NR546 WEEK 5 EXAM WITH CORRECT
ANSWERS WITH RATIONALES
Pharmacologic Treatment of Major Depressive Disorder - ANSWER-
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Serotonin antagonists and reuptake inhibitors (SARIs)
Miscellaneous antidepressants
Monoamine oxidase (MAO)-B inhibitors
Adjunct: antipsychotics
Pharmacologic Treatment of Bipolar Disorder - ANSWER-Lithium
Anticonvulsants
Second generation antipsychotics
Mood disorders: role of the psychiatric mental health nurse
practitioner (PMHNP) is to: - ANSWER-determine the malfunctioning
brain circuit responsible for the client's presenting symptoms and
select the appropriate medication that targets the associated
neurotransmitter(s)
Mood disorders manifest across a spectrum from: - ANSWER-mania
to major depressive disorder (MDD)
Unipolar depression - ANSWER-major depressive disorder (MDD)
one of the most common mental disorders
,-Approximately 7.1% of adults in the U.S. had episode in last year,
prevalence highest (13.1%) among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or
psychotic symptoms.
Bipolar disorder (BD) - ANSWER-Chronic condition characterized by
extreme fluctuations in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may include
mixed mood or psychotic features
-many have only experienced only one manic episode in their
lifetime
-Mood fluctuations may be separated by periods of high stability or
may cycle rapidly
-diagnosed when a client has one or more episodes of mania or
hypomania with a history of one or more major depressive episodes
-high risk for suicide
mania - ANSWER-characterized by a persistently elevated,
expansive, or irritable mood. Related symptoms may include
inflated self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep, excessive
talkativeness, racing thoughts, flight of ideas (FOI), distractibility,
psychomotor agitation, and a propensity to be involved in high-risk
,activities. Mania leads to significant functional impairment and may
include psychotic features or necessitate hospitalization
Bipolar Type I: - ANSWER-requires at least one episode of mania for
at least one week (or any duration if hospitalization due to
symptoms is required)
Bipolar Type II: - ANSWER-diagnosis requires a current or past
hypomanic episode and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are not of sufficient duration or severity to
cause significant functional impairment, psychosis, or
hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to
report these symptoms, making bipolar more difficult to diagnose if
the client presents in the depression phase.
Cyclothymia: - ANSWER-involves the chronic presentation of
hypomanic and depressive symptoms that do not meet the
diagnostic criteria for a major depressive or manic/hypomanic
episode.
If bipolar depression is mistaken for MDD: - ANSWER-
antidepressant therapy may precipitate a manic episode or induce
rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in
children and adults younger than 25
Antidepressants are used cautiously in clients with bipolar disorder
and never as ________________. - ANSWER-monotherapy
, -Antidepressants should be combined with a mood stabilizer to
prevent the onset of a hypomanic or manic episode
DA, NE Dysfunction causes what mood related symptoms -
ANSWER-Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
5HT, NE Dysfunction causes what mood related symptoms -
ANSWER-Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
neurobiological factors that contribute to mood and mood
disorders: Genetics - ANSWER-MDD and BD are heritable disorders
-genetic factors 31-42% of the disease risk in MDD and 59-85% in
BD
ANSWERS WITH RATIONALES
Pharmacologic Treatment of Major Depressive Disorder - ANSWER-
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Serotonin antagonists and reuptake inhibitors (SARIs)
Miscellaneous antidepressants
Monoamine oxidase (MAO)-B inhibitors
Adjunct: antipsychotics
Pharmacologic Treatment of Bipolar Disorder - ANSWER-Lithium
Anticonvulsants
Second generation antipsychotics
Mood disorders: role of the psychiatric mental health nurse
practitioner (PMHNP) is to: - ANSWER-determine the malfunctioning
brain circuit responsible for the client's presenting symptoms and
select the appropriate medication that targets the associated
neurotransmitter(s)
Mood disorders manifest across a spectrum from: - ANSWER-mania
to major depressive disorder (MDD)
Unipolar depression - ANSWER-major depressive disorder (MDD)
one of the most common mental disorders
,-Approximately 7.1% of adults in the U.S. had episode in last year,
prevalence highest (13.1%) among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or
psychotic symptoms.
Bipolar disorder (BD) - ANSWER-Chronic condition characterized by
extreme fluctuations in mood, energy, and ability to function
-Moods may be manic, hypomanic, or depressed and may include
mixed mood or psychotic features
-many have only experienced only one manic episode in their
lifetime
-Mood fluctuations may be separated by periods of high stability or
may cycle rapidly
-diagnosed when a client has one or more episodes of mania or
hypomania with a history of one or more major depressive episodes
-high risk for suicide
mania - ANSWER-characterized by a persistently elevated,
expansive, or irritable mood. Related symptoms may include
inflated self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep, excessive
talkativeness, racing thoughts, flight of ideas (FOI), distractibility,
psychomotor agitation, and a propensity to be involved in high-risk
,activities. Mania leads to significant functional impairment and may
include psychotic features or necessitate hospitalization
Bipolar Type I: - ANSWER-requires at least one episode of mania for
at least one week (or any duration if hospitalization due to
symptoms is required)
Bipolar Type II: - ANSWER-diagnosis requires a current or past
hypomanic episode and a current or past major depressive episode.
Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are not of sufficient duration or severity to
cause significant functional impairment, psychosis, or
hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to
report these symptoms, making bipolar more difficult to diagnose if
the client presents in the depression phase.
Cyclothymia: - ANSWER-involves the chronic presentation of
hypomanic and depressive symptoms that do not meet the
diagnostic criteria for a major depressive or manic/hypomanic
episode.
If bipolar depression is mistaken for MDD: - ANSWER-
antidepressant therapy may precipitate a manic episode or induce
rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in
children and adults younger than 25
Antidepressants are used cautiously in clients with bipolar disorder
and never as ________________. - ANSWER-monotherapy
, -Antidepressants should be combined with a mood stabilizer to
prevent the onset of a hypomanic or manic episode
DA, NE Dysfunction causes what mood related symptoms -
ANSWER-Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
5HT, NE Dysfunction causes what mood related symptoms -
ANSWER-Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
neurobiological factors that contribute to mood and mood
disorders: Genetics - ANSWER-MDD and BD are heritable disorders
-genetic factors 31-42% of the disease risk in MDD and 59-85% in
BD
