Ch. 16 Depressive Disorders Flashcards

Question

Symptoms of depression from ages 9 to 12

Answer 1

Common symptoms include.. - Morbid thoughts - Excessive worrying. They may reason that they are depressed because... - They have disappointed their parents in some way. There may be... - Lack of interest in playing with friends.

Answer 2

- Common precipitating factors include physical or emotional detachment by the primary caregiver, parental separation or divorce, death of a loved one (person or pet), a move, academic failure, or physical illness. In any event, the common denominator is loss. - The focus of therapy for depressed children is to alleviate the child’s symptoms and strengthen the child’s coping and adaptive skills with the hope of possibly preventing future psychological problems. - Parental and family therapy are commonly used to help the younger depressed child.

Answer 3

- Inappropriately expressed anger - Aggressiveness - Running away - Delinquency - Social withdrawal - Sexual acting out - Substance abuse - Restlessness - Apathy - Loss of self-esteem - Sleeping and eating disturbances, - Psychosomatic complaints A visible manifestation of behavioral change that lasts for several weeks is the best clue for a mood disorder. The perception of abandonment by parents or closest peer relationship is thought to be the most frequent immediate precipitant to adolescent suicide. Treatment - In addition to supportive psychosocial intervention, antidepressant therapy - Black box warning on antidepressants: Increased risk of suicidal thoughts and behavior in children and adolescents

Answer 4

- Bereavement overload occurs when individuals experience so many losses in their lives that they are not able to resolve one grief response before another one begins. Predisposes elderly to depression - The elderly account for a proportionately larger percentage of the suicides in the United States. - Symptoms of depression are often misdiagnosed as neurocognitive disorder when, in fact, the memory loss, confused thinking, or apathy symptomatic of NCD may be the result of depression. - Antidepressant medications are administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity. - ECT in the elderly is “highly effective, safe, and well tolerated” in the geriatric population. May be considered the tx of choice for the elderly individual who is an acute suicidal risk or is unable to tolerate antidepressant medications. - Also interpersonal, behavioral, cognitive, group, and family psychotherapies.

Answer 5

Symptoms of the “baby blues” include... - Worry - Sadness - Fatiguea These symptoms affect about 80 percent of mothers and usually subside within a week or two

Answer 6

Symptoms include... - Depressed mood varying from day to day, with more bad days than good tending to be worse toward evening and associated with... - Fatigue - Irritability - Loss of appetite - Sleep disturbances - Loss of libido - Expresses a great deal of concern about her inability to care for her baby. Symptoms begin somewhat later than those described in the maternity blues and take from a few weeks to several months to abate. Etiology may very likely be a combination of hormonal, metabolic (tryptophan), and psychosocial influences. Treatment varies with the severity of the illness. Psychotic depression may be treated with antidepressant medication, along with supportive psychotherapy, group therapy, and possibly family therapy.

Answer 7

(1) affective, (2) behavioral, (3) cognitive, and (4) physiological Alterations within these spheres differ according to degree of severity of symptomatology.

Answer 8

Symptoms at this level of the continuum are not necessarily dysfunctional. Transient depression subsides quickly, and the individual is able to refocus on other goals and achievements. ■ Affective: Sadness, dejection, feeling downhearted, having the blues ■ Behavioral: Some crying ■ Cognitive: Some difficulty getting mind off one’s disappointment ■ Physiological: Feeling tired and listless

Answer 9

Symptoms at the mild level of depression are like those associated with uncomplicated grieving ■ Affective: Denial of feelings, anger, anxiety, guilt, helplessness, hopelessness, sadness, despondency ■ Behavioral: Tearfulness, regression, restlessness, agitation, withdrawal ■ Cognitive: Preoccupation with the loss, self-blame, ambivalence, blaming others ■ Physiological: Anorexia or overeating, insomnia or hypersomnia, headache, backache, chest pain, or other symptoms associated with the loss of a significant other

