Psychology Chapter on Depression and Medication
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Questions and Answers

Which reason for nonadherence to medication is least likely to be emotional in nature?

  • Religious reasons (correct)
  • Cognitive slowing
  • Sexual dysfunction
  • Fear of becoming addicted

    • Which disorder is NOT classified under unipolar depression?

  • Bipolar I disorder (correct)
  • Major depressive episode
  • Seasonal affective disorder
  • Dysthymic disorder

    • Which neurotransmitter is NOT primarily associated with the biochemical theory of depression?

  • Norepinephrine
  • Dopamine
  • Acetylcholine (correct)
  • Serotonin

    • Which of the following is NOT a part of Beck’s cognitive triad?

    <p>Optimistic outlook on relationships</p> Signup and view all the answers

    Which theory explains depression as a consequence of genetic predisposition and environmental stressors?

    <p>Stress–diathesis model</p> Signup and view all the answers

    What is the primary effect of antidepressants on neurotransmitters in the context of mood disorders?

    <p>They stabilize mood by increasing intrasynaptic availability</p> Signup and view all the answers

    Which of the following conditions is specifically tied to the postpartum period?

    <p>Postpartum blues</p> Signup and view all the answers

    What interrelated biological hypothesis does NOT relate to changes in neurotransmitter regulation?

    <p>Learned helplessness</p> Signup and view all the answers

    What is typically the first symptom to appear in cases of acute lithium toxicity?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which treatment is used for severe cases of lithium toxicity?

    <p>Kidney dialysis</p> Signup and view all the answers

    What is the plasma half-life of lithium?

    <p>24 hours</p> Signup and view all the answers

    Which of the following is a potential symptom of moderate to severe lithium toxicity?

    <p>Mild confusion</p> Signup and view all the answers

    What physiological change is associated with bipolar disorder?

    <p>Decrease in Na+,K+-ATPase activity</p> Signup and view all the answers

    Which of the following symptoms might indicate the need for immediate medical help in lithium users?

    <p>Slurred speech</p> Signup and view all the answers

    What should lithium patients maintain in their diet for better management of their condition?

    <p>Balanced diet with adequate salt intake</p> Signup and view all the answers

    What is one of the consequences of decreased calcium channel activity in neurons during bipolar disorder?

    <p>Reduced neurotransmitter release</p> Signup and view all the answers

    At what lithium serum level does mild to moderate toxicity start to manifest?

    <p>1.5 to 2.0 mEq/L</p> Signup and view all the answers

    Which of the following side effects of lithium is most likely to occur in about 70% of patients?

    <p>Thirst</p> Signup and view all the answers

    What is the therapeutic serum level range of lithium?

    <p>0.6 to 1.2 mEq/L</p> Signup and view all the answers

    Which symptoms should be immediately reported to a healthcare provider while on lithium?

    <p>Vomiting and severe tremor</p> Signup and view all the answers

    Which intervention is recommended to help reduce nausea when taking lithium?

    <p>Taking it with meals</p> Signup and view all the answers

    What should patients increase in their diet if they experience heavy sweating while on lithium?

    <p>Sodium intake</p> Signup and view all the answers

    Which symptom is associated with severe lithium toxicity?

    <p>Seizures</p> Signup and view all the answers

    What should be monitored during lithium therapy in relation to blood draws?

    <p>8 to 12 hours after the last dose</p> Signup and view all the answers

    Which of the following is NOT a cardinal symptom of Parkinson Disease?

    <p>Difficulty swallowing</p> Signup and view all the answers

    What causes the imbalance in dopamine transmission seen in Parkinson Disease?

    <p>Loss of pigmentation in substantia nigra</p> Signup and view all the answers

    What is the primary treatment for extrapyramidal symptoms (EPSEs)?

    <p>Anticholinergics</p> Signup and view all the answers

    Which condition is characterized by a subjective feeling of restlessness and jittery feelings?

    <p>Akathisia</p> Signup and view all the answers

    Which medication is considered the gold standard for treating bipolar disorder?

    <p>Lithium</p> Signup and view all the answers

    What symptom is NOT associated with tardive dyskinesia?

    <p>Tremors</p> Signup and view all the answers

    What is the primary neurotransmitter imbalance found in Parkinson Disease?

    <p>Acetylcholine and dopamine</p> Signup and view all the answers

    Which of the following is a side effect of anticholinergic drugs?

