depression, bipolar, suicide Flashcards
anergia
lack of energy
elated mood
stamina untiring, exaggerated sense of energetic behavior
anhedonia
lack of interest in life’s activites
major depressive disorder
at least 2 weeks or more of sad mood or lack of interest in life activities w/ at least 4 other s/s
1. anhedonia
2. changes in weight/sleep
3. change in energy, concentration, decision-making
4. lack of self-esteem & goals
MDD t/x
cyclic antidepressants
MAOIs
SSRIs
atypical antidepressants
SSRIs
most common & effective med
safer for use in older adults
more compliance
s/s of depression like insomnia and low appetite go back to normal after ~1 week
cyclic antidepressants
oldest form of antidepressants (1950s)
blocks activity of norepinephrine & serotonin
takes 6 weeks to reach full effect
used less often in the elderly
c/x: liver dysfunction, MI, MAOIs, glaucoma, BPH, urinary retention,DM, hyperthyroidism, CVD, renal dysfunction, respiratory dysfunction
atypical antidepressants
used when pt doesn’t respond to SSRIs
MAOIs
monoamine oxidase inhibitors
not commonly prescribed bc of potential fatal side effects & drug interactions
takes 2-4 weeks for it to work
d/c period takes 6 weeks to clear out of body
HYPERTENSIVE CRISIS: life threatening condition bc pt eats tyramine food (aged cheese, sauerkrat, cured meats, draft beer, fermented soy)
s/s: occipital headache, HTN, nausea, vomitting, chills, sweating, restlessness, nuchal rigidity, dilated pupils, fever, motor agitation
happens within 20-60 minutes of ingestion
serotonin syndrome
side effect of taking SSRI & MAOI together
s/s: altered mental status [confusion, agitation], neuromuscular excitement [muscle rigidity, weakness, sluggish pupils, shivering, tremors], autonomic abnormalities [hyperthermia, tachycardia, tachypnea, diaphoresis]
ECT
electroconvulsive therapy
indications:
* pt unresponsive to antidepressants
* pregnant women
* actively suicidal pts
* pts w/psychotic features & marked psychomotor disturbances
pt recieves electrical impulse to brain causing a seizure
NPO after 12am, no fingernail polish, void b4 procedure, IV line
monitor vitals & gag reflex after arousal
pt will be sleepy, tired, hungry, and possible short-term memory loss
psychotherapy
combo w/meds most effective t/x
goals: symptom remission, psychosocial restoration, prevent relapse & relationship/occupational troubles
interpersonal therapy: difficulties w/ relationships, grief reactions, role disputes & transitions
behavior therapy:: posivitely reinforce interactions w/ environment & improve social skills
cognitive therapy: focuses on how pt thinks about self, others, future & distorted thinking
nursing interventions for depression
- 1st priority is PT SAFETY: assess for suicidal ideation/
- promote ADLs
- allow pt to talk about intense feelings
- manage meds & monitor for s/e
- depression is an illness not lack of motivation/willpower
*younger pts on antidepressants are at higher risk for suicidal ideation due to increased energy * BLACK BOX WARNING
bipolar disorder
extreme mood swings of mania & depression
mania: euphoria, grandiose, energetic, sleepless, poor judegment, rapid thoughts & speech
depression: same as those w/MDD
1st episode of condition is depressed phase until manic episode begins (misdiagnosis of MDD 1st)
more common in highly educated ppl & occurs = in M/F in 20s & 30s
young men @ high risk of suicide
2nd to depression for worldwide disability
nursing interventions of bipolar disorder
- offer energy & protein-dense finger foods (sandwiches, fruit juices, granola bars, shakes)
- ensure safe environment
- set limits on manipulative behaviors
- rechannel energy for physical activity
- decrease stimuli ( reduce time w/TV & music)
- speak in short simple clear sentences
- do not give into their need for immediate gratification, set boundaries, monitor impulsive behaviors
