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psychia finals > depression > Flashcards

depression Flashcards

1
Q

refers to the client’s pervasive and enduring emotional state (subjective)

A

mood

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2
Q

the outward expression of the client’s emotional state (objective)

A

affect

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3
Q

outward emotional expression is consistent with mood

A

congruent affect

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4
Q

outward emotional expression is incompatible with the situation

A

inappropriate affect

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5
Q

displays a facial expression that is incongruent with mood or situation

A

inappropriate affect

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6
Q

monimal outward expression is observed

A

blunted affect

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7
Q

little or slow to respond facial expression

A

blunted affect

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8
Q

absence of outward emotional expression

A

flat affect

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9
Q

no facial expression at all

A

flat affect

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10
Q

a mood disorder that causes a persistent feeling of sadness and loss of interest

A

depression

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11
Q

natural response to a loss

A

grief

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12
Q

painful feelings come in waves, often intermixed with positive memories associated with loss

A

grief

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13
Q

self ssteem is maintained

A

grief

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14
Q

intense sadness and withdrawal from usual activities

A

grief and depression

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15
Q

mood and/or interest are decreased

A

depression

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16
Q

feelings of worthlessness and self loathing are common

A

depression

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17
Q

how many weeks does a depressive episode last for it to be classified as major depressive disorder

A

2 weeks

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18
Q

what is the dsm v diagnostic criteria for major depressive disorder

A
  • weeks of depressive episode
  • with at least 4 of the following:
    anhedonia
    appetite disturbance
    sleep disturbance
    psychomotor agitation or retrdation
    fatigue
    feelings of worthlessness
    recurrent suicidal thoughts
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19
Q

what is another name for persistent depressive disorder

A

dysthymia

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20
Q

how long should a depressive mood last for it to be categorized as persistent depressive disorder

A

2 years

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21
Q

what is the dsm v diagnostic criteria for persistent depressive disorder

A
  • depressed mood for at least 2 years
  • and at least two of the following
    appetite disturbance
    sleep disturbance
    fatigue
    feelings of worthlessness
    feelings of hopelessness
    poor concentration or difficulty making decision
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22
Q

this mood disturbance generally occurs in younger populations

A

atypical depression

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23
Q

this depression is more common in women

A

atypical depression

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24
Q

this depression causes increased appetite and/or weight gain

A

atypical depression

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25
Q

what are the characteristics of atypical depression

A
  • increased appetite and/or weight gain
  • hypersomnia
  • leaden paralysis
  • extreme sensitivity to interpersonal rejection
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26
Q

this depression occurs often in older adults

A

melancholic depression

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27
Q

what are the characteristics of melancholic depression

A
  • inability to be cheered up
  • anhedonia
  • at least three of the following
    • depression worse in the morning
    • early morning awakening
    • psychomotor retardation
    • significant anorexia or weight loss
    • excessive/inappropriate guilt
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28
Q

this depression has mood disturbance that occurs during the first 30 days postpartum

A

postpartum depression

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29
Q

what is the predisposing factor for postpartum depression

A

postpartum depression

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30
Q

what are the characteristics of postpartum depression

A
  • consistent with those of depression
  • anxious, irritable, or tearful but also having periods of normalcy
  • overconcern or delusional thoughts about baby’s health
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31
Q

this type of depression occurs in conjunction with a seasonal change

A

seasonal affective disorder

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32
Q

which is more common onset of seasonal depression disorder

A

spring onset depression

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33
Q

what is the specific etiology for depressive disorders

A

unknown

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34
Q

what are the monoamine neurotransmitters

A

serotonin, dopamine, norepinephrine

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35
Q

this monoamine neurotransmitter controls food intake, sleep and wakefulness, regulation of emotions

A

serotonin

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36
Q

this monoamine neurotransmitter causes changes in attention, learning and memory, sleep and wakefulness mood

A

norepinephrine

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37
Q

this monoamine neurotransmitter controls motivation, cognition; regulates emotional responses

A

dopamine

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38
Q

what are the situations when monoamine neurotransmitters get dysregulated

A
  • too few neurotransmitters are released
  • neurotransmitters linger too briefly in synapses
  • releasing presynaptic neurons reabsorb them too quickly
  • conditions in the synapses do not support linkage with post synaptic receptors (monoamine oxidation)
  • number of post synaptic receptors have decreased
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39
Q

how much concordance does major depression have between twins

A

40-50%

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40
Q

how many times are first degree relatives of depressed individuals likely to develop depression in comparison to the general population

