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NUR 201 Week 12 > Depressive Disorders & ECT > Flashcards

Depressive Disorders & ECT Flashcards

1
Q

Concepts

  • Mood
  • Affect
  • Depression
A
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2
Q

?

Is the loss of interest or pleasure

A

Anhedonia

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3
Q

?

Is a pervasive and sustained emotion that may have a major influence on a person’s perception of the world. i.e., depression, joy, elation, anger, anxiety

A

Mood

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4
Q

?

Is described as the external & observable emotional rxn assoc w/an experience

A

Affect

Mood and affect are used interchangeably, but mood is subjective, and affect is more objective and observed

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5
Q

?

Is an alteration in mood that may be expressed by feelings of sadness, despair, & pessimism
- There’s a loss of interest in usual activities & somatic sx’s may be evident
- Changes in appetite, sleep pattern, and cognition are common

A

Depression

> Pathological depression occurs when adaptation is ineffective, & the sx’s are significant enough to impair functioning

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6
Q

?

This is 1 of the leading causes of disability in the US
- Most prevalent psychiatric disorder
- Women > men 2:1

A

Major depressive disorder (MDD)

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7
Q

Major depressive disorder (MDD)

  • depressed mood
  • loss of interest or pleasure in usual activities
  • impaired social & occupational functioning for @ least 2 wks
  • no other cause
A
  • No h/o manic behavior & sx’s that cannot be attributed to the use of substances or a general medical condition
  • Dx will also identify the degree of severity of sx’s (mild/moderate/severe) & whether there is evidence of psychotic, catatonic, or melancholic features
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8
Q

DSM 5 - MDD

A
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9
Q

?

This condition involves a persistent depressive disorder
- Feeling sad or “down in the dumps”

! No evidence of psychotic sx’s

A

Dysthymic disorder

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10
Q

Dysthymic disorder

! Essential feature is the chronically depressed mood or possibly an irritable mood in children or adolescents
- Occurs for most of the day; more days than naught, for @ least 2 years
- For children & adolescents, a 1-year timeframe

A

> Dx is identified as early-onset, which occurs < age 21 or late-onset, which occurs @ 21 & older

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11
Q

Premenstrual dysphoric disorder (PMDD)

  • markedly depressed mood
  • excessive anxiety, mood swings
  • dec interest in activities (in the wk prior to menses)
A

> Improves shortly after the onset of menstruation & becomes minimal or absent in the wk post-menses

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12
Q

Substance/Medication-Induced Depressive Disorder

Depressed mood is assoc w/intoxication or withdrawal from -

> alcohol, amphetamines
cocaine, hallucinogens
opioids
phencyclidine-like substances
sedatives, hypnotics, anxiolytics

A

Depressive Disorders d/t another medical condition -

  • Stroke, TBI
  • Thyroid disorders, Cushing’s dz
  • Huntington’s, Parkinson’s
  • MS
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13
Q

Predisposing Factors

  • Biological theories
  • Genetics
    > a genetic link found in family & twin studies
  • Biochemical influences
    > May be d/t a deficiency in the neurotransmitter’s norepinephrine, serotonin, dopamine, & most recently discovered, acetylcholine
A
  • Neuroendocrine disturbances
    > Depression is assoc w/the dysfunction of the adrenal cortex & possibly diminished release of TSH
  • Physiological influences
    > an imbalance of estrogen & progesterone has also been implicated in the predisposition to PMDD
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14
Q

Psychosocial Theories

A
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15
Q

Learning Theory

It was theorized that learned helplessness predisposes individuals to depression by imposing a feel of lack of control over their life situation

A

Psychoanalytical Theory

Freud postulated that the loss of a loved one either actually by death or emotionally by rejection can lead to melancholy

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16
Q

Learning Theory

It was theorized that learned helplessness predisposes individuals to depression by imposing a feel of lack of control over their life situation

A

Psychoanalytical Theory

Freud postulated that the loss of a loved one either actually by death or emotionally by rejection can lead to melancholy

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17
Q

Object Loss Theory

Absence of attachment

A
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18
Q

Cognitive Theory (Beck)

  • The underlying cause of depression is cognitive distortions that result in negative, defeated attitudes (rather than affective)
  • These cognitive distortions arise out of a defect in cognitive development & the individual feels inadequate, worthless, & rejected by others
  • Outlook of the future is one of pessimism & hopelessness
A

Negative expectations of
1. environment
2. future
3. self

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19
Q

___ Model

Combined effects of genetic, biochemical, & psychosocial influences

A

Transactional

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20
Q

Developmental Implications: Childhood

> Childhood depression can include hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping & eating disturbances, social isolation, delusional thinking, & suicidal thoughts or action

> In many depressed children, there’s a genetic predisposition towards the condition which is then precipitated by a stressful situation

A

> Common precipitating factors include physical or emotional detachment by the primary caregiver; parental separation or divorce; death of a loved one, person, or pet; a move; academic failure; or physical illness
- In any event, the common denominator is loss

21
Q

Developmental Implications: Elderly

A
  • High % of suicide among the elderly
  • ECT is an important alternative in treatment of depression in the elderly, esp considering the problematic side effects of antidepressant agents in this population
22
Q

Developmental Implications: Adolescence

visible manifestation of behavioral change that lasts for several weeks

A
23
Q

?

