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Psych > depressive disorders (2) > Flashcards

depressive disorders (2) Flashcards

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1
Q

alteration in mood that is expressed by feelings of sadness, despair, pessimism
-loss of intrest
-somatic symptoms
-changes in appetite and sleep

A

depression

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2
Q

when is depression normal?

A

the symptoms are a transient and healthy response to loss or change

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3
Q

when is depression pathological?

A

when adaptation fails to occur or is ineffective, unable to care for self

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4
Q

which disorders fall under persistent depressive disorder

A

-premenstrual dysphoric disorder
-substance/medication-induced depressive disorder
-depressive disorder due to other med condition (hypothyroid)

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5
Q

how do you help depressive disorder due to another medical condition

A

fix the condition

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6
Q

what kind of depression does seasonal affective disorder fall under

A

major depressive disorder

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7
Q

what kind of depression consists of feelings of low-level depression for most of the day and a majority of days over 2 years (plus 2 other symptoms)

A

persistent depressive disorder

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8
Q

what are some of the symptoms that can be used to indentify persistent depressive disorders

A

-poor apetite / overeating
-insomnia/hypersomnia
-low energy/fatigue
-poor concentration or difficulty making decisions
-hopelessness

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9
Q

is persistent depressive disorder severe enough for a hospital

A

no

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10
Q

what are some symptoms of premenstrual dysphoric disorder (PMDD)

A

-mood swings
-irritability or anger
-depressed mood
-anxiety, tension, on edge
-decreased interest
-difficult concentration
-lethargy, lack of energy
-appetite change
-hypersomnia, insomnia
-breast tenderness

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11
Q

what are the 2 manin diagnostic criteria for major depressive disorder

A

-derpessed mood most of the day nearly every day
-anhedonia (lack of pleasure)

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12
Q

how many symptoms must be present to diagnose MDD and how long do they need to last

A

5 or more, last for at least 2 weeks with change in functioning

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13
Q

what is used to specify episodes of MDD?

A

diagnostic specifiers (single or recurring, mild/mod/severe, with or without psychotic or catatonic features, etc.)

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14
Q

what are the 2 main neurotransmitters in depression

A

serotonin and norepinephrine

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15
Q

what are the 3 cognitive distortions that serve as the basis for depression

A

1) negative xpectations of the environment
2) negative expectations of the self
3) negative expectations of the future

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16
Q

what aspects of life does mild depression affect?

A

diet, sleep, hygeine

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17
Q

what aspects of life does moderate depression affect?

A

put on medication, risk for suicide

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18
Q

what are the 4 kinds of treatment fro depression

A

-psych treatment (therapy)
-pharmacology
-ECT
-brain stimulation therapy

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19
Q

what is the older kind of antidepressant med

A

MAOIs

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20
Q

what were the first drugs made specifically for depression

A

MAOIs

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21
Q

examples of MAOIs

A

Phenelzine (NArdil), tranylcypromine (PARnate), isocarboxazid (MARplan)

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22
Q

what is important to restrict in people taking MAOIS?

A

tyramine containing foods

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23
Q

examples of food to RESTRICT in people taking MAOIs

A

aged cheese, raisin, fava beans, red wine, caviar, smoked/processed meat, soy

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24
Q

examples of food to LIMIT in people taking MAOIs

A

gouda /american / mozzarella, yogurt, sour cream, avocado, banana, over-ripe fruit, beer, white wine, coffee, cola, tea, hot chocolate, choclate, meat extracts

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25
Q

what can happen when you eat tyramine when on MAOIs

A

hypertensive crisis

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26
Q

what are symptoms of hypertensive crisis

A

headache, n/v, tachycardia, fever, diaphoresis, epistaxis, CP, SOB, vision changes

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27
Q

treatment of hypertensive crisis

A

gastric lavage (NG) / activated charcoal, IV vasodilators

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28
Q

what other meds should you not take with MAOIs

A

-other antidepressants!!! (fatal)
-sympathomimetics (cold meds), stimulants, antihypertansives, meperidine / opioids, antiparkinson

29
Q

how long do you have to wait before starting a new antidepressant after being on MAOIs

A

14 days

30
Q

examples of tricyclic antidepressants

A

ending in “mine”
Imipramine

31
Q

what is important to rememebr in suicidal patients on MAOIs or tricyclic antidepressants?