A

3

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41
Q

how does the psychodynamic theory of depression work

A

it resolves from unresolved grieving in an early stage of the child-parent relationship. the person remains fixated in the anger stage and turns the anger inwards, resulting in a weak ego and punitive superego

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42
Q

people with low self-esteem ,who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience what

A

depression

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43
Q

this is the most commonly used instrument for assessing symptoms of depression

A

hamilton depression rating scale

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44
Q

the instrument is designed to be administered by clinicians after a structured or unstructured interview of the patient to determine their symptoms

A

hamilton depression rating scale

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45
Q

what does a score below generally represent for hamilton depression rating scale

A

the absence of remission of depression

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46
Q

what does a score between 7 to 17 represent in hamilton depression rating scale

A

mild depression

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47
Q

what does a score between 18 to 24 represent in hamilton depression rating scale

A

moderate depression

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48
Q

what does a score 25 and above represent in the hamilton depression rating scale

A

severe depression

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49
Q

what are the antidepressant types that are used in depression

A
  • selective serotonin reuptake inhibitors
  • tricyclic antidepressants
  • atypical antidepressants
  • monoamine oxidase inhibitors
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50
Q

this antidepressant blocks the reuptake of serotonin

A

selective serotonin reuptake inhibitors

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51
Q

this antidepressant has fewer sedating anticholinergic and cardiovascular side effects

A

selective serotonin reuptake inhibitors

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52
Q

how many days of selective serotonin reuptake inhibitor therapy does insomnia decrease

A

3 days

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53
Q

how many days does it take for selective serotonin reuptake inhibitor normalize appetite

A

5 to 7 days

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53
Q

how many days does it take for selective serotonin reuptake inhibitor to improve mood, concentration and interest in life

A

7 to 10 days

54
Q

what time should you give fluoxetine (prozac) if the patient is nervous

A

fluoxetine (prozac)

55
Q

what time should you give fluoxetine (prozac) if the patient is nervous

A

fluoxetine (prozac)

56
Q

what time should you give fluoxetine (prozac) if the patient is nervous

A

fluoxetine (prozac)

57
Q

what are the nursing implications for fluoxetine prozac

A

administer in am if patient is nervous
administer in pm if patient is drowsy
monitor for hyponatremia
encourage adequate fluids
report sexual difficulties to physician

58
Q

when should you administer sertraline (zoloft) if patient is drowsy

A

pm

59
Q

what are the nursing implications of sertraline (zoloft)

A

administer in PM if client is drowsy
encourage use of sugar free beverages or hard candy
drink adequate fluids
monitor hyponatremia
report sexual difficulties to physician

60
Q

what are nursing implications for paroxetine (paxil)

A

administer with food
administer in PM if client is drowsy
encourage use of sugar-free hard candy or beverages
encourage adequate fluids

61
Q

what are nursing implications for citalopram (celexa)

A

monitor for hyponatremia
administer with food
administer dose at 6 pm or later
promote balanced nutrition and exercise

62
Q

what are nursing implications for escitalopram

A

check orthostatic blood pressure
assist client to rise slowly from sitting position
encourage use of sugar free beverages or hard candy
administer with food

63
Q

what are the selective serotonin reuptake inhibitors for depression

A

fluoxetine (prozac)
sertraline (zoloft)
paroxetine (paxil)
citalopram (celexa)
escitalopram (lexapro)

64
Q

this occurs when theres is an inadequate washout period between taking MAOIs and SSRIs or when MAOIs are combines with mepiridine

A

serotonin syndrome

65
Q

what are symptoms of serotonin syndrome

A

change in mental state: confusion and agitation
neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse and muscle paralysis
autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and diaphoresis

66
Q

this primarily blocks reuptake of norepinephrine and some degree of serotonin reuptake blockage

