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Exam 4-DWB > Depression > Flashcards

Depression Flashcards

1
Q

Significant issues with adolescents and mental health

A
  1. context for looking at it
  2. developmental framework
  3. significance for FNP practice
  4. concerns about how to address them
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2
Q

Statistics with adolescents and mental health

A
  1. four million children/adolescents in US have serious mental disorder that causes significant functional impairment
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3
Q

Of children 9-17 years old, 21% have

A

a diagnosable mental or addictive disorder

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4
Q

half of all lifetime mental disorders begin by what age

A

14

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5
Q

Why does depression stand out in adolescents

A
  1. affects growth and development
  2. affects school performance
  3. affects family life/relationships
  4. affects adolescent adjustment
  5. potential to affect long-term functioning
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6
Q

Depression in adolescents is difficult to diagnosis why

A

because it can be difficult to distinguish it from normal adolescent growth and development

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7
Q

Depression in adolescents is the leading cause of what

A

suicidal behavior and suicide

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8
Q

Major depression in adolescence is a psychosocial dysfunction manifested by

A
  1. severe sadness
  2. withdrawn behavior
  3. boredom
  4. low self-esteem
  5. feeling helpless and hopeless
  6. sense that there is no meaning to life
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9
Q

Depression in adolescence must be differentiated between

A

symptoms of depression from chronic, sad, irritable moods, which are normal experiences;
Must decide which behaviors are normal variants, developmental transitions, temperamental manifestations, or primary manifestations of psychiatric disorders

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10
Q

DSM-5 classifications for depression diagnosis

A
  1. major depressive disorder
  2. persistent depressive disorder {dysthymia}
  3. premenstrual dysphoric disorder {PMDD}
  4. substance-/medication-induced depressive disorder
  5. depressive disorder d/t another medical condition
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11
Q

Major Depressive Disorder {MDD} DSM-5 criteria

A

5 or more symptoms must be present during same 2-week period; with at least one of the symptoms being depressed mood or loss of interest or pleasure:

  1. depressed or irritable mood
  2. diminished interest or pleasure in activities
  3. weight change or appetite disturbance
  4. insomnia or hypersomnia
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12
Q

Persistent Depressive Disorder {dysthymia} DSM-5 criteria

A
  1. an overwhelming, chronic state of depression
  2. depressed mood most days for at least 2 years with baseline irritable or depressed
  3. has not gone for more than 2 months without 2+ of the following sx:
    a. poor appetite or overeating
    b. insomnia or hypersomnia
    c. low energy
    d. low self-esteem
    e. difficulty making decisions
    f. feelings of hopelessness
  4. symptoms must cause significant distress in social, work, school, or other areas of functioning
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13
Q

With persistent depressive disorder {dysthymia} you must rule out

A
  1. substance abuse
  2. manic episodes
  3. other medical conditions
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14
Q

What underlies the risk for depression

A

genetics:

children with depressed parents have 3 x the risk to be diagnosed, with peak incidence between 15-20 years old

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15
Q

What is common with adolescent depression

A

it is often chronic and comes and goes

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16
Q

what are the reasons for not treating depression in child/adolescence

A
  1. stigma attached to mental illness
  2. atypical presentations
  3. lack of adequate mental health education
  4. lack of providers
  5. insurance issues
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17
Q

What is a big problem for younger children with depression

A

underdiagnosis and treatment d/t tendency to somatize, to present with general aches and pains

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18
Q

Traditional Depression Signs

A
  • sadness
  • tearfulness
  • depressed mood
  • sleep disturbance
  • appetite disturbance
  • poor concentration
  • suicidal ideation or actions
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19
Q

Incidence of depression

A
  • women>men
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20
Q

Consider depression with

A
  • unusual and recurring fatigue
  • unexplained weight loss
  • vague, unexplained physical symptoms or “just not right” feeling
  • irritability and/or apathy
  • frequent dr visits
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21
Q

Depression overlaps with

A
  • fibromyalgia
  • migraines/headache syndrome
  • premenstrual syndrome (severe)
  • irritable bowel syndrome
  • chronic fatigue syndrome
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22
Q

Brain scan for patient with depression

A
  • is markedly different than not depressed
  • decreased brain activity
  • less areas of cognitive function lit up on MRI
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23
Q

Types of depression

A
  1. major depressive episode
  2. dysthymic disorder
  3. double depression
  4. seasonal affective disorder
  5. depression secondary to substance abuse
  6. postpartum depression
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24
Q

Major depressive episode

A
  • single or recurrent
  • is most common form
  • maintains mood/function until depression hits
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25
Q

Dysthymic diorder

A
  • not a major depression

- living at subpar level

26
Q

double depression

A
  • either dysthymic or major depression with anxiety
27
Q

Symptoms of double depression

A 
depression sx:
- fatigue
- feeling down
- lack of interest
anxiety sx:
- insomnia
- racing thoughts
- inability to sit still
28
Q

tretament for double depression

A

treatment with antidepressants will often relieve both sets of symptoms

29
Q

Seasonal affective disorder

A

depressed in fall and winter with less exposure to ambient light

30
Q

Depression secondary to substance abuse

A
  • “chicken or the egg” situation: difficult to determine which brought on the other;
  • attack on both angles
31
Q

postpartum depression

A
  • occurs directly after childbirth

- can be severe, every woman should be screened

32
Q

Things to remember about depression

A
  • depression is depression regardless of cause
  • all depression merits treatment
  • never make assumptions or minimize patients complaints
33
Q

