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PSYCH > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

Epidemiology of depressive disorders

A

2x more women, more white, worse in AfAm, SAD, dec SES

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2
Q

Etiology of depressive dx incl per age group

A
  • diathesis stress
  • psych - cog predis, neg and/or unrealistic expectations and perceptions (learned helplessness)
  • teens - role confusion, conf w/ ind and maturation
  • older - societal attitude, self-esteem, hopeless, major life changes
  • genetic
  • inflam process
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3
Q

Biochemical rf for depressive dx

A
  • NT - Dp, 5-HT, Nor, ACh, glut
  • cortisol
  • hormones
  • electros
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4
Q

Which body system is r/t depression

A

Thyroid (hypo)

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5
Q

MDD

A
  • 5+ in 2W pd of wt loss, appetite change, sleep disturbance, fatigue, psychomotor agitation or retardation, worthless or guilt, less conc, recurrent thoughts of death
  • PLUS dep mood or anhedonia
  • marked impair in soc or occup fxn
  • may/not have psychotic sx
  • can be chronic over 2Y (recur often esp in 1st year, sx distress and impair, not attrib to psychio fx, absence manic/hypomanic episode)
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6
Q

Criteria for MDD in kids and teens

A
  • 5+ sx in 2wk dep or irritable AND anhedonia
  • PLUS 3 of following (sig wt or appetite dec, insomnia or hypersomnia, psych agit or retard, feel guilt/worthless, dec conc or indecision, recurrent death/suicide)
  • other sx, vague phys complaints, freq miss school, poor performance, “bored”, sub use, inc anger/hostility, reckless
  • sx must cause sig distress or impaired fxn
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7
Q

What is considered sig wt loss?

A

5+ lbs in a month

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8
Q

What is considered insomnia

A

under 6h per night

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9
Q

Depressive sx up to age 3

A
  • FTT
  • feed prob
  • lack playfulness
  • lack emo expression
  • dec speech and motor dev
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10
Q

Depressive sx age 3-5

A
  • prone to accidents
  • phobias
  • aggressiveness
  • excessive self-reproach for minor infracs
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11
Q

Depressive sx age 6-8

A
  • vague phys complaints
  • agg bx
  • clingy
  • avoid ppl and challenge
  • behind social/academic performance
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12
Q

Depressive sx age 9-12

A
  • morbid thoughts
  • excess worry
  • lack social interest
  • think they have disappointed parents
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13
Q

Disruptive mood dysreg dx

A
  • age 6-18y, onset before age 10
  • sx anger and constant, severe, irritably present btwn outbursts
    ** temper tantrum w/ verbal and bx attributes 3x/w for 1y in at least 2 settings
  • comorb with ODD, ADHD, MDD
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14
Q

Persistent depressive disorder aka dysthymia

A
  • low level dep felt thru most of the day for majority days
  • sx for at least 2y in adults
  • at least 1y in kids and adults
  • 2+ of the following - dec appetite or overeating, insomnia, hypersomnia, low energy, poor self-esteem, difficulty thinking, hopelessness
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15
Q

Tx for persistent dep dx

A

Antideps, often MAOIs and SSRIs

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16
Q

Premenstrual dysphoria dx

A
  • Sx clustered in last week prior to period incl mood swing, lability, irritability, dep/anx, feel overwhelm, diff conc
  • other phys sx like dec energy, overeat, insomnia, breast tenderness, ache, bloat, wt gain
  • sx dec sig or disappear w/ onset of menstruation
  • usually get SSRIs just for premenstrual period
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17
Q

Sub-induced dep dx

A
  • person does not experience dep sx in absence of drug/alc use or w/d
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18
Q

Dep dx assoc with another medical condx

A
  • cause by kid fail, Parks, Alz
  • sx result from ind dx or certain meds not considered MDD
  • look at hx, sx, labs
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19
Q

primary care screen for dep

A
  • pt don’t go to PCP for dep
  • most present w/ somatic complaints - insom, fatigue, wt loss
  • need for consistent dep screen for all pt every visit
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20
Q

psychomotor retardation

A
  • visibly slow PA like mvt and speech
  • slow talk, pause before speech, slow chew, long time to cross room
  • assoc with severe dep
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21
Q

