Depression Flashcards
What is mood?
A pervasive and sustained emotion that influences ones perception of the world and how one functions
What is affect?
Outward emotional expression
What are examples of affect?
Blunted, bright, flat, inappropriate, labile, restricted
What is depression?
A mental state characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration
Depressive disorders affect who (general) and how do they affect them?
Kids and adults; somatic & cognitive changes, lower quality of life, premature death/suicide, sleeping, concentration, weight, agitation, decreased sexual desire
Who is depression most common in?
Females, 18-29 y/o
If a kid is suspected of having a depressive disorder, how might they present?
With somatic issues like a stomach ache or headaches, less interactions with peers, avoid play and recreations that they previously liked, irritable instead of sad.
What is a new depressive disorder diagnostic in the DSM-5?
Disruptive mood dysregulation
T/F people with depressive disorder experience a low quality of life and are at greater risk for physical health problems
True
Chronic victimization and substance abuse increases the risk of what in kids?
Depression, suicide ideation, and suicide attempts
How can we treat these side effects of antidepressants:
dry/inflammed mouth and caries
Sugarless gum and candies, 6-8 cups water, toothpaste for dry mouth, pilocarpine drops
How can we treat these side effects of antidepressants:
nausea, vomiting
Take med with food (crackers, toast, tea) or change medications
How can we treat these side effects of antidepressants:
weight gain
Balanced diet and exercise regularly. Can also change medicines
How can we treat these side effects of antidepressants:
urinary hesitation and consitpation
6–8 cups of water per day, bulk laxative, daily exercise, 6–8 cups of water per day, diet rich in fresh fruits, vegetables, and whole grains
How can we treat these side effects of antidepressants: diarrhea
Maintain fluid intake, OTC antidiarrheal
How can we treat these side effects of antidepressants:
drowsiness
Don’t drive when drowsy, plan for rest time, no alcohol, shift dosing time, lower medication dose
How can we treat these side effects of antidepressants: fatigue
Daily exercise
How can we treat these side effects of antidepressants: Blurred vision
Pilocarpine drops, magnifying glass
How can we treat these side effects of antidepressants: flushing and sweating
Frequent baths, lightweight clothing, Terazosin once daily
T/F: depression in older adults is often undetected or inadequately treated
True
Depression in older adults is often associated with what chronic illnesses
Heart disease, stroke, and cancer
In older adults, what can depressive symptoms be confused with?
Bipolar, dementia, and cerebrovascular symptoms
Suicide is a high risk for the older population, but specifically…. (men or women)
Men and people 75 or older
Major depressive disorder diagnostic criteria
1 or more moods; depressed or loss of interest/pleasure in nearly all activities for 2 weeks. 4 of 7 symptoms must be present: disruption of sleep, appetite, concentration, energy, psychomotor agitation, excessive guilt, worthlessness, suicidal ideation
Major depressive disorder diagnostic criteria
1 or more moods; depressed or loss of interest/pleasure in nearly all activities for 2 weeks. 4 of 7 symptoms must be present: disruption of sleep, appetite, concentration, energy, psychomotor agitation, excessive guilt, worthlessness, suicidal ideation
What groups have higher incidences of depression? White, black, Asian, hispanic, or native americans?
White, native americans
Name 2 risk factors for depression
Prior episodes, family history, lack of social support, lack of coping abilities, environmental stressors, substance use and abuse, medical/mental illness comorbidity
What word do native americans and middle eastern use to describe depression?
heartbrokenness
Someone from the West Indies would use what word in-place of depression?
brain fog
Zar and running amok describe what?
Depressed, sad, hopeless, and discouraged
According to neurobiology theories, depression is caused by what?
A deficiency or dysregulation in the CNS concentrations of serotonin, dopamine, and norepinephrine
Psychoneuroimmunology
Research into proteins, known as chemical messengers, between nerve cells. Increased cytokine levels are associated w/depression and cognition impairment= inflammatory rxn are involved in development of mental health disorders
Freuds view on depression
Due to an early lack of love, care, warmth, protection which results in anger, guilt, helplessness, and fear regarding the loss of love
The conflict between wanting to be loved and the fear of rejection leads to….
Self-punishment, self-rejection, low self-esteem, and depression
Developmental theorists think that depression results from…
Loss of a parent through death, separation, or lack of emotionally adequate parenting which delays developmental milestones
What are the 3 specific goals of depression treatment?
1) reduce/control/eliminate symptoms
2) improve occupational and psychosocial function
3) reduce relapse through recovery-oriented strategies
What 2 types of theories have been shown to be as effective as pharmacotherapy in milder depressions?
-Cognitive: prevents relapse and is implemented by a trained professional
- Interpersonal: recognizes and seeks to overcome losses, role confusion, social isolation, and deficits in social skills
Combination therapy is usually effective. If not, what can be done in-place of that?
ECT, light therapy, rTMS
What are alternative therapies?
Acupuncture, yoga, tai chi, meditation, guided imagery, massage therapy, music/art therapy
Would interviewing a family member or friend about the patients day-to-day life help with diagnosis?
