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23. Depression Flashcards

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1
Q

pervasive and sustained emotion that colors one’s perception of the world and how one functions in it

A

mood

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2
Q

expression of mood

A

affect

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3
Q

affect w/ reduced intensity of emotion expressed; shows little emotions/feelings

A

blunted

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4
Q

affect w/ absence of expression; like face is immobile (common in schizo)

A

flat

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5
Q

affect where emotion does not fit the situation

A

inappropriate

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6
Q

affect w/ range of emotions that change rapidly or abruptly (common in borderline personality and bipolar)

A

labile

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7
Q

affect w/ mild restriction in range and intensity of emotion; not as reduced as blunted

A

restricted/constricted

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8
Q

what characterizes depression

A
  • sadness
  • loss of interest or pleasure (anhedonia)
  • feelings of guilt or low self-worth
  • disturbed sleep or appetite
  • low energy
  • poor concentration
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9
Q

What is one of the most common risk factors for suicide

A

depression

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10
Q

when does depression become a depressive disorder

A
  • pt experiences somatic and cognitive changes
  • interferes w/ functioning
  • mood causes psychological distress
  • mood causes behavioral impairment
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11
Q

What is depression commonly mistaken for in older adults

A

dementia - due to lapse in memory

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12
Q

disorder characterized by depressed mood, loss of interest or pleasure in usual activities (anhedonia), and social and occupational function impaired for at least 2 weeks (must include all 3 plus 4 other sxs)

A

major depressive disorder

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13
Q

criteria for major depressive disorder (at least 4)

A
  • disruption of sleep (insomnia or oversleeping)
  • changes in appetite (or weight)
  • decreased concentration
  • decreased energy (anergia)
  • psychomotor agitation or retardation
  • excessive guilt or feelings of worthlessness
  • suicidal ideations
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14
Q

what is depression in older adults commonly associated with?

A

chronic illness (sxs possibly confused w/ dementia or stroke)

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15
Q

T/F: highest suicide rates are in people older than 75

A

True

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16
Q

how does depression manifest in children and adolescents

A
  • more common are anxiety and somatic sxs
  • decreased interaction w/ peers (socially withdrawn)
  • avoidance of play and recreation
  • irritable rather than sad mood; high risk of suicide
  • treatment successful in 60-80% but response to tx is slower than in adults
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17
Q

epidemiology of depression

A
  • ages 18-29 3x higher prevalence than 60 and older
  • 2x higher in adolescent and adult women rather than adolescent and adult men
  • cultural and ethnic variations (will describe sxs differently)
  • often co-occuring w/ other psych and substance-related disorders
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18
Q

risk factors for depression

A
  • prior episode of depression
  • FHx of depressive disorders
  • lack of social support
  • lack of coping abilities
  • presence of life and environmental stressors
  • current substance use or abuse
  • medical comorbidity
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19
Q

biologic theories of depression

A
  • genetics
  • neurobiologic (dopamine, serotonin, and NE are decreased)
  • neuroendocrine and neuropeptide (relationship between depression and under functioning thyroid)
  • psychoneuroimmunologic
    (increased cytokine levels associated w/ depression and cognitive impairment -> inflammation)
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20
Q

psychosocial theories of depression

A
  • psychological theories
  • psychodynamic factors (Freud)
  • behavioral factors (Skinner)
  • cognitive factors (Beck)
  • developmental factors
  • family factors
  • social factors
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21
Q

goals of treating depression

A
  • reduce or control sxs
  • if possible eliminate signs and sxs
  • improve occupational and psychosocial function
  • reduce likelihood of relapse and recurrence through recover-oriented strategies
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22
Q

priority care issues for depression

A

safety and assessment of suicide risk

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23
Q

nursing assessment for depression

A
  • MSE
  • physical systems review and thorough hx of medical problems
  • medication hx
  • PE
  • characteristic sxs: appetite and weight changes, sleep disturbance, decreased energy
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24
Q

