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TOPIC 2 Flashcards

1
Q

when is disruptive mood dysregulation disorder (DMDD) diagnoed?

A

ONLY diagnosed in childhood (onset is before age 10)

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2
Q

risk of suicide is especially high in what age group

A

older adults (>65)

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3
Q

biopsychosocial model includes…

A

*Biological factors
*Psychological factors
*Social factors
that either lead to promoting health or causing disease

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4
Q

The Stress-Diathesis Model of Depression

A

diathesis (predisposition or vulnerability to developing a given disorder) + stress (precipitation cause or triggerinc circumstance) = disorder

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5
Q

learned helplessness

A

people are used to being helped out they may not even try on their own

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6
Q

Cognitive Theory -
Beck’s Cognitive Triad

A

Negative view of self
+.
Pessimistic view of the world
+.
Belief that negative reinforcement will continue

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7
Q

Clinical Manifestations of Depression

A

*Mood of sadness, despair, emptiness
*Negative, pessimistic thinking
*Anhedonia
*Anergia
*Avolition
*Low self esteem
*Apathy
*Social withdrawal
*Excessive emotional sensitivity
*Irritability**
*Low frustration level
*Insomnia or hypersomnia
*Disruption in concentration and decision-making ability
*Excessive guilt
*Indecisiveness

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8
Q

what is the most common presentation of depressive symptoms in children

A

irritability

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9
Q

Assessing for depression: standardized scales

A

*Hamilton Depression Scale
*SAD PERSONS Scale

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10
Q

Assessing suicide risk

A

*SAD PERSONAS Scale
*SAFE-T

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11
Q

Suicidal ideation

A

process of thinking about killing oneself

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12
Q

Suicidal gesture

A

action that indicates a person may be about ready to carry out a plan for suicide

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13
Q

Suicide attempt

A

all willful, self-inflicted, life threatening attempts that have not led to death

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14
Q

Completed suicide

A

the act of intentionally ending ones life

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15
Q

what me done for a client who is at high risk for attempting suicide

A

-1:1 continuous monitoring at ARMS LENGTH from client
-documentation every 15 minutes and observation continuously (includes bathroom and shower)

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16
Q

Major Depressive Disorder (MDD) symptoms

A

-Depressed mood most of the day
-Feelings of worthlessness or excessive or inappropriate guilt
-Significant unintentional weight loss or gain
-Insomnia or hypersomnia
-Diminished interest or pleasure
-Diminished ability to think or concentrate
-loss of energy
-Recurrent thoughts of death, recurrent suicidal ideation

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17
Q

Persistent depressive disorder (PDD)

A

depression symptoms are less severe than in MDD, and they symptoms must have persisted for at least 2 years and often clients with PDD are able to function in life roles with less disruption than seen in MDD.

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18
Q

Disruptive mood dysregulation disorder (DMDD) onset

A

Onset before age 10 (diagnosis can be carried to adulthood if symptoms persist)

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19
Q

Disruptive mood dysregulation disorder (DMDD) symptoms

A

-Severe, recurrent temper outbursts (verbal and/or behavioral)
-Inconsistent developmental level
-Persistent irritability or anger for most of the day (regardless of setting)

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20
Q

treatment for isruptive mood dysregulation disorder (DMDD)

A

-Family supportive therapy
-Behavior modification therapy
-Medications (e.g., stimulants, antidepressants, mood stabilizers may be used)

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21
Q

Anergia

A

reduction in or lack of energy

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22
Q

Anhedonia

A

an inability to find meaning or pleasure in existence

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23
Q

apathy

A

a lack of feeling, emotion, or interest

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24
Q

insomnia

A

recurring problems in falling or staying asleep

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25
Q

hypersomnia

A

increased amount of sleep

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26
Q

Psychomotor agitation

A

a tension relieving activity (pace, nail-biting, smoke, tap their fingers)

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27
Q

Psychomotor retardation

A

feelings of fatigue can result in slowed movements

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28
Q

Vegetative signs of depression

A

include somatic changes and alterations in those activities necessary to support physical life and growth such as eating, sleeping, elimination and sex

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29
Q

Mindfulness-based cognitive behavioral therapy (MCBT)

A

a combination of CBT and mindfulness based stress reduction techniques.

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30
Q

Electroconvulsive therapy (ECT)

A

Usually, ECT is done when medications (pharmacologic methods) do not work. It is a procedure done under general anesthesia in which small electric currents are passed though the brain, intentionally triggering a brief seizure. ECT seems to change the brain chemistry that can quickly reverse the symptoms of certain mental illnesses

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31
Q

Vagus nerve stimulation (VNS)

A

An invasive procedure, performed by a neurosurgeon requiring the implantation of electrodes and a pulse generator that stimulates the vagus nerve; affects blood flow to specific parts of the brain and affects NTs including serotonin and norepinephrine

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32
Q

Rapid (or Repetitive) Transcranial magnetic stimulation (rTMS)

A

a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression

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33
Q

Deep brain stimulation

A

electrodes must be surgically implanted into several areas of the brain affected by depression, am insulated wire is connected to an impulse generator that generates stimulations to specific areas of the brain

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34
Q

Bright light therapy

A

particularly helpful for clients experiencing Seasonal Affective Disorder (SAD).