A

tricyclic antidepressants

67
Q

what is the half-life of tricyclic antidepressants

A

15 - 30 hours

68
Q

what is the half-life of tricyclic antidepressants

A

15 - 30 hours

69
Q

what is the lag period of tricyclic antidepressants

A

1 to 4 weeks - only then will the symptoms begin to decrease

70
Q

what is the lag period of tricyclic antidepressants

A

1 to 4 weeks - only then will the symptoms begin to decrease

71
Q

what are the tricyclic antidepressants recommended for depression

A

amitriptyline (elavil)
amoxapine (asendin)
doxepin (sinequan)
imipramine (tofranil)
desipramine (norpramine)
nortriptyline (pamelor)

72
Q

what are the nursing implications for imipramine (tofranil)

A

assist client to rise slowly from sitting or supine position
ensure adequate fluids and balanced nutrition
encourage use of sugar free beverages and hard candy
encourage exercise

73
Q

what are the nursing implications for amitriptyline (elavil)?

A

assist client to rise slowly from sitting position
administer at bedtime
encourage use of sugar-free beverages and hard candy
ensure adequate fluids and balanced nutrition
encourage exercise
monitor cardiac function

74
Q

what are the antidepressants given when there is inadequate response to or presence of side effects from SSRIs

A

atypical antidepressants

75
Q

what are atypical antidepressants recommended for depression

A

venlaxafine (effexor)
duloxetine (cymbalta)
buproprion (wellbutrin)
nefazodone (serzone)
mirtazapine (rameron)

76
Q

this interferes with enzyme metabolism (monoamine oxidase)

A

monoamine oxidase inhibitors (MAOI)

77
Q

how long is the lag period of monoamine oxidase inhibitors

A

2 to 4 week lag period before reaching therapeutic level

78
Q

how long is the washout period of monoamine oxidase inhibitors

A

5 to 6 weeks is recommended before changing into another regimen

79
Q

what are the monoamine oxidase inhibitors

A

isocarboxazid (marplan)
phenelzine (nardil)
tranylcypromine (parnate)

80
Q

what are nursing implications for monoamine oxidase inhibitors

A

assist client to rise slowly from sitting position
administer in AM
administer with food
ensure adequate fluids
perform essential teaching on importance of low tyramine diet

81
Q

why do you need to have prescriptions and refills in limited amounts for MAOI and cyclic antidepressants

A

because both MAOI and cyclic depressants are potentially lethal when taken in overdose

82
Q

what are the numerous drugs that interact with MAOIs

A

ampetamines
ephedrine
fenfluramine
isoproterenol
meperidine
phenylephrine
phenylpropanolamine
pseudoephedrine

83
Q

what are the numerous drugs that interact with MAOIs

A

ampetamines
ephedrine
fenfluramine
isoproterenol
meperidine
phenylephrine
phenylpropanolamine
pseudoephedrine
SSRI antidepressants
tricyclic antidepressants
tyramine

84
Q

this is a life threatening condition that can result when a client taking MAOIs ingests tyramine containing foods

A

hypertensive crisis

85
Q

what is another name for hypertensive crisis

A

cheese reaction

86
Q

this is a trace monoamine with indirect catecholamine releasing properties

A

tyramine

87
Q

what degrades tyramine so it wont stimulate the sympathetic nervous system

A

monoamine oxidase

88
Q

what are the clinical manifestations of hypertensive crisis

A

severe hypertension (BP>180 mmHg systolic)
hyperpyrexia (T>41C)
tachycardia
diaphoresis
tremors
cardiac dysrhythmias

89
Q

what is the onset of hypertensive crisis

A

20-60 minutes after ingestion of tyramine containing foods

90
Q

what is the drug of choice for hypertensive crisis

A

phentolamine

91
Q

what is the management for hypertensive crisis

A

phentolamine and tyramine-free food (no aged, no cheese, no processed food

92
Q

what are the cheeses that are not considered as aged cheeses?

A

cottage cheese, cream cheese, ricotta cheese, processed cheese slices

93
Q

this involves delivering enough electric impulses to the brain to cause a seizure

A

electroconvulsive therapy

94
Q

what are the indications for electroconvulsive therapy

A

pregnant women
patients with intolerable side effects a therapeutic doses
actively suicidal patients
patients who are unresponsive to pharmacologic antidepressants

95
Q

what is the mechanism of action of electroconvulsive therapy

A

electric shocks corrects chemical imbalance in brain by stimulating brain chemistry

96
Q

what are the pre procedure preparation for electroconvulsive therapy

A

remove nail polish
npo post midnight
starv iv line
instruct to void before procedure

97
Q

what are the drugs given prior to the electroconvulsive therapy?