biologic nursing interventions for depression

A
  • therapeutic relationship
  • teaching physical care
  • administering antidepressants
  • monitor medications
  • managing side effects
  • monitor for drug interactions
  • teaching patients about medications
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25
Q

psychologic nursing interventions for depression

A
  • thought stopping and positive self talk
  • behavior therapy: activity scheduling, social skills and problem solving
  • interpersonal therapy
  • family and marital therapy
  • group therapy
  • patient an family teaching
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26
Q

social interventions for depression

A
  • milieu therapy
  • safety: increased risk of self harm with feeling better and having increased energy
  • family education and support
  • organizations
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27
Q

somatic therapies for depression

A
  • electroconvulsive therapy (ECT) when other treatments fail
  • light therapy (phototherapy) works for seasonal depression
  • repetitive transcranial magnetic stimulation: less invasive than ECT (takes 20-30 sessions)
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28
Q

describe ECT

A
  • treats severe depression, mania, and schizophrenia with other treatments fail
  • rapid tx of depressive sxs
  • general anesthesia
  • electric currents sent into brain that cause seizure
  • 1-3 treatments per week (total of 6-12)
  • contraindications include heart disease, increased ICP and problems w/ anesthesia
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29
Q

what is a new option for treatment resistance depression

A

nasal spray esketamine (produces more pathways in the brain to regulate emotions including glutamate and GABA)

30
Q

disorder where depressed mood is present daily; MDD sxs present for 2 years in adults and 1 year in children/adolescents (sxs last longer than MDD)

A

persistent depressive disorder (dysthymia)

31
Q

disorder characterized by recurring mood swings, feelings of sadness, or sensitivity to rejection in final week before onset of menses

A

premenstrual dysphoric disorder

32
Q

characteristics of premenstural dysphoric disorder

A
  • more prominent than traditional PMS sxs
  • mood begins to improve a few days after menses begins
  • stress, hx of interpersonal trauma, and seasonal changes are associated w/ this disorder
33
Q

disorder w/ onset prior to age of 10; includes verbal outbursts and physical aggression which can disrupt family and social functioning; can occur w/ ADHD

A

disruptive mood dysregulation disorder

34
Q

black box warning for all antidepressants

A

increased risk suicide for adolescents and young adults

35
Q

black box warning for citalopram

A

increased risk of increased QT interval and Tornado de Pointes

36
Q

MOA for SSRI

A

inhibits re-uptake of NT serotonin which increases serotonin availability

37
Q

examples of SSRIs

A
  • fluoxetine (Prozac)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
38
Q

side effects of SSRIs

A
  • headache
  • dizziness
  • tremors
  • nervousness
  • insomnia
  • fatigue
  • nausea
  • diarrhea or constipation
  • weight gain or loss
  • dry mouth
  • sweating
  • sexual dysfunction
39
Q

clinical features of serotonin syndrome

A
  • confusion or mental status changes
  • motor restlessness
  • tremors (ataxia)
  • fever/diaphoresis
  • mydriasis (dilated pupils)
  • autonomic instability
  • GI disturbances (diarrhea)
40
Q

what causes serotonin syndrome

A

taking 2 meds at once that both increase levels of serotonin

41
Q

what to do with prescriptions after serotonin syndrome occurs

A
  • withdrawal meds

- can restart 1 med after getting better

42
Q

how long does it take for SSRIs to become effective

A
  • some have initial improvement within 7 days

- complete relief of sxs within several weeks

43
Q

how to discontinue antidepressant

A
  • slow tapering necessary

- don’t stop abruptly to avoid discontinuation syndrome (flu-like sxs)

44
Q

what OTC supplement can increase risk of serotonin syndrome

A

St John’s Wort

45
Q

MOA of tricyclic antidepressants

A

blocks re-uptake of released NE and prevents it from reentering the adrenergic nerve