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35
Q

non-invasive brain stimulation therapies

A

*Transcranial magnetic stimulation (TMS) & rapid TMS (rTMS)
*Electroconvulsive Therapy (ECT)

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36
Q

invasive brain stimulaton therapies

A

*Vagus nerve stimulation (VNS)
*Deep brain stimulation

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37
Q

Indications for Electroconvulsive Therapy (ECT)

A

-Patient is suicidal or homicidal
-Extreme agitation or stupor
-Life-threatening illness as a result of the refusal of foods or fluids
-History of poor antidepressant drug response or a good ECT response (i.e., standard medical treatment has been ineffective)

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38
Q

first line antidepressant classes

A

-SSRIs
-SNRIs
-Atypical antidepressants
-TCAs

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39
Q

second line antidepressants classes

A

MAOIs
CAMs (st. johns wort)

40
Q

Atypical Antidepressants

A

-mirtazapine
-bupropion
-ketamine & esketamine

41
Q

Black Box Warning on antidepressant medications

A

on ALL antidepressant medications; indicates that there is an increased risk of suicidal thinking, feeling and behavior.

42
Q

SAD PERSONAS Scale

A

· S: Sex (1 if male)
· A: Age (1 id <19 or >45)
· D: Depression or hopelessness (2)
· P: Previous attempts or psychiatric care (1)
· E: Excessive alcohol or drug use (1)
· R: Rational thinking loss (psychotic or organic illness) (1)
· S: Separated, widowed, divorced (1)
· O: Organized plan or serious attempt (2)
· N: No social support (1)
· A: Availability of lethal plan
· S: Stated future intent (1)

43
Q

SAFE-T: The 5 steps are as follows…

A

· Identify risk factors
· Identify protective factors
· Conduct suicide inquiry (note suicidal thoughts, plans, behavior, intent
· Determine risk level intervention (determine risk and choose appropriate intervention to address and reduce risk)
· Document (assessment of risk, rationale, intervention and follow up)

44
Q

6-8 on SAD PERSONAS Scale

A

probably requires psychiatric consultation

45
Q

> 8 on SAD PERSONAS Scale

A

probably requires hospital admission, voluntary or involuntary

46
Q

0-5 on SAD PERSONAS Scale

A

may be safe to discharge (depending on circumstance). If sent home, have follow-up appointment arranged and discharge patient with family or friend

47
Q

Selective Serotonin Reuptake Inhibitors (SSRIs) action

A

*Inhibit the reuptake of active serotonin in the brain, effectively increasing the serotonin level

48
Q

onset of effectiveness for SSRIs

A

1-2 weeks

49
Q

full effectiveness for SSRIs

A

2-4 weeks

50
Q

common side effects of SSRIs

A

*Headache, nausea (usually resolve within a few days)
*Sexual problems (often dose-related)

51
Q

Potential toxic effects of SSRIs and SNRIs

A

serotonin syndrome

52
Q

Client Teaching for SSRIs

A

*Allow time for symptom relief
*Report intolerable side effects or worsening depression
*Monitor for suicidality
*Risk for suicide is greatest during the first 1-4 weeks of antidepressant therapy

53
Q

Fluoxetine half life

A

5 weeks

54
Q

what is important if changing from fluoxetine to an MAOI

A

*the client must wait 5 weeks to begin the MAOI to avoid serotonin syndrome

55
Q

when changing from an SSRI to and MAOI how long must the client wait between meds

A

2 weeks

56
Q

clinical presentation of serotonin syndrome

A

*Hyperactivity or restlessness
*Tachycardia à cardiovascular shock, irregular heartbeat
*Fever à hyperpyrexia
*Elevated blood pressure
*Irrationality, mood swings, hostility
*Altered mental status (e.g., delirium)
*Seizures (status epilepticus)
*Myoclonus, incoordination, tonic rigidity
*Abdominal pain, diarrhea, bloating
*Apnea (may lead to death)

57
Q

Serotonin Syndrome

A

occurs when medications that work to release serotonin, cause high levels of the chemical serotonin to accumulate in the body; Excess serotonin causes symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures).

58
Q

what is the first thing to do when treating serotonin syndrome

A

discontinue offending agents

59
Q

how to treat symptoms of serotonin syndrome

A

*Administer serotonin receptor blockade (cyproheptadine, methysergide, propranolol)
*Cooling blankets, chlorpromazine (for hyperthermia)
*Dantrolene, diazepam (for muscle rigidity or rigors)
*Anticonvulsants
*Artificial ventilation
*Induced paralysis

60
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) action

A

*Inhibit the reuptake of active serotonin and norepinephrine in the brain

61
Q

onset of full effectiveness for SNRI

A

2-4 weeks

62
Q

common side effects of SNRIs

A

*Nausea, dizziness, nervousness, anticholinergic effects
*Increase in blood pressure
*Titrate on/ taper off and use extended release to decrease side effects, do not discontinue abruptly

