ATI Ch 13, Depressive Disorders Flashcards
1
Q
What is depression classified as?
A
A mood (affective) disorder
Depression is a widespread issue, ranking high among causes of disability.
2
Q
What is a potential risk factor for suicide in clients with depression?
A
Family or personal history of suicide attempts, comorbid anxiety disorder, comorbid substance use disorder, poor self-esteem, lack of social support, chronic medical condition
These factors increase the risk for suicide in individuals with depression.
3
Q
What percentage of clients with a depressive disorder have comorbid anxiety disorders?
A
Approximately 70%
This combination can lead to poorer prognosis and higher risk for suicide and disability.
4
Q
List some common comorbidities associated with depressive disorders.
A
- Psychotic disorders (schizophrenia)
- Substance use disorders
- Eating disorders
- Personality disorders
Clients often use substances to relieve manifestations of depression.
5
Q
What is Major Depressive Disorder (MDD)?
A
A single episode or recurrent episodes of unipolar depression resulting in significant change in normal functioning
MDD is not associated with mood swings from major depression to mania.
6
Q
What are the criteria for diagnosing Major Depressive Disorder?
A
At least five of the following findings occurring almost every day for a minimum of 2 weeks:
* Depressed mood
* Difficulty sleeping or excessive sleeping
* Indecisiveness
* Decreased ability to concentrate
* Suicidal ideation
* Increase or decrease in motor activity
* Inability to feel pleasure
* Increase or decrease in weight of more than 5% of total body weight over 1 month
These symptoms must last most of the day.
7
Q
What was the bereavement exclusion in the context of depression?
A
Previously used to exclude diagnosis if clinical findings occurred within the first 2 months after a significant loss
Now, a client can be diagnosed with depression during this period to avoid treatment delays.
8
Q
What is a specifier in the context of MDD diagnosis?
A
A more specific classification used in the DSM-5-TR to further diagnose MDD.
9
Q
What are psychotic features in MDD?
A
The presence of auditory hallucinations or delusions.
10
Q
What is postpartum onset in relation to MDD?
A
A depressive episode that begins within 4 weeks of childbirth.
11
Q
What is seasonal affective disorder (SAD)?
A
A form of depression that occurs seasonally, usually during the winter.
12
Q
What is the first-line treatment for SAD?
A
Light therapy.
13
Q
Define persistent depressive disorder.
A
A milder form of depression lasting at least 2 years for adults or 1 year for children.
14
Q
What is premenstrual dysphoric disorder (PMDD)?
A
A depressive disorder associated with the luteal phase of the menstrual cycle.
15
Q
What is the prevalence of PMDD among menstruating clients?
A
2% to 6%.
16
Q
List some emotional manifestations of PMDD.
A
- Mood swings
- Irritability
- Depression
- Anxiety
- Feeling overwhelmed
- Difficulty concentrating
17
Q
List some physical manifestations of PMDD.
A
- Lack of energy
- Overeating
- Hyper- or insomnia
- Breast tenderness
- Aching
- Bloating
- Weight gain
18
Q
What is substance-induced depressive disorder?
A
Clinical findings of depression associated with the use of or withdrawal from drugs and alcohol.
19
Q
What is the goal of treatment during the acute phase of MDD?
A
Reduction of depressive manifestations.
20
Q
How long does the acute phase of MDD treatment generally last?
A
6 to 12 weeks.
21
Q
What is the goal of treatment during the continuation phase of MDD?
A
Relapse prevention through education, medication therapy, and psychotherapy.
22
Q
How long does the continuation phase of MDD treatment generally last?
A
4 to 9 months.
23
Q
What is the goal of treatment during the maintenance phase of MDD?
A
Prevention of future depressive episodes.
24
Q
How long can the maintenance phase of MDD last?
A
It can last for years.
25
What are the most significant risk factors for depression?
Family history and a previous personal history of depression
## Footnote
These factors significantly increase the likelihood of developing depressive disorders.
26
How much more common are depressive disorders in females compared to males?
Twice as common
## Footnote
This statistic highlights gender disparities in the prevalence of depression.
