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Psych Exam 1 > Depression > Flashcards

Depression Flashcards

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1
Q

Etiology of depressive disorders

A

Biological Factors
genetics
neurotransmitter abnormalities
increased cortisol
hormonal disturbances ( thyroid problems)
inflammatory processes
diathesis stress model (predisposition to depression and stress can bring it out)
psychological factors
cognitive theory- psychological predisposition
negative or unrealistic expectations
unrealistic perceptions leads to recurrent dissatisfaction
learning theory- learned helplessness, lack of coping skills

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2
Q

contributing factors of depression: child

A

Common thread is loss
genetic predisposition for a mood disorder and stress may cause depression
physical or emotional detachment to primary care giver
parent separation/divorce
death of loved one/pet
relocation
academic failure
physical illness

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3
Q

contributing factors of depression: Teens

A

conflicts between independence and maturation
role confusion
grief/loss
relationships breakups
abandonment

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4
Q

contributing factors of depression: older adults

A

bereavement overload (loss of spouse, friends, home, independence)
chronic pain
financial problems
life changes (job ending/ retirement/ relocation)
societal attitudes may lead to decreased self esteem; helplessness; hopelessness

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5
Q

Identify the 5 types of depressive disorders

A

Major depressive disorder
disruptive mood disorder
persistent depressive disorder (formerly dysthymia)
premenstral dysphoric disorder
substance/medication induced depressive disorder

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6
Q

all 5 depressive disorders share what 5 symptoms

A

sadness, irritability, emptiness, somatic concerns, and impairment of thinking, all of which affect ability to function

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7
Q

anhedonia

A

loss of pleasure or interest in things

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8
Q

depressive symptoms of children 0-3

A

FTT
feeding problems
lack of playfulness
lack of emotional expression
delay in speech or motor development

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9
Q

depressive symptoms of children 3-5

A

prone to accidents
phobias
aggressiveness
excessive self-reproach for minor infractions

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10
Q

depressive symptoms of children 6-8

A

vague physical complaints
aggressive behavior
cling to parents
avoid new people and challenges
behind in social skills/ academic performance

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11
Q

depressive symptoms of children 9-12

A

morbid thoughts
excessive worry
lack of interest socially
think they have disappointed parents

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12
Q

Major Depressive Disorder

A

anhedonia or depressed mood
chronic lasting 2 years
recurrent episodes
symptoms cause distress or impaired function
wt loss, fatigue, sleep disturbances, psychomotor agitation or retardation
recurrent thoughts of death

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13
Q

DMDD (disruptive mood dysregulation disorder)

A

only children
ages 6-18
onset before age 10
symptoms include anger, constant severe irritability
temper tantrums with verbal and behavioral outburst atleast 3x weekly
displays irritability, anger, and temper tantrums in at least 2 settings (home, school, with peers)

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14
Q

Persistent Depressive Disorder

A

formerly dysthymia
low-level depressive feelings
symptoms for at least 2 years in adults, 1 year child/adolescents
must have 2 of the following (decreased appetitie or overeating, insomnia or hypersomnia, low energy, poor self esteem, difficulty thinking, and hopelessness

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15
Q

Premenstrual Dysphoric Disorders

A

symptoms 1 week prior to onset of period
mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating
SSRI’s given 1 week prior to period
symptoms decrease significantly or disappear with onset of menstration

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16
Q

substance induced depressive disorder

A

only depressed when using substances
does NOT experience symptoms when not using

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17
Q

affect

A

observed responsiveness of a person’s emotional state.
ex: flat, blunted, constricted, congruent, sad

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18
Q

mood

A

persons emotional state or feelings expressed in own words
document patients description

19
Q

lability

A

mood swings
happy one moment and sad the next

20
Q

psychomotor retardation

A

visible slowing of physical activity
slow talking, long pauses before speaking, taking log time to cross a room, slow food chewing, waiting longer than usual between bites
associated with severe depression

21
Q

psychomotor agitation

A

increased activity and mental tension
restlessness, pacing, tapping of fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around.

22
Q

phases of treatment

A

acute phase (6 to 12 weeks)
continuation (4-9 months)
maintenance phase (1 year or more)

23
Q

general antidepressant medication education

A

takes 4-6 weeks to see improvement
physiological symptoms improve before psychological
increased risk of SI
discontinuing med as soon as you feel better may result in relapse
meds usually needed 6-9 months past relief of symptoms, up to 12-24 months
do not drink alcohol
non medical interventions include exercise and less caffeine

24
Q

SSRI’s

A

first line therapy
rare risk of serotonin syndrome
tine, pram, done
fluoxetine, paroxetine, sertraline, citalopram, escitalopram, vortioxetine, vilazodone

25
Q

possible side effects of SSRI’s

A

dry mouth
sex problems, tension headaches, blurred vision
drowsiness
nausea
insomnia
diarrhea
nervousness, agitation, restlessness
dizziness

