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PMHNP Purple Book Review > Ch. 9 Depressive Disorders and Bipolar Disorders > Flashcards

Ch. 9 Depressive Disorders and Bipolar Disorders Flashcards

1
Q

What is the single strongest predictor of depression?:
a. alcohol use b. having a depressed parent c. age over 65 d. co-morbid anxiety

A

b. having a depressed parent
-children of depressed parents 3x more likely to experience MDD in their lifetimes than general pop
-40% chance of depressive episode before age 18

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2
Q

Neurovegetative symptoms seen in MDD are related to functions of the ______ and the _____ and the hormones they secrete

A

hypothalamus and pituitary

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3
Q

True or False: dysphoria is often triggered by changes in levels of sex steroids that occur during the menstrual cycle

A

True

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4
Q

In response to stress the hypothalamus releases ______, which stimulates the pituitary to release ______. This then stimulates the adrenals to release _______.

A

-CRH (corticotropin-releasing hormone)
-ACTH (adrenocorticotropic hormone)
-cortisol

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5
Q

True or False: hyperactivity of the HPA has been shown to be present in people with MDD

A

True,
HPA-axis controls physiological response to stress
-feedback pathways

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6
Q

Overtime, elevated ______ levels damage the CNS by altering neurotransmission and electrical signal conduction

A

cortisol
-can cause changes in size and function of brain tissue

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7
Q

True or False: MDD may be associated w/ proinflammatory cytokine activation

A

True

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8
Q

All of the following are possible NT function abnormalities causing depression except:
a. dysregulation of biogenic amine NTs b. low levels of endogenous catecholamines c. low levels of tryptophan d. high levels of 5HTIAA e. unusually high receptor sensitivity for NTs f. low density of receptor sites in certain areas

A

d. high levels of 5HTIAA, it is instead LOW levels of the serotonin metabolite 5HTIAA

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9
Q

True or False: structural changes in those w/ chronic/severe depression show hypovolemic hippocampus and prefrontal cortex-limbic striatal regions

A

True

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10
Q

What is the average age of onset for MDD?
a. adolescence b. mid-20s c. 30-40 yrs d. over 50 years

A

b. mid-20s
-risk is equal between genders before puberty and after menopause, otherwise greater in women
-also a greater source of morbidity than with any other illness

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11
Q

True or False: 15% of people with MDD will die by suicide

A

True

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12
Q

Risk Factors for MDD include all of the following except:
a. genetic loading b. prior episode MDD c. male gender d. postpartum period e. medical comorbidity f. single marital status g. environmental stressors

A

c. male gender
-female gender is a risk factor for MDD

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13
Q

Which of the following is not an assessment tool for MDD?
a. GAD-7 b. PHQ-9 c. EPDS d. BDI f. HAM-D

A

a. GAD-7

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14
Q

True or False: initial presentation of MDD often manifests as vague somatic complaints

A

True,
body aches, pains, headaches, muscle pains, lack of energy, GI issues

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15
Q

symptoms of ______ and ______ are almost always present in some degree in MDD

A

anhedonia and sleep disturbance

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16
Q

True or False: in children MDD may present more as an irritable mood

A

True

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17
Q

SIGECAPS stands for:

A

Sleep: insomnia or hypersomnia
Interest: reduced, with loss of pleasure
Guilt: often unrealistic
Energy: mental and physical fatigue
Concentration: distractibility, memory disturbance, indecisiveness
Appetite: decreased or increased
Psychomotor: retardation or agitation
Suicide: thoughts, plans, behaviors.

