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Psychopharm Study - Final exam prep
Nursing (Chamberlain University)
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Mood disorders
Mood disorders are abnormalities of mood, which include depression, mania, or both. These disorders
occur across a spectrum and affect between 10-20% of the population (Coleman et al., 2020). Mood
disorders include depressive disorders and bipolar disorders and may be comorbid with other
conditions. Major depressive disorder (MDD) and bipolar disorder (BD) are among the most disabling
mental health disorders (Sall et al., 2021). Pervasive symptoms affect mood, thought processes, physical
health, work, and relationships. Death by suicide may result when mood disorders are inadequately
diagnosed and undertreated. Antidepressants account for approximately 15 of the top 200 prescription
medications prescribed and dispensed in the United States (Chisholm-Burns et al., 2019).
First-line medications for the treatment of severe depression based on the tolerability
and low side effect profile include SSRIs, SNRIs, bupropion.
The role of the psychiatric mental health nurse practitioner (PMHNP) is to determine the malfunctioning
brain circuit responsible for the client's presenting symptoms and select the appropriate medication that
targets the associated neurotransmitter(s).
Unipolar Depression
Mood disorders manifest across a spectrum from mania to major depressive disorder (MDD).
Unipolar depression or major depressive disorder (MDD) is one of the most common mental disorders.
Approximately 7.1% of adults in the U.S. have experienced at least one major depressive episode in the
last year, with prevalence highest (13.1%) among individuals aged 18-25 (National Institute of Mental
Health [NIMH], 2019). Common symptoms of MDD include a depressed mood or loss of interest or
pleasure in daily activities, irritability, withdrawal, and problems with sleep, eating, energy,
concentration, or self-worth. Clients with severe depression may experience thoughts of suicide or
psychotic symptoms.
Bipolar disorder (BD)
Bipolar disorder (BD) is a chronic condition characterized by extreme fluctuations in mood, energy, and
ability to function. The World Mental Health Survey Initiative reported total lifetime prevalence
estimates of 2.4% (Yatham et al., 2018). Clients with BD may experience recurrent episodes and
remissions. Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic
features. Most bipolar depression clients experience depression symptoms, and 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. BD is diagnosed when a client has one or more episodes of mania or
hypomania with a history of one or more major depressive episodes. BD is associated with significant
morbidity and mortality. Clients diagnosed with bipolar disorder are at high risk for suicide. Correct and
early diagnosis and treatment are essential to prevent complications and maximize treatment response
(Stahl, 2021). Examine the image below to learn more.
Bipolar Type I:
The diagnosis of bipolar I disorder requires at least one episode of mania for at least one week (or any
duration if hospitalization due to symptoms is required). Mania is 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 (Yatham et al., 2018).
Bipolar Type II:
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A diagnosis of bipolar II disorder 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:
Cyclothymia involves the chronic presentation of hypomanic and depressive symptoms that do not meet
the diagnostic criteria for a major depressive or manic/hypomanic episode.
Bipolar I depression may be misdiagnosed as major depressive disorder (MDD); therefore, it is essential
to rule out past episodes of hypomania or mania. Clients are reluctant to report mania or hypomania
symptoms. If bipolar depression is mistaken for MDD, antidepressant therapy may precipitate a manic
episode or induce rapid-cycling bipolar depression, which 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 monotherapy. Antidepressants should be combined with a mood
stabilizer to prevent the onset of a hypomanic or manic episode.
Symptoms
Mood-related symptoms may be characterized as having either too little positive affect, known as
dopamine (DA) norepinephrine (NE) dysfunction or too much negative affect, also known as 5-
hydroxytryptamine (5HT) norepinephrine (NE) dysfunction. Affective symptoms are often related to
neurotransmitter activity. Pharmacologic treatments help modulate neurotransmitter activity. The
PMHNP must determine the dysfunctions responsible for the client's presenting symptoms. Knowledge
of the associated symptoms and circuits enables the selection of medication whose mechanism of action
will target those symptoms. Examine the image below to learn more.
