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Mental Health

Mood Disorders: Depression

QuestionAnswer
Major depressive disorder (MDD) is twice as common in women
A depressive syndrome frequently accompanies other psychiatric disorders such as anxiety disorders, and schizoaffective disorder
Persons with anxiety disorder, personality disorders, adjustment disorder, and brief depressive reactions commonly present with depression
_______ is one of the most common psychiatric presentations. mixed anziety-depression
Comorbidity of depression and anxiety has been shown to result in a higher rate of suicide, greater severity of depression, greater impairment in social and occupational functioning, and poorer response to treatment.
People with chronic medical problems are at a ____risk for depression than those in the general population. greater
Patients with this disorder experience substantial pain and suffering, as well as psychological, social, and occupational disability, during the depression. Major Depressive Disorder (MDD)
A person with MDD presents with a history of One or more major depressive episodes and no history of manic or hypomanic episodes.
A severe form of mood disorder that is characterized by delusions or hallucinations. Delusional or psychotic major depression
This mood disorder often has an early and insidious onset and is characterized by a chronic depressive syndrome that is usually present for most of the day, more days than not, for at least 2 years. Dysthymic Disorder (DD)
The main differences of MDD and DD are in the duration and the severity of the symptoms
Symptoms of this depressive disorder cause clinically significant distress in social, occupational and other important areas of functioning. Dysthymia
With dysthymia, 2 or more of the following are present: Decreased or increased appetite, insomnia or hypersomnia, low energy or chronic fatigue, decreased self esteem, poor concentration or difficulty making decisions, and feelings of hopelessness or despair.
Early onset of dysthymia is what age? Before 21 years of age
Late onset of dysthymia is what age? 21 years of age or older
MDD specifier that means breaks with reality; hallucinations and delusions. Psychotic Features
MDD specifier that means peculiar voluntary movement, echpraxia or echolalia and negativism. Catatonic Features
MDD specifier that means having anorexia or weight loss, diurnal bariations with symptoms worse in the morningd, early morning awakening. Melancholic Features
MDD specifier meaning within 4 weeks postpartum; severe anxiety, possible psychotic features. Postpartum Onset
MDD specifier that means generally occurring in fall or winter and remitting in the spring. SAD Seasonal Features
A specifier for MDD and dysthmia meaning appetite changes or weight gain, hypersomnia, extreme sensitivity to perceived interpersonal rejection. Atypical Features
Primary Risk Factors for Depression: HX of prior episodes, family HX of depressive disorder, HX suicide attempts, female, 40 years or younger, postpartum period, medical illness, absence of social support, negative stressful life events, active alcohol or substance abuse.
What are the four common theories of depression? Biological theories, psychodynamic influences and live events, cognitive theories, and learned helplessness.
Many CNS neurotransitter abnormalities can cause clinical depression
An important regulator of sleep, appetite, and libido. Serotonin
A serotonin circuit dysfuntion can result in poor impulse control, low sex drive, decreased appetite, and irritability.
Decreased levels of norepinephrine in the medial forebrain bundle may account for anergia anhedonia, decreased concentration, and diminished libido in depression
reduction in or lack of energy and an inabilityt to find meaning or pleasure in existence anergia anhedonia
What systems are believed to be involved in the pathophysiology of major depressive episode? dopamine, acetylcholine, and GABA
It is not considered unlikely that a _______ deficiency alone is the actual cause of depression. catecholamine
When the neurotransmitters become overtaxed through stressful events, what may occur? neurotransmitter depletion
The neuroendocrine characteristic most widely studied in relationship to depression has been hyperactivity of the hypothalamic-pituitary-adrenal cortical axis.
An exogenous steroid that suppresses cortisol. Dexamethasone
Clients with psychotic major depression are among those with the highest rates os nonsuppression of cortisol on the dexamethasone suppression test
When the phaxe of REM sleep associated with dreaming occurs earlier reduced REM latency
Patients with out reduced REM latency are not likely to respond to treatment with tricyclic antidepressants (TCA's)
The three negative thoughts known as Beck's cognitive triad are: A negative, self-deprecating view of self; A pessimistic view of the world; The belief that negative reinforcement will continue in the future.
Thoughts that are repetitive, inintended, and not readily controllable. automativ negative thoughts
What is the goal of cognitive behavioral therapy with depressive mood disorders? To change the way clients think and thus relieve the depressive syndrome.
How is cognitive behavioral therapy with depressive mood disorders accomplished? Assisting the client with identifying and testing negative cognition, developin alternative thinking patterns, rehearsing new cognitive and behavioral responses.
One of the most popular theories of the cause of depression learned helplessness
What is the first thing that should be assessed in a patient being assessed for depression? Suicide potential
What are the key symptoms in depression. depressed mood and anhedonia
Psychomotor agitation is evidenced in depression by Constant pacing, and wringing of hands.
Slower movements are known as psychomotor retardation
What are some vegetative signs of depression? change in bowel movements and eating habits, sleep disturbances, and disinterest in sex.
What is the affect of a person who is depressed? Feelings of hopelessness and despair are readily reflected in the person's affect.
