Midterm 2 Material Depression (Chp 15), Bipolar Disorder (Chp 16), Anxiety (Chp 11), Violence (Ch24), Anger + Aggression, Chapter 10 Trauma Informed Care Flashcards
Differentiate major depression disorder MDD (5) vs Persistent Depression Disorder PDD (3)
Major Depressive Disorder (5)
- Suicidal Ideation
- Unable to function
- May have psychosis
- Anorexia
- Depressed mood in nearly all activities
Persistent Depressive Disorder (3)
- Symptoms less severe (not hospitalized)
- Overeating
- Chronic, must be depressed for 2 years to be diagnosed PDD
Children and Adolescents may display what type of depressive symptoms? (4)
- Anxiety
- Somatic symptoms
- Decreased interactions/avoidance
- Irritable rather than sad mood; high suicide risk
In older adults, when does suicide peak? Second peak?
Middle age
Second peak at age 75
True or false: Depressive disorders in older adults is commonly associated with chronic illness
True, depression is typically secondary to a chronic illness in the geriatric population
What is the highest priority assessment for a depressed individual?
Risk of suicide
How do you assess for depression? What does it stand for?
Sad mood/Sleep distrubances
Interest diminished (Anhedonia)
Guilt/Feelings of worthlessness
Energy loss (Anergia)/Esteem loss
Concentration diminished
Appetite changes
Psychomotor retardation
Suicidal ideation
Risk factors of Depression? (11)
First degree family history of depressive disorders
Age 40 years or younger
Member of the LGBTQ community
Postpartum period
History of prior episodes of depression/ suicide attempts
Absence of social support
Negative, stressful life events, particularly early trauma
Chronic medical illness
History of sexual abuse
Active alcohol or substance use disorder
Female gender
Cognitive theory is the theory that…
the triad of negative beliefs cause depression due to a negative reaction to the world:
- Negative view of self
- Negative view of the world
- Belief that only bad things will happen in the future
Learned Helplessness is the…
Belief that negative events are their fault and can’t fix them
Diathesis-stress theory is…
The combination of events (stressors) and biological factors (neurotransmitter imbalance or genetics) cause depression
What is the most commonly used assessment tool for depression?
Hamilton Depression Scale
What should you assess for someone with depression? (6)
- Evaluate patient’s risk of suicide or harm to others
- Determine if the depression is primary or secondary to another disorder
- Assess for history of depression
- Assess support systems
- Assess for triggering events
- Complete a psychosocial and spiritual assessment
What are the nursing care plans for depression? (Name at least 4/9)
- Risk for suicide
- Ineffective coping
- Low self esteem
- Hopelessness
- Helplessness
- Self care deficit
- Risk for self-mutilation
- Despair
- Depressed mood
What are nursing interventions for depression? (7)
- Therapeutic communication
- Medication therapy
- Health teaching and health promotion
- Milieu therapy
- Mindfulness-Based cognitive therapy
- Group Therapy
- First-line psychotherapy interventions
What is the first-line treatment for depression?
SSRIs
Side effects of SSRIs
Common (7)
Serious (2)
Common:
- Sexual dysfunction
- Increased weight
- Headache
- Dizziness
- Constipation/diarrhea
- Insomnia
- Anxiety
Serious:
- Serotonin syndrome
- Mania
Possibly not on the exam
Second-line treatment for depression are? Examples?
What effect do they have on SSRI’s?
SNRIs: duloxetine, venlafaxine
SNDIs: mirtazapine
Augment the effects of SSRIs
How do TCAs work?
What are some common side effects? (8)
Blocks the reuptake of norepinephrine and serotonin
Common side effects:
- Anticholinergic side effects (4)
- Adrenergic side effects
- Tachycardia
- Orthostatic hypotension
- Cardio-toxicity
- Dizziness
- Weight gain
- Sedation
MAOIs work by…
Side effects…(8)
Should caution eating…
Blocking the enzyme involved in breaking down monoamines resulting in an increase in; norepinephrine, dopamine, serotonin
Side effects include
- Hyertensive crisis
- Weight gain
- Fatigue
- Sexual dysfunction
- Hypotension
- Muscle cramps
- Urinary retention
- Constipation
Should caution eating tyramine rich foods such as
- Chocolate
- Cheese
- Meat
- OTC cough medication
- Alcohol
- Tofu
- Died fruits and veggies
- Avocados
What is the number 1 most effective treatment to date for depression?