Psychomotor agitation

A
  • inc activity from mental tension
  • restless, pace, tap ft/fingers, abrupt start/stop talk, meanlessly move objects
  • assoc with agitation dep
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22
Q

Nursing problems for dep

A

risk suicide, hopeless, ineff coping, lack support, social iso, self-care deficit

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23
Q

Recovery model

A

Healing possible and attainable
- focus on pt strength to improve health and reach full potential
- tx goal mutually dev
- based on pt’s personal needs and values
- measured

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24
Q

How to prioritize hypothesis

A

rank probs by urgency, complexity, time

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25
Q

Tx for dep

A
  • therapeutic comm
  • edu CBT
  • give meds
  • safety
  • ID supports
  • est sleep routine
  • group therapy
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26
Q

Considerations for antidepressants

A
  • improve in 4-6w
  • physio sx improve before psych ones (danger of SI w/ inc energy)
  • see inc sleep, dec fatigue and crying, inc frustration tolerance
  • don’t drink alc
  • supp with exercise to inc sleep
  • not addictive
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27
Q

How to handle SE of antideps?

A

dose adjustment or switch to diff med in class

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28
Q

How to stop antideps?

A

d/c meds 6-9M past sx relief; take up to 12-24M
- if stop meds when feel better, relapse

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29
Q

What happens if you stop antideps abruptly?

A

Can get w/d sx like nausea, anx, flu, insomnia

30
Q

Which antideps work best?

A

Similar across the board but diff SE
- all inc avail of NTs

31
Q

Order of pharm antidep therapy

A
  • SSRIs first (most tolerable)
  • SNRIs next
  • tricyclic antideps
  • MAOIs last resort bc food restrictions
32
Q

What are SSRIs good for

A

OCD, psychomotor agit
- first line
- fewer SE

33
Q

SSRI names

A

escitalopram, sertraline, citalopram, fluoxetine, paroxetine, vortioxetine, vilazodone

34
Q

SNaRIs names

A

venlafaxine, duloxetine

35
Q

SNRI names

A

desvenlafaxine
- metabolite of venlafaxine

36
Q

SRI SE

A

drowsy, *dry mouth, insomnia, diarrhea, nerves, agit, dizzt, *sex prob, *HA, *blur vis
*most common

37
Q

SRI NC

A
  • take 4-8w to work
  • SE dec in 4-6w
  • monitor for SI, extreme agit, fever, inc BP, manic sx
  • sleep hygiene
  • avoid caff if anx
  • teach relax techs
  • abrupt d/c mild or severe sx (electric surge, brain shiver, pins and needles, black out, short term mem loss, syncope)
38
Q

Serotonin syndrome sx

A
  • mental chx like agit, conf, restless, leth, delirium, irritable, dizzy, halluc
  • ANS - diaphoresis, flush, tachy, mydriasis
  • neuromusc myoclonus (twitch/jerk), hyperreflexia, tremor
  • N/V/D
39
Q

What happens if serotonin syndrome goes untreated

A

worse myoclonus, HTN, rigor, acidosis, resp fail, rhabdo

40
Q

When do Sr Sx sx appear

A

often w/i 6h of first dose of new med, dose chx, initial OD

41
Q

What causes death in Sr sx

A

hyperpyrexia, CV shock, death

42
Q

tx for Sr sx

A
  • remove med (dec sx w/i 24h but can take weeks for full recovery)
  • BDZ for agit, sz, muscle stiff
  • O2
  • IVF for fever and hydration
  • other sx and supportive care
  • drugs for HR and BP
  • Sr-prod blocking agents
43
Q

Which drugs are given for tachy/HR control with sr sx

A

esmolol or nitroprusside

44
Q

which drugs re given for hypo in sr sx

A

phenylephrine or epi

45
Q

Sr-prod blocking agents

A
  • last resort for sr sx
  • meds like cyproheptadine HCl
  • dose in 4mg tab; wt-based after 2y old (usually 12-16mg)
46
Q

TCAs

A
  • older, generic, less $
  • block Sr and Nor reuptake
  • imipramine, despramine, doexpin, amitriptyline
  • take 10-14d for fx, full fx 4-8w
  • start low and gradually inc bc meds resemble antipsychotics and SE
  • often give at night bc sedative
47
Q

SE of TCAs

A

antichol - hot, dry, blur, red, conf, delirium, dry, dilate pupils, ortho hypo, tachy
***FALLS

48
Q

Big risk of TCAs

A

OD
- fatal CNS dep esp with other dep like alc

49
Q

What to check before starting TCA?

