MH exam 2

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jsullivan
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73874
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MH exam 2
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2011-03-19 16:47:46
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personality mood
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mh exam 2
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  1. serotonin and norepinepherine neurotransmitters are? w/ depression?
    decreased
  2. serotonin and norepinephrine neurotransmitters are? w/ mania?
    increased
  3. How is MDD classified?
    • -depressed mood and/or anhedonia QD x 2wks plus four or more of the following:
    • 1) change in appetite, weight, sleep
    • 2) fatigue
    • 3)poor concentration/indecisiveness
    • 4) agitation or retardation
    • 5) feelings of worthlessness/guilt
    • 6) s/i
  4. What are some types of the sub-types for MDD?
    • 1) catatonic features
    • 2) melanchoic features
    • 3) atypical features
    • 4) Seasonal Affective D/O
    • 5) postpartum onset
    • 6) psychotic features
  5. What are the atypical features of MDD?
    • -mood reactivity (mood brightens in respnse to external events, like someone visiting pt.)
    • -significant weight gain and incr. appetite
    • -hypersomina
    • -leaden paralysis (feeling weighted down in extremeties)
    • -extreme sensitivity to interpersonal rejection (causes significant occupational or social impairment)
  6. Discuss the psychotic features sub-type of MDD
    • * delusions or hallucinations
    • -mood congruent: content is consistent w/ typical depressive themes (eg. personal inadequacy, guilt, desease, nihilism, deserved punishment)

    -mood incongruent: content not typical of depressive themes (e.g. thought insertion (someone is inserting thoughts into my brain), thought broadcasting (ppl can read my thoughts), delusions of control
  7. What are the key features of Dysthmic Disorder?
    • 1) low grade, rarely remitting depression
    • 2) depression that lasts >1 year in children and >2 years in adults
    • 3) may have atypical features
  8. Discuss SSRIs
    • Selective Serotonin Reuptake Inhibitors:
    • -1st tx of choice
    • -can cause serotonin syndrome
    • -s/e: wt gain, sexual dysfunction

    Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft
  9. What is serotonin syndrome?
    • - overabundance of serotonin in the CNS
    • Symptoms:
    • -confusion, diaphoresis, hyperreflexia, ataxia, myoclonus (brief, involuntary twitching of a muscle or a group of muscles), restlessness, shivering, tremor

    -occurs when agents are used together w/ MAOI's or St. John's Wort, or other drug combos
  10. How do Dual Reuptake/Novel Agents work? What are they?
    they work on more than 1 NE

    • Cymbalta (NE and SE)
    • Effexor (NE and SE)
    • Remeron (NE and SE)
    • Wellbutrin (NE and DA)
  11. Discuss Tricyclic andidepressants (TCAs).
    • TCAs:
    • -older, less commonly used bc of anticholinergic effects...caution use in elderly bc they are already dehydrated!
  12. What are the TCAs? S/E?
    • (most generic names end in -ine) Sinequan, Anafranil, Elavil, Endep, Ludiomil, Norpramine, Pertrofane, Pamelor, Surmontil, Tofranil, Vivactil...
    • S/E: anticholinergic!
    • -dry mouth, blurred vision, constipation, orthostatic hypotension, sexual dysfunction, agranulocytosis, wt. gain/loss, tremor
  13. Discuss MAOIs antidepressant
    • -used rarely
    • -can cause hypertensive crisis
    • -pt. must be on tyramine restricion diet
    • -EMSAM- new transdermal patch, fewer restrictions
  14. What are the MAOIS
    Nardil, Parnate, marplan, Emsam
  15. Discuss the Hypertensive Crisis that can occur w/ MAOI's
    • when meds prevent the breakdown of the monoamine it builds up, resulting in:
    • -severe occipital or temporal HA
    • -diaphoresis
    • -mydriaisis (excessive pupil dilation)
    • -nuchal rigidity
    • -palpations
    • -elevated BP
  16. What are the food restrictions for a pt. on MAOIs?
    • avoid: beer/red wine, aged cheese, dry sausage, fava or italian beans, brewers yeast or Marmite extract, smoked fish, liver, sauerkraut
    • avoid in large amounts: ripe avocado, yogurt, ripe bananas, soy sauce
  17. What are the mood stabalizers?
    Lithium, Tegretol, Depakote, Lamictal, (atipical antipsychotics like Zyprexa)
  18. What is the therapeutic range for lithium? discuss lithium
    -therapeutic range = 0.05-1.5, draw serum levels 12 hours after last dose

    -don't restrict fluid or salt and use caution w/ diuretis bc
  19. What are Lithium s/e?
    -polyuria, polydipsia, muscle weakness, fine tremor, GI upset, diarrhea, nausea
  20. What are s/sx of severe Lithium toxicity?
    • lethargy, impaired concentraion or confusion, coma, seizures, ataxia, twithching, coarse tremors, dysarthria, nustagmus, nephropathy, (2.5-3.5= very dangerous levels)
    • -w/ chronic use= nephrogenic DI and chronic RF, hypothyroidism
  21. What are some causes of Lithium toxicity?
    • -OD
    • -kidney disease
    • -Na deficiency
    • -strange/drastic diets
    • -diuretics
    • -fevers
    • -gastroenteritis
    • -dehydration
  22. Bipolar I
    one or more manic or mixed episodes, may be accompanied by psychosis
  23. Bipolar II
    one or more major depressive disorders w/ at least 1 hypomanic episode, psychosis is not present
  24. Cyclothymic disorder
    • -at least 2 years of numerous hypomanic episodes and periods of depressive symptoms (pt. is cycling)
    • -specifiers: "rapid cycling" = 4 or more episodes in 12 months, or seasonal pattern
    • -either bipolar I or II can be mixed
  25. How can mania be evidenced in adolesence?
    • -psychotic features
    • -truancy
    • -antisocial behavior
    • -drug use
    • -school failure
    • -possible long-standing behavioral problems (prodromal? {early s/sx of bipolar?})
    • -mean onset of 1st manic episode: early 20s
  26. what is the course of a manic episode?
    • rapid onset, often occur after a significant stressor
    • episodes last few wks to several months and end abruptly, often followed bya MDD episode

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