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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
  • 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)
  • PLUS irritable AND anhedonia
  • 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, irritability 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
Tx for dep
- therapeutic comm - edu CBT - give meds - safety - ID supports - est sleep routine - group therapy
26
Considerations for antidepressants
- 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
27
How to handle SE of antideps?
dose adjustment or switch to diff med in class
28
How to stop antideps?
d/c meds 6-9M past sx relief; take up to 12-24M - if stop meds when feel better, relapse
29
What happens if you stop antideps abruptly?
Can get w/d sx like nausea, anx, flu, insomnia
30
Which antideps work best?
Similar across the board but diff SE - all inc avail of NTs
31
Order of pharm antidep therapy
- SSRIs first (most tolerable) - SNRIs next - TCAs - MAOIs last resort bc food restrictions
32
What are SSRIs good for
OCD, psychomotor agit - first line - fewer SE
33
SSRI names
escitalopram, sertraline, citalopram, fluoxetine, paroxetine, vortioxetine, vilazodone
34
SNaRIs names
venlafaxine, duloxetine
35
SNRI names
desvenlafaxine - metabolite of venlafaxine
36
SRI SE
- Most common: dry mouth, sex prob, HA, blur vis - drowsy, insomnia, diarrhea, nerves, agit, dizzy
37
SRI NC
- take 4-8w to work - SE dec in 4-6w - monitor for SI, extreme agit, fever, inc BP, manic sx - sleep hygiene - teach relax techs
38
Serotonin syndrome sx
- 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
What happens if serotonin syndrome goes untreated
worse myoclonus, HTN, rigor, acidosis, resp fail, rhabdo
40
When do Sr Sx sx appear
often w/i 6h of first dose of new med, dose chx, intentional OD
41
What causes death in Sr sx
hyperpyrexia, CV shock
42
tx for Sr sx
- 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
Which drugs are given for tachy/HR control with sr sx
esmolol or nitroprusside
44
which drugs are given for hypo in sr sx
phenylephrine or epi
45
Sr-prod blocking agents
- last resort for sr sx - meds like cyproheptadine HCl - dose in 4mg tab; wt-based after 2y old (usually 12-16mg)
46
TCAs
- older, generic, less $ - block Sr and Nor reuptake - imipramine, despramine, doxepin, 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
SE of TCAs
antichol - hot, dry, blur, red, conf, delirium, dry, dilate pupils, ortho hypo, tachy ***FALLS
48
Big risk of TCAs
OD - fatal CNS dep esp with other dep like alc
49
What to check before starting TCA?
- ECG for cardiac bc can cause MI, tachy, dysrhythmia - Check hx sz - hx preg, glaucoma
50
Early tx sx of TCAs
early morning wake up, feel worse in am, some worry and anx
51
Sx tx for TCAs
- 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
MAOI patho
block monoamine oxidase which metabolizes Sr, Nor, Dp, tyramine (causes inc in NTs)
53
Names of MAOIS
isocarboxazid, phenelzine, tranylcypramine, selegiline patch
54
Benefit of selegiline patch
dec intx and food restriction
55
What are MAOis good for
unconventional dep (arms and legs feel heavy), anx, panic, bulimia, social phobia
56
Common SE of MAOIs
dry, n, diarr/c, HA, drowsy, insomnia, dizzy, skin rxn patch site
57
less common SE of MAOIs
muscle jerk/cramp, dec BP, dec sex drive, wt gain, prob start urine flow, prickle/tingle (parasthesia)
58
Why to watch what you eat with MAOIs? and NC
- 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
subs that cause BP
aged cheese, meat, overripe fruit/veg, fermented, marinated, beans, condiments, ALC (even non-alc beer), Demerol, OTC cold meds, SSRIs!
60
Other MAOI NC
- rarely given with SSRI bc risk of Sr sx - avoid high amt of caff - avoid choc and avocado
61
HTN crisis sx
- 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
Tx for HTN crisis
- phentolamine (regitine) - alpha-adrenergic blocker - vasodil SL nifedipine (Ca ch blocker) aka Procardia - supp/sx care
63
Bupropion (NDRI)
- c/i in eating dx and hx sz - dec sex SE - use with smoke cessation - considered "energizing"
64
Trazadone
- given at hs for sedative as adjunct with other AD - chemically sim to TCAs
65
Mirtazapine
good for sleep - NaSSAs
66
SSRIs for kids and teens
- 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
TCAs in kids
- more SE; potential dysrhythmia - potential lethal in OD - kids impulsive so we avoid
68
Other tx for dep
- photo - ECT - VNS - TMS - DBS (rare) - exercise - relax (med, guided imagery, massages)
69
Supplements
John's wort, SAMe, omega 3
70
Advanced practice tech for dep
psychotherapy like CBT, IPT (interpersonal), time limited psycho, bx, group therapy
71
Parts of PHQ-9
- 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
Early signs of HTN crisis
flush, sweat, anx, irritability, severe HA
73
SRI w/d sx
- abrupt d/c mild or severe sx (electric surge, brain shiver, pins and needles, black out, short term mem loss, syncope)
74
What sub to avoid when anx w/ SRIs?
Caffeine

PSYCH (19 decks)

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