Mental health exam 3

What neurotransmitters are depleted in depression?

Serotonin, norepinephrine, and dopamine.

What is the pathophysiology of depression?

Depletion of serotonin, norepinephrine, and dopamine at synaptic junctions leads to impaired mood regulation.

What are conditions that can mimic depression?

Parkinson's disease, Huntington's disease, Alzheimer's disease, traumatic brain injury, hypothyroidism, substance use or withdrawal, and vitamin deficiency.

What DSM-5 criteria must be present to diagnose Major Depressive Disorder?

Five or more symptoms during the same 2-week period, with at least one being depressed mood or loss of interest.

What are the two required hallmark symptoms of Major Depressive Disorder?

Depressed mood and anhedonia (loss of interest or pleasure).

What is anhedonia?

Loss of interest or pleasure in almost all activities.

What are common signs and symptoms of depression?

Sadness, hopelessness, fatigue, social withdrawal, sleep disturbances, appetite changes, poor concentration, feelings of worthlessness, and suicidal thoughts.

What is the priority nursing assessment for a client with depression?

Assess for suicidal thoughts, plan, intent, and means.

What should the nurse assess first in a client with depression?

Client safety by assessing suicide risk.

What nursing intervention is a priority for hospitalized clients with depression?

Monitor closely for suicide risk and encourage participation in ADLs and structured activities.

Why should the nurse pace interactions with a client who has depression?

Psychomotor retardation may slow the client's responses.

What bowel problem is common in depression?

Constipation caused by slowed GI motility.

What nursing interventions help prevent constipation in depression?

Encourage walking, fluids, and a high-fiber diet.

How should the nurse communicate with a client who has depression?

Use positive, empathetic communication that instills hope.

What outpatient interventions are recommended for depression?

Medication management, psychotherapy, exercise, good sleep hygiene, and follow-up care.

What is the first-line medication class for Major Depressive Disorder?

Selective Serotonin Reuptake Inhibitors (SSRIs).

Which neurotransmitter is primarily increased by SSRIs?

Serotonin.

What should the nurse teach a client starting an SSRI?

Take it consistently, do not stop abruptly, and report worsening depression or suicidal thoughts.

Why is suicide risk increased when antidepressants are first started?

Energy may improve before mood improves, increasing the ability to act on suicidal thoughts.

What finding indicates treatment for depression is improving?

Improved mood, increased participation in activities, better sleep, improved appetite, and no suicidal ideation.

What finding indicates depression is worsening?

Increased hopelessness, worsening withdrawal, inability to perform ADLs, or suicidal thoughts.

What is the overall nursing priority for a client with depression?

Maintain safety while promoting recovery and improving daily functioning.

What medication class is considered first-line for Major Depressive Disorder?

Selective Serotonin Reuptake Inhibitors (SSRIs).

Which neurotransmitter do SSRIs primarily increase?

Serotonin.

Which medications are SSRIs?

Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).

What disorders are SSRIs commonly used to treat?

Major depressive disorder, anxiety disorders, OCD, PTSD, and panic disorder.

What is the black box warning for SSRIs?

Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

What should the nurse monitor when a client first starts an SSRI?

Worsening depression, suicidal thoughts, or unusual behavior changes.

How long do SSRIs usually take to reach their full therapeutic effect?

Several weeks.

What common side effects occur with SSRIs?

Nausea, headache, insomnia, sexual dysfunction, and GI upset.

What is serotonin syndrome?

A potentially life-threatening condition caused by excessive serotonin.

What are signs of serotonin syndrome?

Agitation, confusion, fever, sweating, tremor, hyperreflexia, diarrhea, and muscle rigidity.

What should the nurse do if serotonin syndrome is suspected?

Stop the medication and notify the provider immediately.

Which medication class blocks the reuptake of serotonin and norepinephrine?

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).

Which medications are SNRIs?

Venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).

What should the nurse monitor in clients taking SNRIs?

Blood pressure because SNRIs may increase it.

Which medication class should be used cautiously because of anticholinergic side effects and cardiac toxicity?

Tricyclic Antidepressants (TCAs).

Which medications are TCAs?

Amitriptyline, nortriptyline, and imipramine.

What are common anticholinergic side effects of TCAs?

Dry mouth, constipation, urinary retention, blurred vision, and tachycardia.

Which antidepressants require clients to avoid tyramine-rich foods?

Monoamine Oxidase Inhibitors (MAOIs).

Which medications are MAOIs?

Phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).

What foods should clients taking MAOIs avoid?

Aged cheeses, cured meats, fermented foods, beer, wine, and other tyramine-rich foods.

What serious complication can occur if tyramine is consumed while taking an MAOI?

Hypertensive crisis.

What teaching should the nurse provide for all antidepressants?

Take the medication consistently, do not stop abruptly, and report worsening depression or suicidal thoughts.

What finding indicates antidepressant therapy is effective?

Improved mood, increased activity, improved sleep, improved appetite, and decreased depressive symptoms.

What is Bipolar Disorder?

A mood disorder characterized by alternating episodes of depression and mania or hypomania.

What is the pathophysiology of Bipolar Disorder?

Altered regulation of neurotransmitters causes abnormal mood, energy, activity, and behavior.

What are the major risk factors for Bipolar Disorder?

Family history, genetics, stressful life events, and neurotransmitter imbalances.

What is the difference between Bipolar I and Bipolar II?

Bipolar I includes at least one manic episode, while Bipolar II includes hypomania and major depressive episodes without full mania.

What are the hallmark signs and symptoms of Bipolar Disorder?

Alternating episodes of depression and mania with significant changes in mood, energy, sleep, and behavior.

What is the priority nursing assessment for a client with Bipolar Disorder?

Assess current mood, risk for self-harm, risk for harm to others, sleep, nutrition, and medication adherence.