Little of not facial expression is what kind of an affect? flat affect
Feelings frequently reported by depressed people include: anxiety, worthlessness, guilt, helplessness and hopelessness, and anger.
______ is a painful partner to depression low self esteem
This is one of the core characteristics of depression and suicide, as well as a characteristic or schizophrenia, alcoholism, and physical illness. hopelessness
What are the attributes of hopelessness? negative expectations for the future, loss of control over future outcomes, passive acceptance of the futility of planning to achieve goals, emotional negativism as expressed in despair, despondency, or depression.
_____ and _____ are natural optcomes of profound feelings of hopelessness. anger and irritability
Lethargy and fatigue can result in psychomotor retardation
________ may range from slowed and difficult movements to complete inactivity and incontinence psychomotor retardation
A patient constantly pacing, biting their nails,smoking, tapping their fingers, or engaging in some other tension relieving activy is a demonstration of psychomotor agitation
Overeating occurs more often in _____ than ____. dysthymia than depression
_____ are a cardinal sign of depression. changes in sleep patterns
_________provides an escape from painful feelings in a depressed person. hypersomnia
A thorough medical and neurological examination helps determine if the depression is primary or secondart to a nost of medical or other psychiatric disorders as well as medications.
When assessing a patient who is depressed, be sure to evaluate: Whether the client is psychotic, whether the client has taken drugs or alcohol, whether medical conditions are present, and whether the client has a HX of a comorbid psychiatric syndrome.
The plan of care for a client who is depressedis based on the individual's symptoms and attempts to encompass a bariety of areas in the person's life. Safety is always the highest priority.
Which phase of treatment for depression is directed at reduction of depressive symptoms and restoration of psychosocial and work function? acute phase (6 to 12 weeks)
Hospitalization may be required in this phase of treatment of a person suffering from major depression. acute phase (6 to 12 weeks)
Which phase of treatment for depression is directed at prevention of relapse through pharmacolotherapy, education, and depression-specific psychotherapy? continuation phase (4-9 months)
Which phase of treatment for depression is directed at prevention of further episodes of depression? maintainance phase (1 or more years)
The basic level nurse working with depressed patients engages in counseling, health teaching, promotion of self-care activities, and milieu management.
Including families in discharge planning facilitates progress in what ways? Increases family's understandng and acceptance of the depressed family member, increases the clients use of aftercare facilities in the community, contributes to higher overall adjustment in the client after discharge.
When a person is acutely and severly depressed, the structure of the _____ may be indicated. hospital setting
The advanced practice nurse is qualified to provide depressed patients with psychotherapy, social skill training, and group therapy
This type of psychotherapy helps people change their negative style of thinking and behaving Cognitive-behavior therapy (CBT)
This type of psychotherapy focuses on working through personal relationships that may contribute to depression. Interpersonal Therapy (IPT)
Studies show this type of therapy to be at least as effective as medication, with the patients showing a lower relapse rate. Cognitive-behavior therapy (CBT)
_____ is a widespread modality for the treatment of depression. group treatment
These drugs can positively alter poor self concept, degree of withdrawal, vegetative signs of depression and activity level.. antidepressants
One drawback to the use of antidepressant medication is that improvement in mood may take up to 1 to 3 weeks
If a client is acutely suicidal antipressants might take too long and the use of _______ can be reliably and effectively used. ECT
Primary considerations when choosing an antidepressant are: Side effect profile, ease of administration, HX of past response, safety and medical considerations, and specific subtype of depression if applicable.
Secondary considerations when choosing an antidepressant are: Neurotransmitter specificity, family HX of response, blood level considerations, cost.
What are the targets of pharmacological interventions for depression. neurotransmitters and receptor sites
What are the first line agents in the antidepressant class: SSRI's, the newer atypical antidepressants, and Cyclic antidepressants (TCA's)
What are the second line interbentions for antidepressant classes? MAOI's and ECT
Block the neuronal uptake of serotonin through blockade of the reuptake process. Selective Serotonin Reuptake Inhibitors (SSRI's)
SSRI's are recommended as a first line therapy for all types of depression except Psychotic depression, melancholic depression and mild depression.
What might the first choic of therapy be for psychotic depression? ECT
These drugs have a lower incidence of anticholinergic side effects, less cardiotoxicity, and faster onset of action than the TCA's. SSRI's
SSRI's, SNRI's and newer atypical antidepressants have a low lethality risk in suicide attempts compared with TCA's
The most significant undesirable outcome from SSRI's is sexual dysfunction (anorgasmia)
Overactivation of the central serotonin receptors caused by either too high a dose or interation with other drugs. Serotonin Syndrome
Symptoms of serotonin syndrome are: Abdominal pain, diarrhea, sweating, fever, tachycardia, elevated BP, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility and mood changes.
Severe manifestation of serotonin syndrome can induce Hyperpyrexia (excessively high fever), cardiovascular shock, or death.
