Psych Exam 2: Depression

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jwhughes
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296474
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Psych Exam 2: Depression
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2015-02-22 09:27:33
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psych
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Exam 2
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  1. What is characterized by a persistently depressed mood lasting a minimum of 2 weeks
    Major depressive disorder
  2. what is anhedonia
    without pleasure
  3. What is terminal insomnia and what is it a red flag of
    • early morning awakening
    • Depression
  4. What is bereavement exclusion
    a person is not diagnosed with depression in the first two months of a significant loss
  5. What depressive disorder relates to children between the ages of 6 and 18 and refers to situations in which a person has frequent temper tantrums resulting in verbal or behavioral outbursts
    Disruptive Mood Regulation Disorder
  6. What is dysthymic disorder
    feelings of depression that consistently last for at least 2 years
  7. What is the common age dysthymic disorders occur
    teenage years
  8. What refers to a cluster of symptoms that occur in the last week prior to the onset of a woman's period (lutile phase)
    Premenstrual dysphoric disorder
  9. What are the two major neurotransmitters involved in mood
    • serotonin
    • norepinephrine
  10. What neurotransmitter is an important regulator of sleep, appetite, and libido
    serotonin
  11. What neurotransmitter is responsible for modulating attention and behavior
    norepinephrine
  12. What is the ability of the brain to produce new brain cells and how does depression affect this mechanism
    • neurogenesis
    • reduces it because the neurotransmitters become overtaxed
  13. What effect does depression have on the hypothalamic-pituitary-adrenal cortical axis
    hyperactivity causes increased urine cortisol levels and elevated corticotropin-releasing hormone
  14. What is the physiological vulnerabilities such as genetic predispositions, biochemical makeup, and personality structure referred to
    diathesis
  15. In the diathesis stress model, what does the stress part refer to
    life events that impact an individual's vulnerabilities
  16. Name three assumptions of Beck's cognitive triad
    • negative, self-depreciating view of self
    • pessimistic view of the world
    • belief that negative reinforcement will continue
  17. What is anergia
    lack of energy or physical passivity
  18. How might pyschomotor agitation present in depression
    constant pacing, ringing of hands
  19. What are some vegetative signs of depression
    change in bowel movements, eating habits, sleep disturbances, and disinterest in sex
  20. What are somatic complaints of depression
    headache, backache, malaise
  21. What is the outward representation of a person's internal state of being and is an objective finding
    affect
  22. What is a HALLMARK of depression
    waking at 3-4 am, then staying awake or sleeping for short periods
  23. How long is the acute phase of major depression and what is the primary goal
    • 6-12 weeks
    • reduced symptoms and restoration of psychosocial/work function
  24. How long is the continuation phase of major depression and what is the primary goal
    • 4-9 months
    • prevent relapse through pharmacotherapy, education, and depression-specific psychotherapy
  25. How long is the maintenance phase of major depression and what is the primary goal
    • 1> years
    • Prevent relapse and possibly phase out medicine
  26. What should the nurse do if a patient is mute during communication attempts
    • make observations
    • use simple, concrete words
    • allow time for patient to respond
    • Listen for covert messages (suicide)
    • Avoid platitudes (things will look up...)
  27. What are nursing interventions for anorexia secondary to depression
    • small, high calorie, high protein snacks frequently
    • encourage family/friends to remain with patient during meals
    • Give patient food choices
    • Weigh patient weekly
  28. What are nursing interventions for insomnia secondary to depression
    • rest after activities
    • encourage patient to get up, dress, stay out of bed
    • relaxation techniques in evening
    • reduce stimulus in evening
  29. What are nursing interventions for constipation secondary to depression
    • monitor I&O (bowel movements!)