What are the side effects of this procedure? (5)
ECT
Electroconvulsive therapy
Side effects
- Short-term memory loss
- Confusion
- Headache
- Muscle soreness
- Nausea
Who does not qualify for ECT?
Patient’s with cardiac issues
What patients should be cautioned for ECT? (3)
Head trauma
Seizure disorders
Brain tumors
When is clinical depression considered treatment resistant?
When 2 or more pharmacological interventions fail
When is ECT indicated? (5)
- When drug therapy fails
- There is a need for rapid, definitive response when a patient is suicidal or homicidal.
- The patient exhibits extreme agitation or psychomotor retardation and stupor
- The patient has severe mania
- The patient develops a life-threatening illness because of refusal of foods and fluids
Common cognitive disorders
What is filtering?
Taking negative details and magnifying them while filtering out all positive aspects of a situation
Common cognitive disorders
Polarized thinking
Things are either “black or white”. We have to be perfect or we’re a failure-there is no middle ground or shades of gray.
Common cognitive disorders
Overgenralization
Coming to a general conclusion based on a single incident or a single piece of evidence =. If something bad happens only once, we expect it to happen over and over again.
Common cognitive disorders
Jumping to conclusions
Without individuals saying so, we think we know what they are feeling and why they act the way they do
Common cognitive disorders
Catastrophizing
We expect disaster to strike, no matter what. We exaggerate the importance of insignificant events.
Common cognitive disorders
Personalization
A distorted belief that everything others do or say is somehow about us.
Common cognitive disorders
Control fallacies
We see ourselves as helpless, a victim of fate, having no control, or we assume total responsibility for the pain and happiness of everyone around us (over control).
Common cognitive disorders
Fallacy of fairness
We feel resentful because we think we know what is fair, but other people won’t agree with us.
Common cognitive disorders
Blaming
We hold other people responsible for our feelings and behaviors. Nobody can “make” us feel any particular way…only we have control over our own emotions and emotional reactions.
Common cognitive disorders
Should
We have a lost of ironclad rules about how we and others should and must behave
Common cognitive disorders
Emotional reasoning
We believe that what we feel must be true automatically. “I feel it; therefore it must be true”
Common cognitive disorders
Global Labeling
We generalize one or two qualities into a negative global judgement. For example, “I’m a loser” verses “In one situation, I failed.”
Common cognitive disorders
Always being right
I have to prove my opinions and actions are correct. Being wrong is unthinkable
What does OARS stand for?
Open-ended questions
Affirmations
Reflective reasoning
Summaries
What does BATHE stand for in motivational interviewing
Background
Affect
Trouble
Handle
E
What does ICRA stand for?
I
C
R
A
COC Conceptual Framework
(Inquiry and Caring (6)
Centerpiece of Inquiry and Caring (4)
- Professionalism
- Leadership
- Communication
- Critical Thinking
- Patient-centered care
- Safety
- Person
- Nursing
- Health
- Environment
Adverse Childhood Experiences (ACEs) (3)
3
2
5
Abuse
- physical
- emotional
- sexual
Neglect
- physical
- emotional
Household challenges
- Mental illness
- Intimate partner violence
- Parental separation or divorce
- Incarceration
- Substance abuse
Social Determinants of Health (5)
- Education access and quality
- Healthcare access and quality
- Economic stability
- Neighborhood and built environment
- Social and community context
Guiding Principles of Trauma Informed Care (6)
- Safety (physical and psychological)
- Trustworthiness and transparency
- Peer support and mutual self-help
- Collaboration and mutuality
- Environment, voice, and, choice
- Cultural, historical, and gender issues
What are the symptoms of PTSD? (8)
How long do these symptoms last?
- Helplessness/Hopelessness
- Flashbacks
- Nightmares
- Persistent avoidance of stimuli r/t event
- Persistent numbing of general responsiveness
- Relationship issues
- Cognitive distortions
- Increased: arousal, exaggerated startle response, lack of trust
These symptoms last for more than 4 weeks
Treatments for PTSD
Psychotherapy (6)
- Prolonged exposure therapy
- Cognitive process therapy
- Eye movement desensitization and reprocessing
- Cognitive behavior therapy
- Family therapy
- Relaxation/stress relieving techniques
PTSD pharmacology tx (3)
SSRIs:
- Sertraline
- Paroxetine
Psilocybin Mushrooms
True or False: Therapy in combination with medications is needed for medication to be effective for PTSD
True