Answer 10

Dysthymia (persistent depression disorder) is an example. Characterized by symptoms that are enduring for at least 2 years ■ Affective: Feelings of sadness, dejection, helplessness, powerlessness, hopelessness; gloomy and pessimistic outlook; low self-esteem; difficulty experiencing pleasure in activities ■ Behavioral: Sluggish physical movements (i.e., psychomotor retardation); slumped posture; slowed speech; limited verbalizations, possibly consisting of ruminations about life’s failures or regrets; social isolation with a focus on the self; increased use of substances possible; self-destructive behavior possible; decreased interest in personal hygiene and grooming ■ Cognitive: Slowed thinking processes; difficulty concentrating and directing attention; obsessive and repetitive thoughts, generally portraying pessimism and negativism; verbalizations and behavior reflecting suicidal ideation ■ Physiological: Anorexia or overeating; insomnia or hypersomnia; sleep disturbances; amenorrhea; decreased libido; headaches; backaches; chest pain; abdominal pain; low energy level; fatigue and listlessness; feeling best early in the morning and continually worse as the day progresses

Answer 11

Also called Major Depressive Disorder ■ Affective: Feelings of total despair, hopelessness, and worthlessness; flat (unchanging) affect, appearing devoid of emotional tone; prevalent feelings of nothingness and emptiness; apathy; loneliness; sadness; inability to feel pleasure ■ Behavioral: Psychomotor retardation so severe that physical movement may literally come to a standstill, or psychomotor behavior manifested by rapid, agitated, purposeless movements; lumped posture; sitting in a curled-up position; walking slowly and rigidly; virtually nonexistent communication (verbalization reflect delusional thinking); no personal hygiene and grooming; social isolation is common, with virtually no inclination toward interaction with others ■ Cognitive: Prevalent delusional thinking with delusions of persecution and somatic delusions being most common; confusion, indecisiveness, and an inability to concentrate; hallucinations reflecting misinterpretations of the environment; excessive self-deprecation, self-blame, and thoughts of suicide ■ Physiological: A general slowdown of the entire body, reflected in sluggish digestion, constipation, and urinary retention; amenorrhea; impotence; diminished libido; anorexia; weight loss; difficulty falling asleep and awakening very early in the morning; feeling worse early in the morning and somewhat better as the day progresses

Answer 12

■ Has experienced no physical harm to self. ■ Discusses feelings with staff and family members. ■ Expresses hopefulness. ■ Sets realistic goals for self. ■ Is no longer afraid to attempt new activities. ■ Is able to identify aspects of self-control over life situation. ■ Expresses personal satisfaction and support from spiritual practices. ■ Interacts willingly and appropriately with others. ■ Is able to maintain reality orientation. ■ Is able to concentrate, reason, solve problems, and make decisions. ■ Eats a well-balanced diet with snacks to prevent weight loss and maintain nutritional status. ■ Sleeps 6 to 8 hours per night and reports feeling well rested. ■ Bathes, washes and combs hair, and dresses in clean clothing without assistance.

Answer 13

Depressed mood Feelings of hopelessness and worthlessness Anger turned inward in the self Misinterpretations of reality Suicidal ideation, plan, and available means

Answer 14

Depression Preoccupation with thoughts of loss Self-blame Grief avoidance Inappropriate expression of anger Decreased functioning in life roles

Answer 15

Expressions of helplessness, uselessness, guilt, and shame Hypersensitivity to slight or criticism Negative, pessimistic outlook Lack of eye contact Self-negating verbalizations

Answer 16

Apathy Verbal expressions of having no control Dependence on others to fulfill needs

Answer 17

Expresses anger toward God Expresses lack of meaning in life Sudden changes in spiritual practices Refuses interactions with significant others or with spiritual leaders

Answer 18

Withdrawn Uncommunicative Seeks to be alone Dysfunctional interaction with others Discomfort in social situations

Answer 19

Inappropriate thinking Confusion Difficulty concentrating Impaired problem-solving ability Inaccurate interpretation of environment Memory deficit

Answer 20

Weight loss Poor muscle tone Pale conjunctiva and mucous membranes Poor skin turgor Weakness

Answer 21

Difficulty falling asleep Difficulty staying asleep Lack of energy Difficulty concentrating Verbal reports of not feeling well rested

Answer 22

Uncombed hair, disheveled clothing, offensive body odor

Answer 23

■ Has self-harm to the individual been a voided? ■ Have suicidal ideations subsided? ■ Does the individual know where to seek assistance outside the hospital when suicidal thoughts occur? ■ Has the patient discussed the recent loss with staff and family members? ■ Is he or she able to verbalize feelings and behaviors associated with each stage of the grieving process and recognize own position in the process? ■ Have obsession with and idealization of the lost object subsided? ■ Is anger toward the lost object expressed appropriately? ■ Does the patient set realistic goals for self? ■ Is he or she able to verbalize positive aspects about self, past accomplishments, and future prospects, including a desire to live? ■ Can the patient identify areas of life situation over which he or she has control? ■ Is the patient able to participate in usual religious practices and feel satisfaction and support from them? ■ Is the patient seeking interaction with others in an appropriate manner? ■ Does the patient maintain reality orientation with no evidence of delusional thinking? ■ Is he or she able to concentrate and make decisions concerning own self-care? ■ Is the patient selecting and consuming foods sufficiently high in nutrients and calories to maintain weight and nutritional status? ■ Does the patient sleep without difficulty and wake feeling rested? ■ Does the patient attend to personal hygiene and grooming? ■ Have somatic complaints subsided?

