Ch. 16 Depressive Disorder Flashcards by Courtney (Brianna) Sluss

mood

emotion that we’re feeling

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affect

emotion that we’re seeing

“someone may look sad”

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Depression is more common in

young women than in young men

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anhedonia

loss of interest or pleasure in usual activities

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Major Depressive Disorder

Characterized by a depressive mood
Anhedonia
Symptoms present for at least 2 weeks
No history of manic behavior
Cannot be attributed to use of substances or another medical condition

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Dysthymic Disorder

"eeyore"
Sad or down in the dumps
No evidence of psychotic symptoms
Essential feature is a chronically depressed mood for: 
most of the day
more days than not
at least two years

Daily life

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Premenstrual dysphoric disorder

Depressed mood
Anxiety 
Mood swings 
Decreased interest in activities
Symptoms begin during week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

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Substance-induced depressive disorder

Considered to be the direct result of physiological effects of a substance

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Depressive disorder associated with another medical condition

Attributable to the direct physiological effects of a general medical condition

Chronic or Terminal

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Childhood depression

precipitated by a loss

alleviate symptoms and strengthen coping skills

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adolescence

symptoms: anger, running away, substance abuse, sexual acting out, delinquency

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Adolescence depression

a visible manifestation of behavioral change that last for several weeks

treat with antidepressants

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Antidepressants

BLACK BOX WARNING FOR INCREASED RISK OF SUICIDE IN CHILDREN AND ADOLESCENTS

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Postpartum Depression

May last for a few weeks to several months
Associated with hormonal changes, tryptophan metabolism, or cell alterations

Treatments:
Antidepressants and psychosocial therapies

Symptoms:
Fatigue
Irritability
Loss of appetite
Sleep disturbances
Loss of libido
Concern about inability to care for infant

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Transient depression

Symptoms at this level of the continuum are not necessarily dysfunctional.

the “blues”, some crying, some difficulty getting mind off one’s disappointment, feeling tired ad listless

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Mild depression

Symptoms of mild depression are identified by clinicians as those associated with normal grieving.

Affective: Anger, anxiety

Behavioral: Tearful, regression

Cognitive: Preoccupied with loss

Physiological: anorexia, insomnia

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Moderate Depression

Symptoms associated with dysthymic disorder

Affective: Helpless, powerless

Behavioral: Slowed physical movements, slumped posture, limited verbalization

Cognitive: Retarded thinking processes, difficulty with concentration

Physiological: Anorexia or overeating, sleep disturbance, headaches

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Severe Depression

Includes symptoms of major depressive disorder and bipolar depression

Affective: feelings of total despair, worthlessness, flat affect

Behavioral: psychomotor retardation, curled-up position, absence of communication

Cognitive: prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts

Physiological: a general slow-down of the entire body

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outcomes for the client

no physical harm
discuss the loss
sets realistic goals
attempts new things

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risk for suicide

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encourage to talk
be direct
maintain close observation

complicated grieving

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express emotions

crying is acceptable

low self esteem

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be accepting
encourage client
encourage independence to perform ADL’s

powerlessness

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help client set goals

encourage to take responsibility

support services

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suicide hotline
support groups
financial assistance

Group Therapy

talk and recover

Electroconvulsive Therapy

thought to increase levels of biogenic amines

side effects of ECT

temporary memory loss and confusion

risks of ECT

mortality, brain damage, permanent memory loss

Psychopharmacology

Tricyclics Selective serotonin reuptake inhibitors(SSRIs) Monoamine oxidase inhibitors (MAOIs) Serotonin-norepinephrine reuptake inhibitors

SSRI's( serotonin being increased)

``` Celexa(citalopram) Lexapro(escitalopram) Luvox(fluvoxamine) Paxil(paroxetine) Prozac(fluoxetine) Zoloft(sertraline) ```

SSRI's adverse reactions

sexual side effects; guys don;t want to take dry mouth, tremor, sweating, increased anxiety(serotonin is increased)

serotonin syndrome

tachycardia, fever, increased bp, tonic rigidity, seizures leading to apnea and death

treatment of serotonin syndrome

receptor blockade with Cyproheptadine(Periactin) and/or Propranolol.

SSRI teaching

do not discontinue suddenly bc of withdrawal

Serotonin-norepinephrine reuptake inhibitors (new atypicals or SNRIs)

Work in various ways blocking the reuptake of serotonin, norepinephrine, and/or dopamine.

cymbalta

SNRI: useful with comorbid pain

Vestra

SNRI: depression with impaired social functioning

Wellbutrin

SNRI: assistance with smoking cessation increases risk for seizures

Desyrel

SNRI: taken at night to aid with sleep

Tricyclics (TCA)

Depression to target symptoms such as insomnia or anorexia

TCA adverse reactions

Anticholinergic: dry mouth, blurred vision, constipation, urinary hesitancy, weight gain, postural hypotension(fall risk)

TCA toxic effects

cardiac issues, dysrhythmias, MI, heart block, need full cardiac work up

TCA client teaching

can take 10-14 days to work with full effect up to 6-8 weeks. dose generally taken at bedtime do not stop suddenly

MAOI's

lowers the enzyme responsible for breaking down norepinephrine, serotonin, dopamine, and tyramine.

MAOI's side effects

Weight gain, insomnia, confusion, and hypotension (most common and normal side effect).

MAOI: Hypertensive Crisis

Hypertensive crisis occurs after ingesting a substance containing tyramine. Since MAOI’s lower the enzyme for breaking down tyramine, ingesting more of it is toxic and causes the increased blood pressure that may lead to the hypertensive crisis. Monitor blood pressure Do not take over the counter cough medicine

Tyramine foods

smoked/aged meats, sausages, cheeses, yeast, chocolate, red wine, caffeine, soy sauce, beer, figs, avocados

Must stay on drug and dietary restrictions for how many weeks after stopping MAOI's?

2 weeks

Ch. 16 Depressive Disorder Flashcards

(48 cards)