Mood disorder- Depressive dissorder Flashcards
What are other mood dissroders?
Major depressive disorder (MDD) -Grieving
Persistent Depressive disorder (dysthymia)
Premenstrual dysphoric disorder
Substance/medication-induced depressive disorder
Depressive disorder due to another medical condition
Define a major depressive disorder.
Persistently depressed mood, impaired functioning with:
Cognition
Physical,
Behavioural symptoms
Lasting for at least 2 weeks to 5/6 months
Describe the DSM-5.
patient must have at least 5 or + symptoms during 2week that are a change from previous functioning, Depressed mood and/or loss interest/pleasure must be present.
What are the symptoms for DSM-5, to diagnose a patient with Major Depressive Disorder?
- Depressed mood
- Loss of interest/pleasure
- Weight loss or gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feeling worthless or excessive/inappropriate guilt
- Decreased concentration
- Thoughts of death/suicide
What are the features of MDD?
- Psychotic features
- Melancholic features
- Atypical features
- Catatonic features
- Postpartum onset
- Seasonal features
What are the characteristics of a Psychotic feature?
Presence of disorganized thinking
Delusions
Hallucinations
What are the characteristics of a Melancholic feature?
Endogenous depression Severe apathy Weight loss Profound guilt Symptoms worse in AM
What are the characteristics of a Atypical feature?
Dominant vegetative symptoms
Younger onset
Slow psychomotor
Often anxiety
What are the characteristics of a Catatonic feature?
Unresponsiveness
Psychomotor retardation
Withdrawal
Nagativity
What are the characteristics of a Postpartum feature?
Within 4 weeks of childbirth
Common for psychotic features to accompany
Increase risk of harm to infant with rumination/delusions
What are the characteristics of a Seasonal features feature? (Seasonal Affective Disorder - SAD)
Begin fall/winter
Anergia/hypersomnia
Overeating/weight gain
Responds well to light therapy
How to recognize a Persistent depressive disorder (dysthymia)?
Depressed feelings for most of the day/time At least 2 years in adults (1year in children) Have at least 2 of the following: Decreased appetite (overating) Sleep disturbance Low energy Poor self esteem Difficulty thinking/concentrating Hopelessness**
What are the characteristics of a Persistent depressive disorder?
Onset usually starts at teenage years
Symptoms are bad enough to bring daily distress, but not enough to require hospitalization
States: “always felt this way”
Many have full blown major depressive episodes
What are the characteristics of a Premenstrual dysphoric disorder?
Last week before menstruation
Interferes with ability to work/ADL’s
Mood swings, irritability, depression, anxiety, difficulty concentrating
What are the characteristics of a Substance/medication induced depressive disorder?
Prolonged use/withdrawal
Depressive symptoms last longer than physical effects
Once substance is removed-symptoms will remit
What are the characteristics of a Depressive disorder due to another medical condition?
Chronic pain
Long term illness
Disease with neuroanatomical changes
Disease with neuroendocrine changes
(brain injuries, cortisol levels, thyroid hormones)
What is the etiology of a Depressive disorder?
Biological factors:
Genetic, Biochemical, Stressful life events, Hormonal, Inflammation, Diathesis-stress model
Psychological factors: Cognitive theory (if always negative, will be negative. Helps change ways person change), Learned helplessness
What are the biological factors for a Depressive disorder?
Genetics: Twins 50%, Genetics (parents, premature, trauma in utero, dramatic birth)
Biochemical: Role of neurotransmitters, Serotonin, Norepinephrine
Hormonal: neuroendocrine, HPA (axis), Increase urine cortisol, Increase CRH
Inflammation: Increase C-reactive protein, Increase Interleukin-6
Diathesis-Stress model: predisposing MH problems
What are the assessments for a Depressive disorder?
Assessment tools Assessment of suicide potential Key assessment findings Areas to assess Age considerations Self assessment
What are the assessment tools for Depressive disorder?
Beck depression inventory
The Hamilton Depression rating scale
PHQ-9
What are the key assessment findings?
Anhedonia Depressed mood Psychomotor Somatic complaints Vegetative signs
What does the SIG E CAPS stands for on a depressive disorder?
Sleep disturbance Interest decreased in pleasure activities & sex Guilty feelings Energy decreased Concentration decreased Appetite- increase or decreased Psychomotor function decreased Suicidal ideations
What are the areas to assess with a Depressive disorder patient?
Affects (flat?) Thought process (poor judgement, decrease concentration) Mood (decrease) Feelings Cognitive changes Physical behaviour (vegetative state) Communication Religious beliefs and spirituality (faith increase happyness)
What are the assessment Guidelines-Depression (PG 255)?
