NR546 Week 5 Test Your Knowledge Questions And Answers | Verified Study Set Pharmacologic Treatment of Major Depressive Disorder ✅Selective serotonin reuptake inhibitors (SSRIs) Serotonin -norepinephrine reuptake inhibitors (SNRIs) Norepinephrine and dopamine reuptake inhibitors (NDRIs) Serotonin antagonists and reuptake inhibitors (SARIs) Miscellaneous antidepressants Monoamine oxidase (MAO) -B inhibitors Adjunct: antipsychotics Pharmacologic Treatment of Bipolar Disorder ✅Lithium Anticonvulsants Second generation antipsychotics Mood disorders: 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) Mood disorders manifest across a spectrum from: ✅mania to major depressive disorder (MDD) Unipolar depression ✅major depressive disorder (MDD) one of the most common mental disorders -Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among individuals aged 18 -25 S/S -depressed mood -loss of interest or pleasure in daily activities -irritability -withdrawal -problems with sleep, eating, energy, concentration, or self -worth -severe depression: may experience thoughts of suicide or psychotic symptoms. Bipolar disorder (BD) ✅Chronic condition characterized by extreme fluctuations in mood, energy, and ability to function -Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features -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 -diagnosed when a client has one or more episodes of mania or hypomania with a history of one or more major depressive episodes -high risk for suicide mania ✅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 Bipolar Type I: ✅requires at least one episode of mania for at least one week (or any duration if hospitalization due to symptoms is required) Bipolar Type II: ✅diagnosis 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: ✅involves the chronic presentation of hypomanic and depressive symptoms that do not meet the diagnostic criteria for a major depressive or manic/hypomanic episode. If bipolar depression is mistaken for MDD: ✅antidepressant therapy may precipitate a manic episode or induce rapid -cycling bipolar depression -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 DA, NE Dysfunction causes what mood related symptoms ✅Decreased positive affect: depressed mood loss of joy lack of interest loss of energy decreased alertness decreased self -confidence appetite changes 5HT, NE Dysfunction causes what mood related symptoms ✅Increased negative affect: depressed mood guilt fear/anxiety hostility irritability loneliness appetite changes neurobiological factors that contribute to mood and mood disorders: Genetics ✅MDD and BD are heritable disorders -genetic factors 31 -42% of the disease risk in MDD and 59 -85% in BD -causes of mood disorders complex, 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 neurobiological factors that contribute to mood and mood disorders: Neuroanatomy ✅Inefficient information processing by one or more brain circuits may result in mood disorder symptoms. -Recent research has tied depression to decreased activity of the prefrontal cortex. The prefrontal cortex controls attention, memory, mood, and personality. neurobiological factors that contribute to mood and mood disorders: Neural Networks ✅The classic monoamine hypothesis of depression posits that depression occurs as a result of a deficiency of one or all three monoamine transmitters (serotonin, norepinephrine, and dopamine), while mania may result from an excess -this hypothesis has limitations, 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 neurobiological factors that contribute to mood and mood disorders: 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 and 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.