Unit 6 Flashcards
Dysthymic Disorder
persistent depressive disorder.
patient is still able to function but does not feel well.
What is leading cause of death in adolescence?
Suicide
What is leading psychosocial disorder in elderly?
Depression
What is important to watch in children to see if there is possibly a depression problem?
Watch behaviors & playing.
Kid with depression will typically have disruptive mood disregulation disorder -> angry outburst and/or irritability.
DSM criteria for Major Depressive Disorder
5 or more of the following occurring nearly everyday for most waking hours over the same 2 week period:
Depressed mood, anhedonia, significant weight loss or gain, insomnia or hypersomnia, increased or decreased motor activity, angeria, feelings of worthlessness, decreased concentration, recurrent thought of death or suicide.
DSM criteria for Dysthymic Disorder
Two or more of the following are present:
Decreased or increased appetite, insomnia or hypersomnia, low energy/chronic fatigue, decreased self-esteem, poor concentration, feelings of hopelessness or despair.
Biological theories about Depression
Genetic theories
Biochemical factors
Alterations in hormonal regulation
Sleep abnormalities
Psychodynamic influences and life events
Theory of depression
early life trauma - exaggerated stress response
Etiologic Theories of Depression
Biological Psychodynamic influences and life events Cognitive Theory (negative thinking) Learned helplessness Integrated Approach
What does cognitive therapy do?
Retrains the brain to think differently
Nursing Diagnoses for Depression
Risk for Suicide Chronic Low Self-esteem Hopelessness Constipation Ineffective Coping
SSRI
important facts
- Therapeutic effect 1-4 weeks (longer in elderly)
- low side effect profile: Sexual dysfunction, sleep disturbance, loose BM, N/V.
- serious side effect - Serotonin Syndrome
- don’t stop abruptly
- avoid alcohol & other CNS depression.
- Change positions slowly
- Don’t take MAOIs or St. John’s wart with SSRIs
- Approve all other drugs, including OTC, with physician before taking.
Novel Agents for Depression
important facts
- 4-8 weeks onset (12 weeks geriatric)
- includes SNRIs
- do not stop abruptly
- do not take with MAOIs
- may cause weight gain.
Novel Agents for Depression
example drugs
-Buproprion (Wellbutrin) - may increase B/P, urinary retention
- Duloxentine (Cymbalta) - SNRI
- Mirtazapine (Remeron)
- Nifazodone (Serzone)
-Trazedone (Desyrl) - potent very drowsy
Venlafaxine (Effexor) - SNRI
Example of SSRI
- Citalopram (Celexa)
- Escitaloram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
TCA’s (tricyclic antidepressant)
example drugs
- amitriptyline (Elavil)
- imipramine (Tofranil)
- Nortriplyline (Pamelor)
TCA’s
important facts
- more sedating, take at night
- risk for falls
- Cardiovascular risks: MI, heart block, etc
- Not recommended for elderly
MAOI’s
example drugs
- phenelzine (Nardil)
- tranyleypromine (Parnate)
MAOI’s
important facts
- onset 3-5 days, full effect takes 4 - 8 weeks
- taken for 6 - 12 months then may start weening off
- may become tolerant and need increased dose
- NO TYRAMINE
- Risks: HTN, stroke, or death
- Many drug interactions, ask doctor before taking anything else (including OTC drugs and herbs)
Electroconvulsive Therapy
- Application of small doses of electricity to one or both sides or the brain.
- Used for Major depressive disorder, Mania, some Schizoaffective Disorders.
- usually takes multiple treatments, patient is put to sleep for procedure, short term memory loss is common.
3 Types of bipolar disorders
- Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymic Disorder
Bipolar I disorder
involves periods of severe mood episodes from mania to depression.
Bipolar II disorder
is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.
cyclothymic disorder
describes periods of hypomania with brief periods of depression that are not as extensive or long-lasting as seen in full depressive episodes.
Mania/hypomania
distinct period of abnormally and persistently elevated, expansive or irritable mood
S/S of mania and hypomania
- inflated self esteem or gandiosity
- decreased need for sleep
- more talkative than usual
- flight of ideas
- destractability
- increase in goal directed activity - psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences
Causes of bipolar disorder
- Genetic factors
- Neurobiological causes (neurotransmitter alterations, neurobiological alterations)
- Social status
- Psychosocial factors
Nursing Diagnoses - Mania
- Disturbed thought processes
- Imbalanced nutrition, less than body requirements
- sleep deprivation
- noncompliance
- risk for self or other directed violence
