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What is characterized by a persistently depressed mood lasting a minimum of 2 weeks
Major depressive disorder
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what is anhedonia
without pleasure
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What is terminal insomnia and what is it a red flag of
- early morning awakening
- Depression
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What is bereavement exclusion
a person is not diagnosed with depression in the first two months of a significant loss
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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
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What is dysthymic disorder
feelings of depression that consistently last for at least 2 years
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What is the common age dysthymic disorders occur
teenage years
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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
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What are the two major neurotransmitters involved in mood
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What neurotransmitter is an important regulator of sleep, appetite, and libido
serotonin
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What neurotransmitter is responsible for modulating attention and behavior
norepinephrine
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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
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What effect does depression have on the hypothalamic-pituitary-adrenal cortical axis
hyperactivity causes increased urine cortisol levels and elevated corticotropin-releasing hormone
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What is the physiological vulnerabilities such as genetic predispositions, biochemical makeup, and personality structure referred to
diathesis
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In the diathesis stress model, what does the stress part refer to
life events that impact an individual's vulnerabilities
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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
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What is anergia
lack of energy or physical passivity
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How might pyschomotor agitation present in depression
constant pacing, ringing of hands
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What are some vegetative signs of depression
change in bowel movements, eating habits, sleep disturbances, and disinterest in sex
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What are somatic complaints of depression
headache, backache, malaise
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What is the outward representation of a person's internal state of being and is an objective finding
affect
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What is a HALLMARK of depression
waking at 3-4 am, then staying awake or sleeping for short periods
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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
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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
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How long is the maintenance phase of major depression and what is the primary goal
- 1> years
- Prevent relapse and possibly phase out medicine
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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...)
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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
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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
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What are nursing interventions for constipation secondary to depression
- monitor I&O (bowel movements!)
- High fiber food
- exercise
- fluids
- possible laxative/enema
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What is the goal of antidepressant therapy
complete remission of symptoms
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What antidepressants are recommended as first line therapy for depression
SSRI
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What is the MOA of SSRI
block neuronal uptake of serotonin increasing the availability at the synaptic cleft
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What is the most significant, undesirable outcome reported by patients on SSRI
sexual dysfunction
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What is a life-threatening event associated with SSRI and what kind of symptoms would be present
- serotonin syndrome
- abdominal pain, diarrhea, fever, tachycardia
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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
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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
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What class does celexa, zoloft, prozac, lexapro, and paxil fall under
SSRI
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What do you encourage patient on SSRI to be concious of regarding their diet
adequate sodium intake
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What is the MOA of TCA
inhibit reuptake of serotonin and norepinephrine
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Why does TCA cause a sedative effect
blocks histamine receptors
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How long till TCA begin to work? to their full effect?
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What TCA may be good for a patient who is lethargic and fatigued
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What TCA may be good for a patient who is agitated and restless
- sedative
- Amitriptyline, doxepin
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TCA adverse effects
- anticholinergic
- hypotension
- high risk for lethal overdose
- URINARY RETENTION, SEVERE CONSTIPATION
- Weight gain
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What medications are contraindicated with TCA
- MAOI
- Phenothiazine
- Barbituates
- Disulfiram
- Oral contraceptives
- Anticoagulants
- Some Antihypertensives
- Benzos and alcohol
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What kind of patients are contraindicated in taking TCA
- recent MI (or other cardiovascular issues)
- Narrow-angle glaucoma
- seizures
- pregnant
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How long for TCA to begin to be effective? be fully effective?
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How long should nurse reassure patient on TCA that side effects of hypotension, dizziness, and drowsiness go away
after first few weeks
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When should patient be educated to take TCA
at bedtime
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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)
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What can happen if patient suddenly stops taking TCA
nausea, altered heartbeat, nigthmares, cold sweats in 2-4 days
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Food that should be avoided with patient on MAOI and why
- tyramine
- prevent hypertensive crisis
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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
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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
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Drugs that interact with MAOI
- OTC cold, allergy, congestion (ephedrine, phenylephrine, hydrochloride)
- TCA
- Narcotic
- Antihypertensive
- Amine precursor (levodopa)
- Sedatives
- Stimulants
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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
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What is a patient with bipolar disorder who has many episodes of mood swings together (4+/yr)
rapid cycler
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What is first line treatment for patients with seasonal affect disorder
light therapy
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