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