CNUR 304 Unit 3: Mood Disorders, Depressive Disorders, Bipolar Disorders, Psychopharmacology, and Suicide

Comprehensive practice flashcards covering mood disorders, diagnostic criteria, psychopharmacology, clinical nursing interventions, and suicide risk assessment based on CNUR 304 lecture notes.

Mood Disorders

A group of psychiatric disorders that affect how an individual feels, changing their thinking, behavior, and physical functions; they often present during adolescence and are treatable across the lifespan.

Emotions

A state of arousal defined by subjective states of feeling that individuals experience internally and personally.

Mood

A pervasive and sustained emotional response that may influence an individual's perceptions and internal emotional state.

Affect

Observable outward behaviors, including facial expressions, that correspond with subjective feelings and display emotional state externally.

Continuum of Emotional Responses

A clinical spectrum of emotional functioning ranging from adaptive responses (emotional responsiveness and uncomplicated grief reactions) through suppression of emotions and delayed grief reactions, to maladaptive responses (depression and mania).

Exit Events

Psychosocial stressors characterized by separations or losses, which impact the onset and maintenance of depression more significantly than entrance events (additions or introductions).

Anhedonia

The profound loss of interest or pleasure in nearly all activities, hobbies, or sexual desire; reported in approximately $97\%$ of depression cases and serves as a core diagnostic symptom of Major Depressive Disorder.

Patient Health Questionnaire-9 (PHQ-9)

A standardized $9$-item clinical screening tool used to assess depression severity, with score ranges categorized as: $0\text{--}4$ (None), $5\text{--}9$ (Mild), $10\text{--}14$ (Moderate), $15\text{--}19$ (Moderately Severe), and $20\text{--}27$ (Severe).

Major Depressive Disorder (MDD)

A mood disorder requiring at least $5$ symptoms present during the same $2$-week period (including depressed mood or anhedonia) causing significant distress or functional impairment; episodes typically last $5\text{--}6$ months, with $20\%$ persisting beyond $2$ years.

Persistent Depressive Disorder (PDD)

Formerly termed Dysthymic Disorder; a chronic depressive condition defined by depressed mood for most of the day, on most days, for at least $2$ years in adults ($1$ year in youth), accompanied by at least $2$ other depressive symptoms.

Electroconvulsive Therapy (ECT)

A psychiatric somatic treatment that passes electrical currents through the brain to induce a therapeutic seizure; delivered in a series of $6\text{--}12$ treatments under general anesthesia and muscle relaxation for treatment-resistant depression, acute suicidal crisis, or rapid cycling.

Increased Intracranial Pressure (ICP)

The single absolute medical contraindication to receiving electroconvulsive therapy (ECT).

Cognitive Distortions

Consistent, automatic errors in thinking (such as personalizing, catastrophic thinking, self-blame, overgeneralization, and jumping to conclusions) addressed in CBT via thought-stopping and positive thought substitution.

Selective Serotonin Reuptake Inhibitors (SSRIs)

The current first-line class of antidepressant medications that selectively block the reuptake of serotonin ($5\text{-HT}$) into the presynaptic terminal, offering fewer anticholinergic and antihistaminic adverse effects than older classes.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

An antidepressant drug class (including venlafaxine, duloxetine, and desvenlafaxine) that acts on both serotonergic and noradrenergic neurons; commonly prescribed for depression, anxiety disorders, neuropathic pain, and fibromyalgia.

Tricyclic Antidepressants (TCAs)

An older antidepressant class (including amitriptyline, imipramine, and nortriptyline) that blocks the reuptake of norepinephrine and serotonin; carries potent anticholinergic side effects and is highly fatal in overdose due to cardiotoxicity and neurotoxicity.

Monoamine Oxidase Inhibitors (MAOIs)

An antidepressant drug class (such as phenelzine and moclobemide) that inhibits the monoamine oxidase enzyme, requiring strict dietary avoidance of tyramine-containing foods to prevent life-threatening hypertensive crises.

Hypertensive Crisis

A life-threatening complication associated with MAOIs triggered by tyramine ingestion or sympathomimetic interactions; characterized by sudden severe hypertension, nuchal rigidity, occipital headache, palpitations, sweating, nausea, and vomiting.

Serotonin Syndrome

A potentially fatal toxic state caused by excess serotonin transmission; presents within $24$ hours with a clinical triad of altered mental status, autonomic instability, and neuromuscular abnormalities (hyperreflexia, clonus, tremors, and rigidity).