    <p>Blurred vision</p> Signup and view all the answers

    What may happen if anticholinergics are given to a patient with tardive dyskinesia?

    <p>Worsening of symptoms</p> Signup and view all the answers

    Which of the following statements accurately describes neuroleptic malignant syndrome?

    <p>It is potentially fatal.</p> Signup and view all the answers

    Which group of patients is at higher risk for developing extrapyramidal side effects?

    <p>Older adults</p> Signup and view all the answers

    What is a recommended approach for preventing extrapyramidal side effects in high-risk patients?

    <p>Monitor for early symptoms of EPSEs</p> Signup and view all the answers

    Which class of antipsychotics is known to cause more extrapyramidal side effects?

    <p>High-potency antipsychotics</p> Signup and view all the answers

    What is the time frame in which buspirone typically achieves its full effect?

    <p>1 to 6 weeks</p> Signup and view all the answers

    Which of the following is a characteristic of buspirone?

    <p>Nonsedating with decreased abuse potential</p> Signup and view all the answers

    What type of symptoms are characterized by hallucinations and delusions in schizophrenia?

    <p>Positive symptoms</p> Signup and view all the answers

    Which drug is considered a first-line agent for the treatment of anxiety spectrum disorders?

    <p>SSRIs</p> Signup and view all the answers

    Which of the following should be avoided due to potential additive effects when taking certain anxiety medications?

    <p>Alcohol and CNS depressants</p> Signup and view all the answers

    Study Notes

    Desired Effect

    • Nonadherence to treatment can be caused by sexual dysfunction, side effects, emotional dulling, cognitive slowing, denial of need, fear of addiction, religious reasons, and interference with work.

    Antidepressant Drugs

    • Treat mood disorders including unipolar depression, bipolar disorder, and related disorders like dysthymic disorder, cyclothymic disorder, substance-induced depressive or bipolar disorder, seasonal affective disorder, postpartum blues, depression, psychosis, premenstrual dysphoric disorder and nonsuicidal self injury.
    • Etiology includes genetic theory, biochemical theory, psychosocial theories, and cognitive theory.
    • Genetic theory supports that twin studies and adoption studies can determine the influence of genetics on depression.
    • Biochemical Theory focuses on the role of serotonin and norepinephrine neurotransmitters in depression.
    • Psychosocial Theories include the stress-diathesis model of depression, learned helplessness, and cultural considerations.
    • Cognitive Theory uses Beck's cognitive triad which includes negative, self-deprecating view of self, pessimistic view of the world, and the belief that negative reinforcement will continue.
    • Biochemical Theory of Depression posits neurotransmitter depletion is linked to depression.
    • Antidepressants stabilize mood by increasing the intrasynaptic availability of certain neurotransmitters including norepinephrine (NE), serotonin (5-HT), and dopamine (DA).
    • Interrelated Biological Hypotheses include receptor dysregulation, inflammation, methylation, premature neuronal death, lack of synaptogenesis, and altered genetic output.

    Parkinson Disease and Extrapyramidal Side Effects (EPSES)

    • Cardinal Symptoms: Tremors, Bradykinesia, Rigidity, Postural Instability.
    • Associated Symptoms: Difficulty swallowing, Drooling, Weight loss, Choking, Impaired breathing, Urinary retention, Constipation.
    • Parkinson Disease Effects: Pigmented neurons of the substantia nigra lose their pigmentation and decline dopamine production.
    • Decrease in dopamine transmission to the basal ganglia results in an imbalance with acetylcholine.
    • Causes of EPSES vs. causes of Parkinson effects:
      • Parkinson's Disease: imbalance related to neurodegeneration of the substantia nigra at the beginning of the dopamine tracts.
      • EPSES: blockage of dopamine receptors in the basal ganglia at the end of the dopamine tracts.
    • Treating EPSES vs. Parkinson Disease:
      • Parkinson's Disease: treated with antiparkinsonian agents that increase dopamine levels like levodopa/carbidopa (Sinemet), levodopa with anticholinergic agents (benztropine [cogentin]), or both.
      • EPSES: treated with anticholinergics only.

