) preferred for Tx of bipolar disorder over lithium in the united states? | Has a superior therapeutic index, a better toxicity profile, and a wider range of effectiveness in subtypes of bipolar disorder (e.g. rapid cycling and mixed mood states) as compared with lithium.
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| What is the only anticonvulsant mood stabilizer not associated with weight gain and in fact is associated with weight loss in up to 50% of patients? | Topiramate (Topamax)
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| What Tx of bipolar disorder involves the application of electrodes to the head to deliver an electrical impulse to the brain causing seizures? | Electroconvulsive Therapy (ECT)
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| When is Electroconvulsive Therapy (ECT) indicated? | *There is need for rapid response when PT is suicidal or homicidal *PT is in extreme agitation or stupor *PT develops life-threatening illness due to refusal of foods/fluids *PT has Hx of poor drug response, Hx of good ECT response, or both
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| What is the course of treatments for Electroconvulsive Therapy (ECT)? | 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.
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