FINISH Mnemonic

An acronym identifying the hallmark features of antidepressant discontinuation/withdrawal syndrome, which typically emerges within days and lasts roughly $10$ days: Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, and Hyperarousal.

Bupropion (Wellbutrin)

An activating norepinephrine-dopamine reuptake inhibitor (NDRI) prescribed at $100\text{--}450\,\text{mg/day}$; notably lowers seizure threshold and is strictly contraindicated in individuals with seizure history, head trauma, or eating disorders.

Bipolar I Disorder

A severe bipolar subtype characterized by the occurrence of at least one full manic episode lasting at least $1$ week (or requiring hospitalization), with elevated, expansive, or irritable mood and marked functional impairment.

Bipolar II Disorder

A bipolar disorder diagnostic category meeting criteria for at least one hypomanic episode (lasting at least $4$ consecutive days without psychotic features or required hospitalization) and at least one major depressive episode, with no history of mania.

Cyclothymic Disorder

A chronic mood disturbance lasting at least $2$ years in adults ($1$ year in youth) characterized by numerous periods of hypomanic symptoms alternating with mild to moderate depressive symptoms that do not meet full criteria for Bipolar II or MDD.

Rapid Cycling

A bipolar course specifier defined by at least $4$ mood episodes (depression, mania, or hypomania) occurring within a $12$-month period, which can occasionally shift within months or $24$-hour windows, indicating poorer global functioning.

Bipolar Disorder Mood Cycling

The comparative spectrum of mood fluctuations illustrating differences between Cyclothymia (hypomania alternating with mild depression), Bipolar Type II (hypomania alternating with major depression), and Bipolar Type I (full mania alternating with major depression).

Lithium

The standard first-line mood stabilizer and drug of choice for acute mania and bipolar relapse prevention; maintains a narrow therapeutic range of $0.6\text{ to }1.0\,\mu\text{mol/L}$ (maintenance) and $0.8\text{ to }1.2\,\mu\text{mol/L}$ (acute mania).

Lithium Toxicity

A dangerous toxic state occurring when serum levels exceed $1.5\,\text{mEq/L}$ (drowsiness, coarse hand tremor, confusion, slurred speech) and worsening above $2.0\,\text{mEq/L}$ (ataxia, dilute polyuria, dysrhythmias, seizures, coma, death); exacerbated by sodium depletion.

HLA-B*1502 Screening

A mandatory pharmacogenetic test conducted prior to starting carbamazepine (Tegretol) therapy to evaluate the patient's risk of developing life-threatening cutaneous reactions like Stevens-Johnson syndrome (SJS).

Lamotrigine 5-Day Re-titration Rule

A safety requirement specifying that if a patient misses lamotrigine (Lamictal) doses for $5$ consecutive days ($5 \times t_{1/2}$ of $24\,\text{hours}$), the dose must be re-titrated from the starting dose ($25\,\text{mg/day}$) to prevent Stevens-Johnson syndrome.

SAD PERSONS Scale

An evidence-based assessment mnemonic for evaluating suicide risk: Sex (male), Age, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social support deficit, Organized plan, No spouse, and Sickness.

In psychiatric assessment, how are emotions, mood, and affect distinguished from one another?

Emotions are subjective states of arousal experienced internally and personally. Mood is a pervasive and sustained emotional response that colors a person's perceptions and internal state. Affect consists of observable behaviors, such as facial expressions, that display mood externally to others.

What stages comprise the continuum of emotional responses from adaptive to maladaptive?

The continuum progresses from adaptive responses (emotional responsiveness and uncomplicated grief reaction) through suppression of emotions and delayed grief reaction, to maladaptive responses (depression and mania).

What are the lifetime prevalence and hospitalization rate statistics for depression discussed in the lecture?

Depression has an $11.3\%$ lifetime prevalence ($1\text{ in }8$ adults meet criteria for a mood disorder in their lifetime), and the likelihood of women with depression being hospitalized is $1.5\times$ higher than men.

Why is differential medical screening especially critical before diagnosing depression in older adults?

It is essential to screen for and rule out organic brain damage before diagnosing depression in elderly patients.

In the psychosocial etiology of depression, how do exit events compare to entrance events?

Exit events (such as separations and losses) are more impactful and trigger depression more often than entrance events (such as additions and introductions).

