Mood Disorders

  1. What is the subjective experience of emotions or feelings?
  2. What is the outward expression of a persons inner state of being?
  3. What are some causes of depression?
    Biochemical, hereditary, hormonal
  4. List the biochemical causes of depression
    • *Serotonin
    • *Norepinephrine
    • *Dopamine
    • *Acetylcholine
  5. What is the hereditary cause of depression?
    *genetic predisposition
  6. What is the hormonal cause of depression?
    *Corticotrophin releasing hormones
  7. What are the types of depressive disorders
    • * major depressive disorder
    • * dysthymic disorder
  8. What is major depressive disorder?
    • * Unipolar Disorder
    • * Mild to severe lasting at least 2 weeks
    • * May include delusions & hallucinations
  9. What is Dysthymic disorder?
    * Chronic disorder where depressive mood is persistent lasting more than 2 years.
  10. What is a chronic disorder where depressive mood is persistent lasting more than2 years?
    Dysthymic Disorder
  11. What is a unipolar disorder, that is mild to severe lasting at least 2 weeks, may include delusions and hallucinations?
    Major Depression Disorder
  12. List the Subtypes of depression?
    • * Psychotic
    • * Melancholic
    • * Atypical
    • * Catatonic
    • * Postpartum
    • * Seasonal
  13. What are the types of Bipolar disorders?
    • * Bipolar 1
    • * Bipolar II
    • * Cyclothymic
  14. What is Bipolar I?
    * At least one episode of mania alternating with major depression
  15. What is Bipolar II?
    * Hypomanic episodes alternating with major deprssion
  16. What is Cyclothymic?
    * Hypomanic episodes alternating with minor depression
  17. What is at least one episode of mania alternating with major depression?
    Bipolar I
  18. What is hypomanic episodes alternating with major depression?
    Bipolar II
  19. What is hypomanic episodes alternating with minor depression?
    Cyclothymic bipolar
  20. What are these characteristics of?
    * Inflated self esteem
    * Decreased need for sleep
    * Unfocused, distracted
    * Verbose, flight of ideas
    Characteristics of a manic episode
  21. What are characteristics of a manic episode?
    • * Inflated self esteem
    • * Decreased need for sleep
    • * Unfocused, distracted
    • * Verbose, flight of ideas
  22. What are mixed moods, such as major depression & manic depression, with one or more of the following s/s, delusions, hallucinations, disorganized speech, or disorganized behavior?
    Schizoaffective disorder
  23. This is considered to be normal, until it interferes with life?
  24. What is schizoaffective disorder?
    Its mixed mood disorder, major depression, or manic, with 1 or more of delusions, hallucinations, disorganized speech, or disorganized behavior.
  25. can we teach during a panic attack?
    No- we have to just help them get through it and let them know they will not die. then we can help them learn how to recognize symptoms, and teach breathing, relaxation, and meditation.
  26. What can a nurse do to avoid feelings of frustration when establishing a relationship and working with a severely depressed client?
    Expect the client to be withdrawn and disinterested in a relationship
  27. The nurse knows the major factor that distinguishes bipolar from a unipolar disorder is the??
    Presence of mania
  28. You are reassessing your client. Which behavior indicated the manic phase is resolving?

    A) She talks less and more slowly
  29. What is the most important outcome for a client with a mood disorder?
  30. The nurse is caring for a client who is moderately depressed. Which of the following responses would the nurse expect from this client about decision-making?

    D) "What do you think I should do now."
  31. A young man has been placed on one-to-one precaution due to his suicidal ideation. The nurse has been spending time talking to him and he has identified many factors that affect his feelings and reactions to others. The next step for the nurse is to assist the client with:
    Problem Solving
  32. A new nurse on a psychiatric unit who has been working in medical units asks the staff about suicide assessments. "I don't feel comfortable asking a client about suicide. Won't this lead to the client fulfilling my fear?" What should staff tell the new nurse?
    It is not possible to give someone suicidal ideation.
  33. The nurse caring for client with depression is aware that at what point is it particularly important to assess the client's suicidal ideation?
    When the client begins to recover