Yes
Past history assessment for depression
CNS, endocrine, anemia, chronic pain, autoimmune illness, diabetes, menopause, surgery, abortion, child birth,
Physical assessment for depression
VS, CBC, LFT, EKG, urinalysis, appetite and weight changes, sleep disturbances, tiredness, decreased energy, and fatigue
Hypersomnia
Prolonged sleep episodes at night or increased daytime sleep. Pt complains of not feeling rested
Terminal insomnia
Waking too early and not being able to go back to sleep. Pt complains of not feeling rested
What should the nurse gather information on related to medications during the assessment?
Frequency and dosage, prescribed/OTC meds, assess lethality of meds, herbal intakes, drugs,
What is included in the psychosocial assessment?
Mental status exam, coping skills, developmental history, family history, patterns of relationships, support system, education/work history, history of abuse. Identify pt strengths and weakness, include fam member in interview.
Anhedonia
Loss of interest or pleasure
What are the 5 common self-report scales for depression and assessing mood/affect?
-GQH (get health questionnaire)
-CES-D
-BDI (beck depression inventory)
-SDS
-PRIME-MD
Psuedodementia
Memory difficulties which are signs of depression in older adults but commonly mistaken for dementia
Suicidal behavior
Occurrence of persistent thought patterns and actions that indicate a person is thinking about, planning, or enacting suicide
Children most often use ____ as their method of suicide compared to men using ___ and women using ___
- suffocation
- firearms
- pills, poison
How can the nurse prioritize care with depression?
1- assess suicide
2- physical impact of depression
What are some blocks to communication when dealing with someone who is depression?
Being overly cheerful or cheerleading. Instead, be calm and supportive
What is one of the 1st nursing interventions in physical care?
Re-establish normal sleep patterns and healthy nutrition
Patients with coronary heart disease can do what to help decrease depressive symptoms within 4 weeks?
Deep breathing exercises 3 times a day
Meds should be continued for at least ___ months to ___ year after the pt achieves complete remission of symptoms
6 months
1 year
What 3 classes of meds commonly have an impact on vital signs?
MAOIs, TCAs, or SNRIs
Why do people stop taking their SSRIs?
GI (cramping, diarrhea), heartburn
Most common side effects of TCAs
Antihistaminic (sedation, weight gain), anticholinergic (blurred vision, dry mouth, constipation, UR, tachycardia, decreased memory)
Symptoms of a hypertensive crisis
Sudden, severe pounding headache, racing pulse, flushing, stiff neck, chest pain, n/v, diaphoresis
Alpha 2 antagonist med
Remeron
Alpha 2 ant side effects
Sedation, anticholinergic, appetite increase, weight gain, hypercholestremia, weak, lack of energy, dizzy, hypertriglyceridemia
What is the least lethal antidepressant?
SSRI
Common SSRI meds (5)
fluoxetine (Prozac), sertraline (Zoloft), paroxetine, escitalopram (Lexapro), citalopram (Celexa)
Common side effects of SSRI
GI distress, sedation, weight loss/gain, anticholinergic, cramping, heartburn
-take w/food
Common SNRI meds (4)
desvenlafaxine (Pristiq XR), duloxetine (Cymbalta), levomilnacipran (Fetzima), venlafaxine (Effexor XR)
Common SNRI side effects
N/v, anticholinergic, weight gain, diaphoresis, sexual dysfunction
-watch for HTN, take w/food
Common med for NDRI
Bupropion
Side effects of trazodone (Oleptro)
Sedation, antichol, headache, dizzy, n/v
Common TCAs
amitriptyline, clomipramine, amoxapine
Common MAOIs
Isocarboxazid, phenelzine, tranylcypromine, selegiline
Side effects for MAOI
Headache, drowsy, dry mouth, ortho hypoTN, insomnia, weight loss, rare priapism
Side effects for TCAs
sedation, weight gain, anticholinergic, tachycardia, decreased memory
-take at bedtime, increase water and fiber, sugarless candy
Serotonin syndrome
Develops within hours/days, s/s are AMS, agitation, myoclonus, hyperreflexia, fever, diaphoresis, ataxia, diarrhea.
Nursing interventions for serotonin syndrome
- stop using the drug
- notify the provider
- IV fluids, antipyretics, cooling blanket
Cognitive therapy approaches are considered 1st line treatment and should be in all nursing care plans
Yes
When depressed, increased energy can often be a sign of ….
Suicide plans
When depressed, increased energy can often be a sign of ….
Suicide plans
Milieu therapy
Helps maintain socialization skills and continue interaction with others
Telehealth
Use of electronic approaches and communications that support Clincal and professional health care that facilitate biobehavioral health needs. Assess, diagnose, treat, collaborate
Hypothyroidism is associated with depression
yep
Medical home model
Health care coordinated by 1 health provider which allows for meaningful relationships
Dysthymia
Persistent depressive disorder; major depression that lasts for 2 years if an adult or 1 year if a kid
Premenstrual dysphoric disorder
Recurring mood swings, sadness, sensitivity to rejection in the final week before the onset of menses. Mood will improve a few days after menses begins. Stress, history of interpersonal trauma, and seasonal changes are associated
Disruptive mood dysregulation disorder
Severe irritability and outbursts of temper. Begins before the age of 10, kids display outbursts 2-3 times a week and can occur with ADHD
rTMS
Mild treatment resistant depression. 37 minutes, 20-30 session over 4-6 weeks
ECT
Severe depression, rapid treatment needed, succinylcholine (muscle relaxant)
Light therapy
Mild to moderate seasonal depression, non psychotic
Trazadone (medication) should avoid what juice
Grapefruit
