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What are psychological changes in someone addicted to alcohol?
- - increased anxiety
- - defensive style developed
- - denial, rationalization, projection
+ Depression, anxiety, narcissim, low self esteem
What are the thought processes of someone with depression?
- - Poor judgement
- - Poor memory & concentration
- - Confusion
- - Difficulty making decisions
- - Suicidal or homicidal thoughts (Must always be assessed)
What are atypical or novel antidepressants?
- - Efexor
- - Remeron
- - Cymbalta
- - Desyrel
- - Pristiq & Wellbutrin (not to pts w/ hx of seizures)
What TCA's are used to treat depression?
What are the common side effects?
- - Elavil
- - Sinequan
- - Tofranil
- S/E: blocks acetylcholine = wt. gain
- drowsiness = blocks heart conduction!
- blocks histamine = constipation, dry mouth
- blocks epinephrine = hypotension
- cardiac arrhythmias
- lowers seizure threshold
What are MAOI's used to treat?
#1 to watch out for??
Atypical depression, PTSD, panic disorders, and bulimia.
- #1 to watch out for is a tyramine free diet (its' a must)
- Watch for HTN CRISIS!
What SSRI's are used to treat depression?
Who should not use them?
- - Prozac
- - Zoloft
- - Paxil
- - Luvox
- - Celexa
- - Lexapro
- Pregnant women should not use them as they are a danger to the baby
How does alcoholism progress?
non use --> social use --> dependency -->physical and psych
- - addiction
- - loss of control
- - drink despite ETOH related problems
When assessing for substance/alcohol addiction what do you ask?
What do you look for?
- -How often, how much, how big is 1, what other drugs
- - opiate addicts exaggerate their use to get higher doses.
- - alcohol addicts minimize use r/t embarrassment.
- - look for seizures followed by DT's (delerium tremors)
What is masked depression?
- depression dealt thru somatization, anxiety, HA's, aches/pains.
- Influenced by age, culture, socioeconomic background, gender
Seen more in men - usually manifests as substance abuse
What are the S/S of HTN Crisis?
- - ^B/P
- - occipital HA
- - tremors
- - fever, palpitations
- - bounding HR
- - N/V
What are ADS symptoms?
(Anti-depressant discontinuation syndrome)
- - anxiety
- - agitation
- - insomnia
- - dizziness
- - light headedness
- - nausea
- - myalgia
- - fatigue
- - sensory disturbances
What herbal remedies can be used to treat depression?
- - SAMe
- - Folic acid & other B vitamins
- - omega 3 fatty acids
- - exercise!
- Light for SAD (seasonal affective disorder)
When is suicide risk greatest for a person with depression?
When pt. is coming out of depression
What are bipolar spectrum disorders?
- - Mood disorder
- - when a pt. has manic episodes characterized by euphoria, hyperactivity, irritable moods, flight of ideas, extreme self confidence/grandiosity, and little need for sleep or food, alternating with episodes of depression.
What is egosyntonic?
ideas & instincts that are comfortable to someone. They have no knowledge of their disorder.
What is ego dystonic?
- Impulses thoughts and behaviors that go against our personal beliefs.
- They are completely aware their disorder is wrong.
What are the comparisons of depression for men vs. women?
- - 1 in 4 women will develop depression.
- - 1 in 10 men will develop it.
What are s/s of depression?
- - Anxiety 60-80%
- - sense of worthlessness
- - low self-esteem
- - guilt
- - hopelessness, helplessness
- - anger/irritability
- -anhedonia (no interest in anything)
- - spiritual distress, loss of sense of meaning
What affect (emotion) does depression show?
- - grey colored glasses
- - poor posture
- - facial lines all go down
- - fearfulness or unable to cry
- - gloominess
- - despondency
- - apathy
What is the difference between bipolar 1 & 2?
Bipolar 1 ranges from severe depression --> Euphoric mania
- Bipolar 2 ranges from severe depression --> hypomania
- Bipolar 2 people are fully functioning during hypomania
What is cyclothymic disorder?
Mood range from moderate depression to hypomania
Alternating cycles of each
What is dystmic disorder?
Mood ranges from moderate depression to normal.
What are the psychobiological interventions for bipolar disorder?
What is the mood range for major depression?
Unipolar - severe depression to normal.
What are the physical signs of depression including the 4 vegetative signs?
- - Anergia
- - Psychomotor retardation or agitation
- - Poor personal hygiene
- - Vegetative change in eating, sleep, elimination, and libido
Prior to treatment, what tests are done to separate depression from other illnesses?
- -EKG check before meds
What is ECT?
Electroconvulsive therapy used when pharm therapy doesn't work for depression.
Electric shock induces seizure while under local anesthesia.
3-4 times/week for 4 weeks. After w/ propholactic antidepressant.
Discuss St. John's Wart.
Can cause hypomania and serotonin syndrome when taken with SSRIs
Could decrease production of monoamine oxidase, possible HTN when used with MAOI's
What are the symptoms of a manic attack?
- - Distractibility
- - Indiscretion
- - Grandiosity
- - Flight of ideas
- - Activity increase
- - Sleep deficit
- - Talkativeness
How can lithium help bipolar disorder?
Lithium alone can reverse mild to moderate manic symptoms in 1-3 weeks for some patients.
What diseases can cause depression?
- - Hypothyroidism
- - Hypoglcemia
- - Cushings Disease
- - Diabetes
According to the psychoanalytic theory where does MDD come from?
Anger turned inward
According to the cognitive theory, what causes MDD?
- - Pessimistic world view
- - Negative view of self
- - Negative expectations
- - Belief that nothing will change
According to the Biological theory what causes MDD?
- -Genetics - chromosome 15
- -Biochemical - stress and hormones
What causes depression?
What helps depression besides antidepressants?
Depression is caused by a decrease in serotonin, stress response gone awry & huge influx of cortison.
What are some drugs that can cause depression?
- - Antihypertensives
- - Antiparkinsonian agents
- - Steroids
- - Digitalis
- - Alcohol, depressant drugs
- - Withdrawal from stimulant drugs
A system assessment called Bleuler's 4 A's are what?
- Affect - inappropriate, bizarre
- Associative Looseness - lack of much or even any logic connecting thoughts
- Autistic thinking - private inner world
- Ambivalence - conflicting emotions or wishes
What are the dietary restrictions with MAOI's?
- - Spoiled or overripe fruit
- - vegetables: pickles, sauerkraut, fava beans
- - Alcohol: beer or wine
- - Aged cheeses (cream and cottage okay)
- - Aged meats: sausages, salami, pepperoni, liver, canned ham- No SPAM.
- - Other antidepressants
- - Decongestants or nasal sprays
- - Many meds
What are the side effects for Tegretol?
Agranulocytosis or Aplastic Anemia
What are some Adverse Reactions to Depakote?
Severe liver dysfunction and pancreatitis.
What is the therapeutic level of lithium?
What are the dietary considerations when taking lithium?
- Adequate Na++ intake
- 2-3 L of h20
What anticonvulsants & mild tranquilizers are used to treat bipolar disorder?
- - Depakote
- - Tegretol
- - Ativan/ Klonopin