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3400 Mental Health > depression > Flashcards

depression Flashcards

1
Q

Major depressive disorder (MDD)

A

medical illness affecting how you feel, think, and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities

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1
Q

Persistent depressive disorder (dysrhythmia) (PPD)

A

second most common presentation of depressive symptoms

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2
Q

prevalence of MDD

A

lifetime prevalence- 28.2%; 12-month prevalence of MDD- 6.7%

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3
Q

prevalence of PPD

A

lifetime of PPD with major depressive episode- 15.2%; lifetime of PPD with pure dysrhythmia- 3.3%

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4
Q

what is PPD with pure dysrhythmia?

A

milder but more chronic form of depression

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5
Q
A
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6
Q

MDD clinical manifestations

A

depressed mood; loss of interest/pleasure in usual activities; symptoms been present for a least 2 weeks; no history of manic behavior; cannot be attributed to use of other substances or another medical condition (ex. hypothyroidism, bipolar, CNS depressants); can experience psychosis; can be due to chronic pain

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7
Q

PPD clinical manifestations

A

sad or “down in the dumps”; no evidence of psychotic symptoms; essential feature is chronically depressed mood for most of the day, more days than not, and for at least 2 years; most of the time people can push through and still have occupational and social experiences unlike MDD

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8
Q

potential causes of depression disorders

A

other psychiatric disorders, chronic medical problems, hospitalization, certain medications, chronic pain, terminal illness

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9
Q

children/adolescents and depression

A

as young as 3 years old been diagnosed with MDD; incidence in ages 12-17 is 11.93% for at least one major depressive episode; following recovery from acute depressive episode 30-70% of children relapse; 20-50% of adolescents may relapse

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10
Q

older adults and depression

A

clinical depression occurs in 7% of general older population with significant disability to those affected

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11
Q
A
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12
Q

predisposing factors for developing depressive disorders

A

HX of prior episodes; family HX (especially 1st degree relatives); HX of suicide or suicide in family; member of LGBTQ; female; 40 years and younger; postpartum period; chronic medical illness; absence of social support; traumatic events/early trauma; alcohol/substance use disorder; HX of sexual abuse

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13
Q

the neurotransmitters involved in depression and how

A

monoamines, serotonin, norepinephrine, dopamine; abnormalities in the number of receptor sites

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14
Q

PET scan and effect of medication on brain

A

positron-emission tomography showed entire brain was more active following medication for recurrent depression especially in left prefrontal cortex

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15
Q

diathesis-stress model of depression

A

diathesis refers to the biological predisposition such as family HX and stress refers to psychological stressors or environmental stressor that trigger brain changes

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16
Q

biological model of depression

A

due to genetics, biochemical, alterations in hormonal regulation

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17
Q

bio/psychosocial theories of depression

A

cognitive theory- becks cognitive triad, learned helplessness, cultural considerations

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18
Q

becks cognitive triad

A

negative self-deprecating view of self; negative (pessimistic) view of the world; negative views about the future (negative reinforcement will continue)

19
Q

assessment of pt with depression

A

suicidal assessment, ideation related to harm of others (SI/HI), detailed assessment

20
Q

detailed assessment components

A

mood and affect, physical changes- clinical symptoms, cognition and thought content, self-care for nurses

21
Q

assessment findings of someone with clinical depression

A

mood and affect- anxiety, worthlessness, guilt, anger, irritability, may not make eye contact, flat affect; thought content and processes- slow thinking, rumination on faults, indecisiveness, delusional thinking; physical signs and symptoms- psychomotor retardation, psychomotor agitation, vegetative signs of depression, sleep pattern changes; characteristic communication styles- monotone speech, require more time to respond

22
Q

assessment guidelines of depressed individual

A

evaluate pt risk of suicide or harm to others; determine if depression is primary or secondary to another disorder, assess for HX of depression, assess support systems, assess for triggering events, complete psychosocial assessment

23
Q

nursing diagnoses for depressed pt

A

depressed individuals are always at risk for suicide; others include despair, depressed mood, hopelessness, helplessness, risk for self-mutilation, self-care deficit

24
Q

planning for depressed pt

A

focused on specific symptoms, safety is highest priority, recognize and help pt tolerate medication side effects, facilitate supportive nurse-pt relationship, account for presence of depression assessment findings (ex. veg. state, change in activity level)