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18
Q

True or False: suicide risk is high for persons w/ history of past attempts, family history of first-degree relative committing suicide, and presence of psychotic symptoms

A

True,
also:
-concurrent substance abuse or dependency
-current serious health problem

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19
Q

Once started, antidepressants should be continued for minimum of:
a. 4 weeks b. 3 months c. 6 to 12 months d. 2 to 4 years

A

c. 6 to 12 months
-if pt has >2 prior episodes of MDD< consider continuing antidepressants indefinitely

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20
Q

Most antidepressants take _______ (how many weeks) to have therapeutic effect

A

4 to 6 weeks

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21
Q

True or False: antidepressant rebound is common when stopping abruptly, particularly w/ the drugs that have short half-lives

A

True

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22
Q

SSRIs act primarily to ______ by _______:

A

Increase serotonin levels in the CNS by inhibiting their presynaptic reuptake

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23
Q

TCAs act to ______ by ______:

A

Elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake

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24
Q

MAOIs act to _____ by ____:

A

Elevate serotonin and norepinephrine levels by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters

25
Q

SNRIs act to _____ by____:

A

Elevate norepinephrine and serotonin levels by inhibiting dual reuptake of norepinephrine and serotonin
-action very selective on NTs

26
Q

Which of these is not a common side effect of SSRIs?
a. sedation or agitation b. GI disturbances c. EPS d. sexual dysfunction

A

c. EPS

27
Q

NDRIs act to _____ by ______:

A

Increase norepinephrine and dopamine by inhibiting dual presynaptic reuptake.
-Action is very selective

28
Q

SARIs act to ____ by _____:

A

Elevate serotonin levels by inhibiting serotonin reuptake
-dual action, agonist of 5HT-2 receptors

29
Q

True or False: aged cheese, smoked meats, smoked fish, and fermented beverages are tyramine-free and ok to have with MAOIs

A

False, should avoid these foods if taking MAOIs because they contain tyramine

30
Q

Anticholinergic side effects of TCAs include all of these except:
a. dry mouth b. cardiac dysrhythmias c. blurred vision d. constipation e. memory issues

A

b. cardiac dysrhythmias, these can occur with TCAs, but are not an anticholinergic effect
(sorry this is a sneaky question)

31
Q

Which of these is an antiadrenergic side effect?
a. orthostatic hypotension b. sedation c. weight gain d. dry mouth

A

a. orthostatic hypotension
the sedation and weight gain are antihistaminergic side effects and the dry mouth is anticholinergic
*all of these are possible side effects of TCAs

32
Q

True or False: you should adhere to at least 2-week washout period before switching between TCAs and another class of antidepressants

A

True, but should take 5 weeks for fluoxetine

33
Q

True or False: A hypertensive crisis can occur while taking MAOIs if the patient also eats foods containing tyramine

A

True,
can also occur if adding other medications to MAOIs such as TCAs, decongestants, St. John’s wort, asthma meds, stimulants, etc….

34
Q

Symptoms of hypertensive crisis include all of the following except:
a. explosive-like headache b. elevated BP c. facial flushing d. palpitations e. pupillary constriction f. diaphoresis g. fever

A

e. pupillary constriction, instead pupillary dilation occurs

35
Q

When treating hypertensive crisis ________ binds with NE receptor sites and blocks NE

A

phentolamine
-should also d/c the MAOI, stabilize fever

36
Q

True or False: tyramine is a precursor to NE

A

True

37
Q

True or False: When MAO is inhibited, tyramine exerts a strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and NE

A

True

38
Q

Symptoms of serotonin syndrome include all of the following except:
a. agitation and restlessness b. decreased HR and decreased BP c. headache d. sweating e. myoclonic jerking f. confusion g. fever

A

b. decreased in HR and BP, instead causes increased HR and BP
-other symptoms include shivering, goose bumps, loss of coordination, seizures and unconsciousness

39
Q

All of the following can be part of treating serotonin syndrome except:
a. discontinue offending agent b. cyproheptadine c. anticonvulsants e. phenelzine d. autonomic support

A

e. phenelzine

40
Q

Significant side effects of MAOIs include all of the following except: a. hypotension b. insomnia c. weight gain d. anticholinergic side effects d. lightheaded and dizzy e. sexual dysfunction

