NU249/NUR2488- Concept Guides- Exam 2
Mood: “affective disorders” • Applied cognitive theory to depression – people
acquire psychological predisposition to depression
• Mood = refers to state of emotion usually over longer through early life experiences. Which contribute to
period of time negative, illogical, and irrational thought process that
• Affect = current feelings and emotions – in nursing may remain dormant until activated during times of
we refer to clients affect = mood WE perceive them stress
to be experiencing • 3 automatic negative thoughts responsible for
• Mood disorders recognized by DSM5: bipolar development of depression
disorder, MDD, cyclothymia (depressed mood - Negative, self-deprecating view of self “I
includes some mild manic episodes), depressive never do anything well, everyone else seems
disorder (non-specified), dysthymic disorder (milder smarter”
depression), mood disorder due to medical condition, - Pessimistic view of the world
Seasonal affective disorder (SAD) - Belief that negative reinforcement (or no
• **Main goal = patient safety from self harm for any validation for the self) will continue “it
mood disorder doesn’t matter what you do, nothing
• Relapse likely when pt stops taking med because they gets better, I’ll be in the job forever”
feel better – starting and stopping meds can lead to • Triad Consistent in all types of depression regardless
treatment-resistant depression of clinical type
Depression Risk for suicide- Questions to ask,
• Women are 70% more likely to - Always take individual seriously if suicidal ideation
experience depression than men is mentioned
• Accompanies other psychiatric disorder - Ask “Are you thinking of harming (killing)
• Serotonin and norepinephrine = two major yourself?”
neurotransmitters involved in depression
High vs. low risk (Ch 23)
Define common symptoms: • High Risk = psychiatric d/o with severe symptoms of
• DSM5- when pt experiences 5 or more following acute precipitating event protective factors no
symptoms nearly ever day during the same 2 week relevant. Potentially lethal suicide attempt of
period and represents a change from previous persistent ideation with strong intent or suicide
functioning (at least one must be a depressed mood or rehearsal. Admission generally indicated – suicide
loss of interest of pleasure) precautions
- Depressed mood most of the day • Low Risk= modified risk factors, strong protective
- Markedly diminished interest/pleasure in factors. Thoughts of death, no plan, intent or
all or almost all activities most of the day behavior. Outpatient referral, symptom
- Significant weight loss/gain, reduction. Give emergency number/crisis
decreased/increased appetite numbers
- Insomnia or hypersomnia
- Psychomotor agitation or retardation Nursing Diagnosis (Table 15-2)
- Fatigue or loss of energy
• Disturbed thought processes
- Feelings of worthlessness or excessive or
• Chronic low self esteem
inappropriate guilt
- Diminished ability to think, concentrate, or • Imbalanced nutrition
indecisiveness • Constipation
- Recurrent thoughts of death (not fearing • Disturbed sleep pattern
dying) recurrent suicidal ideation without • Ineffective coping
a specific plan, or suicide attempt or • Spiritual distress
specific plan for committing suicide • Disabled family coping
• Diagnosis for MDD = symptoms must cause
significant distress on social, occupational, and other Communication Interventions (Table 15-
important functioning areas AND NOT DUE to
4) Physical Interventions (Table 15-5)
direct physiological effects of substance or general
medical condition. Classes: SSRI, TCA, MAOIs
Beck’s Cognitive Triad (p. 199) CBT SSRIs: Selective Serotonin Reuptake Inhibitors (first line
therapy and most popular)
, NU249/NUR2488- Concept Guides- Exam 2
• Citalopram, fluoxetine, fluvoxamine, states. Panic d/o, social phobia, GAD, OCD, PTSD and
paroxetine, sertraline bulimia.
