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What ar mood disorders also called? What is affect?
- also called affective disorders
- Affect is the outwad expression of your mood
What are the depressive disorders? Bipolar disorders?
- Depressive: MDD, persistent depressive disorder (dysthymia), Post partum depression, Seasonal affective disorder, Premenstrual dysphoric disorder
- Bipolar: Bipolar 1, Bipolar 2, Cyclothymia, Bipolar mixed; manic, depressed
What are the two broad categories for diagnosis? what are the 2 imortant criteria in diagnosis?
- Categories: unipolar and bipolar
- criteria: duration and severity
What are some stats about depression? Who has the highest rsk for recurret depression?
- 2:1 female to male
- 21 million US adults
- Median age of onset=30 years
- Highest rik for recurrent: first case before age 25, more than 16 weeks of depression, recurrence after d/c antidepressant meds
What are the different symptoms of depression? (3 main categories, broken down)
- emotional: feelings of guilt, suicidal, lack of interest, sadness
- Associated symptoms: brooding, rumination
- Physical symptoms: lack of energy, no concentration, change appetite, psychomotor, pain, irritability, worry, anxiety, phobias
What are the levels of depression?
- severe wit psychotic features
What is the DSM-5 criteria for MDD?
- aka unipolar
- 5 or more core symptoms
- 1. symptoms must be a change in functioning and be present all day everyday for at least 2 weeks and must cause distress in functioning
- 2. anhedonia (lack of pleasure)
- 3. thoughts of suicide
- 4. Anergia
- 5. change in appetite sleep
- Core symptoms: feeling of misery, apathy and pessimism
- low self esteem, feelings of guilt, inadequacy and ugliness
- psychomotor retardation
- psychomotor agitation
- sleep disturbance and significant weight change without dieting or changes in appetite
- *severe if occurs with hallucinations and delusions
- recurrent suicidal ideation, a suicide attempt or a specific suicide plan
What is persistent depressive disorder/dysthymia? What is the DS-5 criteria?
- "difficult mind" a mild depressive illness where symptoms are chronic and less severe than MDD
- Criteria: depressed or irritable mood ost of the day for at least 2 years. Decreased/increased appetite, insomnia/hypersomnia, Low energy, decreased self esteem, poor concentration, difficulty making decisions, feeling hopeless
What is postpartum depression? What is postpartum psychosis?
- meets criteri for MDD with onset within 4 weeks of delivery.
- Three categories: post-partum blues, post partum depressions, post partum psychosis
- Psychosis: .01% experience severe/psychotiv depression, depressed mood, agitation, guilt, lack of concentration, lack of interest in the baby, deperseonalization, disturbed sleep, eve when baby is sleeping, rejection of baby, lasts weeks-months, medical emergency
What is seasonal affective disorder? (SAD)
MDDwith seasonal pattern-fall onset; depressive symptoms during fall winter, increased sleep, appetite, carb cravings
what is becks cognitive behavioral theory?
(aaron beck) "depression is the result of negative interpretations (wearing gray instead of rose colored glasses eg, eyore in winnie the pooh) Cognitive distortions: magnifications, minimization, personification, overgeneralization, all or nothing thinking, mind reading
What is Seligman's learned helplessness pessimisticattributional style?
- internal/personal: see selves as the cause
- global/pervasive: affecting all aspects of their life
- Stable/permanent: see situation as unchangeable
- ex. "i am inadequate (internal) at everything (global) and I always will be (stable).
What does serotonin "do" Norepinephrine? what do they both "do" that mediate a broad spectrum of depressive symptoms?
- serotonin: Sex, appetite, aggression
- Norepi: concentration, interest, motivation
- both: depressed mood, anxiety, vague aches and pain, irritability, thought process
How is depression assessed?
- severity exsists along a continuum
- assess for SI
- assess symptoms and impact on daily living
- assess possible causes and past episodes
- assess accompanying symptoms
What is the initial assessment of depressions?
- chief complaint
- Hx of present illness (HPI)
- pst sych hx and tx
- substance abuse
- current stressors and coping skills
- support network
- suicide risk assessment
WHat mental health areas sould be assessed?
- thought processes
- physical behavior
- religious beliefs and spirituality
What is the recovery model for depression? what should you focus on? how are the treatment goals developed? what is treatment based on?
- focus on clients strengths
- treatment goals mutually developed
- based on clinets personal needs and values
What are the nursing interventions for depression clients?
- act on physical comlaints
- interact at a slow pace in a low tone
- encourage personal hygiene
- recognize accomplishments
- reinforce suicidal thoughts do not mean client is a bad person
- active listening and being present
What are the standardized depression screening tools?
- Becks depression inventory
- hamilton depression scale
- Zung's self rating depression scale
- geriatric depression scale
WHat state has the highest suicide rate? how often do they occur? how many/day?
- every 16 minutes
- 10th leading cause of death for aduts 18-65, 90% of suicide victims have psychiatric disorder at the time of their death; there are 4 male suicides for every 1 female, but 3x as many femal attempts
WHat % of alcoholics who die by suicide continue their abuse up to the end of their lives? alcoholism is a factor in how many completed suicides?
