Cognitive

mental functions, the process of knowing, perception, reasoning, learning, ability to think, attention, problem solving, comprehend & judgement

anergia

lack of energy

cyclothymia

a mild bipolar d/o that persists over a long time ; a chronic mental disturbance characterized by mood swings & depression

dysphoria

mood that involves unhappiness, restlessness, and malaise

dysthymia

a chronic mild depression in which the ability to enjoy life is limited & there is a lack of motivation to achieve in school or work

ECT

Electroconvulsive therapy

used to treat depression in select groups such as clients who do not respond to antidepressants or those who experience intolerable medication side effects at therapeutic doses

euthymic

normal or level mood

hypomania

period of abnormally & persistently elevated, expansive, or irritable mood lasting 4 days, does not impair the ability to function and does not improve psychotic features

rumination

to repeatedly go over the same thoughts

tyramine

amino acid dereived from tyrosine; sympathomemetic action, found in chocolate, cola, aged cheese, beer

***pt's taking MAOI's should avoid tyramine containing foods*****

Antidepressants

Tricyclics:  x5-6wks to work, lethal in overdose: amitriptyline (elavil, Endep), clomipramine (anafranil), doxepin (sinequan), imipramine (tofranil)

MAOI: too restrictive: phenelzine (Nardil), isocarboxid (marplan), tranylcypromine (parnate)

SSRI: for major depression: citalopram (celexa), fluoxetine (prozac), fluvoxamine (luvox), paraxetine (paxil), setraline (zoloft)

SNRI : for major depression: venlafaxine (effexor), duloxetine (cymbalta)

Miscellaneous: bupropion (wellbutrin), mirtazapine (remerone), nefanzodone (Serzone), trazodone (desyrel)

Antidepressants

Indications, Actions, Contraindications, Nursing

Indications: to tx major depression, dysthymic d/o, elevate mood & alleviate mod-severe depression, to tx depression associated w/ other d/o's

Action: prevent reuptake of dopamine, noriepi and serotonin resulting in increase of these neurotransmitters

Contraindications/Caution: cardiac, renal, or hepatic insufficiency, elderly or debilitated, psychotic, angle closure glaucoma, BPH & seizure hx

Nursing: anticholinergic s/e(dry mouth, constip, urin ret, blurred vis), sedation, ortho hypo, reduced seizure threshold, tachy, arrhythmias, photosensitivity (tricycl), hypertensive crisis (MAOI), weight loss (SSRI)

do not stop drug abruptly, sunscreen, rise slowly, no etoh, no other meds w/o dr approval

Antimanic Mood Stabilizing Agents

Lithium Carbonate (Eskalith, Lithane)

Indications: tx mania, prevention of bipolar manic-depressive illness, adjunct or alternative to antidepressants in sever recurrent depression & acute major depression

Action: unknown mechanism, efects level of serotonin, noriepi, and distribution of Na, Ca, Mg, & glucose metabolism may account for antimanic and modd stabilizing effects

Contraindications: impaired renal or cardiac function, risk vs benefit if pregnant

Nursing: assess renal, cardia, & thyroid status during therapy, assess electrolytes, monitor blood lithium levels, obtain sample 8-12h after last oral dose, 2x wkly during initiation of tx and q1-3m for chronic tx, give w/ food or milk, adequate Na intake (low Na levels = lithium tox), drink 2000-3000ml day, avoid sodium loss (sweating, saunas, etc.)

Lithium

Therapeutic Levels

Therapeutic Plasma Range

Acute Mania:  1.0-1.5meq/L

Maintenance:  0.6-1.2meq/L

Lithium Toxicity s/s

N, V, Diarrhea, slurred speech, weakness, confusion, blurred vision

AntiManic Mood Stabilizing Agents

to treat BiPolar d/o

Anticonvulsants (seizure drugs to tx bipolar illness)

carbamazepine (tegretol)

gabapentin (neurontin)

valproic acid (depakote, depakene) **depakote 1st drug of choice

lamotrigine (lamictal)

Antimanic Mood Stabilizing Agents

Anticonvulsants for Bipolar D/O

Indications, Actions, Contraindications/Cautions, Nursing

Indications: unlabeled use, tx bipolar mania in combination w/ lithium carbonate or alone when lithium is contraindicated

Action: enhance effects of the inhibitory neurotransmitter GABA

Contraindications/Cautions: hypersensitivity, glaucoma, liver disease, caution in elderly, liver, renal, cardiac disease

Nursing: regular blood tests to avoid dyscrasias, platelet & bleeding times prior to start of valproic acid, monitor for bleeding/bruising, s/s liver impairment, LFT prior to start of meds, monitor for lamotragine tox if used w/ depakote

Suicide & Depression

Depressed individuals who are newly taking antidepressant medication are at an increased risk for suicide

ECT & Pregnancy

ECT can be safely administered to pregnant women

Lack of energy

Depressed individuals can experience a lack of energy known as anergia

Kindling

a process by which seizure activity in the brain is initially stimulated by the cumulative effects o stress, low amount o electric impulses, or chemicals that sensitize neuronal pathways

Hypertensive Crisis

Pts taking MAOI's and who eat foods containing tyramine risk experiencing a hypertensive crisis, which is a potentially fatal reaction

Labile Emotions

An individual experiencing mania can exhibit rapidly changing emotions, also known as labile emotions

Psychodynamic Theories of Freud

the approach to mood disorders , there is a belief that anger turned inward towards oneself can lead to depression

Categories of Mood disorders

Major Depression: (MDD) 2 or more wks of sad mood, lack of interest in life activities, etc.

Bipolar D/O: (BAD) mood cycles of mania and/or depression and normalcy, etc..

Related Mood D/O:

Dysthmia: sadness, low energy, not severe enough to be dx'd w/ MDD

Cyclothymia: mood swings not severe enough to be dx'd w/ BAD

Substance-induced D/O

Mood D/O: due to a general medical condition

Seasonal Afective disorder

Postpartum or maternity blues

Postpartum Depression (hormonally induced)

Postpartum Psychosis

S/S of Adult Depression

Physical: psychomotor activity, sleep, appetite, GI, Neurologic, & sexual disturbances

Psychological: affect, thought & intellectual processes

S/S of Adolescent Depression

agressiveness

running away

delinquency

social w/drawal

inappropriate anger

substance abuse

restlessness

apathy

S/S of Depression in Children

bored, angry, sad, irritable

may not have typical sadness of adults

crying for no reason

tiredness

being rejected or rjecting others

fighting with others

S/S of Depression in the Elderly

s/s similar to dementia

preoccupation w/ physical symptoms (more acceptable)

maintain grooming and cheerful affect

more prone & successful to suicide

s/s of Mania

euphoria, anger, confident, underlying irritability

decr. attention span, Flight of Ideas, overspending, delusional, disoriented

^activity, decr nutrition, insomnia, bizarre dressing, ^sexual activity, poor hygiene, shouting, destructive

Bipolar D/O

Dx requires:

a manic episode of mania (=1 wk of unusual and heightened behavior/mood) in addition to 3 or more of the following:

exaggerated self esteem

sleeplessness

pressured speech

flight of ideas

decr ability to filter extraneous stimuli

^activity w/ ^ energy

multiple, grandiose, high risk activities

Tx: Lithium, Anticonvulsants (depakote), & psychotherapy

Hopelessness (and helpless)

is a trigger word for suicide

Nurses job is to provide hope until they can find it themselves