What percentage of depressed patients present with anhedonia and anxiety?

Anhedonia is present in $97\%$ of depression cases, while anxiety co-occurs in $60\%\text{--}90\%$ of cases.

What depression severity classifications correspond to the total score ranges on the Patient Health Questionnaire-9 (PHQ-9)?

Scores of $0\text{--}4$ indicate None; $5\text{--}9$ indicate Mild; $10\text{--}14$ indicate Moderate; $15\text{--}19$ indicate Moderately Severe; and $20\text{--}27$ indicate Severe depression.

What are the core DSM-5 diagnostic requirements for Major Depressive Disorder (MDD) regarding symptom count and duration?

At least $5$ symptoms must be present in the same $2$-week period, and at least one of the symptoms must be either depressed mood or anhedonia (loss of interest or pleasure).

What is the typical episode duration of Major Depressive Disorder, and what percentage becomes chronic?

An episode typically lasts $5\text{--}6$ months, with $20\%$ of cases becoming chronic and lasting more than $2$ years.

What are the diagnostic criteria for Dysthymic Disorder (Persistent Depressive Disorder)?

A chronically depressed mood present for most of the day on most days for at least $2$ years in adults, accompanied by $2$ or more associated symptoms (such as appetite changes, sleep disturbances, low energy, low self-esteem, poor concentration, or hopelessness).

What is the primary absolute contraindication to Electroconvulsive Therapy (ECT)?

Increased intracranial pressure is the primary absolute contraindication. Relative contraindications include cerebrovascular accident (CVA), brain tumor, severe hypertension, and retinal detachment.

What pre-procedure nursing actions are required prior to Electroconvulsive Therapy (ECT)?

Ensure informed consent was obtained (the nurse confirms consent but does not obtain it); enforce NPO status after midnight (or $6\text{--}8$ hours prior); remove dentures, glasses, contacts, hearing aids, and hairpins; have the patient void to prevent incontinence; and discontinue benzodiazepines the day prior because they interfere with seizure induction.

What are the essential post-procedure nursing priorities following Electroconvulsive Therapy (ECT)?

Place the patient in a side-lying position, monitor airway, vital signs, level of consciousness, and gag reflex, and provide gentle reorientation and reassurance.

What conversational statements must nurses avoid when communicating with a depressed patient?

Nurses must avoid dismissive clichés such as 'tomorrow will be better', 'things could always be worse', and 'everyone gets down sometimes'.

What common cognitive distortions are addressed during Cognitive Behavioral Therapy (CBT) for depression?

Cognitive distortions include the mind creating false thoughts, self-blame, assumptions, personalizing, overgeneralizations, and jumping to conclusions, which are countered using thought stopping, thought substitution, and reviewing personal assets.

Which adverse effect profile distinguishes Citalopram, Paroxetine, and Sertraline among the SSRIs?

Citalopram carries a dose-dependent risk of QT prolongation; Paroxetine is more sedating, causes greater anticholinergic effects, and leads to more weight gain; and Sertraline causes the highest incidence of diarrhea and male sexual dysfunction.

What does the FINISH mnemonic stand for regarding antidepressant withdrawal syndrome, and how long does it usually last?

FINISH stands for Flu-like symptoms, Insomnia, Nausea, Imbalance (dizziness), Sensory disturbances (paresthesias, electric shock-like sensations), and Hyperarousal (agitation, restlessness). It usually lasts approximately $10$ days.

What clinical triad characterizes Serotonin Syndrome, and what is its emergency management?

The triad includes altered mental status (agitation, delirium, restlessness), autonomic instability (hypertension, tachycardia, hyperthermia, diaphoresis), and neuromuscular abnormalities (hyperreflexia, clonus, tremors, rigidity). Treatment requires supportive care and immediate discontinuation of all serotonergic agents.

Why are Tricyclic Antidepressants (TCAs) particularly fatal in overdose situations?

TCAs are fatal in overdose due to severe cardiac toxicity (dysrhythmias, hypotension) and neurotoxicity (seizures, coma).

What dietary restriction is mandatory for patients receiving irreversible MAOIs such as Phenelzine (Nardil)?

Patients must strictly avoid tyramine-containing foods (such as aged cheeses, beer, wine, processed/cured meats, and fava beans) to avoid precipitating a life-threatening hypertensive crisis, and maintain a $2$-week washout period when switching antidepressants.