Adverse/ Toxic Effects: high risk of hypertensive crisis,
Adverse Effects: increased risk of suicide for children and hypotension, sedation, weakness, fatigue, insomnia, changes
adolescents. Headache (usually only few days), nausea, in cardiac rhythm, muscle cramps, anorgasmia or sexual
sleeplessness/drowsiness, tremors, dizziness, sexual impotence, urinary hesitancy/constipation, weight gain.
dysfunction, agitation, anxiety, jitters, nervousness,
suicidal ideation - Hypertensive Crisis: severe headache, stiff sore neck,
Indications: depressive disorder, and anxiety disorders (e.g. flushing, cold, clammy skin, tachycardia, nosebleeds,
panics) in obsessive-compulsive spectrum dilated pupils, n/v chest pain, stroke, coma, death
Potential Toxic Effects: Interactions: tyramine or sympathomimetic drugs can lead to
cerebral hemorrhage or death
-Serotonin Syndrome: rare/life-threatening event, Drugs – OTC cold/allergy meds containing
greatest risk when SSRI admin with MAOI ephedrine, phenylephrine hcl, or phenylpropanolamine, TCAs,
(discontinue SSRI for 2 wk (5 weeks for Prozac) before narcotics, antihypertensive, levodopa, sedatives (alcohol,
starting MAOI – and at least 2 weeks before starting SSRI barbiturates, benzos), general anesthetics, stimulants
if on MAOI) Food - Increased tyramine levels lead to HTN crisis,
CVA, and possible death. MAOIs inhibit
- abd pain, diarrhea, sweating, fever, tachy, elevated breakdown of tyramine in liver. Must restrict intake
BP, alt. mental state, muscle spasms, increased motor of tyramine foods to prevent severe HTM (caffeine,
activity, irritability hostility, mood change, shock or death. ginseng,
TCAs: Tricyclic Antidepressants chocolate, sausages, pickled stuff, yeast products, avocados
especially overripe, fermented meats, milk and milk
• Amitriptyline, doxepin, nortriptyline, products, beer wine, figs, overripe fruits.
amoxapine, clomipramine Contraindications – CVA, HTN, CHF, liver
disease, consumption of foods containing tyramine,
Neurotransmitter Effects: inhibit reuptake of tryptophan, and dopamine, use of certain meds, recurrent or
norepinephrine and serotonin by presynaptic neurons in CNS severe headaches
Indications: admin at night to aid sleep, and compliance
Adverse Effects: anticholinergic effects,
tachycardia, esophageal reflux, orthostatic
hypotension, postural hypotension = dizziness and Refer to boxes 15-3, 15-4, 15-5, and 15-7
risk for falls. CARDIAC problems
Contraindications: 10-14 days or longer for effectiveness is Refer to tables 15-6, 15-7,15-8, 15-9
reached. Full effects = 4-8 weeks. Pt should maintain
therapy for 6-12 months to prevent early relapse. Caution in Other Therapies (ECT, Light Therapy)
older adults because slow drug metabolism may be a pg. 218
problem.
“Start Low, Go Slow” - Light Therapy: first line treatment for seasonal
affective disorder with or without medication. Full
spectrum wavelength light used. May also be useful
MAOIs: Monoamine Oxidase Inhibitors (second line in adjunct to meds in treated chronic MDD or
treatment and only used in depressions when resistant to other dysthymia PDD with seasonal exacs. Effective
meds) because influence of light on melatonin. Exposure
to light suppresses nocturnal secretion of melatonin.
• Phenelzine (Nardil), Tranylcypromine Replicates exposure to sunlight for 30-60mins/day
Sulfate (Parnate), Selegiline Transdermal • ECT: indicated if pt is suicidal or homicidal,
(STS) agitation or stupor is extreme. Life-threatening
STS – inhibits MAO in CNS, no breakdown of tyramine illness is a result of refusal of foods or fluids. History
occurs in the liver and digestive tract. NO restrictive diet includes a poor drug response or a good ECT
required with 6mg patch. Patch that has 9-12mg = NO response. Standard medical treatment has no effect.