- 90% continue until death
- alcohol is a factor in 30%
What are the demographics between males and females in suicide?
- Females: 4x attempts, poisening, 40's and 50s, 16th cause of death
- Males: 4x completion, firearms, 75+, 8th cause of death
What is the warning suicide warning sign pneumonic?
- "Is path warm"
- Substance abuse
- Mood change
What questions should you ask to determine if the client has suicidal ideations, plan, intent. WHat is a contract for safety?
- ideation: Do you have thoughts of killinh self? Who is in control, you or thoughts?
- Plan: do you have a plan? What method? When? Where? Access to means?
- Intent: How intent are you in carrying out the plan? What is stopping you?
- Contract for safety: identify who to notify if feels can't honor contract, "can you agree to speak to a staff of your thoughts change?
What are the risk factors for suicide?
- clearly defined plan, avalaible means clear, intent
- Male, caucasian
- single, divorced, widowed
- prior attempts
- family hx
- chrinic physical illness
- substance abuse
- lack of support
- recent loss
- mental health issues
- prolonged exposure to stressful environment
How can you plan for Acute phase of suicide??
- Goal is ** safety
- maintain adequate nutrition, and balanced rest/activity
- interact with staff and peers
- verbalize improvement in mood
- demonstrate decrease in vegetative symptoms
What are the safety interventions?
- Suicide assessment every shift/mre often; contract for safety;verbal, written
- adjust level of monitoring
- maintain safe environment
- Maintain vigilance when mood improves
What are the cognitive nursing interventions?
- Spend time with client
- identify relationship between thoughts and feelings
- help to identify negative thought patterns
- maintain thought diary
- assist with problem solving
What entails the psychotherpay tx?
- CBT: changes way of thinking
- Interpersonal therapy (IPT): focuses on working throuh personal relationships
- Group therapy: reduces isolation, share feelings
What is ECT?
- indicated in tx resistant depresion; remission rate of 70-90%
- Decrease/elimination of SI in 80%
What is TMS?
- Fda approved in 2208
- treatment resistant clients
- client awake/alert
- MRI type magnets
What are the phases in treatment & recovery and how long does each last?
- Acute phase: (6-12 weeks) hospitalization, restoration of functioning, symptom reduction
- Continuation phase: (4-9 months) prevent relapses, therapies
- Maintenance phase: (1+ year(s)) prevent further episodes
- most effective when combined with therapy
- takes 1-3 weeks to see improvement
- takes 4-6 weeks for max, theapeutic effects
- can precipitate mania and suicida idetion
- may need to treat concurrent anxiety
- four classes: TCAs, MAOIs, SSRIs, Atypical/others SNRI, SNDI
Describe therapeutic index
- high TI: large range
- low TI: small range (lithium/more dangerous)
- inhibit reputake of norepi and serotonin; has sedating effects/aids in sleep
- 4-6 wek for full effect, increased anticholinergic effects; Cardiovascular effects; need full workup; contraindicated if CV disease
- Hghly lethal (fatal in overdose, 2 wk supply can kill anyone)
- Characteristic three ring nucleus
- side effects: most seious is cardiac toxicity= palpitations, tachycardia, dizziness due to increase NE
- Ex: amytriptiline, imipramine, desipramine, nortiptyline, doxepin
- developed for the tx of TB in 1951; not widely used today, are readily absorbed by GI tract and widely distributed throughout body, effects persist even after these drugs are no longer detectable in plasma (1-3 weeks)
- negative drug reaction with any drug metabolized by MAO including SSRIs, TCAs, meperidine, alcohol, CNS depressants, phenylephrine (O/C nasal decongestants), amphetamines) interaction = hyperpyrexia or hyperexcitation syndrome, involving high fever, delirium and HTN); Wne and cheese effect
- examples: isocarboxacid, phenelzine, tranylcypromine, Ensam patch
WHat is the wine and cheese reaction?
Fatal interaction with tyramine containing foods (fermented foods in particular, such as wine and cheese). a decreased MAO = increased tyramine in the body = increased NE in circulation = induction of htn crises= can lead to intracranial bleeding and other organ damage
- *Most widely prescribed drug for depression; they have few s/e and have better compliance;
- specific serotonin uptake inhibitors increas 5HT by inhibiting reuptake
- Adverse effects: nausea, decreased libido, decrease sexual function. Low threat for overdose. Suicide may be considered in severe depression
- examples: fluoxetine, sertraline, paroxetine, fluvoxamine, citolopram, escitalopram
What is the SSRI prototype? how soon will therapy be effective? what is the half life?
- prototye: fluoxetine
- approx 70% of depressed clients will respond to an SSRI therapy at the end of 6 weeks. 4-6 weeks before effects are evident
- Half life: 16-24 hours
What is serotonin syndrome? what drug-drug interaction can occur with SSRIs?
- Serotonin syndrome: Hyperthermia, muscle rigidty, myoclonus, rapid changes in mental status and vital signs; thus it is important to wait upto 6 weeks after mediction is stopped, before starting with another drug
- drug-drug interaction: dangerous with other antidepressant drugs MAOIs in particular
What are the atypical 2nd generation and 3rd gen antidepressants?