Mood Disorders

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  1. Depression has an under activity of what
  2. Mania has an overactivity of what
  3. what is kindling
    neurtransmision altered by stress
  4. Individuals with depression experience
    great personal pain and suffering
  5. Depression is common in what ages
    All ages
  6. What is Mood
    how they feel subjective that the pt shares with you directly what the pt states
  7. What is Affect
    the objective presentation of the pts face what you see
  8. What two disorders are mood and affect affected in
    Mania and Schizophrenia
  9. To be diagnosed with major depression a loss of interest in ADLs must be consistent for how many weeks
    2 wks
    A depressive syndrome frequently accompanies other psychiatric disorders

    • ~schizophrenia
    • ~ substance abuse,
    • ~ eating disorders,
    • ~ anxiety disorders, and personality disorders.

    Depression is high among people with a medical disorder.
  11. What are the two primary S/S of Major Depressive Disorder
    depressed mood and anhedonia
  12. What are two things that would not make you get a diagnosis of Major Depressive Disorder
    A Manic of Hypomanic episode
  13. What are assessment findings that are found in pts with MDD
    •Suicidal ideation

    •Anhedonia and anergia

    •Psychomotor retardation/agitation

    •Vegetative signs

    •Sad affect

    •Slow and/or negative thinking

    •Hopeless, helpless, worthless feelings

    •Poor memory, concentration
  14. Dysthymia
    • Form of depression but can still function: can still do
    • ADL but describe adhbionia for about 2 years

    2 years for adults and 1 year for children
  15. Dysthymia Symptoms Need Three of the Following for Two Years for Adults
    • •Chronic, low-level depression
    • •Poor appetite or overeating
    • •Insomnia or hypersomnia
    • •Low energy/fatigue
    • •Low self-esteem
    • •Negative thinking/guilt
    • •Poor concentration/decision making
    • •Hopelessness
    • •Irritability/anger
    • •Anhedonia/withdrawal
  16. What are S/S in Young people with Depression
    irritable, hostile (Comorbidity: ADHD, anxiety, & substance abuse)
  17. Electroconvulsive Therapy ECT
    •Useful treatment for pharmacotherapy-resistant clients with major psychotic disorder

    •Informed consent required

    •Pretreatment routine similar to preop routine

    •Post treatment routine similar to recovery room

    •Side effects: headache, temporary loss of recent memory
  18. Pharmacological Treatment For Depressive Disorders

    •Specific Atypical New Generation Antidepressants


  19. What are the Bipolar Disoders
    •Bipolar I

    •Bipolar II

    •Cyclothymic Disorder

    •Substance Induced Mood Disorder
  20. Bipolar Disorder is characterized by
    Euphoria and Depression
  21. Bipolar Disorder has the highest
    Suicide Rate
  22. Bipolar I
    •At least one episode of mania alternating with major depression

    –Psychosis may accompany manic episode
  23. Bipolar II
    Hypomanic episode(s) alternating with major depression

    –Not accompanied by psychosis
  24. Rapid Cycling
    four or more episodes in 12-month period)
  25. Cyclothymic Disorder
    •Alternating hypo-mania and depressive episodes.

    •involves cycling between highs and lows, but it never reaches full mania or major depression

    •Hypo-mania: change in mood must be evident for at least 4 days

    •Over a lifetime, the chances of having Cyclothymic Disorder are from 0.4% to 1%.
  26. S/S of Bipolar in young pts
    irritable, impulsive, aggressive, risk taker & hostile

    frequently have rapid cycling

    •Thinking usually grandiose & illogical

    •Treatment: many require long-term or lifelong psychopharmacology
  27. Stage I Hypomania
    • symptoms are not sufficiently severe to cause marked impairment in social/occupational
    • functioning or to require hospitalization

    Happy, humorous, and productive

    Judgement becomes impaired
  28. Stage II Acute Mania
    • marked impairment in functioning of mood (lability), cognition, perception, activity, and behavior. The
    • individual typically requires hospitalization

    Profound impairment to judgement go from sad angry happy in short amount of times, no boudry,
  29. What are the 3 common initial Symptoms of Mania
    elated mood, increased activity, reduced sleep.