The overlap of anxiety and depression

A
  • very anxious people may have underlying depression
  • depression may be present in classic anxiety
  • recovery may be delayed until recognized
34
Q

Common comorbidities to depression

A
  • panic attacks
  • bulimia, anorexia
  • obsessive-compulsive problems
  • frequent mood springs
35
Q

Who is at higher risk of depression

A
  • if one + blood relatives with depression
  • personal/family hx of depression
  • parent loss;
  • early life abuse or trauma
36
Q

When are women at higher risk of depression

A

during hormonal shifts:

  1. puberty
  2. pregnancy
  3. postpartum
  4. menopause
    * *women without previous history may present with first episode during this period
37
Q

Treatment for depression during hormonal shifts

A

treat both hormonal fluctuations and depression

38
Q

Alcohol and depression

A
  • alcohol depresses CNS and slows down nerve firing and may make brain less active
39
Q

What is a common co-occurence with depression

A

Alcohol abuse

40
Q

Moderate drinking and depression

A

no more than 1 drink/day does not predispose a person to depression

41
Q

Primary Care Services for depression

A
  • do no normal PE and lab testing;

- depression that interferes with functioning is often chronic, relapsing, biological illness

42
Q

Medical illnesses that mimic depression

A
  • hypothyroidism
  • low blood sugar
  • vitamin D deficiency
  • caffeine withdrawal
  • early dementia
43
Q

Educating patients about recurrence

A
  • symptoms may recur and they don’t have to face alone

- describe as a medical illness that can recur

44
Q

Fastest and most effective treatment for depression

A
  • use of psychotherapy and medication
  • some pt will say no to one or the other, or both;
  • give whatever they will accept
45
Q

Facts about antidepressants

A
  • not addictive
  • must be taken daily to build up
  • may take 10-14 days to begin to work
  • friends/family notice change before pt often
  • augmenting/stopping not advisable;
  • if one med doesn’t work another may
46
Q

Black box warnings for antidepressants

A
  • warn of possible increase in suicide ideation and action in adolescents
  • 1% increase in suicidal ideation in adolescents
  • medications more beneficial than harmful
  • medications cause minimal changes in pt’s lifestyle;
47
Q

Pure depression treatment

A

any antidepressant will yield 60-70% positive response

48
Q

Antidepressants should be taken for how long

A
  • for a minimum of 4-6 months from time pt feels well;
  • if taken away too soon can precipitate relapse
  • everyone should be tried off meds within first 12 months
49
Q

Transitioning off of antidepressants

A
  • collaborate with pt as to when discontinuation should happen
  • counsel fearful pts to at least try
  • remind pt that if depression recurs, we will know what meds work
50
Q

Natural remedy preferences for depression

A
  • St. Johns wort offered as a substitute to synthetic meds with dose 900-1800 mg/day for 1 month
  • St. Johns wort affects serotonin levels
  • not FDA approved
51
Q

St Johns wort for depression may lower

A

estrogen levels;

  • women taking OBC or hormone replacement and may need adjustments to meds
  • may need to encourage a backup BC method until efficacy is determined
52
Q

St. Johns wort should not be combied with

A

antidepressants

53
Q

adherence to antidepressant treatment

A
  • pt may have difficulty accepting diagnosis and need for medication.
  • 77% stop meds before completing full course;
  • 50% stop within first 30days
54
Q

what should be explored if patient is resistant to antidepressants

A

talk therapy

55
Q

5 points of patient education for depression

A
  1. take med as prescribed every day;
  2. It may take time to see a response
  3. do not stop taking medication without contacting PCP
  4. do not stop med just because you feel better
  5. Call PCP with any concerns or questions
56
Q

Adjunctive recommendations for depression

A
  • exercise generally helps but not specific to depression
  • diet changes to maintain nutrition
  • sleep hygiene and daily structure (get up even if you have nothing to do)
57
Q

Long term management of depression

A
  • recognize that once stabilized, continuation of psychotherapy and/or meds are independent decisions
  • work with pt to determine action plan
  • do not stop both psychotherapy and meds at same time
58
Q

Electroconvulsive therapy for depression

A
  • modality not done in primary care
  • most effective treatment available, statistically
  • not used most often (very invasive)
  • neurotransmitters can change, many side effects to inducing seizures in patients
  • widely misunderstood and unnecissarily avoided
  • used for severe and intractable depression
  • unilateral treatments minimize side effects
59
Q

Amount of Electroconvulsive therapy for depression

A

6-12 treatments over 4-6 weeks

60
Q

Biomarkers for depression

A
  • three of nine particular blood levels are elevated when someone becomes depressed;
  • potential for screening test for at-risk patients
61
Q

inflammatory markers for depression

A
  • elevated with depression;

- unsure of intersection between inflammation and depression

Exam 4-DWB (20 decks)

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