NR546 WEEK 5 TEST YOUR
KNOWLEDGE QUESTIONS AND
ANSWERS
Pharmacologic Treatment of Major Depressive Disorder - ANSWER: Selective
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serotonin reuptake inhibitors (SSRIs)
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Serotonin-norepinephrine reuptake inhibitors (SNRIs) bg bg bg
Norepinephrine and dopamine reuptake inhibitors (NDRIs) bg bg bg bg bg
Serotonin antagonists and reuptake inhibitors (SARIs)
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Miscellaneous antidepressants bg
Monoamine oxidase (MAO)-B inhibitors bg bg bg
Adjunct: antipsychotics bg
Pharmacologic Treatment of Bipolar Disorder - ANSWER: Lithium bg bg bg bg bg bg bg
Anticonvulsants
Second generation antipsychotics
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Mood disorders: role of the psychiatric mental health nurse practitioner (PMHNP) is to:
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- ANSWER: determine the malfunctioning brain circuit responsible for the client's
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presenting symptoms and select the appropriate medication that targets the
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associated neurotransmitter(s)
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Mood disorders manifest across a spectrum from: - ANSWER: mania to major
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depressive disorder (MDD)
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Unipolar depression - ANSWER: major depressive disorder (MDD)
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one of the most common mental disorders
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-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest
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(13.1%) among individuals aged 18-25
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S/S
-depressed mood bg
-loss of interest or pleasure in daily activities
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-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
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-severe depression: may experience thoughts of suicide or psychotic symptoms.
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Bipolar disorder (BD) - ANSWER: Chronic condition characterized by extreme
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fluctuations in mood, energy, and ability to function
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,-Moods may be manic, hypomanic, or depressed and may include mixed mood or
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psychotic features
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-many have only experienced only one manic episode in their lifetime
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-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
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-diagnosed when a client has one or more episodes of mania or hypomania with a
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history of one or more major depressive episodes
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-high risk for suicide bg bg bg
mania - ANSWER: characterized by a persistently elevated, expansive, or irritable
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mood. Related symptoms may include inflated self-esteem, increased goal-directed
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activity or energy, including grandiosity, decreased need for sleep, excessive
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talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor
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agitation, and a propensity to be involved in high-risk activities. Mania leads to
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significant functional impairment and may include psychotic features or necessitate
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hospitalization
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Bipolar Type I: - ANSWER: requires at least one episode of mania for at least one
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week (or any duration if hospitalization due to symptoms is required)
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Bipolar Type II: - ANSWER: diagnosis requires a current or past hypomanic episode
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and a current or past major depressive episode. Symptoms last for at least 4 days
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but fewer than seven.
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-Hypomanic symptoms are not of sufficient duration or severity to cause significant
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functional impairment, psychosis, or hospitalization.
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-Anger and irritability are common.bg bg bg bg bg
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms,
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making bipolar more difficult to diagnose if the client presents in the depression
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phase.
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Cyclothymia: - ANSWER: involves the chronic presentation of hypomanic and bg bg bg bg bg bg bg bg bg
depressive symptoms that do not meet the diagnostic criteria for a major depressive
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or manic/hypomanic episode.
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If bipolar depression is mistaken for MDD: - ANSWER: antidepressant therapy may
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precipitate a manic episode or induce rapid-cycling bipolar depression
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-may contribute to the increased incidence of death by suicide in children and adults
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younger than 25
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Antidepressants are used cautiously in clients with bipolar disorder and never as bg bg bg bg bg bg bg bg bg bg bg
________________. - ANSWER: monotherapy
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-Antidepressants should be combined with a mood stabilizer to prevent the onset of a bg bg bg bg bg bg bg bg bg bg bg bg bg
hypomanic or manic episode
bg bg bg bg
DA, NE Dysfunction causes what mood related symptoms - ANSWER: Decreased
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positive affect:
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depressed mood bg
, loss of joy bg bg
lack of interest
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loss of energy bg bg
decreased alertness bg
decreased self-confidence bg
appetite changes bg
5HT, NE Dysfunction causes what mood related symptoms - ANSWER: Increased
bg bg bg bg bg bg bg bg bg bg
negative affect:
bg bg
depressed mood bg
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes bg
neurobiological factors that contribute to mood and mood disorders: Genetics -
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ANSWER: MDD and BD are heritable disorders
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-genetic factors 31-42% of the disease risk in MDD and 59-85% in BD
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-causes of mood disorders complex, likely involve interactions between
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genetic/epigenetic, biological, psychological, and social factors including:
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• dysfunctions in brain
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• imbalance of neurotransmitters
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• life events
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• abuse or trauma
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• substance use or medication
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• menstruation
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• season changes
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neurobiological factors that contribute to mood and mood disorders: Neuroanatomy -
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ANSWER: Inefficient information processing by one or more brain circuits may result
bg bg bg bg bg bg bg bg bg bg bg bg
in mood disorder symptoms.
bg bg bg bg
-Recent research has tied depression to decreased activity of the prefrontal cortex.