46
Q

uses of tricyclic antidepressants

A
  • depression
  • enuresis
  • OCD
47
Q

examples of tricyclic antidepressants

A
  • amitriptyline (Elavil)
  • clomipramine (Anafranil)
  • desipramine (Norpramin)
  • doxepin (Sinequan)
  • imipramine (Tofranil)
  • Nortriptyline (Pamelor)
48
Q

why are tricyclics not used much anymore

A

lethal in small doses due to cardiac effects

49
Q

side effects of tricyclic antidepressants

A
  • sedation
  • orthostatic hypotension
  • anticholinergic effects
  • cardiovascular effects (arythymias and tachycardia)
  • tremors
  • restlessness and insomnia
  • N/V and confusion
  • pedal edema
  • headache
  • seizures
  • blood disorders
50
Q

MOA of SNRIs

A

prevention of reuptake of NE and serotonin

51
Q

examples of SNRIs

A
  • venlafaxine (Effexor)
  • nefazodone (Serzone)
  • Duloxetine (Cymbalta)
  • desvenlafaxine (Pristiq)
52
Q

side effects of SNRIs

A

similar to SSRIs w/ increased BP

53
Q

MOA of NDRIs

A

inhibit reuptake of NE, serotonin, and dopamine

54
Q

example of NDRIs

A

bupropion (Wellbutrin or Zyban)

55
Q

side effects of NDRIs

A
  • agitation or anxiety
  • insomnia
  • appetite suppression
  • psychosis
56
Q

MOA of SARIs

A
  • blocks serotonin-2A receptor potently

- blocking serotonin reuptake pump less potently

57
Q

example of SARIs

A

trazodone (Desyrel)

58
Q

side effects of SARIs

A
  • sedation
  • weight gain
  • N/V and constipation
  • dizziness
  • fatigue
  • incoordination
  • tremor
  • adverse effect = priapism
59
Q

MOA of MAOIs

A

inhibit MAO enzyme system in CNS -> amines (dopamine, serotonin, and NE) are not broken down -> higher levels in brain

60
Q

side effects of MAOIs

A
  • tachycardia
  • dizziness
  • insomnia
  • anorexia
  • blurred vision
  • palpitations
  • drowsiness
  • headache
  • nausea
  • impotence
61
Q

sxs of MAOI overdose

A
  • sxs appear 12 hours after ingestion
  • tachycardia
  • circulatory collapse
  • seizures
  • coma
62
Q

tx of MAOI overdose

A

protect brain and heart by eliminating toxin

  • gastric lavage
  • urine acidification
  • hemodialysis
63
Q

what must patients taking MAOIs avoid

A

foods that contain tyramine (at risk for hypertensive crisis)

  • aged mature cheeses (cheddar, blue, Swiss)
  • smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, pate)
  • yeast extracts
  • red wines
  • Italian board beans (fava beans)
64
Q

MOA of alpha 2 antagonists (NaSSA)

A

boosts NE/noradrenaline and serotonin by blocking alpha 2 adrenergic presynaptic receptors on serotonin receptor

65
Q

example of NaSSA

A

mirtazapine (Remeron)

66
Q

side effects of NaSSA

A
  • sedation (lower doses)
  • dizziness
  • weight gain
  • dry mouth
  • constipation
  • changes in urinary functioning
67
Q

what is the trifecta effect of mirtazapine (Remeron)

A

helps w/ mood, appetite, and sleep

68
Q

pt teaching for antidepressants

A
  • therapeutic effects may not be seen for as long as 4 weeks
  • don’t stop abruptly
  • avoid smoking and drinking alcohol
  • risk of taking during pregnancy
  • avoid other meds w/ same properties
  • activation effects and risk of suicide
  • MAOIs: avoid foods w/ tyramine
69
Q

side effects of ECT

A
  • short term memory loss
  • hypo or hypertension
  • bradycardia or tachycardia
  • minor arrhythmias
  • headache
  • nausea
  • muscle pain immediately afterward
70
Q

permanent implant used as adjunct for severe depression in adults unresponsive to 4 or more adequate antidepressant txs

A

vagus nerve stimulation (VNS)

Psych (17 decks)

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