Answer 24

■ Patient will seek out staff when feeling urge to harm self. ■ Patient will not harm self. (short, long)

Answer 25

1. Ask pt directly: “Have you thought about killing yourself?” or “Have you thought about harming yourself in any way? If so, what do you plan to do? Do you have the means to carry out this plan? How strong are your intentions to die?” - Risk of suicide is greatly increased if the pt has developed a plan, has strong intentions to die, and if means exist. 2. Create a safe environment for the pt. Remove all potentially harmful objects from pt’s access. Supervise closely during meals and med administration. Perform room searches as necessary. - Patient safety is a nursing priority. 3. Convey an attitude of unconditional acceptance of the pt as a worthwhile individual. Encourage the pt to actively participate in establishing a safety plan. - Relationship founded on trust and acceptance is essential for collaboration with the pt in developing a plan for their ongoing safety. Suicidal clients are often ambivalent about their feelings r/t suicide and discussion about strategies for maintaining safety. Empower the pt to collaborate in preventing a crisis situation. 4. Maintain close observation of the patient. One-to-one contact, constant visual observation, or every-15-minute checks. Place in room close to nurse’s station, no private room. Accompany to off-unit activities and bathroom if necessary. - Close observation is necessary to ensure that patient does not harm self in any way. Facilitates being able to prevent or interrupt harmful behavior. 5. Maintain special care in administration of medications. - Prevents saving up to overdose or discarding and not taking. 6. Make rounds at frequent, irregular intervals (Esp at busy times for staff) - Prevents staff surveillance from becoming predictable. Being aware of pt location is important. 7. Encourage pt to express honest feelings, including anger. Provide hostility release. Help the pt identify the true source of anger and work on adaptive coping skills for use outside the tx setting. - Depression/suicidal behaviors may be viewed as anger turned inward on the self. If anger can be verbalized in a nonthreatening environment, the client may eventually be able to resolve these feelings. 8. Identify community resources that the pt can access for support and assistance as needed post-discharge. - Having a concrete plan for seeking assistance should suicidal ideation recur or intensify post-discharge assists the client to manage symptoms and prevent self-destructive behaviors.

Answer 26

■ Patient will express anger about the loss. ■ Patient will verbalize behaviors associated with normal grieving. ■ Patient will be able to recognize his or her own position in the grief process, while progressing at own pace toward resolution.

Answer 27

1. Determine the stage of grief in which the pt is fixed and the behaviors associated with this stage. - Accurate data is necessary to effectively plan care for the grieving pt. 2. Develop a trusting relationship with the patient. Show empathy, concern, and unconditional positive regard. Be honest and keep all promises. - Trust is the basis for a therapeutic relationship. 3. Convey an accepting attitude and enable the pt to express feelings openly. - An accepting attitude conveys to the pt that you believe they are a worthwhile person. Trust is enhanced. 4. Encourage pt to express anger. Don't become defensive if the initial expression of anger is displaced on the nurse. Help the pt explore angry feelings so that they may be directed toward the actual intended person or situation. - May help the client come to terms with unresolved issues. 5. Help the pt to discharge pent-up anger through participation in large motor activities - Physical exercise provides a safe and effective method for discharging pent-up tension. 6. Teach the normal stages of grief and behaviors associated with each stage. Help the patient to understand that feelings such as guilt and anger are appropriate during the grief process and should be expressed. - Knowledge of acceptability of the feelings associated with normal grieving may help to relieve some of the guilt these responses generate. 7. Encourage the pt to review the relationship with the lost entity. With support and sensitivity, point out the reality of the situation in areas where misrepresentations are expressed. - The pt must give up an idealized perception and be able to accept both positive and negative aspects about the lost entity before the grief process is complete. 8. Communicate to the pt that crying is acceptable. Use of touch may also be therapeutic. - It is important to be aware of individual preferences before employing these interventions. 9. Encourage the pt to reach out for spiritual support during this time in whatever form is desirable to him or her. Assess spiritual needs of the patient and assist to fullfill those needs. - Pt may find comfort in religious rituals with which he or she is familiar.