    Parkinson-like Extrapyramidal Side Effects (EPSES)

    • EPSEs are the result of biochemical changes from antipsychotics that are similar to those symptoms found in Parkinson disease (PD).
    • Akathisia
      • Subjective feeling of restlessness.
      • Restless legs, jittery feelings, nervous energy.
      • Responds poorly to treatment.
      • Most common EPSE.
      • Reassure patient.
      • May need to switch to a different class of antipsychotic medication.
    • Akinesia and bradykinesia
      • Akinesia: absence of movement.
      • Bradykinesia: slowed movement.
      • Includes weakness, fatigue, painful muscles, and anergia (abnormal lack of energy).
      • Be patient, reassure, obtain anticholinergic order.
      • Responds to anticholinergics.
    • Dystonia
      • Abnormal sustained, contracted postures caused by involuntary muscle spasms.
      • Affects limbs, trunk, neck, mouth.
      • Appears early in treatment (within 3 days).
      • Responds to anticholinergics.
      • In emergency, administer parenterally.
      • Types of Dystonia:
        • Torticollis: contracted positioning of the neck.
        • Oculogyric crisis: contracted positioning of the eyes upward.
        • Laryngeal-pharyngeal constriction: can be life-threatening.
        • Give antiparkinsonian drug, benztropine (Cogentin) or antihistamine diphenhydramine (Benadryl) immediately as needed.
        • Offer reassurance.
    • Drug-induced parkinsonism
      • Tremors, bradykinesia, rigidity, postural instability.
      • Develops early in treatment.
      • Assess and report.
      • Obtain order for anticholinergic.
    • Tardive Dyskinesia
      • Caused by long-term use of antipsychotics (“tardive” means “late appearing”) causing the dopamine receptors in the basal ganglia to be hypersensitive.
      • Late appearing, after 6 months or more.
      • Lip smacking, teeth grinding.
      • Tongue thrusting or writhing.
      • Symptoms stop with sleep.
      • Worsens with anticholinergics because it is not caused by an imbalance of dopamine-acetylcholine.
      • Often irreversible.
      • If caught in time, can be averted.
      • No treatment yet developed.
      • Prevention as important approach.
    • Neuroleptic Malignant Syndrome
      • Potentially lethal side effect.
      • Hyperthermia: 101F to 103F to 108F.
      • Rigidity.
      • Autonomic dysfunction.
      • Treatment with dantrolene (Dantrium) muscle relaxant and bromocriptine (Parlodel) centrally acting dopaminergic.
      • Routinely take temperature, assess for symptoms.
    • Pisa Syndrome
      • Patient leans to one side.
      • Acute or tardive.
      • Older adults more vulnerable.

    Higher Risk for Extrapyramidal Side Effects (EPSES)

    • Women, first episode of schizophrenia, older adults, patients with affective symptoms.

    Anticholinergic Drugs for EPSES in Schizophrenia

    • Schizophrenia is linked to excessive dopamine.
    • Antipsychotic drugs block dopamine, which can cause EPSES.
    • Antiparkinsonian drugs can fix the problem that antipsychotics create.
    • If dopaminergic antiparkinsonian drugs are given, schizophrenia might worsen.
    • Anticholinergics drugs are given to restore Ach-dopamine balance.

    Anticholinergic Drug Dosages for EPSES

    • Benztropine (Cogentin) 1 to 4 mg PO or IM one to twice a day. Acute dystonic reactions: 1 to 2 mg IM/IV, then 1 to 2 mg PO BID.
    • Trihexphenidyl (Artane): Start 1 mg daily, increase to usual dosage range, 5 to 15 mg/day.

    Pharmacological Effects

    • Anticholinergic drugs block acetylcholine receptors.
    • Anticholinergics are used alone in the treatment of EPSEs.
    • Antipsychotic drugs block dopamine receptors, causing EPSEs.
    • Blockage of dopamine receptors in basal ganglia produces EPSEs.
    • High-potency antipsychotics like haloperidol (Haldol) cause more EPSEs.

    Side Effects of Anticholinergics

    • Central nervous system effects: Confusion, Cognitive impoverishment, Agitation, Dizziness, Drowsiness, Disturbances in behaviour, Cognitive dysfunction.
    • Peripheral nervous system effects: Dry mouth, Nasal congestion, Urinary hesitation or retention, Blurred vision, Photophobia, Mydriasis, Constipation , Decreased sweating, Fever.