    * rationale- Depressed clients often don't have the energy to carry out a suicide plan, then as they get well from medication and treatment, they may still be suicidal and have the energy to do it
  34. When problem solving with clients who are suicidal, the first step would be to have them:
    Describe their goal they hope to achieve with suicide
  35. The initial goal of the worker on the suicide telephone line is to:
    Establish rapport with the caller
  36. What should the nurse include when teaching a client about panic disorder?
    Symptoms of a panic attack are time limited and will subside
  37. The nurse recognizes that behavior is usually viewed and accepted as normal if it:
    fits within standards accepted by one's society
  38. A client developed a number of compulsive washing rituals over the years and has sought the help of a psychiatrist, who diagnosed obsessive-compulsive disorder. What purpose does the nurse recognize that the behavioral rituals serve?
    Providing temporary and partial relief from her anxiety
  39. While stuck in traffic, a cab driver unexpectedly began to feel lightheaded, tremulous, and sweaty.  His heart began pounding and his breathing became rapid and labored. He thought he was having a heart attack. An cardiac workup in the emergency department revealed no abnormalities. The cab driver asks the nurse, "Am I going crazy?" What is an appropriate nursing response?
    "Although it may feel that way during the midst of an attack, you actually suffer from panic disorder."
  40. The patient has OCD and checks and recheck that doors are locked, what purpose is this serving the patient?
    Provides temporary and partial relief from her anxiety
  41. As part of the milieu therapy, the client has the freedom to?
    Express feelings in a socially acceptable manner
  42. The client with acute stress disorder has avoided feelings of anger toward her rapist and is unable to verbally express them. The nurse suggests which of the following activities to assist the client with expressing her feelings?

    B) Writing in a journal

    * Rationale- This helps the client safely express feelings particularly anger when unable to verbalize them
  43. Nurses will plan nursing care for clients with phobias based on what behavior pattern?

    * Rationale- People with a phobia will avoid the situation or object that causes fear.
  44. According to the Life Changing Event Questionnaire, which situation would most merit a complete assessment by the nurse of a person's stress status and coping abilities?

    A)A person returning to college after his employer ceased operations.
    B)A man whose job is requiring him to relocate to a different city.
    C)A person who has been assigned more responsibilities at work.
    D)A man who recently separated from his wife because of marital problems.
    A)A person returning to college after his employer ceased operations.

    * Rationale - A person returning to college after losing his job is dealing with two significant stressors simultaneously. together, these stressors total more "life change units" than any of the single stressors cited in the other options.
  45. The nurse wishes to use guided imagery to help her client relax. Which comment would be appropriate to include in the guided imagery script?  Select all that apply.

    A)"Imagine others treating you the way they should, the way you want to be treated.."
    B)"With each breath, you are feeling calmer, more relaxed, almost as if you are floating..."
    C)"You are alone on a beach, the sun is warm, and you hear only the sound of the surf..."
    D)"You have taken control, nothing can hurt you now, everything is going your way..."
    E)"You have grown calm, your mind is still, there is nothing to disturb your well-being..."
    F)"You will feel better as work calms down, as your boss becomes more understanding..."
    • B) With each breath, you are feeling calmer, more relaxed, almost as if you are floating...
    • C) You are alone on the beach, the sun is warm, and you hear only the sounds of the surf....
    • E) You have grown calm, your mind is still, there is nothing to disturb your well-being...
  46. Which example of behavior within a family system should the nurse assess as double-bind communication?

    C) A wife tells her husband, "You go ahead and go bowling and try not to worry about me falling on my crutches while I'm alone at home."