Answer 28

■ Patient will verbalize areas he or she likes about self. ■ Patient will attempt new activities without fear of failure. ■ By time of discharge from treatment, client will exhibit increased feelings of self-worth as evidenced by verbal expression of positive aspects of self, past accomplishments, and future prospects.

Answer 29

1. Be accepting of pt and spend time with them even though pessimism and negativism may seem objectionable. Focus on strengths and accomplishments. - Interventions that focus on the positive contribute toward feelings of self-worth. 2. Promote attendance in therapy groups that offer pt simple methods of accomplishment. Encourage patient to be as independent as possible. - Success and independence promote feelings of self-worth. 3. Encourage pt to recognize areas of change and provide assistance toward this effort. - Pt will need assistance with problem-solving. 4. Teach assertiveness techniques: the ability to recognize the differences among passive, assertive, and aggressive behaviors; and the importance of respecting the human rights of others while protecting one’s own basic human rights. - Self-esteem is enhanced by the ability to interact with others in an assertive manner. 5. Teach effective communication techniques, such as the use of “I” messages - “I” statements help to avoid making judgmental statements.

Answer 30

■ Patient will participate in decision making regarding own care within 5 days. ■ Patient will be able to effectively problem solve ways to take control of his or her life situation by time of discharge from treatment, thereby decreasing feelings of powerlessness.

Answer 31

1. Encourage pt to take as much responsibility as possible for own self-care practices. In the most acute stage of severe depression, pts may have extreme difficulty making decisions. It may be more helpful to use active communication to help the client accomplish even basic ADLs. - Providing patient with choices will increase his or her feelings of control. 2. Help pt set realistic goals. - Realistic goals will avoid setting patient up for failure and reinforcing feelings of powerlessness. 3. Help pt identify areas of life situation that he or she can control. - Pt’s emotional condition interferes with his/her ability to solve problems. Assistance is required to perceive the benefits and consequences of available alternatives accurately. 4. Help pt identify areas of life situation that are not within his or her ability to control. Encourage verbalization of feelings related to this inability. - Verbalization of unresolved issues may help pt accept what cannot be changed.

Answer 32

■ Patient will identify meaning and purpose in life, moving forward with hope for the future. ■ Patient will express achievement of support and personal satisfaction from spiritual practices.

Answer 33

1. Be accepting and nonjudgmental when pt expresses anger and bitterness toward God. Stay with pt. - The nurse’s presence and nonjudgmental attitude increase the pt’s feelings of self-worth and promote trust in the relationship. 2. Encourage pt to express feelings related to meaning of own existence in the face of current loss. - Pt may believe he/she cannot go on living without the lost entity. Catharsis can provide relief and put life back into realistic perspective. 3. Encourage pt as part of grief work to reach out to previous religious practices for support. Encourage pt to discuss these practices and how they provided support in the past. - Pt may find comfort in religious rituals with which he or she is familiar. 4. Reassure pt that he or she is not alone when feeling inadequate in the search for life’s answers. - Validation of pt’s feelings and the assurance that others share them offers reassurance and an affirmation of acceptability. 5. Contact spiritual leader of patient’s choice, if he or she requests. - These individuals serve to provide relief from spiritual distress and often can do so when other support persons cannot.

Answer 34

■ Patient will express acceptance of life and situations over which he or she has no control. ■ Patient will verbalize a measure of hope for the future by identifying reachable goals. and ways to achieve them.

Answer 35

1. Identify stressors in pt’s life that precipitated current crisis. - Important to identify causative or contributing factors in order to plan appropriate assistance. 2. Determine coping behaviors previously used and pt’s perception of effectiveness then and now. - Reviewing coping behaviors assists the pt to recognize personal strengths that have been helpful in the past. 3. Encourage pt to explore and verbalize feelings and perceptions. - Identification of feelings underlying behaviors helps patient to begin process of taking control of own life. 4. Provide expressions of hope to pt in positive, low-key manner. "I know you feel you cannot go on, but I believe that things can get better for you. What you are feeling is temporary. It is okay if you don’t see it just now. You are very important to the people who care about you” - Even though the pt feels hopeless, it is helpful to hear positive expressions from others. The pt’s current state of mind may prevent him or her from identifying anything positive in life. It's important to accept the pt’s feelings nonjudgmentally and to affirm the individual’s personal worth and value. 5. Help pt identify areas of life situation that are under own control. - The pt’s emotional condition may interfere with ability to problem solve. Assistance may be required to perceive the benefits and consequences of available alternatives accurately. 6. Identify sources that pt may use after discharge when crises occur or feelings of hopelessness and possible suicidal ideation prevail. - Providing information about local suicide hotlines or other local support services from which he or she may seek assistance following discharge from the hospital promotes follow-through with an ongoing safety plan