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The prefrontal cortex controls attention, memory, mood, and personality.
bg bg bg bg bg bg bg bg bg
neurobiological factors that contribute to mood and mood disorders: Neural Networks -
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ANSWER: The classic monoamine hypothesis of depression posits that depression
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occurs as a result of a deficiency of one or all three monoamine transmitters
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(serotonin, norepinephrine, and dopamine), while mania may result from an excess
bg bg bg bg bg bg bg bg bg bg bg
-this hypothesis has limitations, Emphasis is now shifted from the monoamines to their
bg bg bg bg bg bg bg bg bg bg bg bg
receptors and other downstream events such as the regulation of gene expression,
bg bg bg bg bg bg bg bg bg bg bg bg
growth factors, environmental factors, and epigenetic changes
bg bg bg bg bg bg bg
neurobiological factors that contribute to mood and mood disorders: Neural Signaling -
bg bg bg bg bg bg bg bg bg bg bg
ANSWER: Three principal neurotransmitters, norepinephrine (NE), dopamine (DA),
bg bg bg bg bg bg bg bg
KNOWLEDGE QUESTIONS AND
ANSWERS
Pharmacologic Treatment of Major Depressive Disorder - ANSWER: Selective
bg bg bg bg bg bg bg bg
serotonin reuptake inhibitors (SSRIs)
bg bg bg bg
Serotonin-norepinephrine reuptake inhibitors (SNRIs) bg bg bg
Norepinephrine and dopamine reuptake inhibitors (NDRIs) bg bg bg bg bg
Serotonin antagonists and reuptake inhibitors (SARIs)
bg bg bg bg bg
Miscellaneous antidepressants bg
Monoamine oxidase (MAO)-B inhibitors bg bg bg
Adjunct: antipsychotics bg
Pharmacologic Treatment of Bipolar Disorder - ANSWER: Lithium bg bg bg bg bg bg bg
Anticonvulsants
Second generation antipsychotics
bg bg
Mood disorders: role of the psychiatric mental health nurse practitioner (PMHNP) is to:
bg bg bg bg bg bg bg bg bg bg bg bg
- ANSWER: determine the malfunctioning brain circuit responsible for the client's
bg bg bg bg bg bg bg bg bg bg bg
presenting symptoms and select the appropriate medication that targets the
bg bg bg bg bg bg bg bg bg bg
associated neurotransmitter(s)
bg bg
Mood disorders manifest across a spectrum from: - ANSWER: mania to major
bg bg bg bg bg bg bg bg bg bg bg
depressive disorder (MDD)
bg bg bg
Unipolar depression - ANSWER: major depressive disorder (MDD)
bg bg bg bg bg bg bg
one of the most common mental disorders
bg bg bg bg bg bg
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest
bg bg bg bg bg bg bg bg bg bg bg bg bg
(13.1%) among individuals aged 18-25
bg bg bg bg bg
S/S
-depressed mood bg
-loss of interest or pleasure in daily activities
bg bg bg bg bg bg bg
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
bg bg bg bg bg bg bg
-severe depression: may experience thoughts of suicide or psychotic symptoms.
bg bg bg bg bg bg bg bg bg
Bipolar disorder (BD) - ANSWER: Chronic condition characterized by extreme
bg bg bg bg bg bg bg bg bg
fluctuations in mood, energy, and ability to function
bg bg bg bg bg bg bg bg
,-Moods may be manic, hypomanic, or depressed and may include mixed mood or
bg bg bg bg bg bg bg bg bg bg bg bg
psychotic features
bg bg
-many have only experienced only one manic episode in their lifetime
bg bg bg bg bg bg bg bg bg bg
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
bg bg bg bg bg bg bg bg bg bg bg bg bg
-diagnosed when a client has one or more episodes of mania or hypomania with a
bg bg bg bg bg bg bg bg bg bg bg bg bg bg
history of one or more major depressive episodes
bg bg bg bg bg bg bg bg
-high risk for suicide bg bg bg
mania - ANSWER: characterized by a persistently elevated, expansive, or irritable
bg bg bg bg bg bg bg bg bg bg
mood. Related symptoms may include inflated self-esteem, increased goal-directed
bg bg bg bg bg bg bg bg bg
activity or energy, including grandiosity, decreased need for sleep, excessive
bg bg bg bg bg bg bg bg bg bg
talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor
bg bg bg bg bg bg bg bg bg
agitation, and a propensity to be involved in high-risk activities. Mania leads to
bg bg bg bg bg bg bg bg bg bg bg bg bg
significant functional impairment and may include psychotic features or necessitate
bg bg bg bg bg bg bg bg bg bg
hospitalization
bg
Bipolar Type I: - ANSWER: requires at least one episode of mania for at least one
bg bg bg bg bg bg bg bg bg bg bg bg bg bg bg
week (or any duration if hospitalization due to symptoms is required)
bg bg bg bg bg bg bg bg bg bg bg
Bipolar Type II: - ANSWER: diagnosis requires a current or past hypomanic episode
bg bg bg bg bg bg bg bg bg bg bg bg
and a current or past major depressive episode. Symptoms last for at least 4 days
bg bg bg bg bg bg bg bg bg bg bg bg bg bg bg
but fewer than seven.