A

very fatal in overdose, cardiac arrythmias like vfib / vtach

32
Q

example of SSRIs

A

-fluoxetine (prozac)
-sertraline (zoloft)
-paroxetine (paxil)
-citalopram (celexa)
-escitalopram (lexapro)
-fluvoxamine (luvox)

33
Q

which SSRI causes the least amout of sexual dysfunction

A

escitalopram

34
Q

big side effects of SSRI

A

sexual dysfunction, discontinuation syndrome

35
Q

can you stop SSRIs abrupt?

A

no

36
Q

what occurs when more than 1 drug is used that increases serotonin levels or when high doses are used

A

serotonin syndrome

37
Q

serotonin syndrome triad symptoms

A

1) altered mental status
2) autonomic hyperactivity (tachycardia, fever/flushing, dry mucous mems, hyper/hypotension)
3) neuromuscular abnormality (tremor, hyperreflexia, myoclonus, shivering)

38
Q

what can serotonin syndrome lead to

A

-seizures, coma, death if not recognized

39
Q

which kind of antidepressant increases norepi and serotonin

A

SNRIs

40
Q

which SNRI has a lot of effects

A

venlafaxine (effexor)

41
Q

which SNRI is good for menopause

A

desvenlafaxine (pristiq)

42
Q

what is an example serotonin partial agonisy reuptake inhibitor (SPARI)

A

vilazodone (viibryd)

43
Q

describe dosing and frequency of viibryd (SPARI)

A

decreased dose, once daily with food, dreams/nightmares

44
Q

describe the progressive dosing of the SPARI drug viibryd

A

starting dose is not therapeutic, then progresses to therapeutic dose, then the max dose
10 -> 20 -> 40

45
Q

what med helps with treatment resistance

A

serotonin modulator (vortioxetine (trintellix))

46
Q

what effects do serotonin modulators do?

A

help with resistance (decrease aggression, increase sex drive, increase cognition, onset 2-4 weeks)

47
Q

example serotonin antagonist and reuptake inhibitor (SARI)

A

trazodone (desyrel)

48
Q

why is trazodone (SARI) so commonly used?

A

1 prescribed, helps with sleeping, good with old people

49
Q

which med is used as adjunctive antidepressant therapy “booster”, can help with sexual dysfunction and apathy from SSRI

A

norepinephrine dopamine reuptake inhibitor (NDRI), bupropion (wellbutrin)

50
Q

which med can be given at HS to sedate, stimulates appetitie, often used in alzheimers

A

noradrenergic and specific serotonergic antidepressants (NaSSAs), mirtazapine (remeron)

51
Q

what is the black box warning of antidepressanbts?

A

may cause increase suicidal thoughts and behaviors

52
Q

what new med is for resistant depression, adjunctive use

A

NMDA antagonist, esketamine intranasal (GIVEN IN HEALTHCARE ONLY)

53
Q

why should patients continue to take antidepressants even if they dont seem to work?

A

can take a while to work (4-6 weeks)

54
Q

describe the med plan for antidepressants (3 steps)

A

-give each med a 3 month trial
-stay on med 6-9 months after s/sx stop
-3rd reoccurence = lifelong therapy recommended

55
Q

describe what ECT is

A

induction of a grand mal seizure through the application of electrical current to brain

56
Q

are people undergoing ECT put on anesthesia?

A

yes

57
Q

how long should an ECT seizure last?

A

25 sec - 1 min

58
Q

describe frequency and duration of ECT treatment

A

2-3 times per week for 4-6 weeks

59
Q

indications of use for ECT

A

-severe depression
-vegetative symptoms with derpession
-psychotic
-mania
-schizo

60
Q

what is the only absolute contraindication for ECT

A

increased intracranial pressure

61
Q

should patients be NPO before ECT

A

yes

62
Q

pre-op role of nursing

A

safety / IV / meds

63
Q

role of nurse during ECT

A

-connect devices
-airway
-oxygen
-VS
-record and observe

64
Q

which form of brain stimulation uses bursts of magnetic energy applied to the brain, no seizure activity

A

transcranial magnetic stimulation (TMS)

65
Q

which brain stimulation implants an electrode onto the vagus nerve and sends electrical impulse to vagus nerve and thus to brain, all implanted surgically

A

vagus nerve stimulation

66
Q

which brain stimulation implants electrodes in the brain and generators subcutaneously: electrical impulses are continuously generated and sent to the brain. it was used first in parkinsons, shows promise for depression and OCD treatment

A

deep brain stimulation (DBS)

67
Q

what is the relevance of st johns wort with depression?

A

can not take SSRIs while using

68
Q
A

Psych (19 decks)

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