tyramine diet IS required - Indicated: need for rapid, definitive response when pt
Neurotransmitter Effects: MAOIs prevent breakdown is suicidal or homicidal, extreme agitation or stupor,
of norepinephrine, serotonin, dopamine. Increased levels develops life-threatening illness because refusal of
= Increased mood. food/fluids, history of poor drug response, history of
Indications: for pt’s who have resisted other meds and ECT good ECT response or both, standard medical
treatment. Atypical depression, and re-refractory anxiety treatment has no effect
Mood: “affective disorders” • Applied cognitive theory to depression – people
acquire psychological predisposition to depression
• Mood = refers to state of emotion usually over longer through early life experiences. Which contribute to
period of time negative, illogical, and irrational thought process that
• Affect = current feelings and emotions – in nursing may remain dormant until activated during times of
we refer to clients affect = mood WE perceive them stress
to be experiencing • 3 automatic negative thoughts responsible for
• Mood disorders recognized by DSM5: bipolar development of depression
disorder, MDD, cyclothymia (depressed mood - Negative, self-deprecating view of self “I
includes some mild manic episodes), depressive never do anything well, everyone else seems
disorder (non-specified), dysthymic disorder (milder smarter”
depression), mood disorder due to medical condition, - Pessimistic view of the world
Seasonal affective disorder (SAD) - Belief that negative reinforcement (or no
• **Main goal = patient safety from self harm for any validation for the self) will continue “it
mood disorder doesn’t matter what you do, nothing
• Relapse likely when pt stops taking med because they gets better, I’ll be in the job forever”
feel better – starting and stopping meds can lead to • Triad Consistent in all types of depression regardless
treatment-resistant depression of clinical type
Depression Risk for suicide- Questions to ask,
• Women are 70% more likely to - Always take individual seriously if suicidal ideation
experience depression than men is mentioned
• Accompanies other psychiatric disorder - Ask “Are you thinking of harming (killing)
• Serotonin and norepinephrine = two major yourself?”
neurotransmitters involved in depression
High vs. low risk (Ch 23)
Define common symptoms: • High Risk = psychiatric d/o with severe symptoms of
• DSM5- when pt experiences 5 or more following acute precipitating event protective factors no
symptoms nearly ever day during the same 2 week relevant. Potentially lethal suicide attempt of
period and represents a change from previous persistent ideation with strong intent or suicide
functioning (at least one must be a depressed mood or rehearsal. Admission generally indicated – suicide
loss of interest of pleasure) precautions
- Depressed mood most of the day • Low Risk= modified risk factors, strong protective
- Markedly diminished interest/pleasure in factors. Thoughts of death, no plan, intent or
all or almost all activities most of the day behavior. Outpatient referral, symptom
- Significant weight loss/gain, reduction. Give emergency number/crisis
decreased/increased appetite numbers
- Insomnia or hypersomnia
- Psychomotor agitation or retardation Nursing Diagnosis (Table 15-2)
- Fatigue or loss of energy
• Disturbed thought processes
- Feelings of worthlessness or excessive or
• Chronic low self esteem
inappropriate guilt
- Diminished ability to think, concentrate, or • Imbalanced nutrition
indecisiveness • Constipation
- Recurrent thoughts of death (not fearing • Disturbed sleep pattern
dying) recurrent suicidal ideation without • Ineffective coping
a specific plan, or suicide attempt or • Spiritual distress
specific plan for committing suicide • Disabled family coping
• Diagnosis for MDD = symptoms must cause
significant distress on social, occupational, and other Communication Interventions (Table 15-
important functioning areas AND NOT DUE to
4) Physical Interventions (Table 15-5)
direct physiological effects of substance or general
medical condition. Classes: SSRI, TCA, MAOIs
Beck’s Cognitive Triad (p. 199) CBT SSRIs: Selective Serotonin Reuptake Inhibitors (first line
therapy and most popular)
, NU249/NUR2488- Concept Guides- Exam 2
• Citalopram, fluoxetine, fluvoxamine, states. Panic d/o, social phobia, GAD, OCD, PTSD and
paroxetine, sertraline bulimia.