    • High fiber food
    • exercise
    • fluids
    • possible laxative/enema
  30. What is the goal of antidepressant therapy
    complete remission of symptoms
  31. What antidepressants are recommended as first line therapy for depression
    SSRI
  32. What is the MOA of SSRI
    block neuronal uptake of serotonin increasing the availability at the synaptic cleft
  33. What is the most significant, undesirable outcome reported by patients on SSRI
    sexual dysfunction
  34. What is a life-threatening event associated with SSRI and what kind of symptoms would be present
    • serotonin syndrome
    • abdominal pain, diarrhea, fever, tachycardia
  35. What medication should be avoided with patients on SSRI and if this medicine must be taken, how long should the SSRI be discontinued to reduce risk of serotonin syndrome
    • MAOI
    • 2-5 weeks
  36. If a patient presents symptoms of serotonin syndrome what are the emergency interventions the nurse would take
    • remove offending agents
    • Serotonin-blockade with cyproheptadine, methysergide, propranolol
    • Cooling blankets and chlorpromazine
    • Dantrolene/diazepam (muscle rigidity)
    • Anticonvulsants
    • Artificial ventilation
    • Induction of paralysis
  37. What class does celexa, zoloft, prozac, lexapro, and paxil fall under
    SSRI
  38. What do you encourage patient on SSRI to be concious of regarding their diet
    adequate sodium intake
  39. What is the MOA of TCA
    inhibit reuptake of serotonin and norepinephrine
  40. Why does TCA cause a sedative effect
    blocks histamine receptors
  41. How long till TCA begin to work? to their full effect?
    • 10-14 days
    • 4-8 weeks
  42. What TCA may be good for a patient who is lethargic and fatigued
    • stimulating
    • desipramine
  43. What TCA may be good for a patient who is agitated and restless
    • sedative
    • Amitriptyline, doxepin
  44. TCA adverse effects
    • anticholinergic
    • hypotension
    • high risk for lethal overdose
    • URINARY RETENTION, SEVERE CONSTIPATION
    • Weight gain
  45. What medications are contraindicated with TCA
    • MAOI
    • Phenothiazine
    • Barbituates
    • Disulfiram
    • Oral contraceptives
    • Anticoagulants
    • Some Antihypertensives
    • Benzos and alcohol
  46. What kind of patients are contraindicated in taking TCA
    • recent MI (or other cardiovascular issues)
    • Narrow-angle glaucoma
    • seizures
    • pregnant
  47. How long for TCA to begin to be effective? be fully effective?
    • 7-28 days
    • 6-8 weeks
  48. How long should nurse reassure patient on TCA that side effects of hypotension, dizziness, and drowsiness go away
    after first few weeks
  49. When should patient be educated to take TCA
    at bedtime
  50. What should nurse tell patient who forgets to take dose of TCA
    Take within 3 hours or wait until usual med the next day (NO DOUBLE DOSE)
  51. What can happen if patient suddenly stops taking TCA
    nausea, altered heartbeat, nigthmares, cold sweats in 2-4 days
  52. Food that should be avoided with patient on MAOI and why
    • tyramine
    • prevent hypertensive crisis
  53. Due to the effect of increased blood pressure MAOI has on patient, what should nurse monitor and how often
    BP, especially during first 6 weeks
  54. When does a hypertensive crisis usually occur with patient on MAOI and what are the symptoms
    • within a few hours of ingestion
    • headache
    • stiff/sore neck
    • palpitations
    • increase/decrease HR with chest pain
    • vomiting
    • increase temperature
  55. Drugs that interact with MAOI
    • OTC cold, allergy, congestion (ephedrine, phenylephrine, hydrochloride)
    • TCA
    • Narcotic
    • Antihypertensive
    • Amine precursor (levodopa)
    • Sedatives
    • Stimulants
  56. What steps are taken for patient in hypertensive crisis (HA, Tachycardia, palpitations, HTN, N/V)
    • ER
    • BP
    • 5 mg IV phentolamine or sublingual nifedipine
    • 10 mg nifedipine capsule to carry for emergencies
  57. What is a patient with bipolar disorder who has many episodes of mood swings together (4+/yr)
    rapid cycler
  58. What is first line treatment for patients with seasonal affect disorder
    light therapy

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