Chapter 14: Depressive Disorders Flashcards
Depression lasting minimum of ____ (length of time) is considered Major Depressive Disorder
2 weeks
Disruptive mood dysregulation disorder
Affects …
Describe….
Consider developmental level and r/o autism
Children 6 - 18
Frequent temper tantrums, persistent irritable mood
Persistent depressive disorder - Formerly: Dysthymic Disorder- Adults
How long does the depression last….
Causes social / Job distress but hospitalization is not needed.
2 years
When do PMDD physical discomfort start and stop
Affects 2.5 - 5.5 % women
1 week prior to menstruation- onset of period
When does Substance/ Medication Induced Depressive Disorder occur…
When using or withdrawl from drugs
What is the leading cause of disability worldwide
Depression
Can infants have depression?
Yes
Biological factora of Major Depression Disease
Hyper / Hypoactivity in HPA
Hyperactivity
Describe depression rates for women before puberty & after menopause
Lower
Psychological factors for depression:
Cognitive Theory: Thoughts result in emotions
Early life experiences contribute to negative, illogical, Irrational thoughts activated by times of stress.
Negative self deprecating view of self
Negative view of world
Negative reinforcement will continue in the future…..
Describes
Becks triad
PHQ-9 (Patient Health Questionnaire-9)
Purpose…..
Quick and effective for nurses to assess depression, essential for early intervention.
PHQ-9 (Patient Health Questionnaire-9)
Purpose…..
Quick and effective for nurses to assess depression, essential for early intervention.
Assess for suicide FIRST
____% of MDD will commit suicide
15
What questionire is used to screen for alcohol alcohol use?
C ut down?
A nnoy others with your drinking
G uilty about drinking
E ye opening event
1 positive = problems
2 positive = clinically significa
If CAGE has 2 or more positive (possibly 1 positive) then conduct this….
SBIRT
Screening (Reveal how bad drug addiction is)
Brief Intervention: Give them feedback of their Drug Problem & Encourage behavior change
Referral to treatment
Which feeling associated with depression is most concerning, why?
Hopelessness, correlated to suicide
Age considerations in depression.
Teenagers Sx
Older adults Sx
Teenagers anger & irritability
Older adults physical illness/ pain
When does assessment for suicide need to happen.
Every contact
Suicide ideation is criteria for involuntary hospitalization
T or F
T
Risk for suicide include
Prior attempt
Emotionally close relative woth attempted for completed suicide
Male
Anxiety/ chronic pain
And this personality type….
Borderline
What percentage of people who commit suicide have been seen by care provider within 1 month of the act
44%
Half of these have seen medical professionals within 1 week
Open ended comminuted for Depression
BATHE
B othering What is bothering you?
A ffecting How is it affecting you?
T rouble What about the problem troubles you the most
H andling How are you handling the problem
E mpathy I can see how this would make you feel ____. I hear you telling me you feel ___ about this problem.
Risk for suicide
Hopelessness
Impaired coping
Social isolation
Spiritual Distress
Self-care deficit
Chronic low self esteem
What is the mental problem
Depression
Number for the suicide hotline
988
Promote self care in depressed
Small high calorie food
OOB during day, encouraging groups
Relaxation, reduce stimulus at HS
Step by step ADL reminders
What does OOB mean
Out of bed.
Record this in mental health patients
Safety
Suicide precautions for suicide idealation
GSP / ASP General/ Acute suicide precautions
Q15MIN checks, sharps with supervision, No OWP
What does OWP mean
Observation without Physical Contact.
Watching from across the room is an example
Safety Plan
No harm contracts
I will contact my nurse before I act upon my suicide ideas
125,000$ Psych NP job.
Benefits & Vacations
Serotonin syndrome- Fever Sx
To relieve use cooling blankets and thorazine
T or F
T
TCAs
Which are Stimulating/ Sedative
Desipramine, Amitriptyline, Doxepin
Stimulate
Desipramine
Sedative
Amitriptyline / Doxepin
Do urinary retention/ Constipation warrant immediate attention with TCAs
Yes
How long for full effect of TCAs
4 - 8 wks
Will Drowsiness, Dizziness, OH Orthostatic Hypotension go away in a few weeks after the start of tricyclic antidepressants
Yes
Cephalgia means…
Headache
Procardia / Regitine maybe taken for…
Hypertensive Crisis- MAOI
ECT electroconvulsive therapy
2 - 3 treatments wkly. Total 6 - 12
Contradictions….
Nursing responsibilities
No absolute Contradictions
Assess cardiac conditions, subdural hemotomas, Brain tumors
Nurse responsibilities:
Informed consent
EEG & EKG monitor
General anesthetic & muscle paralyzing agent
What does Electroconvulsive therapy consist of…
30 - 60 sec seizures induced by electrodes attached to head
Primary focus for ECT
Awake in….
15 mins
Plus, airways / VS
Transcranical magnetic stimulation (TMS)
Noninvasive: 30 mins 5 x weekly (For how long)……
Awake & Alert during procedure
Common complaint
4 - 6 week
Head & Jaw Pain
Describe procedure for vagus nerve stimulation to improve depression….
Surgical Implantation wraps around vagus nerve on left side of neck
Deep brain stimulation.
Surgical Implantats used to treat resistant major depression
T or F
T
What type of depression might Light Therapy be used for…
SAD seasonal affective disorder
Morning is best time.
SE: headache, jittery
Exercise may lower depression by decreasing the HPA axis, increase availability of serotonin, improves sleep.
Which group is it most helpful with
Menopausal women
