Psych Depression

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Psych Depression
2015-04-21 15:51:19
lccc nursing psych depression

For Cummings Exam 3
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  1. What are the different depressive disorders? What are the different BPD disorders?
    • Depressive Disorders:
    • -MDD
    • -Dysthymia
    • -PPD
    • -SAD
    • -PMDD

    • BPD:
    • -Bipolar I
    • -Bipolar II
    • -Cyclothymia
    • -Bipolar mixed; manic, depressed
  2. What are some diagnostic issues when it comes to mood disorders? What are the two important criteria in diagnosis?
    • Two broad categories: unipolar and bipolar
    • The two important criteria are duration and severity
  3. What are some important statistics about depression?
    • 2:1 ratio females to males
    • Median age of onset is 30y/o

    • highest risk for reoccurring depression:
    • 1. first case before 25 y/o
    • 2. more than 16 wks of depression
    • 3. recurrence after d/c antidepressant meds
  4. What are the emotional, physical and associated symptoms of depression?
    • Emotional:
    • - feelings of guilt
    • -suicidal
    • -lack of interest
    • -sadness
    • Physical:
    • -lack of energy
    • -no concentration
    • -change in appetite
    • -psychomotor changes
    • Associated:
    • -brooding
    • -rumination
    • -pain
    • -irritability
    • -worry
    • -anxiety
    • -phobias
  5. What are the different levels of depression?
    • Mild
    • Moderate
    • Severe
    • Severe with psychotic features
  6. What is MDD? What is the DSM-5 Criteria?
    • Major Depressive Disorder or Unipolar
    • DSM 5 Criteria: +5 core symptoms
    • 1. Symptoms must be a change in functioning and be present every day, all day for at least 2 weeks and must cause distress in functioning
    • 2. Anhedonia (lack of pleasure)
    • 3. Thoughts of suicide
    • 4. Anergia (decreased energy)
    • 5. Change in appetite/sleep
  7. What are the core symptoms of MDD?
    • Feelings of misery, apathy and pessimism
    • Withdrawn
    • Low self-esteem, feelings of guilt, inadequacy and ugliness
    • Indecisiveness
    • Psychomotor retardation (vegetative signs both in thought and action)
    • Psychomotor agitation (doing meaningless/purposeless activity instead of what is important at the time)
    • Sleep disturbances and significant weight change (without change in diet or appetite)
    • In severe cases, MDD may be accompanied by hallucinations or delusions
    • recurrent suicidal ideation, a suicide attempt or a specific suicide plan
  8. What is Persistent Depressive Disorder/Dysthymia?
    • DSM-5 labels dysthymia as a mild depressive illness where symptoms are chronic and less severe than MDD
    • Criteria: depressed or irritable mood most of the day for at least 2 years. Insomnia/hypersomnia. ¬†Decreased/increased appetite
  9. What are the s/s of dysthymia?
    • Low energy
    • Decreased self-esteem
    • poor concentration
    • difficulty in making decisions
    • feeling hopeless
  10. Describe partpartum depression
    • Meets the criteria for MDD with onset within 4 weeks of delivery
    • 3 categories:
    • 1. post partum blues
    • 2. post partum depression
    • 3. post partum psychosis
  11. What is postpartum psychosis?
    • .01% experience severe/psychotic depression
    • Depressed mood agitation, guilt, lack of concentration, lack of interest in baby
    • Depersonalization
    • Disturbed sleep, even when baby is sleeping
    • Rejection of baby, lasts weeks-months
    • Medical Emergency
  12. What is seasonal affective disorder (SAD)?
    • MDD wit seasonal pattern- fall onset
    • Depressive symptoms during winter/fall
    • Increased sleep, appetite, carb cravings
  13. What is the etiology of depression?
  14. What is Beck's cognitive behavioral theory?
    • Cognitive distortions:
    • -magnification
    • -minimization
    • -personification
    • -overgeneralization
    • -all or nothing thinking
    • -mind reading

    depression is a result of negative interpretation (Wearing gray instead of rose colored glasses)
  15. What is Seligram's learned helplessness pessimistic attributional style?
    • Internal/Personal: see selves as the cause
    • Global/pervasive: affecting all aspects of their life
    • Stable/permanent: see the situation as unchangeable
    • "I am inadequate (internal) at everything (global) and I always will be (permanent)"
  16. Describe how serotonin and norepinephrine attribute to depression
    • Serotonin:
    • -Sex, Appetite, Aggression
    • Norepinephrine:
    • -Concentration, Interest, Motivation
    • BOTH:
    • -Decreased mood
    • -Anxiety
    • -Vague aches and pains
    • -Irritability
    • -Thought process