    • Some clients demonstrate irritability rather than
    • elation.
  30. Stage III Delirious Mania
    • a grave form of the disorder that is characterized by severe clouding of consciousness and an intensification of the
    • symptoms associated with acute mania. The patient’s safety is at stake.
  31. Assessment Findings in Bipolar Disorder
    • •Intrusiveness/ Poor Boundaries
    • •Flight of Ideas
    • •Impulsivity
    • •Grandiosity
    • •Delusions of Grandeur/ Persecution

    • •Displays poor judgment
    • •Typically poor historians
    • •Exhibits psychomotor agitation
    • •Pressured speech
    • •Projects feelings to others
    • •Difficulty problem solving/ “Nothings wrong”
  32. Pharmacological Treatment Bipolar Disorders

    •Carbamazepine (Tegretol)

    •Valproic Acid (Depakene)

    •Gabapentin (Neurotin)

    •Topiramate (Topamax)

    •Lamotrigine (Lamictal)

    •Oxcarbazepine (Trileptal)

    •Select Atypical Antipsychotics

    Select Benzodiazepines
  33. TCAs have common what
    sedation and weight gain
  34. What are the adverse effects of TCAs
    • anticholinergic side effects
    • orthostasis
    • CHF effects
    • Lethal in overdose
  35. What are the TCAs
    • elvail, endep
    • asendin
    • norpramin, pertofrane
    • Adapin, sinequan
    • tofranil
    • Aventyl, pamelor
    • Vivactil
    • Surmontil
    • Ludiomil
  36. SSRIs have minimal and rare what
    minimal sedation and rare weight gain
  37. What are the adverse effects in SSRIs
    • nausea, loose BMs, headace, insomnia
    • serotonin syndrom
  38. What are the SSRIs
    • celexa
    • Prozac
    • Luvox
    • Paxil
    • Zoloft
    • Lexapro
  39. What are the symptoms of Serotonin Syndrome
    • hyperactivity or restlessness
    • tachycardia anc cardovascular shock
    • fever and hyperpyrexia
    • elevated BP
    • altered mental status
    • seizures and status epilepticus
    • myoclonus
    • abdominal pain
    • apnea and death
  40. What serotonin receptor blockades can be given in Seretonin Syndrome
    • cyproheptadine
    • methysergide
    • propranolol
  41. in Serotonin Syndrome what can be given for hyperthermia
    Chlorpromazine and cooling blankets
  42. In Serotoin Syndrome what can be given for muscle rigidity or rigors
    Dantrolene and diazepam
  43. What are the Newer Atypical Agents
    • wellbutrin
    • Zyban
    • Desyrel (Trazodone)
    • Effexor
    • Remeron
    • Cymbalta
  44. What is the pt taking Wellbutrin at risk for
    high seizure risk in at-risk pts
  45. What treatment is Effexor useful in
    Treatment-resistent chronic depression
  46. What is Remeron
    antidote to SSRI sexual dysfunction
  47. What are the MAOIs
    • Nardil
    • Parnate
    • Slegiline transdermal system (EMSAM) skin patch
  48. What is the most critical side effect of MAOIs in older adults
    hypotension risk for falls and injury
  49. What is a toxic effect of an MAOI
    Hypertensive crisis

    often related to interaction with food and select over the counter meds
  50. What are the Hypertenive crisis side effects
    • severe headache
    • stiff neck
    • flushing, cold and clammy skin
    • tachycardia
    • severe nosebleeds
    • dilated pupils
    • chest pain, stroke
    • coma
    • N/V
    • death
  51. What can be given to lower BP in a pt going through hypertensive crisis
    • 5 mg IV phentolamine (regitine)
    • OR
    • oral chlorpromazine

    • OR
    • Procardia: a calcium channel blocker 10mg sub lingual
  52. What are the AEDs
    • Tegretol
    • Depakene
    • Lamictal
    • Neurontin
    • Topamax
  53. What two AEDs can be used off label for bipolar
    Neurontin and Topamax
Card Set
Mood Disorders
midterm mood disorders
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