What should the nurse assess first in a client experiencing Bipolar Disorder?

Client safety and whether the client is currently manic or depressed.

What are priority nursing interventions during a depressive episode?

Assess suicide risk, encourage medication adherence, promote self-care, and provide emotional support.

What are priority nursing interventions during a manic episode?

Maintain safety, decrease environmental stimulation, set consistent limits, and meet nutritional and hydration needs.

Why is sleep assessment important in Bipolar Disorder?

Decreased need for sleep is a common finding during mania and may worsen symptoms.

Why should the nurse monitor nutritional status during mania?

Clients may be too hyperactive or distracted to eat adequately.

What communication technique should the nurse use with a manic client?

Use calm, clear, concise statements and set consistent limits.

Why should the nurse decrease environmental stimulation during mania?

To reduce agitation and prevent escalation of manic behaviors.

What complications can occur with Bipolar Disorder?

Suicide, injury, poor judgment, impaired relationships, and medication nonadherence.

What patient education is important for Bipolar Disorder?

Take medications consistently, maintain a regular sleep schedule, avoid alcohol and drugs, and keep follow-up appointments.

How does the nurse know treatment for Bipolar Disorder is effective?

Mood stabilizes, sleep improves, judgment improves, and the client functions safely.

What findings indicate Bipolar Disorder is worsening?

Increasing mania, worsening depression, poor judgment, medication nonadherence, or suicidal thoughts.

What is the overall nursing priority for Bipolar Disorder?

Maintain safety while promoting mood stabilization and medication adherence.

Why is medication adherence essential in Bipolar Disorder?

It helps prevent relapse and decreases the frequency and severity of mood episodes.

What assessment finding requires immediate intervention in a client with Bipolar Disorder?

Suicidal ideation, homicidal ideation, or behaviors that place the client or others at immediate risk.

What is the first-line medication for Bipolar Disorder?

Lithium.

What is the primary purpose of lithium therapy?

To treat Bipolar I and II, stabilize mood, prevent future mood episodes, and reduce suicidality.

Which mood stabilizers are included in this study guide?

Lithium, valproic acid (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal).

What is the therapeutic lithium level?

0.6–1.2 mEq/L.

What lithium level may be used during acute mania?

Up to 1.5 mEq/L.

When should a lithium blood level be drawn?

12 hours after the last dose.

What laboratory tests should be monitored while taking lithium?

Renal function (BUN, creatinine), thyroid function (TSH), CBC, and lithium level.

Why should renal function be monitored during lithium therapy?

Lithium is excreted by the kidneys, and impaired renal function increases toxicity risk.

Why should thyroid function be monitored during lithium therapy?

Lithium may cause hypothyroidism.

What common side effects occur with lithium?

Fine hand tremor, polyuria, polydipsia, nausea, weight gain, acne, and hypothyroidism.

What are the early signs of lithium toxicity?

Coarse tremor, nausea, vomiting, diarrhea, drowsiness, confusion, and slurred speech.

What are moderate signs of lithium toxicity?

Confusion, ataxia, and muscle twitching.

What are severe signs of lithium toxicity?

Seizures, coma, and renal failure.

What should the nurse do if lithium toxicity is suspected?

Hold the medication and notify the provider immediately.

Why is maintaining adequate sodium intake important while taking lithium?

Low sodium causes lithium retention, increasing the risk of toxicity.

Why should clients taking lithium maintain adequate fluid intake?

Dehydration increases the risk of lithium toxicity.

Which medications should clients avoid while taking lithium?

NSAIDs and diuretics because they increase lithium levels.

Why should clients avoid NSAIDs while taking lithium?

NSAIDs can increase lithium levels and lead to toxicity.

What teaching should the nurse provide for clients taking lithium?

Take with food, do not restrict salt, maintain hydration, never stop abruptly, and know the signs of toxicity.

Which mood stabilizer primarily prevents depressive episodes in Bipolar II Disorder?

Lamotrigine.

What serious adverse effect is associated with lamotrigine?

Stevens-Johnson syndrome.

What should the client do if a rash develops while taking lamotrigine?

Stop the medication immediately and notify the provider.

What serious adverse effects are associated with valproic acid?

Hepatotoxicity, pancreatitis, and teratogenicity.

What serious adverse effects are associated with carbamazepine?

Agranulocytosis, aplastic anemia, and Stevens-Johnson syndrome.

What is the overall nursing priority for clients taking mood stabilizers?

Promote medication adherence, monitor for toxicity, and educate clients to recognize serious adverse effects.

What is mania?

A period of abnormally elevated, expansive, or irritable mood with increased energy and activity that significantly impairs functioning.

What is the pathophysiology of mania?

Dysregulation of dopamine, serotonin, and norepinephrine causes excessive mood elevation, energy, and impulsive behavior.

What is the hallmark characteristic of mania?

Abnormally elevated mood with excessive energy and decreased need for sleep.

What are common signs and symptoms of mania?

Grandiosity, pressured speech, flight of ideas, distractibility, impulsive behavior, poor judgment, increased activity, decreased need for sleep, and hypersexuality.

What is the priority nursing assessment for a client experiencing mania?

Assess safety, risk-taking behaviors, nutritional status, hydration, sleep, and risk of harm to self or others.

What should the nurse assess first in a client with mania?

Client safety and risk for impulsive or dangerous behaviors.

What is the highest nursing priority during acute mania?

Maintain client safety.

Why are clients with mania at risk for injury?

Poor judgment, impulsivity, hyperactivity, and risk-taking behaviors increase the chance of injury.

What nursing intervention helps decrease stimulation during mania?

Provide a calm, quiet environment with minimal distractions.

How should the nurse communicate with a manic client?

Use calm, brief, simple, and direct communication.