63
Q

Client Teaching for SNRIs

A

*Allow time for symptom relief
*Report intolerable side effects, or worsening depression
*Titration of drug dose
*Monitor for suicidality
*Don’t stop taking abruptly (Withdrawal effects are often significant)

64
Q

contraindications for SNRIs

A

HTN
glaucoma

65
Q

tetracyclic antidepressant example

A

mirtazapine

66
Q

what group is mirtazapine good for

A

good for elderly & those with severe depression

67
Q

what is the advantage of mirtazapine

A

has less insomia SE and less sexual dusfunction SE

68
Q

what are the common side effects of mirtazapine

A

significant weight gain and sedation

69
Q

norepinephrine dopamine reuptake inhibitor [NDRI] and nicotinic receptor antagonist example

A

bupropion

70
Q

what are the advantages of bupropion

A

little effect on weight or sexual function

71
Q

what is bupropion also marketed for

A

smoking cessation

72
Q

what are the common side effects of bupropion

A

*Energizing (possible increased anxiety, insomnia; risk for mania induction in clients with undiagnosed bipolar disorder)

73
Q

NMDA antagonists

A

ketamine and esketamine

74
Q

what is the difference between the administration ROUTE of ketamine and esketamine

A

-ketamine: Injection
-esketamine: nasal spray

75
Q

where is ketamine/esketamine given?

A

Administered 1-2 times weekly in provider’s office; MUST STAY IN THE DOCTORS OFFICE FOR 2 HOURS AFTER ADMINISTRATION (not for at home use)

76
Q

what is the action of ketamine

A

acts on glutamate rather than the monoamine neurotransmitters; Reserved for severe, treatment-resistant depression

77
Q

what are the common side effects of ketamine

A

Immediate, temporary disorientation or confusion (must stay in doctor’s office for 2 hours after administration)

78
Q

what is required for the use of TCAs?

A

dose titration (“start low, go slow”)

79
Q

what is the onset of effectiveness for TCAs

A

10-14 days

80
Q

how long does it take for TCAs to reach full effectiveness

A

4-8 weeks

81
Q

what are the common side effects of TCAs

A

*Postural hypotension, tachycardia (usually resolve within 1-2 weeks)
*Anticholinergic effects: Urinary retention, severe constipation = seek immediate medical attention

82
Q

anticholinergic SE

A

dry mouth, constipation, blurred vision, esophageal reflux, tachycardia.

83
Q

what are the potential toxic effects of TCAs

A

*Cardiovascular (dysrhythmias, tachycardia à MI, heart block)
*Serotonin syndrome

84
Q

what is the most important thing to remember about TCA dosages

A

TCA dosages should always be low initially, and gradually increased, especially in older adults with slower drug metabolism due to aging and/or disease processes.

85
Q

what drugs are in the TCA class

A

amitriptyline, doxepin, imipramine, and nortriptyline.

86
Q

client teaching for TCAs

A

-take dose at bedtime
-fall precautions until orthostatic hypotension SE resolve (1-2 weeks)
-DO NOT stop taking abruptly

87
Q

what will the patient experience if they stop taking TCA abruptly

A

*2-4 days later, client will develop nausea, altered heartbeat, nightmares, cold sweats

88
Q

contraindications for TCAs

A

*MANY drug-drug interactions!
*Recent MI
*Narrow-angle glaucoma
*History of seizures
*Pregnant women

89
Q

common SE fro MAOIs

A

*Hypotension
*Muscle cramps
*Sedation, weakness, fatigue OR insomnia
*Anorgasmia or sexual impotence
*Weight gain
*Anticholinergic effects

90
Q

what are the potential toxic effects of MAOIs

A

*Hypertensive Crisis
*Serotonin Syndrome

91
Q

What foods must be avoided with MAOIs?

A

Tyramine foods:
-wine
-beer
-cheeses
-ages foods
-smoked meets

**can cause hypertensive crisis

92
Q

what are the drug-drug interactions for MAOIs

A

*OTC cold/cough meds; other antidepressants; narcotics; general anesthetics; stimulants; sedatives

93
Q

when is a 2 week medication break neesed when taking MAOIS

A

*Between taking MAOI and ingesting any food, drink, or product containing tyramine
*When switching from an MAOI to a different antidepressant
*When switching to an MAOI from another antidepressant (Exception: 5 weeks needed when switching from fluoxetine to an MAOI)

94
Q

what are the symptoms of hypertensive crisis

A

*Severe headache
*Stiff, sore neck
*Flushing; cold, clammy skin
*Tachycardia
*Severe nosebleeds, dilated pupils
*Chest pain, stroke, coma, death
*Nausea and vomiting

95
Q

what should the client do if they are in hypertensive client

A

*Client should go to emergency department immediately
*Blood pressure (BP) must be evaluated!!

96
Q

what can be given to lower the clients BP in a hypertensive crisis?

A

*IV phentolamine (alpha-1 blocker)
*oral chlorpromazine (typical antipsychotic)
*Sublingual nifedipine (calcium channel blocker)

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