Adverse/ Toxic Effects: high risk of hypertensive crisis,
Adverse Effects: increased risk of suicide for children and hypotension, sedation, weakness, fatigue, insomnia, changes
adolescents. Headache (usually only few days), nausea, in cardiac rhythm, muscle cramps, anorgasmia or sexual
sleeplessness/drowsiness, tremors, dizziness, sexual impotence, urinary hesitancy/constipation, weight gain.
dysfunction, agitation, anxiety, jitters, nervousness,
suicidal ideation - Hypertensive Crisis: severe headache, stiff sore neck,
Indications: depressive disorder, and anxiety disorders (e.g. flushing, cold, clammy skin, tachycardia, nosebleeds,
panics) in obsessive-compulsive spectrum dilated pupils, n/v chest pain, stroke, coma, death
Potential Toxic Effects: Interactions: tyramine or sympathomimetic drugs can lead to
cerebral hemorrhage or death
-Serotonin Syndrome: rare/life-threatening event, Drugs – OTC cold/allergy meds containing
greatest risk when SSRI admin with MAOI ephedrine, phenylephrine hcl, or phenylpropanolamine, TCAs,
(discontinue SSRI for 2 wk (5 weeks for Prozac) before narcotics, antihypertensive, levodopa, sedatives (alcohol,
starting MAOI – and at least 2 weeks before starting SSRI barbiturates, benzos), general anesthetics, stimulants
if on MAOI) Food - Increased tyramine levels lead to HTN crisis,
CVA, and possible death. MAOIs inhibit
- abd pain, diarrhea, sweating, fever, tachy, elevated breakdown of tyramine in liver. Must restrict intake
BP, alt. mental state, muscle spasms, increased motor of tyramine foods to prevent severe HTM (caffeine,
activity, irritability hostility, mood change, shock or death. ginseng,
TCAs: Tricyclic Antidepressants chocolate, sausages, pickled stuff, yeast products, avocados
especially overripe, fermented meats, milk and milk
• Amitriptyline, doxepin, nortriptyline, products, beer wine, figs, overripe fruits.
amoxapine, clomipramine Contraindications – CVA, HTN, CHF, liver
disease, consumption of foods containing tyramine,
Neurotransmitter Effects: inhibit reuptake of tryptophan, and dopamine, use of certain meds, recurrent or
norepinephrine and serotonin by presynaptic neurons in CNS severe headaches
Indications: admin at night to aid sleep, and compliance
Adverse Effects: anticholinergic effects,
tachycardia, esophageal reflux, orthostatic
hypotension, postural hypotension = dizziness and Refer to boxes 15-3, 15-4, 15-5, and 15-7
risk for falls. CARDIAC problems
Contraindications: 10-14 days or longer for effectiveness is Refer to tables 15-6, 15-7,15-8, 15-9
reached. Full effects = 4-8 weeks. Pt should maintain
therapy for 6-12 months to prevent early relapse. Caution in Other Therapies (ECT, Light Therapy)
older adults because slow drug metabolism may be a pg. 218
problem.
“Start Low, Go Slow” - Light Therapy: first line treatment for seasonal
affective disorder with or without medication. Full
spectrum wavelength light used. May also be useful
MAOIs: Monoamine Oxidase Inhibitors (second line in adjunct to meds in treated chronic MDD or
treatment and only used in depressions when resistant to other dysthymia PDD with seasonal exacs. Effective
meds) because influence of light on melatonin. Exposure
to light suppresses nocturnal secretion of melatonin.
• Phenelzine (Nardil), Tranylcypromine Replicates exposure to sunlight for 30-60mins/day
Sulfate (Parnate), Selegiline Transdermal • ECT: indicated if pt is suicidal or homicidal,
(STS) agitation or stupor is extreme. Life-threatening
STS – inhibits MAO in CNS, no breakdown of tyramine illness is a result of refusal of foods or fluids. History
occurs in the liver and digestive tract. NO restrictive diet includes a poor drug response or a good ECT
required with 6mg patch. Patch that has 9-12mg = NO response. Standard medical treatment has no effect.
tyramine diet IS required - Indicated: need for rapid, definitive response when pt
Neurotransmitter Effects: MAOIs prevent breakdown is suicidal or homicidal, extreme agitation or stupor,
of norepinephrine, serotonin, dopamine. Increased levels develops life-threatening illness because refusal of
= Increased mood. food/fluids, history of poor drug response, history of
Indications: for pt’s who have resisted other meds and ECT good ECT response or both, standard medical
treatment. Atypical depression, and re-refractory anxiety treatment has no effect