    * Rationale - A double-bind communication is one that is inherently contradictory, that is, a comment that gives conflicting directions. In this case, the wife on crutches suggests that her husband should go bowling but then indicates that she will be at greater risk if he does, which in effect tells him, "go ahead" and "don't do it" at the same time.
  47. Using statements like "always" and "never" when dealing with problem solving, instead of dealing with specific problems. "Harry is always angry"
  48. What is Generalizing when talking about dysfunctional communication?
    Using always and never when dealing with family issues
  49. What is it when family members pretend to be inadequate but well meaning to keep peace in the family at any price. "Don't yell at the children, I put the shoes on the stairs"
  50. Describe what placating is
    What is it when family members pretend to be inadequate but well meaning to keep peace in the family at any price. "Don't yell at the children, I put the shoes on the stairs"
  51. Since we cannot teach someone while they are having a panic attack, what do we need to do?
    we have to help them get through it, let them know they will not die, then we help them learn how to recognize the symptoms.
  52. After you have stayed with someone and helped them through a panic attack, what is the next thing we should do? And what should we teach them?
    First teach them to learn how to recognize the symptoms, and teach them breathing, relaxation, and meditation
  53. For PTSD- we teach patient to use?
  54. For Stress we teach them to use?
    breathing relaxation
  55. A surgery patient, pain control, MRI, or long hospitalization, use?
    guided imagery, music
  56. For a panic attack teach _____ for relaxation?
  57. This type of boundary is well understood by all family members and gives a sense of "I-ness" and "we-ness" and allows members to function without unnecessary interference from other members?
    Clear Boundaries
  58. This type of boundary blends together the roles, thoughts, & feelings of the individual family member, so clear distinctions emerge. individuals expect other family members to know what they are thinking, & believe they know what other members are thinking
    Diffuse Boundaries
  59. This type of boundary is the rules and roles are consistently adhered to no matter what, preventing family members from trying out new roles, isolation may be marked, family members are often cut off from the community and outside influences & even each other?
    Rigid Boundaries
  60. There are 4 types of boundaries that maintain a distinction between individuals in the family- what are those types?
    Clear, Diffuse, Rigid, Inconsistent
  61. What are the 5 dysfunctional communication examples?
    manipulating, distracting, generalizing, blaming, placating
  62. This is a dysfunctional communication - Instead of asking directly for what is wanted, family members use ________ to get what they want?
  63. These are examples of what dysfunctional communication?
    " Child starts a fight with another sibling to get attention" or " if you do this for me, I wont tell dad you are getting bad grades"
  64. To avoid functional problem solving & resolve conflicts within the family, irrelevant details are introduced into the problematic issue... What type of dysfunctional communication is this?
  65. Phrases like "always" & "never" are global statements used to deal with the problematic issue, instead of dealing with the specific problem. Another example of this dysfunctional communications is " Harry is always angry" instead of " Harry, what is bothering you"
  66. This dysfunctional communication is to keep the focus off them, they put this on others for their failures, errors.
  67. This type of dysfunctional communication pretends to be inadequate by keeping the peace in the family, " Don't yell at the children, I put the shoes on the stairs"
  68. This person is who everyone blames their problems on...
    The identified patient
  69. This is a form of displacement in which a family member is blamed for another members distress, the purpose of this is to keep the focus off the painful issues and problems of the blamer.
  70. This form of displacement, the parents are often the blamers and the child is the _____
  71. A situation in which a positive command (usually verbal) is followed by a negative command (often non-verbal), which leaves the recipient confused, trapped, and immobilized because there is no appropriate way to act.
    Double Bind
  72. Birth of a child, employment change, children leaving home, & retirement are all __________ through the family life cycle?
    Transition points
  73. A serious illness, death or divorce, are considered _______ in the family life cycle?
    Interruptions or dislocations
  74. When depression is mixed with anxiety is it easier or harder to treat?
    harder to treat
  75. With depression, the person may or may not have ________?
  76. When assessing for mood of patient, the Affect (facial expression) is considered?
    The objective data
  77. When assessing for mood, its what they are telling you, is considered?
    Subjective data
  78. How is anxiety rated by the patient?
    like a pain scale - (0-10)
  79. What are the 3 types of phases in treatment & recovery for major depression?
    Acute, continuation, & maintenance
  80. This phase of treatment for major depression is directed at reduction of depressive symptoms and restoration of psychosocial & work function? what is the time period?
    Acute - 6-12 wks
  81. This phase of treatment for major depression is directed at preventing relapse through pharmacotherapy education & depression specific psychotherapy? time period for this?
    Continuation - 4-9 months
  82. This phase of treatment for major depression is directed at prevention of further episodes of depression? time period?