27
Why is depression often difficult to recognize in clients over age 65?
It can mimic symptoms of early dementia
## Footnote
Symptoms like memory loss and confusion may be misattributed to dementia.
28
What are some clinical findings of depression that resemble dementia?
* Memory loss
* Confusion
* Behavioral problems (social isolation or agitation)
## Footnote
These symptoms can lead to misdiagnosis in older adults.
29
What role do neurotransmitter deficiencies play in depression?
They can be risk factors for depression
## Footnote
Deficiencies in serotonin and norepinephrine specifically affect mood and behavior.
30
List some neurotransmitters that can be imbalanced in depression.
* Norepinephrine
* Dopamine
* Acetylcholine
* GABA
* Glutamate
## Footnote
Imbalances in these neurotransmitters may contribute to depressive symptoms.
31
What are some other risk factors for depression?
* Stressful life events
* Presence of a medical illness
* Client's postpartum period
* Comorbid anxiety or personality disorder
* Comorbid substance use disorder
* Trauma occurring early in life
## Footnote
These factors can contribute to the onset or exacerbation of depression.
32
Can depression occur as a response to other disorders?
Yes, it can be the primary disorder or a response to another physical or mental health disorder
## Footnote
This indicates the complexity of depression and its interaction with other health issues.
33
What is anergia?
Lack of energy
## Footnote
This is a common symptom of depression.
34
What is anhedonia?
Lack of pleasure in normal activities
## Footnote
This symptom is often seen in individuals with major depressive disorder.
35
What are vegetative findings associated with depression?
* Change in eating patterns
* Change in bowel habits
* Sleep disturbances
* Decreased interest in sexual activity
## Footnote
These findings reflect the physiological impact of depression.
36
What physical assessment findings are common in clients with depression?
* Sad appearance with blunted affect
* Poor grooming and lack of hygiene
* Psychomotor retardation or agitation
* Social isolation
* Slowed speech and decreased verbalization
## Footnote
These findings can help in the clinical assessment of depression.
37
What does psychomotor retardation refer to?
Slowed physical movement and slumped posture
## Footnote
This is a common physical manifestation of depression.
38
True or False: Clients with depression often exhibit high energy levels.
False
## Footnote
Clients typically show signs of low energy and fatigue.
39
What is the Hamilton Depression Rating Scale used for?
It is a standardized screening tool for measuring the severity of depression.
40
Name three standardized screening tools for depression.
* Beck Depression Inventory
* Geriatric Depression Scale (short form)
* Zung Self-Rating Depression Scale
41
What is the purpose of the Patient Health Questionnaire-9 (PHQ-9)?
It is a standardized screening tool for assessing depression severity.
42
What is milieu therapy in the context of nursing care?
A therapeutic environment that promotes healing and social interaction.
43
What should be assessed regarding a client's risk for suicide?
The client's risk for suicide and implement appropriate safety precautions.
44
How should a nurse monitor a client's self-care?
By monitoring the client's ability to perform activities of daily living and encouraging independence.
45
What is an important communication strategy for clients who are unable or unwilling to communicate?
Make observations rather than asking direct questions.
46
Fill in the blank: When communicating with a depressed client, give directions in _______.
[simple, concrete sentences]
47
Why is it important to give clients sufficient time to respond during conversations?
Due to a possible delayed response time.
48
List two goals of individual counseling for clients with depression.
* Problem-solving
* Increasing coping abilities
49
What should clients be taught about discontinuing antidepressant medication?
Do not discontinue medication suddenly.
50
How long can it take to reach full therapeutic benefits from antidepressants?
Several weeks or more.
51
What should clients avoid while taking antidepressants?
* Hazardous activities (e.g., driving or operating heavy equipment/machinery)
* Alcohol
52
What should clients do if they experience thoughts of suicide while on antidepressants?
Notify the provider.
53
True or False: Therapeutic effects of antidepressants are immediate.
False
54
What is assertiveness training in the context of counseling?
Training to help clients express their thoughts and feelings confidently.
55
What are some community resources that may be used in counseling?
Local support groups, mental health services, and educational programs.