26
Q

nursing implications of SSRI’s

A

takes 4-8 weeks to work
most side effects diminish after 4-6 wks
may cause increase in SI, agitation, fever, increased BP, manic symptoms
sleep hygeine
avoid caffeine
teach relaxation techniques
electrical surges, brain shivers, pins and needles on skins, blackouts, short term memory loss, feeling like on the verge of unconciousness

27
Q

Serotonin syndrome

A

mental status changes (agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations
diaphoresis, flushing, fever, tachycardia, mydriasis
myoclonus( muscle twitching, jerking), hyperreflexia, tremors
n/v/d

28
Q

what happens if serotonin meds not stopped during serotonin syndrome?

A

worsening myoclonus, HTN, rigor, acidosis, respiratory failure, rhabdomyolysis
60% pts will develop symptoms within 6 hours of either first dose or new med, change in dosing, or intentional overdose
can be fatal

29
Q

treating serotonin syndrome

A

stop or reduce med
benzodiazepines- diazepam or lorazepam to control agitation, seizures, and muscle stiffness
oxygen
IV fluids
provide symptomatic and supportive care
usually resolves within 24 hours but can take several weeks to go away
drugs to control HR and BP
serotonin production blocking agents- cyproheptadine HCL

30
Q

TCA’s

A

old/cheap
-ine, in
imipramine, desipramine, doxepin, amitriptyline
start low and go slow
increased danger of death by overdose
can lead to fatal CNS depression
anticholinergic side effects

31
Q

nursing implications of TCA’s

A

before initiating TCA check EKG, and for hx of seizures
NO pregnant or getting pregnant
initial early symptoms may include early morning awakening, feeling worse in AM, worry and anxiety
risky to give in patients with CV or older adults

32
Q

anticholinergic side effects

A

hot as a hare, dry as a bone, blind as a bat, red as beet, mad as a hatter
also: sedation and WT gain

33
Q

nursing interventions for TCA’s

A

dry mouth: SF gum or hard candy
GI upset: take with food
Diarrhea: frequent small meals
Constipation: increase fiber and fluids
insomnia: sleep hygiene/ change dosing time/ take in AM
orthostasis: keep hydrated; get up slowly
sex side effects: erectilie dysfunction meds
urinary hesitancy: run water, check amount of void

34
Q

MAOI’s

A

Pheneizine, isocarboxazid, tranylcpromine, selegiline transdermal patch
blocks MAO
usually third choice to treat depression, anxiety, panic, bulimina
NO tyramine foods

35
Q

side effects of MAOI’s

A

dry mouth
n/d/c
HA
drowsiness
insomnia
dizziness/ lightheadedness
skin reaction to patch site
involuntary muscle jerks
low BP
sex side effects
WT gain
urinary hesitancy
muscle cramps
prickling or tingling sensation in skin

36
Q

MAOI nursing implications

A

avoid tyramine rich foods to prevent HTN crisis
aged, smoked, fermented, marinated and processed meats
aged cheeses
overripe fruits and vegetables
beans
condiments
beers/ales/liquors/red wine/ non-alcoholic wines and beers
avoid using with demerol; otc cold meds
rarely used with SSRI
avoid high consumption of caffeine
limited amounts of avocado’s and chocolate

37
Q

hypertensive crisis

A

occipital headache
palpitations
nausea
vomiting
HTN but orthostatic hypotension is possible
dyspnea/SOA
mental status changes
blurred vision
sweating
neck stiffness and soreness
dilated pupils
photophobia
tachycardia or bradycardia
chest pain
disrupted cardiac rate/rhythm

38
Q

treatment of HTN crisis

A

regitine (phentolamine) alpha adrenergic blocker; vasodilator
procardia (sublingual nifedipine) calcium channel blocker; relaxes cardiac muscle
symptomatic and supportive care

39
Q

bupropion (NDRI)

A

contraindicated with eating disorders and hx of seizures
less sexual side effects
used for smoking cessation

40
Q

trazodone

A

chemically similar to TCA
given at bedtime for sedative effect

41
Q

mirtazapine

A

NaSSAs
good for sleep

42
Q

meds for depression in children and teens

A

SSRI
fluoxetine 1st line
BLACK BOX: increased risk of SI
venlafaxine off label use
improvement may be seen in 1-2 weeks, takes up to 12 weeks to see full effect
TCA’s
more s/e potential for dysrhythmias!
potentially lethal overdose

43
Q

Other tx of depression

A

photo/light therapy
ECT
vagal nerve stimulator or DBS
transcranial magnetic stimulation
acupuncture or massage
St. Johns wart. SAMe, omega 3 fatty acid
exercise
decrease caffeine and ETOH
relaxation techniques

Psych Exam 1 (10 decks)

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