Mood/Affect
What is the therapeutic range of Lithium
0.6-1.5 mEq
What 3 things do you ask to evaluate a suicide plan to determine the degree of the suicidal risk
1. is there a specific plan 2. how lethal is the proposed method 3. is there access to the planned method
How long does it take for Zoloft to reach effectiveness
7-10 days or 2-4 weeks
What are nurses qualified to assess
Affect
What are the key points in a mental status assessment
Appearance, behavior, speech, mood, disorders of the form of though, perceptual disturbances, cognition, ideas of harming self or others
What foods are Tyramine found in
Beer, aged cheese, wine, pickled/smoked fish
Action of TCAs
Block the receptor in the brain to acetacholine
What are some examples of low risk lethality methods
Cutting one's wrist, inhaling natural gas, and overdosing on pills
Examples of Antiepileptic drugs (AEDs)
Depakote, Tegretol, Lamictal
Examples of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Effexor, Cymbalta
Examples of Tricyclic Antidepressants (TCAs)
Elavil, Tofranil
Treatment for post-partum depression without psychotic features
Gradual improvement over 6 months after birth, antidepressants, antianxiety, ECT, herbs, dietary supplements, acupuncture, psychotherapy
A patient must have 3 of the following signs to be considered manic in postpartum depression with psychotic features
Grandiosity, decrease need for sleep, changed speech, flight of ideas, psycho-motor agitation, excessive involvement in pleasurable activities without regard to negative consequences
What are some examples of high risk lethality methods
Gun, jumping, hanging, poisoning with carbon monoxide, staging a car crash
Action of MAOIs
Interfere with the destruction of the neurotransmitters, by doing this it increases the synaptic level of the neurotransmitters happening in the brain
Pharmacological therapy used in bipolar disorder
Lithium (drug of choice), Depakote, tegretol, antianxiety meds, antipsychotic meds such as ability or Risperdal
Examples of mood stabilizers
Lithium, Depakote, Tegretol, Lamictal
What types of disorders is Lamictal NOT used for
Manic patients
People with bipolar disorder often exhibit
Manipulative behavior and aggressive behavior
What are some adverse effects of SSRIs
May inhibit spinal reflexes, decrease libido, nausea, and vomiting
Examples of Monoamine Oxidase Inhibitors (MAOIs)
Nardil, Parnate
What is another disorder in which Cymbalta used in?
Neuropathy
Action of lithium
Not completely understood, but they think it strengthens nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior
Why is Tyramine avoided in patients on MAOIs
People on MAOIs are unable to have Tyramine broken down by the liver which can cause a hypertensive crisis
What are 3 defining characteristics of mood disorders
Persistent mood, functional impairment, and disturbed vegetative functioning
Examples of Selective Serotonin Reuptake Inhibitors (SSRIs)
Prozac, Zoloft, Paxil, Celexa, Lexapro
Examples of anti-depressants
Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor, Cymbalta, Nardil, Parnate, Elavil, Tofranil
What happens inn Neuroleptic Malignant Syndrome or Serotonin Syndrome
Reduced consciousness, increased muscle tone, and autonomic dysfunction; life threatening medical emergency
What class of medications causes hypertension in 5% of patients
SNRIs
What is term Melancholy used for
Sadness, despair, and loss of function
Risk factors for depression
Stress, early trauma, neglect, abuse, family history, personality disorders, an psychiatric disorders
Mood is a ________ experience
Subjective
Treatment for postpartum depression with psychotic features
Supportive family, possibly hospitalization, antipsychotics, mood stabilizers, close supervision with infant, psychotherapy, careful use of antidepressants as can cause rapid cycling
What is Postpartum depression with psychotic features
Syndrome characterized by depression, delusions, and thoughts of harming the infant or herself
What is a nursing consideration when a patient is on Tofranil
Tell the patient to rise slowly, can cause orthostatic hypotension
Why are TCAs no longer used as the first line of medications for mood/affect disorders
These medications have many adverse side effects such as blurred vision, dry mouth, tachycardia, and urinary retention
What type of foods do you avoid with MAOIs
