NURS 663 Exam 1 Study Guide 2024

Bipolar one disorder DSM five criteria - Manic episode: 1+ week of a colon elevated, expansive or irritable mood and increase energy. 3+ symptoms from B: distractibility, indiscretion, irresponsible, grandiosity, flight of ideas, activity (Increase goal-orient), decreased need for sleep, talkativeness or pressured speech. Bipolar two DSM five criteria - Hypo mania and major depressive disorder: hypo mania same as mania with decreased severity and duration and no functional impairment for episode of four or more days and no psychosis Mixed episodes (bipolar) - Manic and depressive symptoms time by side usually with comorbid substance abuse increased risk of suicide and psychosis rapid cycling - Four or more cycles per year no greater than a week well period Cyclothymia DSM-V Criteria - Two or more years of mood cycling with dysthymia and hypo mania decreased intensity than bipolar disorder meets criteria for hypo mania but does not meet criteria for major depressive disorder Dysthymia DSM five criteria - HE'S 2 SAD depressive symptoms lasting two or more years that is subsydromal characterized by hopelessness decreased energy, decrease self-esteem for two years, abnormal sleep, abnormal appetite impaired decision-making. MAOÍ Mechanism of action generally - Catalyzes the deamination of monoamines intracellularly and MAO transport Reuptake extracellular monoamines MAO-A Mechanism of action - MAO-A Oxidizes serotonin norepinephrine and epinephrine MAO-B Mechanism of action - Oxidizes phenylalanine MAO-A and MAO-B mechanism of action - Oxidizes dopamine non-preferentially MAOs Neumonic -2 - Date with Tyra banks with wine and cheese in Maui— can cause hypertensive crisis related to tyramine from aged food. MAWIs= my arms weight increased= effective for atypical depression MAOs adverse effects-6 - Hypertensive crisis, diet restriction, avoid meds, five week after Prozac, two week after other antidepressants, no other medications for two weeks after discontinuing MAOs diet restriction-4 compounds - Tyrosine, high tyramine, tryptophan, phenylalanine Tyrosine foods-10 - Aged cheese, aged wine, fava or broad bean pods, sauerkraut, soy sauce, tap or draft beer, overripe fruit, cured meat, spoiled food MAOs drugs to avoid- 6 - Antidepressants, Dextromethorphan, stimulants, sympathomimetics, meperidine, disulfiram MAOs side effects 11 - Increased weight, drowsy, dizzy, orthostatic hypotension, tremor, headache, dry mouth, constipation, change in sexual drive, peripheral Edema, sweating Tricyclic mechanism of action - Inhibit 5HT2, norepinephrine, dopamine and reuptake slows. Amino group interferes with ASP - 98 in HSERT. Causing down regulation of receptors. Tricyclic side effects - Anticholinergic effects (dry mouth, blurred vision, constipation, urine retention, impotence). Histamine effects (sedation, increased weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects (decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and decrease anxiety). Amitriptyline dosing/Class - Start at 25 to 50 mg per day, titrate 25 to 50 mg per day per week, Max dose is 300 mg per day/TCA Names of tricyclics 10 - Amitriptyline, nortriptyline, clomipramine, imipramine, protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine Tricyclics are useful-2 - Pain, migraine Tricyclics adverse effects-2 - Overdoses are cardiotoxic, high potency increases the risk of mania Nortriptyline mnemonic - No-triptyline equals less sedation and hypotension Tricyclics mnemonic-2 - Think car goes over tricycle to remember that an overdose is cardiotoxic. Do you remember mechanism think trans =serotonin and norepinephrine Chans= Na+ and Ca+ Ans= ACH and histamine Clomipramine mnemonic/class - TCA- think comipramine for obsessive compulsive disorder Imipramine- pneumonic and class - I'm peeingamine- nocturnal enuresis Unilateral electrode in ECT indications - Typically first line because it has less cognitive side effects but has less efficacy What is ECT? - The use of electrical shock current delivered to the brain to induce a seizure that treats depression. Goal is to reverse atrophy. ECT is FDA approved for what - Bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, treatment resistant refractory major depressive disorder What is ECT schedule - Typically Monday Wednesday Friday for 6 to 12 sessions Bilateral electrode placement in ECT indications - Classic placement increases cognitive side effects but has better efficacy. Reserved for urgency such as life- threatening depression profound distress and catatonia ECT side effects and Risks 8 - Cognitive side effects such as memory loss, head, neck, jaw pain, nausea, myalgia's procedure is low risk What is vagus nerve stimulation - It's an implant in the chest that stimulates the left Vegas nerve by Paul stations and it's controlled by an on off switch that is activated by a magnet How does vagus nerve stimulation work - Stimulates the brain stem nuclei which changes serotonin in the limbic and cortical systems Vagal nerve