Decreased positive affect: DA, NE Dysfunction
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
Increased negative affect: 5HT, NE Dysfunction
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
Downloaded by Kim Thompson ()
, lOMoARcPSD|49488095
Genetics
MDD and BD are heritable disorders; genetic factors contribute 31–42% of the disease risk in MDD and
59–85% in BD (Sall et al., 2021). Analysis of the subtypes of MPD and BD helps to provide evidence for a
genetic mood disorder spectrum (Coleman et al., 2020). Gene and genome-wide association studies
have identified candidate genes for contributing to both MDD and BD; however, the causes of mood
disorders are complex and likely involve interactions between genetic/epigenetic, biological,
psychological, and social factors including:
dysfunctions in brain
imbalance of neurotransmitters
life events
abuse or trauma
substance use or medication
menstruation
season changes
Neuroanatomy
Inefficient information processing by one or more brain circuits may result in mood disorder symptoms.
Neural Networks
The classic monoamine hypothesis of depression theorizes that depression occurs because of a
deficiency of one or all three monoamine transmitters (serotonin, norepinephrine, and dopamine),
while mania may result from an excess; however, this hypothesis has limitations. Stahl (2021)
acknowledged that depression is more complex than this simple theory but agrees that the
monoamine hypothesis is helpful to understand the physiological functioning of these NTs. Emphasis
is now shifted from the monoamines to their receptors and other downstream events such as the
regulation of gene expression, growth factors, environmental factors, and epigenetic changes (Stahl,
2021).
Neural Signaling
Three principal neurotransmitters, norepinephrine (NE), dopamine (DA), and serotonin 5HT, have
implications for the pathophysiology and treatment of mood disorders. Norepinephrine, dopamine,
and serotonin are monoamines. Monoamines work in concert and comprise the monoamine
neurotransmitter system. Many of the symptoms of mood disorders are hypothesized to involve
dysfunction of various combinations of monoamine neurotransmitters. All known pharmacologic
treatments for mood disorders act upon one or more of these three neurotransmitters.
Prefrontal Cortex (PFC)
Concentration
Mental fatigue
Mood
PFC & Amygdala
Guilt, suicidality, worthlessness
Striatum
Physical fatigue
Downloaded by Kim Thompson ()
Psychopharm Study - Final exam prep
Nursing (Chamberlain University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Kim Thompson ()
, lOMoARcPSD|49488095
Mood disorders
Mood disorders are abnormalities of mood, which include depression, mania, or both. These disorders
occur across a spectrum and affect between 10-20% of the population (Coleman et al., 2020). Mood
disorders include depressive disorders and bipolar disorders and may be comorbid with other
conditions. Major depressive disorder (MDD) and bipolar disorder (BD) are among the most disabling
mental health disorders (Sall et al., 2021). Pervasive symptoms affect mood, thought processes, physical
health, work, and relationships. Death by suicide may result when mood disorders are inadequately
diagnosed and undertreated. Antidepressants account for approximately 15 of the top 200 prescription
medications prescribed and dispensed in the United States (Chisholm-Burns et al., 2019).
First-line medications for the treatment of severe depression based on the tolerability
and low side effect profile include SSRIs, SNRIs, bupropion.
The role of the psychiatric mental health nurse practitioner (PMHNP) is to determine the malfunctioning
brain circuit responsible for the client's presenting symptoms and select the appropriate medication that
targets the associated neurotransmitter(s).
Unipolar Depression
Mood disorders manifest across a spectrum from mania to major depressive disorder (MDD).
Unipolar depression or major depressive disorder (MDD) is one of the most common mental disorders.
Approximately 7.1% of adults in the U.S. have experienced at least one major depressive episode in the
last year, with prevalence highest (13.1%) among individuals aged 18-25 (National Institute of Mental
Health [NIMH], 2019). Common symptoms of MDD include a depressed mood or loss of interest or
pleasure in daily activities, irritability, withdrawal, and problems with sleep, eating, energy,
concentration, or self-worth. Clients with severe depression may experience thoughts of suicide or
psychotic symptoms.