56
What are tricyclic antidepressants used for?
They are used for treating depression and other mood disorders.
## Footnote
Tricyclic antidepressants can also help with anxiety and chronic pain.
57
Which tricyclic antidepressant is mentioned?
Amitriptyline.
## Footnote
Amitriptyline is commonly prescribed for depression and can also be used for chronic pain management.
58
What is a key client education point for Amitriptyline?
Change positions slowly to minimize dizziness from orthostatic hypotension.
## Footnote
Orthostatic hypotension is a drop in blood pressure that can occur when standing up quickly.
59
How can clients minimize anticholinergic effects?
Chew sugarless gum, eat foods high in fiber, and increase fluid intake to 2 to 3 L/day from food and beverage sources.
## Footnote
Anticholinergic effects can include dry mouth, constipation, and urinary retention.
60
What is the primary concern with monoamine oxidase inhibitors?
The risk for hypertensive crisis.
## Footnote
Hypertensive crisis can occur due to interactions with certain foods and medications.
61
Name a monoamine oxidase inhibitor mentioned.
Phenelzine.
## Footnote
Phenelzine is used to treat depression, particularly atypical depression.
62
What foods should be avoided when taking Phenelzine?
Foods with tyramine, including:
* Ripe avocados or figs
* Fermented or smoked meats
* Liver
* Dried or cured fish
* Most cheeses
* Some beer and wine
* Protein dietary supplements.
## Footnote
Tyramine can cause dangerously high blood pressure when taken with MAOIs.
63
What should clients do before taking any new medications while on MAOIs?
Discuss all medications, including over-the-counter, with the provider.
## Footnote
MAOIs can interact with many medications, leading to severe side effects.
64
What is an atypical antidepressant mentioned?
Bupropion.
## Footnote
Bupropion is used for depression and can also help with smoking cessation.
65
What should clients monitor while taking Bupropion?
Food intake and weight due to appetite suppression.
## Footnote
Bupropion can lead to decreased appetite and potential weight loss.
66
What are some side effects to observe for when taking Bupropion?
Headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, or insomnia.
## Footnote
Clients should notify the provider if these effects become intolerable.
67
What is a critical contraindication for Bupropion?
Avoid administering if at risk for seizures.
## Footnote
Bupropion can lower the seizure threshold.
68
What is the leading treatment for depression?
Selective serotonin reuptake inhibitors (SSRIs).
## Footnote
SSRIs are often the first-line treatment due to their efficacy and safety profile.
69
What is the selective prototype medication for SSRIs?
Paroxetine.
## Footnote
Paroxetine is commonly prescribed for depression and anxiety disorders.
70
Name three other SSRIs mentioned.
Citalopram, Fluoxetine, Sertraline.
## Footnote
These medications are also used to treat depression and anxiety.
71
What are some common adverse effects of SSRIs?
Nausea, headache, and central nervous system stimulation (agitation, insomnia, anxiety).
## Footnote
These effects can vary in intensity among individuals.
72
What sexual side effect can occur with SSRIs?
Sexual dysfunction.
## Footnote
It's important for clients to notify their provider if these effects are intolerable.
73
What syndrome should clients be aware of while taking SSRIs?
Serotonin syndrome.
## Footnote
Symptoms can include confusion, rapid heart rate, and high blood pressure.
74
What should clients do if they notice symptoms of serotonin syndrome?
Withhold the medication and notify the provider.
## Footnote
Early recognition and intervention are crucial.
75
What should be avoided to reduce the risk of serotonin syndrome?
The concurrent use of St. John's wort.
## Footnote
St. John's wort can increase serotonin levels and lead to serotonin syndrome.
76
What lifestyle changes are recommended for clients on SSRIs?
Follow a healthy diet and exercise regimen.
## Footnote
Weight gain can occur with long-term use of SSRIs.
77
What is the primary pharmacological action of SSRIs?
SSRIs selectively inhibit serotonin reuptake, allowing more serotonin to stay at the junction of the neurons.
78
Do SSRIs block the uptake of dopamine or norepinephrine?
No, SSRIs do not block uptake of dopamine or norepinephrine.