- Evaluate risk for harm to self or others
- Evaluate if: Psychotic, drugs/alcohol, medical conditions, comorbid psychiatric syndrome.
- Past history of depression
- Assess support systems
What are the outcomes for a Depressive disorder patient?
Focus on patient’s strengths
Treatment goals mutually developed
Based on patient’s personal needs and values
What are the 3 phases of a Depressive Disorder patient?
- Acute phase (6 to 12 weeks): can be hospitalize to decrease depression
- Continuation phase (4 to 9 months): preventing relapse therapy/meds
- Maintenance phase (1 years or more): prevention of recurrent of depression
How to communicate with severely withdrawn people?
- When a patient is mute, use the technique of making observations
- Use simple, concrete words
- Allow time for the patient to respond
- Listen for covert messages and ask about suicide plans
- Avoid platitudes (don’t worry, going to be fine)
What are the interventions targeting the vegetative signs of depression?
Nutrition- anorexia
Sleep- insomnia
Self care deficits
Elimination- constipation
What are the interventions for nutrition with a patient suffering from a vegetative signs of depression?
Frequent snacks (increase protein & calories)
Encourage family to eat with them
Offer choices with preferences
Weigh weekly
What are the interventions for sleep with a patient suffering of vegetative signs of depression?
Provide periods of rest Encourage getting dressed and out of bed Stay out of bed during the day Relaxation measures Reduce stimuli/stimulants
What are the interventions for self-care deficit with a patient suffering of vegetative signs of depression?
Encourage hygiene care
give strep by step reminders
What are the interventions for elimination with a patient suffering of vegetative signs of depression?
Monitor I&O
Increase fiber & fluids
Exercise
Laxatives PRN
What does the antidepressant target in an individual with depressive disorder?
Sleep disturbance Appetite disturbance (decrease or increase) Fatigue Decreased sex drive Psychomotor retardation or agitation Diurnal variations in mood (worse in the AM) Impaired concentration or forgetfulness Anhedonia
What are the 3 types of antidepressants used?
SSRI (selective serotonin reuptake inhibitor) Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs)
What are the medications for SSRI, antidepressants?
citalopram Celexa
fluoxetine Prozac
sertraline Zoloft
What are the medications for SNRI (Serotonin norepinephrine reuptake inhibitor), antidepressant?
desvenlafaxine Pristiq
duloxetine Cymbalta
venlafaxine Effexor
What are the medications for NDRI (norepinephrine dopamine uptake inhibitors), antidepressant?
bupropion Wellbutrin
What are the biological interventions for depressive disorder?
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
Vagus nerve stimulation
What are the characteristics of an ECT?
Patient is resistant for many meds Electrical currents are passed through the brain causing a seizure altering chemistry of brain. (Cause: decrease and increase BP, HR, RR, O2) Highly effective Bad reputation 2-3 times/ week for 6-12 treatments
What are the indications for an ECT?
Resistant depression
Psychotic illness
Depression associated with Bipolar
May used in primary treatment in special cases
NOT effective: dysthymia, atypical depression, personality disorder, drug dependence
What are the risk factors for an ECT?
Must weigh risks against potential complications
Several conditions pose increase risk
Cardiac disorders (HTN, CHF, arrhythmias)
Brain disorders/issues
What are the procedures for a pre-ECT assessment?
Chest X-Ray
ECG
Urine Analysis
Bloodwork (CBC, BUN, electrolytes)
During the ECT what are the caracteristics?
Hooked up to EEG
Hooked up to ECG
Brief seizures (30-60 sec) are induced by electrical current through electrodes (head)
Patient is under anesthesia
What are the adverse reactions to an ECT?
Wakes up 15 min after
Often confused/disoriented for several hours afterwards
Most suffer retrograde amnesia (don’t remember right before or permanent amnesia)
Some have memory issues; long term
What are the characteristics of a Transcranial Magnetic Stimulation (TMS)?
Patient is on resistant depression medication
Uses MRI-strength magnetic pulses to stimulate brain
Indications: unresponsive to at least 1 antidepressant, can be used in healthy nondepressed people to improve cognitive function
Risk factors: no presence of metal in the area
Describe the procedure and potential adverse reactions to a TMS.
Procedure
Outpatient procedure (30 min 5 times/week for 4-6 weeks)
Patient are awake
Electromagnet placed on scalp
Adverse reactions
Headache, lightheadedness, scalp tingling
Describe the Vagus Nerve Stimulation.