bg bg bg bg bg
-Hypomanic symptoms are not of sufficient duration or severity to cause significant
bg bg bg bg bg bg bg bg bg bg bg
functional impairment, psychosis, or hospitalization.
bg bg bg bg bg bg
-Anger and irritability are common.bg bg bg bg bg
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms,
bg bg bg bg bg bg bg bg bg bg bg bg bg
making bipolar more difficult to diagnose if the client presents in the depression
bg bg bg bg bg bg bg bg bg bg bg bg bg
phase.
bg
Cyclothymia: - ANSWER: involves the chronic presentation of hypomanic and bg bg bg bg bg bg bg bg bg
depressive symptoms that do not meet the diagnostic criteria for a major depressive
bg bg bg bg bg bg bg bg bg bg bg bg bg
or manic/hypomanic episode.
bg bg bg
If bipolar depression is mistaken for MDD: - ANSWER: antidepressant therapy may
bg bg bg bg bg bg bg bg bg bg bg
precipitate a manic episode or induce rapid-cycling bipolar depression
bg bg bg bg bg bg bg bg bg
-may contribute to the increased incidence of death by suicide in children and adults
bg bg bg bg bg bg bg bg bg bg bg bg bg
younger than 25
bg bg bg
Antidepressants are used cautiously in clients with bipolar disorder and never as bg bg bg bg bg bg bg bg bg bg bg
________________. - ANSWER: monotherapy
bg bg bg bg
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a bg bg bg bg bg bg bg bg bg bg bg bg bg
hypomanic or manic episode
bg bg bg bg
DA, NE Dysfunction causes what mood related symptoms - ANSWER: Decreased
bg bg bg bg bg bg bg bg bg bg
positive affect:
bg bg
depressed mood bg
, loss of joy bg bg
lack of interest
bg bg
loss of energy bg bg
decreased alertness bg
decreased self-confidence bg
appetite changes bg
5HT, NE Dysfunction causes what mood related symptoms - ANSWER: Increased
bg bg bg bg bg bg bg bg bg bg
negative affect:
bg bg
depressed mood bg
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes bg
neurobiological factors that contribute to mood and mood disorders: Genetics -
bg bg bg bg bg bg bg bg bg bg
ANSWER: MDD and BD are heritable disorders
bg bg bg bg bg bg bg
-genetic factors 31-42% of the disease risk in MDD and 59-85% in BD
bg bg bg bg bg bg bg bg bg bg bg bg
-causes of mood disorders complex, likely involve interactions between
bg bg bg bg bg bg bg bg
genetic/epigenetic, biological, psychological, and social factors including:
bg bg bg bg bg bg bg
• dysfunctions in brain
bg bg bg
• imbalance of neurotransmitters
bg bg bg
• life events
bg bg
• abuse or trauma
bg bg bg
• substance use or medication
bg bg bg bg
• menstruation
bg
• season changes
bg bg
neurobiological factors that contribute to mood and mood disorders: Neuroanatomy -
bg bg bg bg bg bg bg bg bg bg
ANSWER: Inefficient information processing by one or more brain circuits may result
bg bg bg bg bg bg bg bg bg bg bg bg
in mood disorder symptoms.
bg bg bg bg
-Recent research has tied depression to decreased activity of the prefrontal cortex.
bg bg bg bg bg bg bg bg bg bg bg
The prefrontal cortex controls attention, memory, mood, and personality.
bg bg bg bg bg bg bg bg bg
neurobiological factors that contribute to mood and mood disorders: Neural Networks -
bg bg bg bg bg bg bg bg bg bg bg
ANSWER: The classic monoamine hypothesis of depression posits that depression
bg bg bg bg bg bg bg bg bg bg
occurs as a result of a deficiency of one or all three monoamine transmitters
bg bg bg bg bg bg bg bg bg bg bg bg bg bg
(serotonin, norepinephrine, and dopamine), while mania may result from an excess
bg bg bg bg bg bg bg bg bg bg bg
-this hypothesis has limitations, Emphasis is now shifted from the monoamines to their
bg bg bg bg bg bg bg bg bg bg bg bg
receptors and other downstream events such as the regulation of gene expression,
bg bg bg bg bg bg bg bg bg bg bg bg
growth factors, environmental factors, and epigenetic changes
bg bg bg bg bg bg bg
neurobiological factors that contribute to mood and mood disorders: Neural Signaling -
bg bg bg bg bg bg bg bg bg bg bg
ANSWER: Three principal neurotransmitters, norepinephrine (NE), dopamine (DA),
bg bg bg bg bg bg bg bg