    Maintenance - 1 yr
  83. Continuation & maintenance phases are geared towards maintaining the patient as a functionall and contribution member of the community after the ____________ phase?
  84. Name some nursing diagnosis for depression?
    Risk for suicide, hopelessness, ineffective coping, social isolation, spiritual distress, self care deficit
  85. Risk for suicide, hopelessness, ineffective coping, social isolation, spiritual distress, self care deficit are some nursing diagnosis for __________?
  86. What is the most important thing and the first thing that should be done when assessing a depressed client?
    Ask about suicidal thoughts
  87. Can we put suicidal thoughts in someone's mind?
    No- we cannot put suicidal ideation in anyone's head
  88. What is one of the best interventions of a suicidal patient?
    Asking about it, getting the client to open up and talk
  89. This is highly correlated with suicide?
    Overt Hostility
  90. Working with depressed clients, we as nurses need to ________________________?
    Be aware of our own feelings
  91. What age groups are often overlooked in depression?
    Very young & very old
  92. What is someone attitude who is manic?
    They are demanding & manipulative
  93. How do we communicate as nurses with someone with mania?
    Short, direct statements, set limits
  94. Suicide is defined as ____ turned _______?
    Anger turned inside
  95. What is Para-suicide?
    An apparent attempt at suicide
  96. Why do we talk about self injury, or cutting, when talking with patient about para-suicide?
    Because half of this type of suicidal ideation end up committing suicide.
  97. Verbal cues can be defined as ______ & _____?
    Overt and Covert
  98. What type of verbal cue is " I have a gun"?
    Overt Cue
  99. What type of verbal cue is "everything will be alright tomorrow" ?
    Covert Cue - Its a hidden message they probably have a plan
  100. We need to be aware of changes in behavior, for example, if their demeanor changes from sad to suddenly happy, this could mean??
    They have a plan for suicide, they have come to terms with lethality and access to a method
  101. What is lethality of a method od suicide?
    indicated how quickly a person would die by that mode, classified as high or low risk
  102. When talking about lethality of a method of suicide, there is high and low risk, list some methods for each...
    • Higher risk - (hard method)- using gun, jumping off building, hanging, poisoning, staging car crash
    • Lower risk - (soft method) - slashing wrist, inhaling gas, ingesting pills
  103. When a person is particularly vulnerable when depressed or having command hallucinations, that person is most likely suffering from ______?
  104. What is primary intervention?
    interventions to prevent suicide, activities that provide support, info, and education
  105. This is intervention incudes activities that provide support, info, an education to prevent suicide?
    Primary intrvention
  106. What is secondary intervention?
    Is a treatment of the actual suicidal crisis, may be practiced in clinics, jail, hospitals, telephone hotlines
  107. This is an intervention that is the treatment of the actual suicidal crisis, may be practiced in clinics, hospitals, jail, telephone hotline
    Secondary intervention
  108. What is tertiary intervention?
    Its the treatment of the family after suicide has occurred.
  109. What intervention is for the family or friends of someone who has committed suicide?
    Tertiary intervention
  110. The patient/ staff ration of someone on suicide watch is??
  111. How often should a suicide patient be charted on?
    Every 15-30 min
  112. On an inpatient unit, a client is asked to sign __________?
    A no suicide contract
  113. How long does the crisis phase last?
    4-6 wks
  114. What is the goal of patient in crisis?
    Decrease anxiety so they can increase problem solving
  115. This crisis is a critical period of increased vulnerability & heightened potential, a turning point in the life cycle. (Examples of this include, leaving home, marriage, birth of child, retirement, death of parent)
    Maturational Crisis
  116. This crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. (examples, Loss of job, death of loved one, abortion, divorce, physical or mental illness)
    Situational Crisis
  117. This crisis is not part of everyday life, resulting from events that are unplanned, may be accidental, caused by nature, or man? (examples - natural disaster, flood, fire, earthquake, national disaster, terrorism, war, crime of violence, rape, bombing, child abuse)
    Adventitious Crisis
  118. What are some examples of maturational crisis?
    retirement, birth of child, leaving home, death of parent, marriage
  119. What are some examples of situational crisis?
    Loss of job, death of loved one, abortion, divorce, mental or physical illness
  120. What are some examples of adventitious crisis?
    Fire, earthquake, terrorism, war, child abuse, bombing, rape
  121. Which phase of crisis is it when there is an increase in anxiety stimulates the use of problem solving techniques and defense mechanisms in an effort to solve problems and lower anxiety?
    Phase 1
  122. Which phase of crisis is it when the individual functioning becomes disorganized, and trial and error attempts at solving the problem & restoring a normal balance begins?
    Phase 2
  123. What phase of crisis is it when anxiety can escalate to severe and panic levels, & the person mobilizes automatic relief behaviors, such as withdraw and flight, some form of resolution may be made in this stage?
    Phase 3
  124. What phase of crisis is it, if the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person and lead to serious personality disorganization, depression, confusion, violence against others, or suicidal behavior?
    Phase 4