Stimulation of the vagus nerve boosts neurotransmitters Indications: Epilepsy Treatment resistant depression Still being studied
15 000 - 20 000$
Describe the procedure for the Vagus Nerve Stimulation.
Outpatient procedure
Pacemaker
Wire connected to vagus nerve
IR magnetic wand is held against chest while computer grams frequency
Pulses delivered over 30 sec every 5 min/24 hrs day
What are the adverse reactions to a Vagus Nerve Stimulation?
Risk associated with surgical procedure 1/2 patients will have changes to voice Neck pain/cough/paresthesia/dyspnea should decrease with time, numbness Magnet wand can turn it off temporarily Cost 15 000 - 25 000
What other complementary and integrative therapies exists for depressive disorder?
Light therapy
St. John’s wort
Exercise and outdoor activity
The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, “I hear voices of aliens trying to contact me.” The nurse should recognize this presentation as which type of major depressive disorder (MDD)?
a. Catatonic MDD is marked by nonresponsiveness and extreme psychomotor retardation.
b. Atypical MDD refers to people who have dominant vegetative symptoms such as overeating and oversleeping.
c. Melancholic MDD is characterized by severe apathy, weight loss, profound guilt, and (often) suicidal ideation.
d. Psychotic features of MDD include the presence of disorganized thinking, delusions, hallucinations, or a combination of these symptoms.
d. Psychotic features of MDD include the presence of disorganized thinking, delusions, hallucinations, or a combination of these symptoms.
Which patient statement indicates learned helplessness?
a. Stating that oneself is a horrible person is reflective of Beck’s cognitive triad as it relates to depression.
b. Feeling that the world is “out to get” a person is reflective of Beck’s cognitive triad as it relates to depression.
c. Learned helplessness often occurs during depression if the person feels no control over the outcome of a situation. Patients exhibiting symptoms of learned helplessness feel that undesired events in their lives are self-created, and that nothing can be done to change their outcomes. By blaming herself, the patient has taken accountability for her husband’s actions and assigned blame to herself.
d. Hating oneself is reflective of Beck’s cognitive triad as it relates to depression.
c. Learned helplessness often occurs during depression if the person feels no control over the outcome of a situation. Patients exhibiting symptoms of learned helplessness feel that undesired events in their lives are self-created, and that nothing can be done to change their outcomes. By blaming herself, the patient has taken accountability for her husband’s actions and assigned blame to herself.
The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be the priority on the nurse’s discharge plan of care?
a. Although pharmacological teaching is important, safety is the priority.
b. Safety is always the highest priority in planning care. Even if the patient has not exhibited a risk for self-harm, the potential for such a risk must be addressed with patients who have depression.
c. Awareness of symptoms of increasing depression is important, but safety is the priority.
d. The need for interpersonal contact is not the immediate focus of discharge planning.
b. Safety is always the highest priority in planning care. Even if the patient has not exhibited a risk for self-harm, the potential for such a risk must be addressed with patients who have depression.
The nurse is reviewing orders given for a patient with depression. Which order should the nurse question?
a. A low initial dose of a tricyclic antidepressant to address agitation is considered an appropriate therapy.
b. Selective serotonin reuptake inhibitors (SSRIs) should be given two to five weeks before starting an MAOI to avoid serotonin syndrome. Therefore, the nurse should question this order.
c. Electroconvulsive therapy to treat suicidal thoughts is considered an appropriate therapy.
d. Elavil to address the patient’s agitation is considered an appropriate therapy.
b. Selective serotonin reuptake inhibitors (SSRIs) should be given two to five weeks before starting an MAOI to avoid serotonin syndrome. Therefore, the nurse should question this order.
Which of the following are considered vegetative signs of depression?
a. Although hallucinations and delusions can be symptoms of depression, they are not vegetative signs.
b. Expressions of guilt and worthlessness are affective symptoms of depression.
c. Feelings of helplessness and hopelessness are affective symptoms of depression.
d. Changes in physiological functioning such as appetite and sleep are vegetative signs of depression.
d. Changes in physiological functioning such as appetite and sleep are vegetative signs of depression.
Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.
a. “Do rules apply to you?”
b. “What do you do to manage anxiety?”
c. “Do you have a history of disordered eating?”
d. “Do you think that you drink too much?”
e. “Have you ever been arrested for committing a crime?”
b. “What do you do to manage anxiety?”
c. “Do you have a history of disordered eating?”
d. “Do you think that you drink too much?”
Which chronic medical condition is a common trigger for major depressive disorder?
a. Pain
b. Hypertension
c. Hypothyroidism
d. Crohn’s disease
c. Hypothyroidism
