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NURS 406 > Depression ppt for real > Flashcards

Depression ppt for real Flashcards

Exam 1

1
Q

How many people in the US have had at least 1 major depressive episode

A

An estimated 21.0 million adults in the United States had at least one major depressive episode.

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2
Q

Who is major depressive higher in? What percent?

A

The prevalence of major depressive episode was higher among adult females (10.3%) compared to males (6.2%).

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3
Q

What group of adults is major depression most prevalent in?

A

The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (18.6.2%) (NIH, 2021)

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4
Q

Major Depressive Disorder: Minimum of 5 s/s of a depressed mood for 2 weeks or
more.- What is the acronym?

A

SIG E CAP

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5
Q

Major Depressive Disorder: Minimum of 5 s/s of a depressed mood for 2 weeks or
more.- What are they?

A

Sleep disorder (either increased or decreased)

Interest deficit (anhedonia)

Guilt (worthlessness, hopelessness, rumination)

Energy deficit

Concentration deficit

Appetite disorder (either increased or decreased)

Psychomotor agitation or retardation
Suicidality

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6
Q

Potential Causes for Depression

A
  • Abuse
  • Age; elderly, living alone, lack of social supports
  • Certain Medications; isotretinion (used to treat acne), antiviral drug interferon-alpha and corticosteroids
  • Conflict; disputes with family members or friends
  • Death or loss; can increase the risk for depression
  • Gender; women are twice as likely as men; hormonal changes
  • Genes; family history
  • Major events, serious illness, substance abuse
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7
Q

Treatment Goals for Major Depression: Priority care issues:

A

safety and assessment of suicide risk*

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8
Q

Treatment goals:

A
  • Reduce or control symptoms and, if possible, eliminate signs and symptoms of the depressive syndrome
  • Improve occupational and psychosocial function as much as possible
  • Reduce the likelihood of relapse and recurrence
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9
Q

Depressive Disorders: Children and adolescents: What symptoms are most likely

A

Anxiety and somatic symptoms are more likely

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10
Q

Depressive Disorders: Children and adolescents: Behaviors

A

Decreased interaction with peers; avoidance of play and recreational activities

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11
Q

Depressive Disorders: Children and adolescents: Mood

A
  • Irritable* rather than sad mood; high risk of suicide
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12
Q

DEPRESSIVE DISORDERS ACROSS THE LIFE-SPAN: Older Adults

A

Commonly associated with chronic illness; symptoms possibly confused with those of dementia or stroke
* Suicide peaks in middle age with second peak at age 75

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13
Q

In older adults, when are the suicide peaks?

A
  • Suicide peaks in middle age with second peak at age 75
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14
Q

Nursing Assessment: General appearance and motor behavior

A

(psychomotor retardation, latency of response, psychomotor agitation)

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15
Q

Nursing Assessment: Mood and Affect

A

Anhedonia

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16
Q

Nursing Assessment: Thought process and content

A

(rumination, thoughts of suicide)

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17
Q

Nursing Assessment: Sensorium and intellectual processes

A

(impaired memory)

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18
Q

Nursing Assessment: Judgement and insight

A

(impaired judgment)

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19
Q

Nursing Assessment: Self concept

A

(feelings of worthlessness)

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20
Q

Nursing Assessment: Roles and Relationships

A

(the more severe the depression, the greater the difficulty)

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21
Q

Rating Scales for Depression

A

Patient Health Questionnaire (PHQ-9)

Clinician rating scale: Hamilton Rating Scale for Depression

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22
Q

Nursing Assessment: What else is included?

A

Physical systems review and thorough history of medical problems

  • Medication history
  • Physical examination
  • Neurovegetative symptoms
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23
Q

Nursing Assessment: What is included in Medication History

A

prescribed and over-the-counter
medications; alcohol and mood-altering substances; herbal substances

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24
Q

Nursing Assessment: Neurovegetative symptoms

A
  • Appetite and weight changes
  • Sleep disturbance
  • Tiredness, decreased energy, and fatigue
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25
Q

Nursing Assessment: Outcome identification and intervention

A
  • Free from self-injury*
  • Independently carry out activities of daily living
  • Balance of rest, sleep, and activity
  • Cognitive triad
  • Social activities
  • Return to occupation or school activities
  • Medication compliance
26
Q

Antidepressants: When does initial response develop?

A

Initial response develops after 1 to 3 weeks

27
Q

When are maximal responses to antidepressants seen?