stimulation side effects-4 - Voice altered, breathlessness, neck pain, no cognitive side effects Vagus nerve stimulation is FDA approved for what in under investigation for what - FDA approved for epilepsy and under investigation for major depressive disorder and bipolar disorder What is trans cranial magnetic stimulation - Placement of rapid alternating magnets on scalp cause impulse to structures and is focused Goal of trans cranial magnetic stimulation - Firing of neurons will alter pathology Trans cranial magnetic stimulation is FDA approved for and not approved for - Approved for refractory treatment resistant depression It is not approved for bipolar disorder or schizophrenia What is cognitive therapy based on - Negative thinking increase his depression vulnerability, this therapy challenges beliefs and assumptions related to depression Cognitive therapy indications 11 - Depression, anxiety, PTSD, schizophrenia, phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders, substance abuse disorders Cognitive therapy interventions - Automatic thought restructuring, provide evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater than just antidepressants and anti-depressants are greater than just cognitive behavioral therapy in efficacy What is interpersonal therapy based on - Based on the theory that depression Arises from problematic patterns and relationships Interpersonal therapy indications 5 - Indicated for depression, grief, interpersonal dispute, role transitions, interpersonal skill deficits Interpersonal therapy interventions 3 - Increase relationship awareness, increase interpersonal skills, communication analysis What is behavioral therapy based on - Deficits in reinforcers like present activities and positive interpersonal contacts increased depression vulnerability Behavioral therapy interventions 3 - Increase activity level, structure goalsetting, interpersonal skills training Dialectical behavioral therapy is based on - Increasing emotional regulation Dialectical behavioral therapy Indications - Borderline, bulimia, binge eating, PTSD, substance abuse Dialectical behavioral therapy interventions 4 - Increase skills, mindful practice, monitoring/responding to crisis Involuntary commitment reasons - Danger to self, danger to others, and self Neglect Are there main points of involuntary commitment - 1. Mental illness/developmental disability or drug/alcohol dependence. 2. It is treatable. 3. It is related to the danger to self or others Broad categories of suicide risk factors - Psychological disorder, Nuro biological factors, social factors, psychological factors Psychological disorders related to suicide - Bipolar is greater than depression however 50% are depressed at time of suicide Neurobiological factors of suicide - Decrease serotonin, hereditary, increase reaction of H PA system Social factors of suicide - Economic recession, media reports of suicide, social isolation, decrease social belonging Psychological factors of suicide - Decrease problem-solving and life satisfaction, increase hopelessness and impulsivity Suicidal ideation safety mnemonic - DIOSMIO Detained, impatient, observe, sharp, medical clearance, injuries, or occult overdose Likelihood of attempt pneumonic - Guns & ROSES recent attempt, ongoing thoughts, self harm, ethanol, substance abuse Capacity eval mnemonic - CURBSID communicate, understand, risk, benefit, situation, impact, decision Likelihood of violence mnemonic - PV'd MALES previous violence, male, adult, low intelligence, estranged, substance-abuse Causes of delirium mnemonic - DIMTOP drugs, infection, metabolic derangement, trauma, oxygen deprivation, psychological Substances that increase the risk of violence with intoxication Pneumonic - PISSE PCP, inhalants, stimulants, steroids, ethanol Visual hallucinations medical cause mnemonic - Visual hallucinations from disease of the viscera Signs and symptoms that suggest abuse mnemonic - TEN4 Over & OUT torso, ears, neck, less than four months of age, all over the body, observable pattern, unexposed Body part, timing Suspected child abuse mnemonic - Fuzzy DETAIL details are fuzzy or vague, denied, evolving, tardy, absent, inconsistent, lacking Catatonia mnemonic - Turns a man into a manikin referring to the state of purposeless stupor What is SIADH? - syndrome of inappropriate antidiuretic hormone- increase ADH production equals more water retention in kidneys equals less serum sodium Medications thought to cause SIADH - Carbamazepine, SSRI, amitriptyline, morphine Mood Disorder Questionnaire (MDQ) - Screens for Bipolar Disorder- 13 questions based on bipolar DSM five criteria, screen every patient with depression MDQ Positive score - Includes 7+ symptoms in question one, question two, moderate severe problem in question three Patient health questionnaire nine - Screen all patients with depressive symptoms, nine question based on DSM five criteria for major depressive disorder Other causes of SIADH - Medications, Traumatic brain injury, infections, cancer, hypothyroid