Mental Health Exam 2 Study Guide.

Mental Health Exam 2 Study Guide. Mental Health Exam 2 Study Guide # of Test ? – Mood disorders: Depression (10), Bipolar (10), Medications for Depression and bipolar (9), Suicide (5), ECT (3), & Legal aspects of care (8) Serotonin Inhibitory function: Decreased levels Sadness crave sweets Anxiety/panic low libido Low energy Migraines Insomnia tense, irritable Norepinephrine Excitatory function: Decreased levels fatigue lack of focus difficulty losing weight more melancholic features Dopamine Motivation interest and drive---makes us feel alive Decreased levels difficulty initiating or competing tasks poor concentration implicated in self-medication to make us feel good (cocaine!) GABA: major sedating neurotransmitter Glutamate: major excitatory neurotransmitter Principles That Guide Pharmacologic Treatment The following are several principles that guide the use of medications to treat psychiatric disorders: • A medication is selected based on its effect on the client’s target symptoms such as delusional thinking, panic attacks, or hallucinations. The medication’s effectiveness is evaluated largely by its ability to diminish or eliminate the target symptoms • Many psychotropic drugs must be given in adequate dosages for some time before their full effect is realized. For example, tricyclic antidepressants can require 4 to 6 weeks before the client experiences optimal therapeutic benefit. • The dosage of medication often is adjusted to the lowest effective dosage for the client. Sometimes a client may need higher dosages to stabilize his or her target symptoms, whereas lower dosages can be used to sustain those effects over time • As a rule, older adults require lower dosages of medications than do younger clients to experience therapeutic effects. It also may take longer for a drug to achieve its full therapeutic effect in older adults. • Psychotropic medications often are decreased gradually (tapering) rather than abruptly. This is because of potential problems with rebound (temporary return of symptoms), recurrence of the original symptoms, or withdrawal (new symptoms resulting from discontinuation of the drug). • Follow-up care is essential to ensure compliance with the medication regimen, to make needed adjustments in dosage, and to manage side effects. • Compliance with the medication regimen often is enhanced when the regimen is as simple as possible in terms of both the number of medications prescribed and the number of daily doses. Mood Disorders – Depression (Ch.27)- (Drugs- ALL ANTI-DEPRESSANTS-Tricyclics, SSRIs, MAO inhibitors, Heterocyclics-atypicals, SNRIs-atypicals) Epidemiology  Social class: there is an inverse relationship between social class and report of depressive symptoms Basically, if you’re poor, you don’t spend money on therapy and keep your problems to yourself...until you act out  Race and culture: no consistent relationship between race and affective disorder has been reported o one recent survey revealed:  Depression is more prevalent in whites than blacks  Depression is more severe and disabling in blacks  Blacks are less likely to receive treatment than whites Types of Depressive Disorders 1. Major Depressive Disorder 2. Dysthymic Disorder 3. Premenstrual Dysphoric Disorder 4. Mood disorder due to a general medical condition-NOT innate-required a TRIGGER 5. Substance-induced mood disorder-NOT innate-required a TRIGGER 4 and 5 would also be considered secondary depression kind of like secondary HTN 1. Major depressive disorder-(Extreme despair/Suicidal...Severe)  Characterized by depressed mood (2 or more weeks) Significant change in daily functioning (social, occupational, self-care) Plus any 5 of the following...  Change in sleep pattern-insomnia and over-sleeping  Tiredness  Agitation and psychomotor retardation-easily annoyed and slow to move, talk, respond  Difficulty thinking, focusing, or making decisions  Loss of interest or pleasure in usual activities (Anhedonia)  Social and occupational functioning impaired for at least 2 weeks-stop daily activities  No history of Manic behavior! That’d be Bipolar  Weight change of 5% or more in a month-up or down  Hopelessness, helplessness, delusional, and/or suicidal ideation  Cannot be attributed to use of substances or a general medical condition-that’d be a Mood/Substance Disorder o Must ensure not stemming from a medical condition! o Make sure pt’s idea of depression is in line with symptoms o 1st thing to ask is what their idea is of depression! 2. Dysthymic disorder-(Chronic Depression-Moderate)  Sad or “down in the dumps”- THINK-Snuffleupagus-“Hey Bird” No evidence of psychotic symptoms  Essential feature is a chronically depressed mood for o Most of the day o More days than not o For at least 2 years!!! 3. Premenstrual dysphoric disorder-(Excuse to be mean)-Extreme PMS Essential features  Depressed mood  Anxiety-unique from above two  Mood swings-imagine that...another distinguishing factor  Decreased interest in activities  Symptoms begin during week prior to menses and subside shortly after onset of menstruation Predisposing Factors to Depression Biological theories  Genetics: hereditary factor may be involved  Biochemical influences: deficiency of norepinephrine, serotonin, and dopamine has been implicated Neuroendocrine disturbances  Possible failure within the hypothalamic-pituitary-adrenocortical axis  Possible diminished release of thyroid-stimulating hormone  Rule out medical problem like hypothyroidism or medication side effects Physiological influences- See page 563-563...these above would be reasons of not true depression...Ca, B Vitamins, Accutane  Medication side effects  Neurological disorders  Electrolyte disturbances-when Martin Lawrence ran across the street naked, he said “I was dehydrated!”  Hormonal disorde