Depression

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Author:
hvledger1
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296124
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Depression
Updated:
2015-02-17 20:36:47
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psych
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psych
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psych
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  1. depression is on a continuum from
    mild to severe
  2. major depressive disorder
    • one of the most common mental disorders
    • 13 million adults annually in US
  3. major depressive disorder is a persistent depressed mood for
    2 weeks at least
  4. major depressive disorder
    may be single or recurrent attack
  5. major depressive disorder is
    • lack of interest in previous pleasurable activity (anhedonia)
    • fatigue
    • sleep distrubances
    • appetite changes
    • hopelessness/worthlessness
    • persistent thoughts of death/suicide
    • inability to concentrate or make decisions
    • change in physical activity
  6. depression requires depressed mood and
    5 of the other 8 symptoms
  7. terminal insonmia
    • early morning awakening
    • red flag for depression
  8. hypersomnia
    • sleeps too much
    • 12-16 hours
  9. depressed people can lose
    5% of BW less than a month
  10. bad thoughts can fuel
    insomnia and fatigue
  11. psychomotor retardation
    • reduce amount of physical activity
    • stay in bed or sit in 1 spot all day
    • moves slowly and posture stooped with head down
  12. psychomotor agitation
    • restless
    • changes position often
    • fidgets
    • paces up and down  hall
    • not goal directed
    • doesn't feel energized
  13. objective data for depression
    psychomotor agitation or retardation
  14. major reason for hospitalization in depression
    suicidal thoughts
  15. depressed people fantasize about
    • their funeral
    • dream of death
  16. depression differs from bipolar because
    no mania or hypomania occurs
  17. bereavement exclusion
    people who experienced the loss of significant loved one would NOT be given dx of major depression within first 2 months of loss

    this was removed by the DSM5
  18. now depression can be given for dx in first 2 months of loss
    • because grief can result in depression
    • if not... could delay treatment and adversely affect prognosis
  19. depressive disorders are classified by
    symptoms or situations under which they occur
  20. disruptive mood dysregulation disorder
    • children between 6-18
    • frequent temper tantrums resulting in verbal/behavorial outbursts out of proportion to situation 
    • persistant mood is irritable
  21. disruptive mood dysregulation disorder is given only to
    6-18 who do NOT have another medical/mental dx that could account for tantrums
  22. dysthymic disorder
    • feelings of depression persistently for 2 years
    • not severe enough to require hospitalization usually 
    • "always felt this way"
    • low levels of depression can be occupained by full-blow major depressive episodes
  23. premenstrual dysphoric disorder
    • cluster of symptoms that occur in last week prior to the onset of a woman's period 
    • physical discomfort
    • emotional symptoms 
    • decrease with onset of menses
  24. substance induced depressive disorder
    symptoms of major depressive episode arise from result of prolonged drug/alcohol intoxication or withdrawal
  25. depressive disorder associated with another medical condition
    result of changes that are directly related to certain illnesses such as kidney failure, Parkinson's, Alzheimer's
  26. NOT considered major depressive disorder
    • symptoms from medical dx
    • result of certain medications
  27. leading cause of disability in US
    • depression
    • 1 in 20 people
  28. even infants can display symptoms of
    depression
  29. first of episode of depression in childhood or adolescence
    highly likely to recurr
  30. subsyndromal depression
    • experience many but not all symptoms of major depressive episode
    • increase risk for developing major depression
  31. risk for being undertreated
    • older people
    • especially minorities
  32. comorbidity of depression
    • anxiety
    • schizophrenia
    • substance abuse 
    • eating disorder
    • schizoaffective disorder
  33. risks for depression
    • female
    • unmarried ..great
    • early childhood trauma 
    • family history (1st degree relatives especially)
    • postpartum
  34. two main neurotransmitters for mood
    • serotonin
    • NE
  35. serotonin regulates
    sleep, appetite, libdio
  36. NE regulates
    • attention 
    • behavior
  37. other neurotransmitters that play role in depression
    • dopamine
    • acetylcholine
    • GABA
  38. deficient in glutamate
    interferes with normal neuron transmission in areas that affect mood, attention, cognition
  39. neurogenesis
    • ability of the brain to produce more brain cells
    • reduced in depression?