79
What side effect can Paroxetine cause due to CNS stimulation?
Insomnia.
80
How long does it take for SSRIs to produce therapeutic medication levels?
Up to 4 weeks.
81
What are SSRIs considered for panic disorders and trauma-related disorders?
First-line treatment.
82
What conditions is Paroxetine indicated for? (List at least three)
* Generalized anxiety disorder (GAD)
* Panic disorder
* Obsessive-compulsive disorder (OCD)
* Social anxiety disorder
* Post-traumatic stress disorder (PTSD)
* Depressive disorders
* Adjustment disorders
* Associated manifestations of dissociative disorders
83
Which SSRI is indicated for panic disorder, OCD, social anxiety disorder, and PTSD?
Sertraline.
84
List the conditions Citalopram is indicated for.
* Panic disorder
* OCD
* Generalized anxiety disorder (GAD)
* PTSD
* Social anxiety disorder
85
What conditions is Escitalopram indicated for? (List at least three)
* Generalized anxiety disorder (GAD)
* Obsessive-compulsive disorder (OCD)
* Panic disorder
* PTSD
* Social anxiety disorder
86
Fluoxetine is used for which conditions? (List at least three)
* Panic disorder
* Social anxiety disorder
* OCD
* PTSD
87
What conditions is Fluvoxamine used for?
* OCD
* Generalized anxiety disorder (GAD)
* Social anxiety disorder
* PTSD
88
What are some early adverse effects of SSRIs?
* Nausea
* Diaphoresis
* Tremor
* Fatigue
* Drowsiness
89
What should clients do if they experience adverse effects from SSRIs?
Report adverse effects to the provider.
90
How should SSRIs be taken?
As prescribed.
91
What should clients avoid if they experience drowsiness or fatigue from SSRIs?
Driving.
92
What are some later adverse effects of therapy after 5 to 6 weeks?
Sexual dysfunction, weight gain, headache
## Footnote
Sexual dysfunction includes impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest.
93
What client education should be provided regarding sexual function problems?
Report problems with sexual function
## Footnote
These problems can be managed with dose reduction, medication holiday, or changing medications.
94
What weight changes may occur during therapy?
Weight loss early in therapy followed by weight gain with long-term treatment.
95
What nursing actions should be taken regarding the client's weight?
Monitor the client's weight.
96
What client education is recommended for maintaining weight?
Follow a well-balanced diet and exercise regularly.
97
In which clients should caution be exercised regarding gastrointestinal bleeding?
Clients with a history of gastrointestinal bleed, ulcers, and those taking other medications affecting blood coagulation.
98
What client education should be provided regarding signs of gastrointestinal bleeding?
Report indications of bleeding such as dark stools and emesis that appears like coffee grounds.
99
Who is more likely to experience hyponatremia when taking diuretics?
Older adult clients.
100
What nursing actions should be taken regarding sodium levels?
Obtain baseline blood sodium and monitor levels periodically throughout treatment.
101
What is serotonin syndrome and when can it begin?
A potentially lethal condition that can begin 2 to 72 hours after starting treatment.
102
What are some manifestations of serotonin syndrome?
* Confusion
* Agitation
* Poor concentration
* Hostility
* Disorientation
* Hallucinations
* Delirium
* Seizures
* Tachycardia
* Labile blood pressure
* Diaphoresis
* Fever
* Incoordination
* Hyperreflexia
* Nausea
* Vomiting
* Diarrhea
* Abdominal pain
* Coma
## Footnote
Severe cases of serotonin syndrome can lead to apnea and death.
103
What client education should be provided regarding serotonin syndrome?
Observe for manifestations and withhold medication if any occur, then notify the provider.
104
What is bruxism?
Grinding and clenching of teeth, usually during sleep.
105
What nursing actions should be taken if bruxism is reported?
Report bruxism to the provider.
106
What treatments may be considered for bruxism?
* Switch to another class of medication
* Treat with low-dose buspirone
107
What client education should be provided regarding bruxism?
Use a mouth guard during sleep.
108
What are common symptoms of withdrawal syndrome?