Tyramine
What are some things a nurse would look for in an assessment for depression
agitation, sadness, elation, blunting,
What are some general nursing cares after a patient receives ECT
assess airway, mental status, treat like any other post-op patient
Assessment findings in bipolar disorder
becomes angry quickly, delusional self-confidence, flight of ideas, unlimited energy, inappropriate affect, inability to eat or sleep, dress inappropriately
Signs and symptoms present in Postpartum depression with psychotic features
begins days after birth, onset it 2-3 weeks and almost always within 8 weeks, complains of fatigue, insomnia, restlessness, and inability to move, stand, or work, moms may think baby is the devil and they need to kill it, can have a manic episode present for at least 1 week
What is the action of SSRIs
block the reuptake of and destroy serotonin side effects that an individual may experience
Side effects of TCAs
blurred vision, dry mouth, tachycardia, urinary retention
What are some signs of severe depression
despair and hopelessness, guilt, feel worthless, flat affect, poor posture and hygiene, delusions and hallucinations, terminal insomnia
Side effects of Tegretol
dry mouth, urinary retention
What is the treatment for Neuroleptic Malignant Syndrome
early detection, stop any antipsychotic medications, fluid balance, temperature reduction, and monitoring for complications
What is bipolar disorder
episodes of mania and depression with periods of normal mood and activity in between
How often are labs monitored once a patient has reached therapeutic lithium levels
every 1-2 months
What triggers mild depression
external event followed by the normal grief reaction
When a person eats foods in Tyramine and on MAOIs, what would be the first symptom a patient would exhibit as an adverse reaction
headache
What are the side effects of Electroconvulsive Therapy
headache, nausea, muscle aches, and occasional memory loss
Action of SNRIs
increase serotonin and norepinephrine in the brain
What does lethality mean
indicates how quickly a person would die by a certain method
What is Mania
individuals who are recognized by the presence of euphoric or agitated affected states, and they often suffer from varying degrees of perceptual disturbances (hallucinations)
What are some signs of post-partum depression without psychotic features
irritability is a distinguishing feature, reject infant, abnormal jealousy, obsessive thoughts about harming infant are frightening to mother, may appear awkward in responses to baby
How long does mild depression last
less than 2 weeks
Signs and Symptoms of lithium toxicity
lethargy, muscle weakness, slurred speech, blurred vision, tonic-clonic seizures, and death in severe toxicity
What labs are monitored when on Tegretol
liver enzymes, and CBC
What are examples of de-escalation techniques
maintain safety for everyone, use calm approach, avoid verbal struggles, provide clear options for client, assist with problem solving
Affect is a ________ reflection of mood
objective
What causes Neuroleptic Malignant Syndrome
occurs in patient who have taken conventional antipsychotics; reduction in brain dopamine activity plays a role; rare but can happen if on antipsychotic drugs
What is depression
overwhelming sadness and despair that one feels drained of energy.
What are some signs of moderate depression
persists over time, a person senses a change and often seeks help, low self esteem, helplessness, slow thought process, social withdrawal, anorexia, weight loss, and fatigue
Action of AEDs
reduce the firing rate at very high frequency in the neurons in the brain that helps with the mood swings
What are some interventions for people with mania
remove harmful objects, assess for fatigue, monitor sleep patterns, provide frequent rest periods, use calm and slow interactions, set limits, help focus on one topic, reduce stimuli, avoid competitive games, provide quick finger food snacks for increased nutrition
What is Affect
the observable response a person has to his/her own feelings
What is Mood
the way a person feels
Side effects of Depakote
tremors, weight gain, patient may become sedated
How long does it take for Effexor to reach effectiveness
up to 4 weeks
What is hypomania
when a person is agitated or possibly in euphoric states, but is less severe than mania