  40. stressful life events
    • acetylcholine 
    • NE
    • serotonin all regulates
    • if overworked.. may be depleted
  41. major depression reveals an increase in
    • urine cortisol
    • elevated corticotrophin-releasing hormone
  42. highest rates for non suppression of cortisol with dexamethasone
    DEPRESSION
  43. estradiol
    • form of estrogen
    • affects receptors sensitive to serotonin
  44. what plays a role in depression
    inflammation
  45. 1/3 of people with depression have elevated
    inflammatory biomarkers in absence of physical illness
  46. people treated with what have a higher rate for depression
    cytokines
  47. diathesis-stress model
    • diathesis: biochemical makeup, personality
    • stress: life events
  48. early life trauma may result in
    • long term hyper activity of CNS CRF and NE 
    • leads to neuronal loss
    • exaggerated stress response
  49. cognitive theory
    person's thoughts will result in emotions
  50. Beck found that depressed people process info in
    negative ways
  51. Beck's cognitive triad
    • 1. negative, self-depracting view of self
    • 2. pessimistic view of world
    • 3. belief of negative reinforcement (no validation for self) will continue in future
  52. Seligman believed
    anxiety is initial response of stress and replaced by depression if person feels no control over outcome
  53. Learned helplessness
    • Seligman
    • person believes its their fault
    • nothing can be done about situation
  54. Patient health questionnaire
    • highlights predominant symptoms seen in depression 
    • allows nurse to follow changes in patient's symptoms
  55. online confidential screening test for depression sponsored by NAMI
    www.depression-screeing.org
  56. how many depressed people commit suicide
    15%
  57. anergia
    lack of energy or physical activity
  58. psychomotor retardation is more
    common with depression
  59. vegetative signs of depression
    • change in bowel movements and eating habits
    • sleep distrubances
    • disinterest in sex
  60. affect
    outward respresentation of person's internal state of being and is an objective finding based on nurse's assessment
  61. flat affect
    little to no facial expression
  62. recovery model
    healing is possible and attainable for individuals with mental illnesses 

    focus on patient strengths
  63. acute phase
    • 6-12 weeks
    • reduce symtoms 
    • hospital may be required
  64. continuation
    • 4-9  months
    • prevent relapse
  65. maintenance
    • 1year or more
    • prevent future episodes
  66. when a patient is mute
    • make observations
    • "There are many new pictures on the wall"
    • "You are wearing new shoes"
  67. AVOID platitudes
    • such as "Things will look up"
    • "everyone gets down once in a while"
    • minimizes their feelings..
  68. SSRIs
    • first line of therapy of depression
    • block reuptake of serotonin
    • DON'T produce cholinergic affects
    • low lethality risk
  69. all antidepressants increase
    serotonin, NE, dopamine
  70. SSRIs common effects
    • agitation
    • anxiety
    • sleep disturbance
    • tremor
    • sexual dysfunction
    • tension HA
    • dry mouth
    • sweating
    • weight change
    • mild nausea
    • loose bowel movements
  71. Serotonin syndrome
    • abd pain
    • increase HR
    • muscle spasms
    • diarrhea
    • altered mental states
    • elevated BP
    • apnea
    • worse: hyperpyrexia, cardio schock, death
  72. Serotonin syndrome
    • worse if taken with another serotonin enhancing syndrome such as 
    • MAOIs
  73. TCAs
    inhibit reuptake of NE and serotonin
  74. TCA for lethargic and fatigue
    • desipramine
    • protriptyline
  75. TCAs for agitation or restlessness
    • amitriptyline
    • doxepin
  76. TCAs can cause
    • anticholinergic effects
    • weight gain
    • orthostatic hypotension 
    • postural hypotension 
    • *RISK FOR FALLS
  77. what requires immediate medical attention with TCAs side effect
    • urinary retention
    • severe constipation
  78. administer TCAs at
    night
  79. most serious effects of TCAs
    cardiovascular problems
  80. NOT given with TCAs
    • MAOIs
    • phenothizines
    • barbiturates
    • disulfiram 
    • oral contraceptives
    • anticoagulants
    • antihypertensives
    • benzo
    • alcohol
  81. TCAs contraindicated in
    • MI
    • narrow angle glaucoma
    • history of seizures
    • women are pregnant
  82. interventions for serotonin syndrome
    • serotonin receptor blockade with cyprohepatdine, methysergide, propranolol
    • cooling blanket, chlorpromazine for hyperthermia
    • dantrolene, diazepam for muscle ridgity
