Mood disorders
The most common mental illness seen in practice today.
What is depression?
Expansive mood that is labile, constant activity with a reduced need for sleep. Thought process: flight of ideas, disorganized. Increased goal directed behavior (excessive spending, phone calls, email). Impulsivity (promiscuity, gambling). Lack of insight, poor judgment. Imapired occupational/social funcioning
What are the symptoms of Bipolar I mania?
Paroxetine, fluoxetine, citalopram, escitalopram, sertraline.
What are first-line treatments for major depression?
Show a firm, calm approach. Short, concise explanations or statements, maintain consistency. Frequent staff meetings to agree on approach and limit setting.
What are therapeutic communication strategies used in the treatment of manic patients?
Lamotrigine, carbamazepine, valproate, oxcarbazepine
What are some anticonvulsants used as mood stabilizers?
Periods of normal functioning alternating with recurrent epidosdes of depression and mania.
What are bipolar disorders?
Elevated mood with underlying irritability for at least 4 days. Inflated self-esteem, decreased need for sleep, lasting at least 4 days. More talkative, flight of ideas, distractability, increased goal directed behaviors (socially, at shcool), sexual indiscretion. Does not meet criteria for hospitalization.
What are the symptoms of hypomania?
Lithium carbonate, antiepileptics, and antipsychotics.
What classifications of medications are used as mood stabilizers?
Milieu management, Individual therapy, group therapy, and family therapy, health teaching and health promotion.
What are treatment modalities for bipolar disorder?
Valproate level, liver function, and CBC.
What are baseline and required labs for a patient prescribed Valproate?
Bipolar I, Bipolar II, Cyclothymic disorder
What are the types of Bipolar disorders?
For a period of 2 years, irritable, hypomanic episodes alternating with persistent depressive episodes.
What are the symptoms of cyclothymia?
Controls episodes of acute mania, helps prevent return of mania or depression and decreases the incidence of suicide.
What are the pharmacological actions of lithium carbonate?
HbA1c and lipid panel.
What are the required labs for some prescribed atypical antipsychotics?
50-100 mcg/mL
What is the therapeutic level for valproate?
Mania: Hypomania: Rapid cycling:
What are behaviors associated with bipolar disorders?
For at least 2 weeks: depressed mood, anhedonia, increased/decreased appetite (weight change), insomnia or hypersomnia, fatigue, feelings of worthlessness or guilt, decreased concentration, recurrent thoughts of death.
What are the symptos of major depressive disorder?
Nausea, diarrhea, abdominal pain, and fine hand tremor.
What are some adverse effects when starting lithium carbonate?
Appearance, behavior, speech, affect and mood, thought process and content, perceptual disturbances, insight and judgment.
What is the MENTAL STATUS EXAM. The fundamental assessment in psychiatric assessment, analogous to the physical examination in general medicine. Used to evaluate the patients current cognitive processes
A rare, serious disorder of the skin and mucous membranes, Stevens-Johnson syndrome (SJS).
What is an adverse effect of lamotrigine?
The presence of psychotic symptoms such as auditory hallucinations or delusions while experiencing major depression.
What is Major depressive disorder with psychotic features?
0.6 - 1.2 mEq/L
What is the therapeutic level of lithium?
Take medication with food.
Maintain diet adequate in sodium and fluid intake (1.5 - 3 L/day).
Avoid use of NSAIDs and certain dieuretics.
Notify provider at first signs of Lithium Toxicity.
What should be included in teaching for patients prescribed lithium carbonate?
Lists the specific diagnostic criteria for each mental disorder, based on research and clinical observations.
What is the Diagnositc and Statistical Manual of Mental Disorders, edition 5 (DSM-5)
Olanzapine, risperidone, quetiapine.
What are atypical antipsychotics used in the initial treatment of the manic phase of bipolar disorder?
A form of depression that occurs seasonally, usually during the winter, when there is less daylight.
What is Seasonal affectrive disorder (SAD)?
Nausea, vomitting diarhea, thirst, polyuria, mental confusion, BLURRED VISION, TINNITUS, ataxia.
What are symptoms of Lithium toxicity?
Lithium serum level, TSH, T3, T4, BUN and creatinine.
What are labs regularly required to be checked when prescribed lithium carbonate?
Presence of mental illness, poses a danger to self or others.
Demonstrates severe disability or inability to meet basic ADL's.
Requires treatment but unable to seek it voluntarily related to the impact of the mental illness.
What are the criteria for involuntary in-patient psychiatric admission?
Akathsia, dystonia, parkinsonism, metabolic syndrome and tardive dyskinesia.
What are the side effects of the atypical antipsychotics?