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NURS 419 > Quiz #2: Depression > Flashcards

Quiz #2: Depression Flashcards

1
Q

Grief

A

-Subjective state that follows loss. -Grief is universal; however, the way in which it is expressed is culturally determined.

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2
Q

Depression

A

-Clinical disorder that is severe, maladaptive, and incapacitating.
-Extreme sadness, hopelessness, worthlessness and lack of motivation.

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3
Q

Mania

A

Elevated, expansive, or irritable mood, extreme sense of wellbeing with grandiosity.

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4
Q

How does culture affect depression?

A

Affects symptomatic expression, clinical presentation and effective treatment. (Most people now believe in a biological basis for this disorder)

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5
Q

Statistics for Depression

A

-Lifetime risk for MDD is 7 – 12% for men and 20 – 30% for women
-More than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent MDD
-1/3 of all people with MDD seek help, are accurately diagnosed, and obtain appropriate treatment
-High incidence of MDD is found among patients hospitalized for medical illness
MDD high prevalent in primary care settings

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6
Q

Who is important to screen for MDD?

A

Women of reproductive age. Especially those who have children or plan to become pregnant

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7
Q

Etiology of Depression

A
  1. Biological Theories
  2. Cognitive Theory
  3. Learned Helplessness
  4. Diathesis Stress Model
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8
Q

Etiology of Depression: Biological Theories

A
  • No single biochemical model explains the causes of depression
  • Dominant theory is the dysregulation hypothesis
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9
Q

Dysregulation Hypothesis

A
  • Dysregulation in the amount or availability of 5-HT, the sensitivity of its receptors in relevant regions of the brain, and its balance with other neurotransmitters
  • 5-HT has important brain functions such as aggression, mood, psychomotor activity, irritability, appetite, sexual activity, etc.
  • 5-HT has an important role in the secretion of growth hormone, prolactin, and cortisol, all of which are found to be abnormal in people with depression
  • Most effective antidepressant agents, such as ECT and medications, have been found to enhance neurotransmission of 5-HT
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10
Q

Depression Etiology: Diathesis-Stress Model

A
  • Psychological / biological theory, and is basically the culmination of stress from life experiences (stress) and the vulnerability (diathesis) of a person, such as genetics, psychological, biological, or situational factors, that can lead to depression.
  • Example: A child who has a family history of depression (vulnerability / diathesis) and who has been exposed to a particular stressor, such as exclusion or rejection by his peers (stress) would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers.
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11
Q

Depression Etiology: Cognitive Theory

A

Depression is seen as a cognitive problem arising from a person’s negative view of self, the world, and the future.

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12
Q

Depression Etiology: Learned Helplessness

A
  • Theory proposes that it is not trauma that produces depression but the belief that one has no control over important outcomes in life.
  • It is a behavioral state and a personality trait of one who believes that control over reinforces in the environment has been lost.
  • These negative expectations lead to hopelessness, passivity, and an inability to assert oneself.
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13
Q

Primary Risk Factors for Depression Include

A
  • Female
  • Unmarried
  • Low socioeconomic class
  • Early childhood trauma
  • Presence of negative life event, especially loss and humiliation
  • Family history
  • Ineffective coping ability
  • Postpartum time period
  • Medical illness
  • Absence of social support
  • Alcohol or substance abuse
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14
Q

Depression DSM-5 Criteria

A

Add later

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15
Q

What is an affect?

A

Outward expression of emotion

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16
Q

Depression Affects include

A
  • Sad
  • Flat
  • Blunted
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17
Q

Depression: Moods Include

A
  • Anxious
  • Sad
  • Worthless
  • Helpless
  • Angry
  • Hopeless
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18
Q

Depression: Physical Behavior and Appearance Include

A
  • Psychomotor retardation
  • Disheveled
  • Insomnia
  • Older than stated age
  • Loss of libido
  • Fixed gaze
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19
Q

Depression: Thought Processes Include

A
  • Poor Judgement
  • Indecisive
  • Intrusive, negative thoughts
  • Poor memory
  • Poor Concentration
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20
Q

What is SIG-E-CAPS?

A

Rapid screening for depression

21
Q

What does SIG-E-CAPS stand for?

A
  • Sleep changes: increase during day or decreased sleep at night
  • Interest (loss): of interest in activities that used to interest them
  • Guilt (worthless): depressed elderly tend to devalue themselves

-Energy (lack): common presenting symptom (fatigue)

  • Cognition/Concentration: reduced cognition &/or difficulty concentrating
  • Appetite (wt. loss); usually declined, occasionally increased
  • Psychomotor: agitation (anxiety) or retardations (lethargic)
  • Suicide/death preoccupation
22
Q

PHQ-9

A

-The most commonly used screening questionnaire for depression.