A

a. hypotension, instead could cause hypertensive crisis

41
Q

True or False: NT theory of how ECT works suggests increase in dopamine, serotonin, and norepinephrine

A

True

42
Q

Which theory suggests that ECT works by releasing hormones such as prolactin, TSH, pituitary hormones, endorphins, and adrenocorticotropic hormone:
a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory

A

b. neuroendocrine theory

43
Q

Which theory suggest that ECT works by exerting an anticonvulsant effect, which then produces an antidepressant effect:
a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory

A

c. anticonvulsant theory

44
Q

Contradiction to ECT include all of the following except: a. cardiac disease b. compromised pulmonary status b. hx of brain injury/tumor c. hx of SJS d. anesthesia medical complications

A

c. history of SJS

45
Q

Which of these involves inducing a grand mal seizure induced in an anesthetized person:
a. ECT b. TMS c. VNS d. Phototherapy

A

a. ECT, electroconvulsive therapy
-usual course 6 to 12 tx

46
Q

Which of these involves placement of a small wire coil on the scalp to conduct electrical current, creating a magnetic field, through the tissues of the head:
a. ECT b. TMS c. VNS d. Phototherapy

A

b. TMS
transcranial magnetic stimulation
-performed without anesthesia, office setting
-usually 40 min session, 5x/wk for 6 weeks

47
Q

Which of these involves a pacemaker-like device implanted in the left side of the chest to simulate left branch of nerve:
a. ECT b. TMS c. VNS d. Phototherapy

A

c. VNS
-can be outpatient but anesthesia required

48
Q

Which of these involves 2,500 to 10,000 lux light for 30 min up to 2 hrs, 1 to 2x daily:
a. ECT b. TMS c. VNS d. Phototherapy

A

d. phototherapy

49
Q

All of the following are risk factors for suicide except:
a. 45 or older if male b. 55 or older if female c. divorced/single d. white e. female gender

A

e. female, males are at greater risk for suicide
other risk factors include living alone, psych disorder, physical illness, substance abuse, previous suicide attempt, family hx of suicide, recent loss

50
Q

All of the following symptoms are more pronounced in children with MDD except: a. irritability b. motor retardation c. somatic complaints d. social withdrawal

A

b. motor retardation, this is less common before the onset of puberty, along with:
-psychosis
-hypersomnia
-increase appetite

51
Q

True or False: MDD has a strong separation anxiety component in children

A

True

52
Q

Drug combinations that can cause serotonin syndrome include all of these except:
a. SSRIs and MAOIs b. SSRIs and mood stabilizers c. drug and herbal interactions d. SSRIs and St. John’s wort

A

b. SSRIs and mood stabilizers

53
Q

symptoms of discontinuation syndrome include all of the following except: a. flu-like symptoms b. increased concentration c. fatigue d. myalgia e. nausea and vomiting f. impaired memory g. vertigo

A

b. increased concentration, instead decreased concentration
other symptoms include: lethargy, paresthesia’s, irritability, anxiety, insomnia, crying without w/out provocation, and dizzyness

54
Q

Evidence indicates clients should take an antidepressant agent for at least _____ months after remission of symptoms:
a. 3 months b. 8 months c. 9 months d. 12 months

A

d. 12 months

55
Q

True or False: dysthymia is similar to MDD but has less severe symptoms, and no psychotic symptoms

A

True,
also vegetative symptoms are less likely with dysthymia

56
Q

True or False: women are 2-3 times more likely to develop dysthymia

A

True

57
Q

Dysthymia is characterized by a chronically depressed mood that occurs for most of the day, more days than not, for at least ____ (how long?)

A

2 years
-also prominent: low self-esteem, self-criticism, and a perception of general incompetence compared to others

58
Q

True or False: it can be considered grief/bereavement when symptoms develop within 3 months of the stressor

A

True

PMHNP Purple Book Review (17 decks)

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