How does the reversible MAOI Moclobemide (Manerix) differ from irreversible MAOIs regarding dietary restrictions?

Moclobemide has an enzyme-inhibiting effect lasting $24$ hours, requires no dietary tyramine restrictions at daily doses below $600\,\text{mg/day}$, and causes less sexual dysfunction.

What is the primary neurological contraindication to the use of Bupropion (Wellbutrin)?

Bupropion carries a dose-dependent risk of seizures and is contraindicated in patients with a history of seizures, head trauma, eating disorders, or active electrolyte disturbances.

What is the diagnostic threshold for a manic episode in Bipolar I Disorder?

A distinct period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy lasting everyday for at least $1$ week (or any duration if hospitalization is required), with at least $3$ manic symptoms ($4$ if mood is only irritable).

How do the mood cycling ranges of Cyclothymia, Bipolar Type II, and Bipolar Type I compare across the mood spectrum?

Cyclothymia cycles between hypomania and mild depression; Bipolar Type II cycles between hypomania and major depression (without full mania); and Bipolar Type I spans the full spectrum from major depression up to full acute mania.

What differentiates Bipolar II Disorder from Bipolar I Disorder regarding mood episodes?

Bipolar II requires at least $1$ hypomanic episode (lasting at least $4$ days without psychosis or hospitalization) and at least $1$ major depressive episode, and the patient has never experienced a full manic episode.

How is rapid cycling defined in the context of bipolar and cyclothymic disorders?

Rapid cycling is defined as experiencing at least $4$ distinct mood episodes within a $12$-month period, though mood shifts can also occur within a single month or even over $24$-hour periods.

What are key nursing interventions for nutrition, rest, and communication in a patient experiencing acute mania?

Provide high-calorie, portable finger foods and fluids because the patient is 'on the run', enforce scheduled rest periods, reduce environmental stimuli, set firm consistent limits, and communicate with clear, concise directions without engaging in arguments.

What are the maintenance therapeutic range and toxicity thresholds for serum Lithium?

The maintenance therapeutic range is $0.6\text{--}1.0\,\text{mEq/L}$ ($0.8\text{--}1.2\,\text{mEq/L}$ for acute mania). Levels above $1.5\,\text{mEq/L}$ produce early toxicity (coarse hand tremor, confusion, persistent GI upset), and levels above $2.0\,\text{mEq/L}$ cause severe toxicity (ataxia, dilute polyuria, hypotension, arrhythmias, seizures, coma, death).

What electrolyte imbalance increases the risk of Lithium toxicity?

Depletion of sodium ($\text{NaCl}$ depletion) and dehydration cause the kidneys to reabsorb lithium instead of sodium, rapidly elevating serum lithium levels to toxic ranges.

What genetic screening is required prior to starting Carbamazepine (Tegretol), and what is its effect on drug metabolism?

Patients should be screened for the $\text{HLA-B*1502}$ allele to avoid severe cutaneous reactions. Carbamazepine is a potent CYP3A4 inducer that induces its own metabolism.

What clinical titration protocol is mandatory if a patient misses Lamotrigine (Lamictal) doses for 5 consecutive days?

If Lamotrigine is missed for $5$ days ($5\times t_{1/2}$ of $24$ hours), the patient must completely restart the initial dose titration from the beginning to prevent life-threatening Stevens-Johnson syndrome (SJS).

What are the annual national suicide figures and daily rates reported for Canada?

Approximately $4{,}000\text{--}4{,}500$ individuals die by suicide annually in Canada (an average of $11$ deaths per day), with an estimated $20\text{--}25$ attempts for each completed suicide ($275$ daily attempts).

What demographic disparities exist in Canadian suicide mortality rates concerning sex and Indigenous youth?

Suicide mortality is approximately $3\times$ higher among men compared to women, and Indigenous youth die by suicide at $5\text{--}6\times$ the rate of non-Indigenous youth.

Why does suicide risk paradoxically increase when a severely depressed patient starts to show clinical improvement?

As depressive symptoms begin to lift, patients often regain the physical energy, initiative, and cognitive ability necessary to act upon previously established suicidal ideation.

What clinical risk factors are evaluated in the SAD PERSONS scale for suicide risk assessment?

S = Sex (male), A = Age (older), D = Depression, P = Previous attempt(s), E = Ethanol/substance use, R = Rational thinking loss, S = Social support deficit, O = Organized plan, N = No spouse, S = Sickness (chronic medical illness).