  • This can also include concern of an inability to care for infant
  • In severe forms, it can produce a psychotic-like state & require hospitalization & removal of the infant
A

Postpartum depression

24
Q

Assessment

  • Affect
  • Behavioral
  • Cognitive
  • Physiological
A

Continuum of Depression

> Transient depression - life’s everyday disappointments

> Mild depression - normal grief response

> Moderate depression - dysthymia

> Severe depression - major depressive disorder (MDD)

25
Q

Behaviors & nursing diagnoses

A
26
Q

Outcomes

A
27
Q

Interventions

  • Risk for Suicide
  • Complicated Grieving
A
  • Low self-esteem/self-care deficit
  • Powerlessness
28
Q

Patient Education

  • Nature of the Illness
    > Talking about the stages of grief & the sx’s assoc w/each
    > Talking about what depression is, why people get depressed, & what the sx’s are
  • Support services
    > Suicide Hotline; support groups; legal &/or financial assistance support
A
  • Management of the Illness
    > Medication management; talking about side effects (especially those to report to the physician); the importance of taking the medication regularly; the length of time it takes to take effect; diet (especially important with MAOI’s)
    > Assertiveness techniques; stress management techniques; ways to increase self-esteem; ECT
29
Q

Treatment Modalities for Depression

  • Individual psychotherapy
  • Group therapy; family therapy
  • Cognitive therapy
A
  • Transcranial Magnetic Stimulation
  • Vagal Nerve Stimulation & Deep Brain Stimulation
  • Light Therapy
30
Q

Electroconvulsive Therapy (ECT)

  • Is the induction of a grand-mal (aka generalized) seizure. Done through application of electrical current to the brain. Is safe and effective
  • It’s a treatment alternative for the individual w/depression, mania, or schizoaffective disorder who does not respond to other forms of therapy
  • Has been shown effective in the treatment of severe depression, particularly among depressed clients who are experiencing psychotic symptoms, catatonia, psychomotor retardation, and neuro-vegetative changes such as disturbances in sleep, appetite, & energy
  • ECT is typically considered only after a trial of therapy w/antidepressant medication has proven ineffective. Could be used for the patient who is extremely suicidal or is refusing food & are nutritionally compromised or schizoaffective disorder who does not respond to any other form of treatment
A

! No absolute contraindication(s) for ECT but those with cardiovascular, increased intracranial pressure, intracranial lesions impose a higher risk for adverse effects. Also, osteoporosis, acute & chronic pulmonary disorders, & high-risk or complicated pregnancy

> Exact MOA is unknown & there are multiple effects on the CNS activity incl hormones, hippocampal and amygdala area suggesting that neuroplasticity & possible neurorestorative effects of ECT. The most common side effect is temporary memory loss and confusion

> Although occurrence is rare, the major cause of death w/ECT is of cardiovascular complications such as an myocardial infarction (MI) or a cerebrovascular attack (CVA)

31
Q

?

Is a form of psychosurgery

An electrode is implanted w/the intent of stimulating brain function

A

Deep Brain Stimulation

32
Q

?

Was found to improve client’s mood. Involves implanting an electronic device into the skin to stimulate the vagus nerve

A

Vagal Nerve Stimulation

33
Q

?

Has been shown to be an affective treatment for seasonal affective disorder. Is administered by a light box which contains white fluorescent light tubes covered w/a plastic screen that blocks UV rays. The individual sits in front of the box w/their eyes open

A

Light Therapy

34
Q

?

Is used to treat depression by stimulating nerve cells in the brain. It involves the use of very short pulses of magnetic energy to stimulate nerve cells @ localized areas, like the electrical activity observed with ECT
> Unlike ECT, the electrical waves do not result in a generalized seizure activity

A

Transcranial Magnetic Stimulation (TMS)

35
Q

Antidepressants

! Increase the conc of norepinephrine, serotonin, &/or dopamine

! All of these carry an FDA black-box warning for inc risk of suicidality in children & adolescents

A

> Be alert to sudden lifts in mood

> All classes have side effects of dry mouth, sedation, & discontinuation sx’s

> Avoid drinking alcohol while taking antidepressant therapy (these rx’s can potentiate the effects of others)

> Use sunblock & wear protective clothing as well [skin may be sensitive to sunburn]

36
Q

?