    -both serotonin and norepinephrine mediate a broad spectrum of depressive disorders
  17. What general assessments should be done for depression?
    • Severity exists along a continuum
    • Assess for suicidal ideation
    • Assess symptoms and impact on daily living
    • Assess possible causes and past episodes
    • Assess accompanying symptoms
  18. What initial assessments should be done for depression?
    • Chief complaint
    • History of present illness (HPI)
    • Past psych history and treatment
    • Substance Abuse
    • Current stressors and coping skills
    • Support Network
    • Suicide risk assessment
  19. What assessment are done in a mental status exam?
    • Affect
    • Thought processes
    • Mood
    • Feelings
    • Physical Behavior
    • Communication
    • Religious Beliefs and spirituality
  20. What is the recovery model for depression?
    • Focuses on the client's strengths
    • Treatment goals mutually developed
    • Based on client's personal needs and values
  21. What nursing interventions can be done for depression?
    • SAFETY
    • Act on physical complaints (like pain, constipation)
    • Interact at a slow pace in a low tone
    • Encourage personal hygiene
    • Recognize accomplishments
    • Reinforce suicidal thoughts do make them a "bad" person
    • Active listening and being present
  22. What are some standardized depression screening tools?
    • Beck depression inventory
    • Hamilton depression scale
    • Zung's self-rating depression scale
    • Geriatric depression scale
  23. How is alcohol r/t suicide?
    • 96% of alcoholics who die by suicide continue their abuse up until the end of their lives
    • Alcoholism is a factor in about 30% of all completed suicides
    • Approximately 7% of those with alcohol dependence will die by suicide
  24. Compare and contrast men and women when it comes to suicide
    • Females:
    • -4x attmempts
    • -poisoning
    • -40-50s
    • -16th leading cause of death
    • Males:
    • -4x completion
    • -Firearms
    • -75 and older
    • -8th leading cause of death
  25. Describe the IS PATH WARM warning signs of suicide
    • I: Ideation
    • S: Substance Abuse
    • P: Purposelessness
    • A: Anxiety
    • T: Trapped
    • H: Hopelessness
    • W: Withdrawal
    • A: Anger
    • R: Recklessness
    • M: Mood change
  26. What questions should be asked during a suicide assessment?
    • Ideation: Do you have thoughts of killing yourself? Who is in control, you or the thoughts?
    • Plan: Do you have a plan? What method? Where? Access to means?
    • Intent: How intent are you in carrying out the plan? What's stopping you?
    • Contract for safety: Can you agree to speak to the staff if your thoughts change?
  27. What are the risk factors for suicide?
    • Clearly defined plan
    • Available means, clear intent
    • Male, Caucasian
    • Single, divorced or widowed
    • Elderly
    • Prior attempts
    • Family History of suicide
    • Chronic physical illness*
    • Substance abuse*
    • Lack of support
    • Recent loss
    • Hopelessness
    • Mental health issues
    • Prolonged exposure to stressful environment
  28. How do you plan for the acute phase of depression?
    • #1 Goal is safety!
    • Maintain adequate nutrition
    • Maintain balance of rest/activity
    • Interact with staff and peers
    • Verbalize improvement in mood
    • Demonstrate decrease in vegetative symptoms
  29. What safety interventions should be taken for a client with depression?
    • Suicide assessment at least every shift, but best practice is more often
    • Contract for safety: verbal, written
    • Adjust level of monitoring
    • Maintain Safe environment
    • Maintain vigilance when mood improves
  30. What are some cognitive nursing interventions for a client with depression?
    • Spend time with the client
    • Identify relationships between thoughts and feelings
    • Help Identify negative thought patterns
    • Maintain thought diary
    • Assist with problem solving
  31. What forms of psychotherapy are often used for depression?
    • Cognitive Behavioral Therapy (CBT): changes negative way of thinking
    • Interpersonal Therapy (IPT): focuses on working through personal relationships
    • Group therapy: reduces isolation, share feelings
  32. How does ECT effect depression?
    • Indicated for treatment resistant depression