Bipolar disorder (BD)
Bipolar disorder (BD) is a chronic condition characterized by extreme fluctuations in mood, energy, and
ability to function. The World Mental Health Survey Initiative reported total lifetime prevalence
estimates of 2.4% (Yatham et al., 2018). Clients with BD may experience recurrent episodes and
remissions. Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic
features. Most bipolar depression clients experience depression symptoms, and 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. BD is diagnosed when a client has one or more episodes of mania or
hypomania with a history of one or more major depressive episodes. BD is associated with significant
morbidity and mortality. Clients diagnosed with bipolar disorder are at high risk for suicide. Correct and
early diagnosis and treatment are essential to prevent complications and maximize treatment response
(Stahl, 2021). Examine the image below to learn more.
Bipolar Type I:
The diagnosis of bipolar I disorder requires at least one episode of mania for at least one week (or any
duration if hospitalization due to symptoms is required). Mania is 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 (Yatham et al., 2018).
Bipolar Type II:
Downloaded by Kim Thompson ()
, lOMoARcPSD|49488095
A diagnosis of bipolar II disorder 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:
Cyclothymia involves the chronic presentation of hypomanic and depressive symptoms that do not meet
the diagnostic criteria for a major depressive or manic/hypomanic episode.
Bipolar I depression may be misdiagnosed as major depressive disorder (MDD); therefore, it is essential
to rule out past episodes of hypomania or mania. Clients are reluctant to report mania or hypomania
symptoms. If bipolar depression is mistaken for MDD, antidepressant therapy may precipitate a manic
episode or induce rapid-cycling bipolar depression, which 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 monotherapy. Antidepressants should be combined with a mood
stabilizer to prevent the onset of a hypomanic or manic episode.
Symptoms
Mood-related symptoms may be characterized as having either too little positive affect, known as
dopamine (DA) norepinephrine (NE) dysfunction or too much negative affect, also known as 5-
hydroxytryptamine (5HT) norepinephrine (NE) dysfunction. Affective symptoms are often related to
neurotransmitter activity. Pharmacologic treatments help modulate neurotransmitter activity. The
PMHNP must determine the dysfunctions responsible for the client's presenting symptoms. Knowledge
of the associated symptoms and circuits enables the selection of medication whose mechanism of action
will target those symptoms. Examine the image below to learn more.
Decreased positive affect: DA, NE Dysfunction
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes
Increased negative affect: 5HT, NE Dysfunction
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
Downloaded by Kim Thompson ()
, lOMoARcPSD|49488095
Genetics
MDD and BD are heritable disorders; genetic factors contribute 31–42% of the disease risk in MDD and
59–85% in BD (Sall et al., 2021). Analysis of the subtypes of MPD and BD helps to provide evidence for a
genetic mood disorder spectrum (Coleman et al., 2020). Gene and genome-wide association studies
have identified candidate genes for contributing to both MDD and BD; however, the causes of mood
disorders are complex and likely involve interactions between genetic/epigenetic, biological,
psychological, and social factors including:
dysfunctions in brain
imbalance of neurotransmitters
life events
abuse or trauma
substance use or medication
menstruation
season changes
Neuroanatomy
Inefficient information processing by one or more brain circuits may result in mood disorder symptoms.
Neural Networks
The classic monoamine hypothesis of depression theorizes that depression occurs because of a
deficiency of one or all three monoamine transmitters (serotonin, norepinephrine, and dopamine),
while mania may result from an excess; however, this hypothesis has limitations. Stahl (2021)
acknowledged that depression is more complex than this simple theory but agrees that the
monoamine hypothesis is helpful to understand the physiological functioning of these NTs. Emphasis
is now shifted from the monoamines to their receptors and other downstream events such as the
regulation of gene expression, growth factors, environmental factors, and epigenetic changes (Stahl,
2021).
Neural Signaling
Three principal neurotransmitters, norepinephrine (NE), dopamine (DA), and serotonin 5HT, have
implications for the pathophysiology and treatment of mood disorders. Norepinephrine, dopamine,
and serotonin are monoamines. Monoamines work in concert and comprise the monoamine
neurotransmitter system. Many of the symptoms of mood disorders are hypothesized to involve
dysfunction of various combinations of monoamine neurotransmitters. All known pharmacologic
treatments for mood disorders act upon one or more of these three neurotransmitters.
Prefrontal Cortex (PFC)
Concentration
Mental fatigue
Mood
PFC & Amygdala
Guilt, suicidality, worthlessness
Striatum
Physical fatigue
Downloaded by Kim Thompson ()