25
Q

evidence-based interventions for pt with depressive disorder

A

communication; health teaching/promotion; milieu therapy; first line psychotherapy interventions- CBT (first line), IPT, PST, CBT-I; mindful-based cognitive therapy; group therapy

26
Q

CBT

A

cognitive behavioral therapy

27
Q

IPT

A

interpersonal psychotherapy

28
Q

PST

A

problem-solving therapy

29
Q

CBT-I

A

cognitive behavioral therapy for insomnia

30
Q

communication guidelines for interacting with pt with depressive disorder

A

pt may speak slow and be slow to comprehend, pt may be mute (extreme depression), sitting with pt in silences is valuable (can be very meaningful to pt)

31
Q

evidence-based practice interventions for individuals with depressive disorder

A

pharmacological, biological, and integrative therapies; brain stim therapies; complementary and integrative therapies

32
Q

pharmacological, biological, and integrative therapies

A

antidepressant medication therapy, antipsychotics, other durgsanti

33
Q

antidepressant medications for therapy

A

SSRIs, SNRIs, SDRIs- norepi. dopamine reuptake inhibitors, TCAs, MAOIs

34
Q

brain stimulation therapies

A

below are somatic treatments: ECT- electrical stim to brain, 3x a week then wean to 2x a week but never abruptly stop; Vagus nerve stim (VNS)- implant wraps around vagus nerve and does continuous stim for 30 seconds every so often during 24 hour day; transcranial magnetic stimulation (TMS)- outpatient; deep brain stimulation (DBS)- imbedded in brain

35
Q

complementary and integrative therapies

A

light therapy- seasonal depression; St johns wort- organic mood stabilizer; s-adenosylmethionine (SAMe); peer support of individual diagnosed with MI

36
Q

electroconvulsive therapy

A

induction of grand mal (gen.) seizure with application of electrical current; probes placed bilaterally in frontotemporal region or unilaterally on dominant side; dose of stim is based on pt seizure threshhold; seizure lasts about 15-25 seconds; usually every other day 3x a week; usually require 6-12 treatments

37
Q

contraindications to ECT

A

increased intracranial pressure from a brain tumor, recent CVA, or other cerebrovascular lesions, etc.; individuals with MI, CVA, aortic or cerebral aneurysm, severe HTN, and CHF within past 3-6 months are at high risk

38
Q

clinical use for ECT

A

effective in treating: treatment resistant depression, major depression with psychotic symptoms, pt with life-threatening psychiatric conditions such as salf-harm or acute mania, or pt who tried antidepressants but side effects are too bad or meds are ineffective

39
Q

when ECT may be idicated

A

need for rapid definitive response because pt is suicidal or homicidal, pt extremely agitated or psychomotor retardation and stupor (catatonia or mania), severe mania, pt develops life-threatening illness d/t refusal of food and fluids, pt has HX of poor drug response and or HX of good ECT response, standard medical treatment has no effect

40
Q

advantages of SSRIs

A

effective in depression with anxiety features and depression with psychomotor agitation, better tolerated, safer in event of OD, lower anticholinergic side effects

41
Q

side effects of SSRIs

A

headaches, GI disturbance, insomnia, fatigue, initial anxiety, sexual problems, agitation, bleediing risk, risk of serotonin syndrome

42
Q

advantages of TCAs

A

effective in depression and in symptoms like insomnia and anorexia, different TCAs effective for pt who are lethargic or who are experiencing agitation or restlessness

43
Q

side effects of TCAs

A

weight gain, sedation, nausea, anticholinergic symptoms, orthostatic hypotension, cardiotoxic side effects

44
Q

special precaution fro monoamine oxidase inhibitor (MAOI)

A

used as antidepressants for pt who have not responded to other antidepressant meds or have atypical depression; believed that MAOI prevent breakdown of norepinephrine, serotonin, and dopamine that increases levels of these amines in brain causing mood elevation; inhibit breakdown of dietary tyramine in liver (ingesting food with tyramine can cause HTN crisis and potential CVA and death)

45
Q

evaluation of treatment of pt with depression

A

ongoing; outcomes compared with stated outcome criteria and short term and intermediate treatment goals; plan of care is revised when desired outcomes not met

3400 Mental Health (8 decks)

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