23
Q

Expected outcomes for patients with depression

A

Patient will be emotionally responsive and return to pre-illness level of functioning

24
Q

What actions by the nurse can be done to help the patient reach their expected outcomes?

A
  • Allow patient to recognize feelings
  • Analyze stressors and strengthen patient’s self-esteem
  • Increase patient’s sense of control, awareness of choices, and responsibility for behavior
  • Encourage healthy interpersonal ties with others
  • Promote understanding of maladaptive emotions and to acquire adaptive coping responses to stressors
25
Q

Planning of care for patients with depression

A
  • Safety is the highest priority!
  • Risk Assessment: Self harm or harm to others
  • Environment of Care: Suicide Prevention and Therapeutic Milieu
  • Patient Care: Safety, Therapy and Medications, Emotional Response And Social Functioning.
26
Q

Depression Implementation: Nurse-Patient Relationship

A
  • Patient may resist involvement through withdrawal and nonresponsiveness
  • Nurse needs to be quiet, warm and accepting
  • Develop rapport through shared time, even if patient talks little, and through supportive companionship
27
Q

Physiological Treatments for Depression Include

A
  • May need to monitor diet
  • Sleep Disturbances
  • Self-Care needs, such as bathing and dressing
  • Psychopharmacology
28
Q

Depression Implementation: Expressing Feelings

A

Should reinforce that depression is self-limiting and that the future will get better

29
Q

Depression Implementation: Cognitive Strategies Include

A
  • Help patient explore feelings and their view of the problem.
  • Focus on modifying the patient’s thinking (they tend to focus on negative thinking)
  • Help patient examine accuracy of perceptions, logic and conclusions (move them from unrealistic to realistic goals; increase self-esteem; involve patient in productive tasks or activities
30
Q

Therapeutic Communication Techniques Include

A
  • Listening
  • Broad openings
  • Restating
  • Clarifying
  • Reflection
  • Silence
31
Q

Depression: Psychopharmacology

A
  • SSRIs*
  • TCAs*
  • MAOIs*
  • SNRIs
  • NDRI
  • NASSA
32
Q

What is the primary cause of depression?

A

In depression, dysregulation of serotonin is the primary cause… either not enough serotonin or the body breaks down the serotonin before it can be used

33
Q

How does SSRI’s treat depression?

A

SSRIs block the reuptake of serotonin, allowing for more serotonin to stay in the synaptic space and to activate the serotonin receptors  which is known to initiate the neurons known to affect mood, motor system, etc

34
Q

How do MAOI’s treat depression?

A

monoamine oxidase is an enzyme that breaks down neurotransmitters (including serotonin and norepinephrine) – an MAOI inhibits that enzyme -> more epinephrine and serotonin

35
Q

How do TCA’s treat depression?

A

work similar to SSRIs, except that they block reuptake of both serotonin and norepinephrine

36
Q

SSRI’s Include

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
37
Q

SSRI’s

A
  • First-Line Treatment for Depression
  • Low risk for lethal overdose
  • Taper slowly (can cause discontinuation syndrome ie dizziness, Irritability, N/V and Insomnia)
38
Q

SSRI’s Side Effects Include

A
  • Insomnia
  • Headache
  • N/V
  • Sexual Dysfunction
  • Hyponatremia
39
Q

What is Serotonin Syndrome?

A
  • Rare and life-threatening event associated with SSRIs
  • Related to over-activation of the central serotonin receptors caused by either too high a dose or interaction with other drugs
40
Q

Risk for Serotonin Syndrome is increased when

A

SSRI is administered with a second serotonin-enhancing agent, such as MAOI

41
Q

Symptoms of Serotonin Syndrome Include

A
  • Abdominal pain, N/V
  • Sweating, fever
  • Tachycardia, elevated BP
  • Altered mental status
  • Muscle spasms and increased motor activity
42
Q

Tricyclic Antidepressants Include

A

Amitriptyline (Elavil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Nortriptyline (Aventyl)

43
Q

TCA’s: Side Effects Include

A
  • Dry mouth, constipation, urinary retention, cardiac toxicity, sedation
  • Need cardiac workup before initiation of therapy
44
Q

TCA’s Cautions

A
  • Lethal in overdose

- Use cautiously in elderly, cardiac patients, seizure disorders, and liver or kidney dysfunction

45
Q

MAOI’s Include

A

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

46
Q

MAOI’s: Dietary Restrictions Include

A
  • Tyramine: meat that is pickled, aged, smoked or fermented; chocolate; beer, wine; fermented foods: aged cheese.
  • Can cause hypertensive crisis
47
Q

MAOI’s are contraindicated with

A
  • SSRI’s

- Interacts with numerous medications

48
Q

Antidepressants and the Risk for Suicide

A

There is an increased risk for suicide 2-6 weeks after starting a patient on antidepressants

NURS 419 (11 decks)

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