A

atropine
methohexital (brevital) iv
succinylcholine (anectine) iv

98
Q

why is atropine given prior to ect?

A

to reduce secretions during seizure

99
Q

why is methohexital given prior to ect

A

to make the procedure painless

100
Q

why is succinylcholine (anectine) given prior to ect

A

to relax muscle so it doesnt contract and break bones

101
Q

what are the criteria of good, induced seizure?

A
  • motor convulsions for at least 20 seconds
  • increased heart rate for 30 to 50 seconds
  • brain seizure for 30 to 150 seconds
102
Q

what are the side effects of electroconvulsive therapy

A
  • mild confusion/brief disorientation
  • fatigue
  • headache
  • short term memory loss
103
Q

what are post procedure care for electroconvulsive therapy

A
  • oxygenate patient with 100% concentration until able to breathe unassisted
  • monitor for any respiratory problems
  • reorient patient as they return from a groggy state
  • administer benzodiazepines if patient is agitated
104
Q

this psychotherapy focuses on difficulties in relationships such as grieving, role disputes and role assumption

A

interpersonal therapy

105
Q

this psychotherapy aims to increase frequency of positive interactions while decreasing negative interactions

A

behavioral therapy

106
Q

this psychotherapy focuses on how the patient perceives the future, themselves, their experiences and other people

A

cognitive therapy

107
Q

this is the tendency to think only between two polar opposites (e.g., all or none, black or white, etc.)

A

absolute, dichotomous thinking

108
Q

this is drawing a conclusion despite the lack of evidence

A

arbitrary inference

109
Q

this is when the person concentrate on small detail (mostly negative) while ignoring other more significant details

A

specific abstraction

110
Q

this is jumping into conclusions despite having little to no experience about something

A

overgeneralization

111
Q

this is undervaluing or overvaluing something (like overvaluing the negative experience while undervaluing the positive experience)

A

magnification and minimization

112
Q

this is self-inferencing external events despite having no evidence

A

personalization

113
Q

what are general appearance and motor behavior of someone with depression

A
  • looks sad
  • slouched with head looking down
  • psychomotor retardation
  • (+) latency of response
  • psychomotor agitation
114
Q

this is when the patient takes 30 seconds to react to something

A

latency of responce

115
Q

this is when patient has slow body movements, slow cognitive processing, and slow verbal interaction

A

psychomotor retardation

116
Q

this is when there is increased body movements and thoughts

A

psychomotor agitation

117
Q

this means losing any sense of pleasure from any activity

A

anhedonia

118
Q

this is when the patient does not care about anyone or anything

A

apathy

119
Q

this means negative thinking

A

pessimism

119
Q

this means going repeatedly over the same things

A

rumination

120
Q

these psychotic hallucinations tell the patient to commit suicide

A

command hallucination

121
Q

this is when a patient cannot use cognitive abilities to solve problems or to make decisions due to apathy or pessimism

A

impaired judgement

122
Q

what is the number one nursing diagnosis for depression

A

risk for suicide

123
Q

how do you provide safety for a depressed patient

A
  • determine suicidal tendencies
  • institute suicide precautions by removing harmful items and increasing supervision
124
Q

t/f:
you should begin patient interaction with several shorter visits

A

true

125
Q

t/f:
you should sit with client for a few minutes at interval throughout the day

A

true

126
Q

t/f:
you should do try to always converse with the client the entire time

A

false
It is not necessary for the nurse to talk to clients the
entire time; rather, silence can convey that clients are
worthwhile even if they are not interacting

127
Q

t/f:
you should always be cheerful around patients and try to cheer them up

A

Avoid being overly cheerful or trying to “cheer up”
clients

128
Q

t/f:
you shouldnt ask patients to perform global tasks since its harmful to them

A

false

129
Q

how do u build competency for slightly more complex tasks

A

use the patient’s success in small, concrete steps as basis to increase self esteem

130
Q

what should u do if the patient is unable to choose between articles of clothing

A

the nurse selects clothing and directs patient to put them on

131
Q

what should you do when patient is unable to put on clothing

A

assist the patient

psychia finals (2 decks)

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