A
  • Maximal responses may not be seen for 12 weeks
28
Q

Antidepressant FDA black box warning

A
  • FDA Black Box Warning/May increase suicidal tendencies during early treatment*
  • Safety: ↑ risk of self harm with feeling better and having increased energy*
  • Activation concerns
29
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A
  • Fluoxetine
  • Sertraline
  • Fluvoxamine
  • Paroxetine
  • Citalopram
  • Escitalopram
30
Q

Selective Serotonin Reuptake Inhibitors (SSRIs) Common side effects

A
  • feeling agitated, shaky or anxious
  • feeling or being sick
  • diarrhea or constipation
  • blurred vision
  • dry mouth
  • sexual dysfunction/decreased libido
  • insomnia
  • sweating
31
Q

SEROTONIN/NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIS)

A
  • Desvenlafaxine
  • Duloxetine
  • Levomilnacipran
  • Venlafaxine
32
Q

SEROTONIN/NOREPINEPHRINE
REUPTAKE INHIBITORS: Common side effects

A
  • Nausea
  • Headache
  • Nervousness
  • Sweating
  • Insomnia*
  • Hypertension*
  • Sexual dysfunction
33
Q

Tricyclic Antidepressants

A
  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil)
  • Doxepin (Silenor)
34
Q

Management Pearls for Tricyclic Antidepressants

A
  • Administer at bedtime to reduce daytime sedation
  • Orthostatic hypotension: teach pts to sit or lie down when feeling lightheaded
35
Q

Most dangerous adverse effect of Tricyclic Antidepressants

A
  • Most dangerous adverse effect: Cardiac toxicity*
36
Q

Tricyclic Antidepressants: side effects

A

Anticholinergic effects

37
Q

Anticholinergic effects- that saying

A

Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.

38
Q

Tricyclic Antidepressants: Anticholinergic effects

A
  • Hot as a hare: increased body temperature
  • Blind as a bat: mydriasis (dilated pupils)
  • Dry as a bone: dry mouth, dry eyes,
    decreased sweat
  • Red as a beet: flushed face
  • Mad as a hatter: delirium
39
Q

Monoamine Oxidase Inhibitors

A
  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline (Emsam)
40
Q

How often are Monoamine Oxidase Inhibitors used?

A

Rarely used due to the side effect profile

41
Q

What is a major side effects of MAOIs?

A

Hypertensive crisis from dietary tyramine

42
Q

Hypertensive Crisis

A
  • Severe headache, confusion
  • Tachycardia, hypertension, profuse sweating
  • Nausea and vomiting
  • Stroke and death
43
Q

How to prevent hypertensive crisis from MAOIs?

A
  • Avoid age meats, bananas, smoked fish, cheese, wine, beer
44
Q

Treatment for hypertensive crisis?

A
  • Treatment: Intravenous vasodilator
  • Labetalol, sodium nitroprusside, phentolamine
45
Q

ATYPICAL ANTIDEPRESSANTS

A
  • Bupropion (Wellbutrin)
46
Q

When do effects of Bupropion occur?

A
  • Antidepressant effects begin in 1 to 3 weeks. A delayed antidepressant effect.
  • Can be given with Paroxetine to augment effect.
  • Advantages
  • No Weight gain
  • No Sexual dysfunction
  • No Sedation
  • Assist with smoking cessation
    Disadvantages
  • No as effective as SSRI
  • Can increase anxiet
47
Q

What can Bupropion be given with to augment effect?

A

Paroxetine

48
Q

Advantages of Bupropion?

A
  • No Weight gain
  • No Sexual dysfunction
  • No Sedation
  • Assist with smoking cessation
49
Q

Disadvantages of Bupropions?

A
  • No as effective as SSRI
  • Can increase anxiety
50
Q

Bupropion Hydrochoride side effects

A
  • Lowers seizure threshold* Do not give to an anorexic/bulimic patient or patient with a seizure disorder
  • Insomnia, agitation, tremor
  • Weight loss
  • Nausea, GI upset, take w/food, constipation
  • Blurred vision, dizziness, headache, dry mouth
  • Tachycardia
51
Q

What is associated with SSRIs?

A

Serotonin syndrome

52
Q

Serotonin syndrome- when does it begin

A
  • Often begins w/in 72 hours after treatment
53
Q

Effects of Serotonin syndrome?

A
  • Altered mental status (agitation, anxiety, confusion, disorientation, hallucinations, and impaired concentration)
  • Fever, excessive sweating, incoordination, hyperreflexia, and tremor
  • Concurrent use of MAOIs and other SSRI agents that raise serotonin*
  • Can lead to death if medication is not discontinued*
  • Spontaneously resolves after discontinuing the drug*
54
Q

What happens if you take MAOIs with SSRIs?

A
  • Concurrent use of MAOIs and other SSRI agents that raise serotonin*
55
Q

Drug interactions of SSRIs

A

MAOIs

SSRIs

Saint John’s wort

56
Q

MAOI + SSRIs

A

Risk of serotonin syndrome*W

57
Q

What is required to take MAOIs and SSRIs

A
  • Minimum 14 day wash-out period required when switching to or from an SSRI
58
Q

SSRIs + SSRIs

A

Risk of serotonin syndrome when placed on two SSRIs*

59
Q

SSRIs + St. John’s Wort

A

Risk of serotonin syndrome. Not FDA approved.

60
Q

Sustained Release Drugs

A

SR stands for sustained release; it may
be taken twice per day

61
Q

Extended Release Drugs

A

XL stands for extended release; it only needs to be taken once per day.

62
Q

Other Medical Treatments and Psychotherapy

A
  • Electroconvulsive therapy (ECT)
  • Psychotherapy (combined with medications)
  • Cognitive behavioral therapy (CBT): focus on cognitive distortions

NURS 406 (29 decks)

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