    Overdose of Anticholinergic Drugs

    • CNS hyperstimulation: Confusion, excitement, hyperpyrexia, agitation, disorientation, delirium, or hallucination.
    • CNS depression: Drowsiness, sedation, or coma.
    • CV, urinary, and GI system, eyes as well.
    • Use cautiously during pregnancy.
    • Older individuals have more pronounced reaction.

    Interactions with Anticholinergics

    • Alert the patient to dangers of OTC drugs and other prescription drugs that intensify the atropine-like effects of anticholinergics.
    • Other interactions: Intensification of sedative effects when combined with CNS depressants, decrease in absorption when using antacids and antidiarrheal drugs.

    Teaching Patients

    • Avoid discontinuing drugs abruptly.
    • Taper over a 1 week period.
    • Avoid driving until tolerance develops and drowsiness and blurred vision diminish.
    • Avoid over-the-counter medications that have anticholinergic or antihistamine properties.
    • Avoid alcohol.
    • Avoid antacids.

    Selected Anticholinergic Drugs

    • Benztropine (Cogentin): most frequently prescribed anticholinergic antiparkinsonian drug.
    • Diphenhydramine (Benadryl): antihistamine effective for most parkinsonia-like disorders; causes considerable sedation in some; less potent than benztropine.
    • Trihexphenidyl (Artane): unavailable parenterally.

    Other Treatment Options for EPSES

    • Dopamine agonist- amantadine (Symmetrel).
    • Beta Blocker- propranolol (Inderal).
    • Benzodiazepines- diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin).
    • Vitamins E and B6 possibly for TD.

    EPSE Prevention

    • Establish whether patient is from high-risk group: Woman, Older adult, First episode of schizophrenia, Has affective symptoms.
    • Obtain baseline information about EPSEs: Use validated tool.
    • Choose drug with lower risk for EPSEs: High risk: Haldol, Prolixin, traditional antipsychotics, Lower risk: atypical agents.
    • Monitor patient regularly.
    • If EPSEs develop: Switch to atypical agent, If on atypical agent, lower dose; switch to atypical agent with better side effect profile; add antiparkinsonian agent.

    Antimanic Drugs

    • Treatment Goals for Bipolar Disorder: Remission, Prevention, Return to premorbid function.
    • Maintenance Therapy for Bipolar Disorder: Prevent relapse, Reduce suicide risk, Improve functioning, Reduce subthreshold symptoms (Symptoms not quite reaching a level of clinical diagnostic significance).

    Lithium

    • Gold standard for bipolar disorder.
    • Naturally occurring element.
    • Treatment and prophylaxis of manic phase.

    Pharmacological Effects

    • Inhibits release of norepinephrine, serotonin, and dopamine.
    • Facilitates their reuptake into presynaptic terminals, decreasing the synaptic levels of these neurotransmitters—the very action that one would surmise needs to occur in the hyperactive state of mania.
    • Normalizes a dysfunctional second messenger system.

    Lithium Toxicity Symptoms

    • Early symptoms of acute lithium toxicity include gastrointestinal (GI) problems like nausea and vomiting, Diarrhea, Abdominal pain, Bloated stomach.
    • These symptoms usually develop within one hour of taking excess lithium.
    • If you have moderate to severe lithium toxicity, you’ll likely get neurological symptoms after the gastrointestinal symptoms.
    • These include mental status changes that can range from mild confusion to delirium, Uncontrolled shaking (tremors), Coordination and balance issues (ataxia), Muscle twitches (myoclonus), Slurred speech (dysarthria), Overactive reflex responses (hyperreflexia), Uncontrolled eye movements (nystagmus), Hyperthermia (severe cases), Seizures (severe cases), Coma (severe cases).
    • Get immediate medical help if you take lithium and have these symptoms.

    Lithium Toxicity Treatment

    • Stomach pumping (gastric lavage).
    • Whole-bowel irrigation, involving taking a special solution by mouth or through a tube that goes through your nose and into your stomach, clearing your gastrointestinal system of lithium.
    • Activated charcoal (if you took other medications or substances as well).
    • Kidney dialysis (hemodialysis ).
    • IV fluids.
    • Various medications to treat symptoms.
    • You’ll likely receive treatment in an ER or ICU.

    Lithium Pharmacokinetics

    • Peak blood levels: 1 to 3 hours.
    • Absorption: GI tract.
    • Excretion: Kidneys.
    • Plasma half-life: 24 hours.
    • Narrow therapeutic index.