Mixing an SSRI with a _______is when the risk for serotonin syndrome seems to be greatest. MAOI
Alprazolam is a benzodiazepine anxiolytic
Alprazolam is as effective in trating depression as TCA's
These drugs inhibit the reuptake of norepinephrin and serotonin by the presynaptic neurons in the CNS. TCA's
An increase of norepinephrine and serotonin in the brain is believed to be responsible for mood elevations
The sedative effects of TCA's are attributed to antihistamine actions and somewhat to anticholinergic actions.
Clients must take therapeutic doses of TCA's for ________ before these agents start to work. 10-14 days or longer
Regardless of which TCA is given the dosage should always be low initially and should increase gradually
The anticholinergic actions of TCA's are dry mouth, blurred vision, tachycardia, constipation, urinary retention, and esophageal reflux.
What side effects of TCA's warrant immediate medical attention? urinary retention and severe constipation
The potential toxic effects of TCA's are: dysrhythmias, tachycardia, myocardial infarction, and heart block.
Clients should have a thorough _____ before beginning TCA therapy. cardiac workup
Use of an ________ along with a TCA is contraindicated. MAOI
Use of an _______with a TCA may precipitate a psychotic episode in a person with schizphrenia. antidepressant
An _______ with a TCA can precipitate a manic episode in a client with bipolar disorder. antidepressant
Bipolar patients often receive _______ instead of TCA with antidepressants. lithium
Who should not be treated with TCA's? HX of myocardial infarction, narrow-angle glaucoma or HX of seizures, and pregnant women.
The nurse should teach the patient that drowsiness, dizziness, and hypotension from TCA usually subside after the first few weeks
When should the patient take the full dose of TCA? at bedtime
Inactivates certain brain amines such as norepinephrine, serotonin, dopamine, and tyramine. MAOI
An increase in norepiniphrin, serotonin, dopamine, and tyramine neurotransmitters can raise the mood of depressed persons
The increase of this neurotransmitter can lead to high BP, hypertensive crisis, and enventually to a cerebrovascular accident. tyramine
People taking MAOI's need to reduce their intake of tyramine
What foods are high in tyramine? Avocadoes, figs, bananas, fermented or smoked meats, livers, ferments sausages, dried pickle or cured fish, smoked fish, practically all cheeses, yeast extract, protein dietary supplements.
MAOI's are particularly effective for people with atypical depression as well as some other disorders.
The most serious reaction to the MAOI is Increase in BP, with the possible development of intracranial hemorrhage, hyperpyrexia, convulsions, coma, and death.
When a hypertensive crisis is suspected in a patient receiving an MAOI, Immediate medical attention is crucial. Antihyypertensive medications such as phentolamine (Regitine) are slowly administered intravenously.
Why would use of an MAOI be contraindicated in a patient who has had surgery in the previous 10-14 days? risk for blood clots
Patient's taking MAOI's should avoid what kind of restaurants? Chinese
MAOI's are contraindicated in patients with: Cerebrovascular disease,HTN and CHF, liver disease, consumption of foods with tyramine,tryptophan, and dopamine, use of certain meds, recurrent or severe headaches, surgery last 10-14 days, younger than 16 years.
What is the most critical adverse reaction to MAOI (especially in the elderly)? hypotension
What are the toxic effects of MAOI's? Severe headaches; stiff, sore neck; flushing, cold, clammy skin; tachycardia; severe nosebleeds, dilated pupils; chest pains, stroke, coma, death;nausea snd vomiting.
ECT is indicated when: There is a need for rapid definitive response when a client is suicidal,risk of other treatments outweight ECT, HX of poor drug response, client prefers it.
ECT is useful in treating clients with major depression and bipolar depressive disorders, especially when psychotic symptoms are present.
ECT is also indicated for manic clients whose conditions are resistant to treatment with lithium and antipsychotic drugs and for clients who are rapid cyclers.
A client with bipolar disorder who whas many episodes of mood swings close together (4 or more in 1 year). Rapid Cycler
What other patients other that MDD patients can benefit from ECT? Schizophrenia, schizoaffective syndromes, psychotic clients who are pregnant, and clients with Parkinson's disease.
On awakening from ECT, the patient may be confused and disorientated
______ is not a permanent cure for depression. ECT
The first line treatment for SAD. light therapy
Why is light therapy effective? Because of its effects on melatonin.
______ demonstrated superior efficacy compared to placebo and was generally comparable in effect to low-dose TCA's. St. John's wort
St. John's wort should not be taken with MAOI's, SSRI's amphetamines or other stimulants.
This delivers an electrical fiel to the cerebral cortices, but unlike in ECT, the waves do not result in generalized seizure activity. Transcranial Magnetic Stimulation (TMS)
_______ symptoms of depression are alterations in those activities necessary to support physical life and growth (eating, sleeping, elimination, sex) vegetative
Depression commonly accompanies medical disorders
Beck suggests that the etiology of depression is related to negative processing of information
A depressed client tells the nurse "There is no sense in trying. I am never able do anything right!" The nurse can identify this cognitive distortion as an example of overgeneralizing
A depressed client has received antidepressant medication for 3 weeks. The nurse would begin to look for improvement in insomnia