The blockade of norepinephrine uptake results in s/e’s of tremor, cardiac arrhythmias, sexual dysfunction, & HTN

Blockade of serotonin reuptake results in GI disturbances, incr agitation, & sexual dysfunction

> Other s/e incl insomnia, HA, & wt loss
! Several rx interactions & incl supplements, lithium, & dig

A

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

37
Q

?

> Trazodone can cause prolonged penile erection (if this erection persists longer than an hour, seek emergency treatment)

> Teach the patient taking bupropion (Wellbutrin) to not double-up on the rx (this rx is given in divided doses because it can incr the risk of sz)

A

Atypical antidepressants

38
Q

?

Inhibit monoamine oxidase from metabolizing norepinephrine, serotonin, & dopamine

> Grp of rx is often reserved for those who don’t respond to any other depressants & aren’t regularly used as a 1st line treatment b/c of their adv rxn

> rx interactions are vast [concomitant use w/ results in serious, sometimes fatal effects resembling neuroleptic malignant syndrome (NMS)]

A

Monoamine oxidase inhibitors (MAOIs)

39
Q

Monoamine oxidase inhibitors (MAOIs)

! Avoid ___ containing foods

This is found in aged cheese, wine (chianti), beer, chocolate, colas, coffee, tea, sour cream, smoked & processed meats, beef & chicken liver, canned figs, soy sauce, overripe & fermented foods, pickled herring, raisins, caviar, yogurt, yeast products, broad beans (fava), cold remedies, & diet pills

A

TYRAMINE

! Consumption with tyramine can lead to a life-threatening hypertensive crisis !

40
Q

?

This condition is characterized by fever, muscle rigidity, diaphoresis, tachycardia, as well as labile BP

A

NMS (Neuroleptic Malignant Syndrome)

41
Q

?

  • Is 1 of the oldest known groups of antidepressants
  • Incr the combo of serotonin, norepinephrine, & dopamine
  • Are older & less expensive than newer drugs but b/c of the high risk of fatality w/overdose, these rx’s are not given to the suicidal pt

! Also have more side effects than any other antidepressant !
* Blurred vision
* Constipation
* Urinary retention
* Orthostatic hypotension
* Decr the sz threshold

A

Tricyclic antidepressants (TCAs)

42
Q

Tricyclic antidepressants (TCAs)

> Teach pt to drink fluids & incr their fiber intake

! Fatal cardiac dysrhythmia can occur w/overdose

TCAs are not given to patients with glaucoma or BPH

A

! Avoid smoking while taking TCAs

TCAs & MAOIs are never given together b/c of their rx interactions

43
Q

?

> Are the 1st line of rx treatment

Work by inhibiting the reuptake of serotonin. May need 4-6 weeks or longer before seeing signs of benefit. Generally adv rxns decr within 2-4 wks of starting therapy

Do not stop the drug abruptly; taper slowly to prevent the discontinuation of sx’s

> Pregnant women should avoid paroxetine (Paxil) as it has been shown to cause birth defects

A

Selective serotonin reuptake inhibitors (SSRIs)

s/e -
GI disturbances
incr agitation
sexual dysfunction
hyponatremia (common in the elderly)
! Insomnia, HA, wt loss

44
Q

?

! This is the most severe, adverse reaction to monitor for (effects are potentiated with the combination of SSRIs, MAOIs, & St. John’s wort)

➭ change in mental status; restlessness; hyperreflexia
➭ tachycardia, labile BP, sweating, shivering, tremors

A

Serotonin syndrome

If this is noted, requires immediate discontinuation of medications that have causative factors

45
Q

?

➭ Citalopram
➭ Escitalopram
➭ Fluoxetine
➭ Fluvoxamine
➭ Paroxetine
➭ Sertraline
➭ Vilazodone

A

Selective serotonin reuptake inhibitors (SSRIs)

46
Q

?

➭ Desvenlafaxine (Pristiq)
➭ Duloxetine (Cymbalta)
➭ Venlafaxine (Effexor)

A

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

47
Q

?

➭ Isocarboxazid (Marplan)
➭ Phenelzine (Nardil)
➭ Tranylcypromine (Parnate)
➭ Selegiline Transdermal System (Emsam)

A

Monoamine oxidase inhibitors (MAOIs)

48
Q

?

➭ Bupropion (Wellbutrin, Zyban)
➭ Forfivo XL
➭ Maprotiline
➭ Mirtazapine (Remeron)
➭ Nefazodone (Serzone)
➭ Trazodone

A

Atypical antidepressants

49
Q

?

A

Tricyclic Antidepressants (TCAs)

NUR 201 Week 12 (4 decks)

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