    • anticonvulsants
    • artificial ventilation
    • induction of paralysis
  83. MAOIs
    • breaking down NE, serotonin, dopamine, tyramine
    • increases in the synapes
  84. SSRIs complaint
    sexual dysfunction
  85. common side effects of MAOIs
    • orthostatic hypotension
    • weight gain
    • edema
    • change in cardiac rate and rhythm 
    • constipation
    • urinary hestinancy
    • sexual dysfunction
    • vertigo
    • overactivity
    • muscle twitch
    • hypomanic 
    • manic behavior 
    • insomnia
    • weakness/fatigue
  86. toxic effects of MAOIs
    • increase in BP
    • *monitor bp routinely
  87. hypertensive crisis with MAIOs and tyramine
    • few hours after ingestion
    • begin with HA
    • stiff/sore neck
    • palpitations
    • increase or decrease HR
    • N/V 
    • increase in temp
  88. give what for hypertensive crisis
    • calcium channel blocker, nifedipine
    • alpha-adrenergic blocker, phenotoloamine
    • pyrexia: hypothermic blankets/ice packs
  89. foods to AVOID with MAOIs
    • avocados (esp. overripe)
    • fermented bean curd/soybean, soybean paste
    • figs (esp. overripe), bananas in large amounts
    • fermented meats, smoked or aged
    • fermented bolgna, peperroni, salami
    • dried, cured, smoked, fermented fish 
    • PRACTICALLY ALL CHEESES
  90. foods to AVOID with MAOIs #2
    • yeast extract
    • imported beers
    • protein dietary supplements
    • chocolate
    • fava beans
    • caffeineted beverages
    • ginseng
  91. contraindicated for MAOIs
    • stroke
    • hypertensive/CHF
    • liver disease
    • recurrent/severe headaches
    • surgery in previous 10-14 days
    • younger than 16 yr
  92. what to tell MAOI user if they have a severe HA?
    go to emergency room
  93. what should be monitored for 1st 6 weeks with MAOIs
    bp
  94. After MAOI is stopped, how long does patient have to wait to resume normal diet?
    14 days
  95. what do antidepressants have with children?
    black box warning
  96. discontinuation syndrome when stop taking antidepressants
    • anxeity
    • dysphoria
    • flu like symptoms
    • dizzy
    • excessive sweat
    • insomnia
  97. when to use ECT
    • patient is suicidal/homicidal
    • meds have failed
    • marked agitation, vegetative symptoms or catatonia
    • major depression with psychotic features or for pervasive hallucinations
  98. who else can benefit from ECT
    • depression with marked psychomotor retardation
    • manic patients who are resistant to meds
    • rapid cyclers
    • schizophrenia
    • schizoaffective syndromes
    • pregnant psychotic women
    • Parkinson's
  99. ECT not neccesary for
    • dysphoric disorder
    • unconventional depression
    • personality disorder
    • drug dependence
    • secondary depression
  100. transcranial magnetic stimulation
    noninvasive treatment modality that uses MRI strength magnetic impulses to stimulate focal areas of the cerebral cortex
  101. TMS
    • patient is awake and alert
    • patient may feel slight tapping or knocking in head
    • contraction of scalp
    • or tightening of jaws
    • **memory problems
  102. TMS side effects
    • HA and lightheadedness
    • scalp tingling and discomfort
  103. Vagus nerve stimulation
    • boosts levels of neurotransmitters
    • also used for anxiety, obesity, or pain
  104. VNS
    • pacemaker like device
    • implanted in left chest wall
    • wrapped around vagus nerve on left side of neck
  105. how to turn off the Vagus nerve stimulation
    • place magnet over implant
    • especially helpful when exercising or public speaking
  106. deep brain stimulation
    • electrodes are surgically implanted into specific areas of brain in order to stimulate those regions identified to be underactive in depression
    • more invasive
  107. light therapy
    • first line treatment for seasonal affective disorder 
    • seasonal differences in amount of daylight
  108. side effect of light therapy
    • HA
    • jitterness
  109. St. John's Wort
    • not FDA approved
    • flower available in tea/tablet
    • increases serotonin, NE, dopamine
    • treatment: mild-moderate depression
    • use caution in pregnancy or kids
  110. overgeneralizations
    The patients takes one fact or event and makes a general rule  out of it ("He always.." "I never"
  111. self blame
    patient consistently blames self for everything percieved negative
  112. mind reading
    the patient assumes others don't like him or her wihtout any real evidence that assumptions are correct
  113. discounting positive attributes
    patient focuses on the negative

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