    • remission rate of 70-90%
    • Decrease/elimination of SI in 80%
    • 6-12 treatments
    • Effective for pregnant women
    • Short term memory loss and HA are main complaints
  33. What is TMS?
    • Transcranial Magnetic Stimulation
    • Treatment resistant depression
    • Non-invasive while client is awake and alert
    • MRI type magnets stimulate nerve cells in area of brain associated with mood and depression
  34. What are the phases of treatment and recovery for depression?
    • Acute phase: 6-12 wks
    • -hospitalization, restoration of functioning, symptom reduction
    • Continuation Phase: 4-9 mo
    • -prevent relapse, therapies
    • Maintenance phase: 1 yr +
    • -Prevent further episodes
  35. Describe the use of antidepressants, including the four kinds
    • Most effective when combined with therapy
    • Takes 1-3 wks to see improvement and 4-6 wks for Max, therapeutic effect
    • Can precipitate mania
    • Can precipitate suicidal ideation
    • May need to treat concurrent anxiety
    • 4 types: Tricyclic Antidepressants (TCAs), Monoamine oxidase inhibitors (MAOIs), Selective serotonin reuptake inhibitors (SSRIs), Atypical anti-depressants with as SNRI, SNDI
  36. Describe TCAs and name the most common ones
    • Inhibit the reuptake of norepinephrine and serotonin
    • Sedating effect, aids in sleep
    • 4-6 wks for full effect
    • Increased anticholinergic effects
    • Cardiovascular side effects, need full workup, contraindication for cardiac disease and no longer often prescribed due to cardiotoxicity
    • High lethality- fatal in overdose (2wk dose is deadly)
    • Characteristic three ring nucleus of drug
  37. Name some TCA medications
    • Amytriptiline (Elavil)
    • Imipramie (Tofranil)
    • Desipramine (Norpramin)
    • Nortriptyline (Pamelor)
    • Doxepin (Sinequan)
  38. What are the side effects of TCAs?
    • Cardiotoxicity: palpitations, tachycardia, dizziness
    • Increased norepinephrine is the culprit
  39. What are MAOI inhibitors? Name the most common ones
    • Originally created for TB treatment
    • Not widely used today
    • Absorbed by the GI tract and widely distributed throughout the body
    • Effects persist even after these drugs are no longer detectable in the plasma (1-3 weeks)
    • MAIOs:
    • Isocarboxacid (Marplan)
    • Phenelzine (Nardil)
    • Tranylcypromine (Parnate)
    • Emsam patch
  40. What teaching is essential for MAOIs?
    • Will lead to a hypertensive crisis (risk of CVA and organ damage)
    • These foods include fermented foods (wine, cheese, chocolate, sausages, etc)
  41. What two antidepressant medications cannot be used together and why?
    • MAOI with ____
    • Has many negative drug interactions including:
    • SSRIs
    • TCAs
    • Meperidine
    • Alcohol
    • CNS depressants
    • Phenylephrine (OTC nasal decongestant)
    • Will cause "hyperexcitiation syndrome" with hyperpyrexia, hypertension and delirium
  42. Describe SSRIs and the mechanism of actions
    • Most widely prescribed for depression as they have fewer SE and better client adherence
    • AE: nausea, decreased libido and sexual function
    • Low threat to overdose. suicide may be considered in severe depression
    • MOA: specific serotonin uptake inhibitor increases 5-HT by inhibiting reuptake. 6wks for full effect
    • Dangerous if taken with other antidepressants, esp MAOIs*
  43. What are the most common SSRIs?
    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Paroxetine (Paxil)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)
    • Escitalporam (Lexapro)
  44. What is serotonin syndrome?
    • Do not stop SSRI drug abruptly, titrate for 6 weeks to stop one and begin another antidepressant
    • Hyperthermia (not first sign but most noticeable)
    • Muscle rigidity
    • Myoclonus
    • Rapid changes in mental status and VS
  45. What are some newer antidepressants?
    • Venlafaxine (Effexor): sometimes used for pain, split does for XR
    • Duloxetine (Cymabalta): used in diabetic neuropathy and other pain syndrome
    • Mirtazapine (Remeron): sleep promoting, appetite stimulation, few sexual SE
    • Buproprion (Wellbutrin): fewer sexual SE, increases seizure risk, activating antidepressant, smoking cessation
  46. What are some atypical 2nd & 3rd gen antidepressants
    • Amoxapine (Asendin)
    • Reboxitine (Vestra)
    • Desvenlafaxine (Pristiq)
    • Trazodone (Desyrel)