A
  • ECG for cardiac bc can cause MI, tachy, dysrhythmia
  • Check hx sz
  • hx preg, glaucoma
50
Q

Early tx sx of TCAs

A

early morning wake up, feel worse in am, some worry and anx

51
Q

Sx tx for TCAs

A
  • sugar free gum/candy for dry mouth
  • take with foods for GI
  • freq small meal for diarr
  • inc fiber/fluids in diet/exercise for constipate
  • sleep measure, give in am/pm based on sx
  • hydrate, get up slow for orthostasis
  • ED meds for sex
  • run water, check void amt for urinary hesitancy
52
Q

MAOI patho

A

block monoamine oxidase which metabolizes Sr, Nor, Dp, tyramine (causes inc in NTs)

53
Q

Names of MAOIS

A

isocarboxazid, phenelzine, tranylcypramine, selegiline patch

54
Q

Benefit of selegiline patch

A

dec intx and food restriction

55
Q

What are MAOis good for

A

unconventional dep (arms and legs feel heavy), anx, panic, bulimia, social phobia

56
Q

Common SE of MAOIs

A

dry, n, diarr/c, HA, drowsy, insomnia, dizzy, skin rxn patch site

57
Q

less common SE of MAOIs

A

muscle jerk/cramp, dec BP, dec sex drive, wt gain, prob start urine flow, prickle/tingle (parasthesia)

58
Q

Why to watch what you eat with MAOIs? and NC

A
  • often inc bp
  • watch for HTN crisis, intercranial hemorrhage, coma, death
  • watch for 1st 6w esp
  • often occurs w/i 15-90 min of ingesting subs
59
Q

subs that cause BP

A

aged cheese, meat, overripe fruit/veg, fermented, marinated, beans, condiments, ALC (even non-alc beer), Demerol, OTC cold meds, SSRIs!

60
Q

Other MAOI NC

A
  • rarely given with SSRI bc risk of Sr sx
  • avoid high amt of caff
  • avoid choc and avocado
61
Q

HTN crisis sx

A
  • occipital HA, palpits, N/V, HTN but ortho hypo, AMS, blur vis, dyspnea/SOA, sweat, neck stiff/sore, big pupils, photophobias, tachy/brady, chest pain, disturbed cardiac r/r, coma, death
62
Q

Tx for HTN crisis

A
  • phentolamine (regitine) - alpha-adrenergic blocker
  • vasodil SL nifedipine (Ca ch blocker) aka Procardia
  • supp/sx care
63
Q

Bupropion (NDRI)

A
  • c/i in eating dx and hx sz
  • dec sex SE
  • use with smoke cessation
  • considered “energizing”
64
Q

Trazadone

A
  • given at hs for sedative as adjunct with other AD
  • chemically sim to TCAs
65
Q

Mirtazapine

A

good for sleep
- NaSSAs

66
Q

SSRIs for kids and teens

A
  • BLACK BOX inc risk SI
  • fluoxetine first line
  • Venlafaxine, SSNRI off label
  • both low SE; mild N, HA, stomachache
  • inc 1/2W, 12W for full fx; pt feel chx in 4-8w
  • give for 6-24M
67
Q

TCAs in kids

A
  • more SE; potential dysrhythmia
  • potential lethal in OD
  • kids impulsive so we avoid
68
Q

Other tx for dep

A
  • photo
  • ECT
  • VNS
  • TMS
  • DBS (rare)
  • exercise
  • relax (med, guided imagery, massages)
69
Q

Supplements

A

John’s wort, SAMe, omega 3

70
Q

Advanced practice tech for dep

A

psychotherapy like CBT, IPT (interpersonal), time limited psycho, bx, group therapy

71
Q

Parts of PHQ-9

A
  • little interest or pleasure
  • feeling down, dep, hopeless
  • trouble sleep
  • poor appetite or overeat
  • feeling bad about self
  • trouble conc on things
  • psychomotor agit or retard
  • thoughts you would be better off dead
72
Q

Early signs of HTN crisis

A

flush, sweat, anx, irritability, severe HA

PSYCH (15 decks)

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