  125. Suicide is among the 3 leading causes of death in people ages ________?
    15 - 24
  126. What type of diagnosis is the most reliable risk factor for suicide?
    Psychiatric diagnosis
  127. The psychiatric nurse must continually assess for suicide potential among all patients, but especially among who??
    Schizophrenic, depressed, and alcoholic patients
  128. If a patient is contemplating suicide, the next step is to assess the _________?
  129. While assessing a suicidal patient, you as the nurse must always use _________ to their feelings and parts of what client is saying?
  130. What are the 4 factors in which lethality is measured by?
    • 1- the degree or effort it takes to plan suicide
    • 2- specifity of the plan
    • 3- accessibility of the weapon of method
    • 4- the ease by which on may or may not be rescued
  131. Often family members feel __________ after a suicide of someone
  132. Individuals experiencing crises have an urgent need for ______?
  133. Because of the individuals emotional state during crisis, he or she is ___________?
    unable to problem solve and requires guidance and resources to resolve the crisis
  134. During a crisis, the individual cannot sustain the emotional & physiological state any longer, so the body and psyche want to reestablish that equilibrium we need so, they..... ?
    either adapt new coping skills or resort to maladaptive behaviors
  135. It is our job as a nurse to listen to the patient, let them describe the event, while doing that, we use ____________ listening to validate th feelings of the person and to establish nurse client relationships?
  136. Our goal as a nurse during a crisis is to get them back to ______?
    Pre- Crisis levels
  137. While getting them through the crisis, or back to pre-crisis level, when should counseling begin?
    After the crisis is over, not during, the mailn goal is to get through the crisis, then we can help get them the support...
  138. If individuals do not adapt to the crisis with support and coping skills, what will happen?
    they will resort to ineffective coping skills, like fighting, drugs, and alcohol
  139. What is the number one mental health problem in the US?
  140. What is the "unhappiness that is pathologically intense"?
  141. What is definition of depression?
    Unhappiness what is pathologically intense
  142. There is an estimate of ______% of people with major depression choose suicide?
  143. Manic behavior is a ______ in mood?
  144. This is characterized by varying degrees of elation, hyperactivity, agitation accelerated thinking and speaking.
  145. This is a mood disorder involving one or recurrent major depressive episodes without sign of mania?
    Depressive disorder
  146. This is marked by one or more manic episodes, with or without subsequent or alternating major episodes?
    Bipolar Disorder
  147. In all degrees of mania, there is little ______?
  148. Manic clients evade _____?
  149. These clients are preoccupied with rapid association of ideas, word play and flight of ideas.
    Manic clients
  150. ______ % of clients with major depression respond to antidepressant therapy?
  151. What does ECT stand for?
    Electroconvulsive Therapy
  152. What is the client given just before the ECT shock is administered?
    short acting anesthetic and a muscle relaxant
  153. Where are the electrodes applied for ECT?
    applied to the temples
  154. What is happening to the client during the ECT?
    Client experiences a typical grand mal seizure with tonic and clonic phases.
  155. Since the client is experiencing a grand mal seizure during ECT, how should the staff keep patient safe during therapy?
    Staff should not attempt to restrain the clients body, but should keep their extremities safe to prevent injury
  156. How are the clients prepared for ECT?
    Like a surgical procedure, informed consent, NPO, monitoring vital frequently after procedure
  157. How should the client be positioned after ECT?
    on their side, to prevent aspiration
  158. __________  is common after ECT? and can last how long?
    • Confusion
    • weeks or even months after treatment
  159. nursing care of the manic client is focused primarily on _________ until the manic state subsides
    maintaining physical health
  160. The manic client's flight of ideas, prevents significant ________ contact?
  161. The manic clients talking, singing, dancing, and teasing are frequently accompanied by what?
    Anorexia, weight loss, insomnia, & constipation
  162. The nurse intervenes with a manic client by keeping environmental stimuli ________?
    to a minimum
  163. The manic clients mood can do this, when others do not respond to their enthusiasm or do not reach in accordance to their expectations?
    moods can quickly change to irritation or even rage
  164. What type of therapy should be monitored closely with manic clients?
    Lithium & Anticonulsants
  165. This therapy needs frequent monitoring of blood levels because of its therapeutic index?
    Lithium Therapy
  166. What % of patients do not respond to lithium, there for will be on other drugs such as Tegretol?
  167. If lithium alone doesn't respond then what other drug is used in a manic client?
  168. Like with a _________ client, you have to reinforce reality with a manic client as well?
    schizophrenic client
  169. Like with a schizophrenic client, you have do what with the manic client?
    reinforce reality
  170. As a nurse, evaluation in a manic client is met when ________, ________, ________?
    • Improvement on becoming involved with people and life
    • Physical needs are met
    • Client is safe
  171. If the manic client has improved on becoming involved with the people and life, their physical needs have been met, and client remains safe, then its safe to assume the ___________ has been met?
Card Set
Mood Disorders
3rd semester - exam 2 Psych