Nausea, sensory disturbances, anxiety, tremor, malaise, unease
## Footnote
Withdrawal syndrome can occur after long-term use of medications.
109
How should medication be tapered to avoid withdrawal effects?
Taper the medication slowly according to a prescribed tapered dosing schedule
## Footnote
Avoid abrupt discontinuation of the medication.
110
What is a contraindication for Paroxetine?
Paroxetine is a teratogenic medication
## Footnote
Other SSRIs pose less risk during pregnancy.
111
In which clients should SSRIs be used cautiously?
Clients with liver and renal dysfunction, seizure disorders, history of gastrointestinal bleeding, or bipolar disorder
## Footnote
Bipolar disorder carries a risk for mania.
112
What can concurrent use of TCAs, MAOIs, or St. John's wort cause?
Serotonin syndrome
## Footnote
Serotonin syndrome is a potentially life-threatening condition.
113
How long before starting an SSRI should MAOIs be discontinued?
14 days
## Footnote
This helps prevent adverse interactions.
114
How long before starting an MAOI should Fluoxetine be discontinued?
5 weeks
## Footnote
This is to prevent serotonin syndrome.
115
What should clients avoid while taking SSRIs?
Concurrent use of TCAs, St. John's wort, alcohol, NSAIDs, and anticoagulants
## Footnote
These combinations increase the risk of adverse effects and bleeding.
116
What should be monitored when SSRIs are used with warfarin?
Prothrombin time (PT) and INR levels
## Footnote
This monitoring is essential to prevent bleeding complications.
117
What are the nursing actions for clients on SSRIs regarding bleeding?
Assess for indications of bleeding and the need for dosage adjustment
## Footnote
Monitor for bruising and hematuria.
118
What is the recommended method of administration for SSRIs?
SSRIs may be taken with food
## Footnote
Taking SSRIs in the morning can minimize sleep disturbances.
119
How long can it take to achieve therapeutic effects from SSRIs?
Up to 4 weeks
## Footnote
Clients should be educated about this timeline.
120
Fill in the blank: SSRIs should be taken on a _______ basis to establish therapeutic plasma levels.
daily
## Footnote
Consistent dosing is crucial for efficacy.
121
What is the prototype medication for serotonin norepinephrine reuptake inhibitors (SNRIs)?
Venlafaxine
122
Name an additional medication classified as an SNRI.
Duloxetine
123
What are common adverse effects of SNRIs?
* Nausea
* Insomnia
* Weight gain
* Diaphoresis
* Sexual dysfunction
124
In which clients should caution be applied when administering SNRIs?
Clients with a history of hypertension
125
What is the expected pharmacological action of SNRIs?
Inhibit the uptake of serotonin and norepinephrine; minimal inhibition of dopamine
126
List the therapeutic uses of SNRIs.
* Major depression
* Panic disorders
* Generalized anxiety disorder
127
What are some complications associated with SNRIs?
* Headache
* Nausea
* Agitation
* Anxiety
* Dry mouth
* Sleep disturbances
128
What nursing actions should be taken regarding hyponatremia in older adult clients on SNRIs?
Obtain baseline blood sodium and monitor levels periodically
129
What nursing actions should be taken for clients experiencing anorexia resulting in weight loss?
Monitor the client's weight
130
What client education should be provided regarding diet and exercise?
Follow a well-balanced diet and exercise regularly
131
What nursing actions should be taken to monitor for hypertension in clients taking SNRIs?
Monitor for increases in blood pressure
132
What should be reported if a client experiences sexual dysfunction while on SNRIs?
Report problems with sexual function
133
What are the contraindications for SNRIs?
* Teratogenic effects
* Contraindicated in clients taking MAOIs
* Duloxetine contraindicated in clients with hepatic disease or heavy alcohol use
134
What should clients avoid when taking SNRIs?
Abrupt cessation of the medication and alcohol
## Footnote
Alcohol can cause CNS depression when taken with SNRIs
135
What can concurrent use of MAOIs and St. John's wort cause?
Serotonin syndrome
## Footnote
This can be potentially fatal
136
How long before starting an SNRI should MAOIs be discontinued?
