13 Depressive Disorders

Question 1

depression

Answer 1

mood (affective) disorder

• widespread issue
• ranking high among causes of disability
• high risk of suicide

Question 2

common morbidities w Depression

Answer 2

• anxiety disorder (70% of pt)
• psychotic disorder
• substance use disorder
• eating disorder
• personality disorder

Question 3

Depressive Disorders recognized by DSM-5

Answer 3

1 Major Depressive Disorder
2 Seasonal Affective Disorder
3 Persistent Depressive Disorder
4 Premenstrual Dysphoric Disorder
5 Substance-Induced Depressive Disorder

Question 4

Major Depressive Disorder

Answer 4

single or recurrent episode of unipolar depression

• not assoc w mood swings
• results in significant change in a client’s normal functioning

Question 5

Major Depressive Disorder is assoc w atleast 5 of the following manifestations which must occur almost everyday for a min of 2 weeks

Answer 5

-depressed mood
-difficulty sleeping or excessive sleeping
-indecisiveness
decr ability to concentrate
-suicidal ideation
-incr/decr motor activity
-inability to feel pleasure
-incr/decr wt

Question 6

MDD can be further diagnosed w more specific classification using the DSM-5

Answer 6

Psychotic Features

Postpartum onset

Question 7

Psychotic Features

Answer 7

presence of auditory hallucination or delusion (client thinking they have a fatal disease)

Question 8

Postpartum onset

Answer 8

beings w/in 4 wks of childbirth

-can include delusions

Question 9

Seasonal Affective Disorder

Answer 9

form of depression that occurs seasonally

-usually winter bc less daylight

Question 10

first line of tx for SAD

Answer 10

light therapy

Question 11

Persistent Depressive Disorder

Answer 11

milder form of depressin

• usually early onset (child-adolescent)
• lasts atleast 2 yrs for adults
• contains at least 3 manifestations of depression

Question 12

Premenstrual Dysphoric Disorder

Answer 12

• assoc w luteal phase of menses

- 2-6% of fem causes problems that can be severe enough to interfere w ability of pt to work/interact w others

Question 13

Premenstrual Dysphoric Disorder

manifestations

Answer 13

-mood swing
-irritability
-depress
-anxiety
-difficulty concentrating
-lack energy
overeat
-hyper or insomnia
-breast tenderness
-aching
-bloating
-wt gain

Question 14

Premenstrual Dysphoric Disorder

Tx

Answer 14

• exercise
• diet
• relaxation therapy

Question 15

what is the most significant risk factor for depression?

Answer 15

family/personal hx

Question 16

risk factors for depression

Answer 16

• fam hx
• personal hx
• female
• 65+ yo
• neurotransmitter deficiencies

Question 17

neurotransmitter deficiencies that cause depression

Answer 17

serotonin (mood, sex, sleep, hunger, pain)
norepinephrine (attentn + behavior)
dopamine, acetylcholine, GABA, glutamate

Question 18

expected findings in depression

Answer 18

• anergia
• anhedonia
• anxiety
• sluggish or unable to relac
• vegetative findings
• somatic reports [fatigue, GI, pain]

Question 19

vegetative findings in depression

Answer 19

• change in eating
• sleep disturbance
• decr sexual activity
• change in bowel habits

Question 20

anorexia is usually assoc w _____ + incr intake is assoc w ______

Answer 20

A: MDD
II: PMDD

Question 21

physical assessment findings in depression

Answer 21

• blunted
• poor grooming/hygiene
• psychomotor retardation (more common)
• psychomotor agitation
• socially isolated
• slowed speech, decr verbalization, delayed response like too tired to speak

Question 22

types of standardized screening

Answer 22

• hamilton depression scale
• beck depression inventory
• geriatric depression scale
• zung self rating
• pt health questionnaire

Question 23

milieu therapy

Answer 23

• suicide risk
• self care
• communication
• maintenance of safe environment
• counseling

Question 24

SSRI

drug names

Answer 24

• citalopram
• fluoxetine
• setraline

Question 25

leading Tx for depression

Answer 25

selective serotonin reuptake inhibitors

Question 26

SSRI | A/E

Answer 26

- nausea - headache - CNS stim (agitation, insomnia, anxiety) - sexual dysfunction (contact provider) - serotonin syndrome - wt gain w long term use

Question 27

avoid the use to ____ while on SSRI

Answer 27

st john's wort | -incr risk of serotonin syndrome

Question 28

tricyclic antidepressant | drug name

Answer 28

amitriptyline

Question 29

tricyclic antidepressant | A/E

Answer 29

- ortho hypotension: move slowly | - antichol effect: chew sugarless hum, high fiber diet, incr fluid intake

Question 30

monoamine oxidase inhibitors MAOI | drug name

Answer 30

phenelzine

Question 31

MAOI: phenelzine | pt teachings

Answer 31

- due to HTN crisis, avoid foods high in tyramine | - avoid all meds including OTC w/o first discussing w provider

Question 32

atypical antidepressant | drug name

Answer 32

bupropion

Question 33

bupropion (atypcl antidprssnt) | teaching

Answer 33

- observe for: headache, dry mouth, GI distress, constipatn, incr HR, nausea, restless, insomnia - monitor food intake + wt due to appetite suppresion

Question 34

bupropion (atypcl antidprssnt) | CI

Answer 34

at risk for seizures

Question 35

serotonin norepinephrine reuptake inhibitors SNRI | drug names

Answer 35

venlafaxine | duloxetine

Question 36

SNRI: venlafaxine, duloxetine | A/E

Answer 36

- nausea - insomnia - wt gain - diaphoresis - sex dysfunction

Question 37

SNRI: venlafaxine, duloxetine | caution

Answer 37

pt w Hx of HTN

Question 38

st john's wort

Answer 38

plant product | -relief of manifestations of mild depression

Question 39

st john's wort | A/E

Answer 39

- photosensitivity - skin rash - rapid HR - GI distress - ab pain

Question 40

light therapy

Answer 40

exposure of the face to 10k-lux light box 30 min/day

Question 41

types of alternative/complimentary therapies

Answer 41

- light therapy - electroconvulsive - transcranial magnetic stimulation - vagus nerve stimulation

Question 42

Interpersonal Therapy

Answer 42

encourages client to focus on personal relationship that contribute to depressive disorder

Question 43

exercise on depression

Answer 43

- helps improve + prevent relapse | - 30 min 3-5x/wk