    What goes wrong in bipolar disorder

    • Cause: Decrease in Na+,K+-ATPase activity.
      • Neuronal membranes become irritable, requiring fewer stimuli for cell firing.
      • Sodium accumulates, diminishing the hyperpolarizing functions of inhibitory neurotransmitters.
      • Neuron fires more easily, but with loss of amplitude. This causes calcium channels to decrease activity, resulting in reduced neurotransmitter release.

    Patient Guidelines: Lithium

    • Take at the same time daily.
    • Mild side effects are transient.
    • Report vomiting, coarse hand tremor, sedation, weakness, and vertigo.
    • Maintain salt intake and a balanced diet.
    • Illness with fever, excessive sweating might require dose adjustment.
    • Lithium level: morning blood draw 8 to 12 hours after last dose.

    Common Side Effects

    • Therapeutic serum level of lithium is 0.6 to 1.2 mEq/L.
    • Common side effects include nausea, dry mouth, diarrhea, thirst, drowsiness, mild hand tremor, polyuria/polydipsia (occur in 70% of patients), weight gain , bloated feeling, sleeplessness, lightheadedness.

    Toxic Effects

    • Mild to moderate: 1.5 to 2.0 mEq/L. -We do not want lithium to be higher than 1.5.
    • Moderate to severe: 2 to 3 mEq/L -More serious symptoms include previous symptoms plus ataxia, giddiness, tinnitus, blurred vision, large output of dilute urine, delirium, nystagmus.
    • Severe toxicity: >3 mEq/L - Manic patients may take their meds too much and become toxic (LETHAL).
      • Previous symptoms, plus seizure, organ failure, renal failure, coma, death.

    Key Nursing Interventions

    • Discuss side effects that should subside: Nausea, dry mouth, diarrhea, thirst, mild hand tremor, weight gain, bloatedness, insomnia, lightheadedness).
    • Identify the side effects that require immediate notification of the physician (Vomiting, severe tremor, sedation, muscle weakness, vertigo).
    • Suggest taking lithium with meals to reduce nausea.
    • Suggest drinking 10 to 12 glasses of water per day. Can be juice, just liquid.
    • Advise elevating feet to relieve ankle edema.
    • Advise consistent dietary sodium intake; increase sodium if a major increase in perspiration occurs.

    Anticonvulsants

    • Divalproex sodium—Depakote.
    • Valproates.
    • Carbamazepine—Tegretol.
    • Lamotrigine—Lamictal.
    • Oxcarbazepine—Trileptal.
    • Over-the-counter drugs might enhance action.
    • Kava-kava and valerian cause additive effect.
    • Avoid driving until tolerance develops.
    • Do not exceed prescribed dose.
    • Avoid alcohol and CNS depressants.
    • Do not stop abruptly, wean off.

    Buspirone

    • Nonsedating.
    • No highs—decreased abuse potential.
    • No cross- tolerance with alcohol, sedatives.
    • Takes 1 to 6 weeks for full effect.
    • No dependence, withdrawal, or tolerance.
    • Divided doses.
    • Must be taken with food.
    • Few drug-drug interactions.

    Other Antianxiety Agents

    • Selective serotonin reuptake inhibitors (SSRIs): SSRIs are first-line agents for anxiety spectrum. Uses: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic attacks, posttraumatic stress disorder (PTSD), and social phobias.
    • Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine (Effexor) and duloxetine (Cymbalta).

    Other Drugs with Antianxiety Properties

    • Clomipramine and other tricyclic antidepressants: Clomipramine (Anafranil).
    • Clonidine (Catapres).
    • Gabapentin (Neurontin).
    • Hydroxyzine (Vistaril, Atarax).
    • Antiepileptics: pregabalin and levetiracetam.
    • Propranolol.

    Schizophrenia

    • Positive symptoms include hallucinations, delusions, abnormal thoughts, agitation, bizarre behavior, excitement, hostility.
    • Negative symptoms include flattened affect, avolition, alogia, anergia, attention deficits, communication difficulties, difficulty with abstractions, poverty of speech.

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    Psych Exam 2 PDF

    Description

    Test your knowledge on depression, medication adherence, and related theories in psychology. This quiz covers various aspects of mood disorders, including neurotransmitters, treatments, and symptoms. Challenge yourself with questions about unipolar depression and lithium toxicity.

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