14 days
## Footnote
This is necessary to prevent serotonin syndrome
137
What should clients monitor for when using NSAIDs and anticoagulants with SNRIs?
Indications of bleeding (bruising, hematuria)
## Footnote
Notify the provider if these occur
138
In which patients should Duloxetine not be used?
Clients with hepatic disease or those who consume large amounts of alcohol
## Footnote
This is due to safety concerns
139
How long can it take for SNRIs to achieve therapeutic effects?
Up to 4 weeks
## Footnote
Clients should be informed about this timeline
140
What is St. John's wort used for?
To relieve manifestations of mild depression
## Footnote
It is not regulated by the U.S. Food and Drug Administration
141
What are some adverse effects of St. John's wort?
Photosensitivity, skin rash, rapid heart rate, gastrointestinal distress, abdominal pain
## Footnote
Clients should be educated about these potential side effects
142
What should clients inform their provider about when taking St. John's wort?
If they are taking St. John's wort with other medications
## Footnote
It can increase or reduce the levels of some medications
143
What foods should be avoided when taking certain antidepressants?
Foods containing tyramine
## Footnote
This is to prevent interactions that could lead to serious side effects
144
What is the first-line treatment for Seasonal Affective Disorder (SAD)?
Light therapy
## Footnote
It inhibits nocturnal secretion of melatonin
145
How long should exposure to a 10,000-lux light box be for light therapy?
30 minutes per day, once or in two divided doses
## Footnote
This exposure is essential for effective treatment
146
True or False: SNRIs can be taken with food.
True
## Footnote
This can help with gastrointestinal tolerance
147
What is electroconvulsive therapy used for?
It can be useful for clients who have a depressive disorder and are unresponsive to other treatments.
## Footnote
Electroconvulsive therapy is often considered when other treatments have failed.
148
Who is responsible for monitoring the client during electroconvulsive therapy?
A specially trained nurse.
## Footnote
This nurse monitors the client before and after the therapy.
149
What does transcranial magnetic stimulation use to stimulate the cerebral cortex?
Electromagnetic stimulation (MRI strength magnetic pulsation).
## Footnote
It is indicated for depressive disorders resistant to other treatments.
150
What is the purpose of vagus nerve stimulation?
It stimulates the vagus nerve using an implanted device.
## Footnote
It is used for clients with depression resistant to antidepressant medications.
151
What is deep brain stimulation?
A treatment that surgically implants electrodes into the brain to stimulate underactive regions.
## Footnote
It is reserved for clients who have tried many other treatments that have failed.
152
What types of psychotherapy can be included in interprofessional care for depression?
* Individual cognitive-behavioral therapy (CBT)
* Interpersonal therapy (IPT)
* Group therapy
* Family therapy
## Footnote
Each type targets different aspects of the depressive disorder.
153
What does cognitive-behavioral therapy (CBT) assist the client with?
Identifying and changing negative behavior and thought patterns.
## Footnote
CBT is a commonly used therapy for various mental health disorders.
154
What does interpersonal therapy (IPT) focus on?
Personal relationships that contribute to the depressive disorder.
## Footnote
IPT helps clients improve their relationships and social functioning.
155
What are the two phases of client education in managing depression?
* Continuation phase
* Maintenance phase
## Footnote
These phases help ensure ongoing support and management of depression.
156
What should be reviewed with the client and family members to identify relapse?
Manifestations of depression.
## Footnote
This proactive approach helps in early detection of relapse.
157
What are some benefits of exercise for clients with major depressive disorder?
* Improves clinical findings of depression
* Helps to prevent relapse
* Even shorter intervals of exercise are helpful
## Footnote
Exercise is considered an adjunct to other therapies.
158
What is included in the nursing evaluation of medication effectiveness?
* Verbalized feeling of less anxiety
* Description of improved mood
* Improved memory retrieval
* Maintenance of a normal sleep pattern
* Greater ability to participate in social and occupational interactions
* Improved ability to cope with manifestations and identified stressors
* Ability to perform activities of daily living
* Report of increased well-being
## Footnote
These indicators vary based on therapeutic intent.