Answer 36

Acute phase (6 to 12 weeks) Continuation phase (4 to 9 months) Maintenance phase (1 year or more)

Answer 37

Importance of close, satisfactory attachments in the prevention of depression and the role of disrupted attachments in the development of depression. Interpersonal psychotherapy focuses on the client’s current interpersonal relations Phase I: Client is assessed to determine the extent of the illness. Extent of illness and treatment is revealed to client. Client is encouraged to continue working and participating in regular activities during therapy. Phase II: Treatment at this phase focuses on helping the client resolve complicated grief reactions, which may include resolving the ambivalence with a lost relationship and assistance with establishing new relationships. Phase III: Therapeutic alliance is terminated. Emphasis on reassurance, clarification of emotional states, improvement of interpersonal communication, testing of perceptions, and performance in interpersonal settings

Answer 38

Once an acute phase of the illness is passed, groups can provide an atmosphere in which individuals may discuss issues in their lives that cause, maintain, or arise out of having a serious affective disorder. The element of peer support provides a feeling of security, because troublesome or embarrassing issues are discussed and resolved. Therapy groups help members gain a sense of perspective on their condition and tangibly encourage them to link up with others who have common problems. A sense of hope is conveyed when the individual is able to see that he or she is not alone or unique in experiencing affective illness.

Answer 39

The ultimate objectives in working with families of clients with mood disorders are to resolve the symptoms and initiate or restore adaptive family functioning. Family therapy is indicated if the disorder jeopardizes the patient’s marriage or family functioning or if the mood disorder is promoted or maintained by the family situation

Answer 40

- Focuses on helping the individual to alter mood by changing the way he or she thinks. The individual is taught to control negative thought distortions that lead to pessimism, lethargy, procrastination, indecisiveness, and low self-esteem. - The general goals in cognitive therapy are to obtain symptom relief as quickly as possible, to assist the client in identifying dysfunctional patterns of thinking and behaving, and to guide the client to evidence and logic that effectively test the validity of the dysfunctional thinking. - Therapy focuses on changing “automatic thoughts” that occur spontaneously and contribute to the distorted affect. - Personalizing: “I’m the only one who failed.” - All or nothing: A person who had a failure or disappointment thinks "I can’t do anything right, I’m a complete failure.” - Mind reading: “He thinks I’m foolish.” - Discounting positives: “The other questions were so easy. Any dummy could have gotten them right.” The client is asked to describe evidence that both supports and disputes the automatic thought. The logic underlying the inferences is then reviewed with the client.

Answer 41

- Mechanism of Action: The induction of a grand mal (generalized) seizure through the application of electrical current to the brain. Increased GABA levels, increased sensitization of 5-HT1A serotonin receptors, increased dopamine binding, and normalized dexamethasone suppression tests in patients who received ECT - Effective with clients who are acutely suicidal and in the treatment of severe depression; clients who are also experiencing psychotic symptoms and those with psychomotor retardation and neurovegetative changes (after meds are used) - Side Effects: temporary memory loss (retrograde and anterograde amnesia) and confusion. - Risks: Mortality (rare), memory loss, brain damage - Meds: Pretreatment meds include atropine sulfate or glycopyrrolate (Robinul). During treatment: ropofol (Diprivan) or etomidate (Amidate). succinylcholine chloride (Anectine).

Answer 42

Noninvasive procedure that is used to treat depression by stimulating nerve cells in the brain. rTMS involves the use of very short pulses of magnetic energy to stimulate nerve cells at localized areas in the cerebral cortex. Does not result in seizure activity

Answer 43

- During studies for the treatment of epilepsy, researchers found that vagal nerve stimulation (VNS) improved mood. This treatment involves implanting an electronic device in the skin to stimulate the vagus nerve. Positive emission tomography studies performed during treatment demonstrate metabolic changes in areas of the brain associated with mood disorders. - DBS is a form of psychosurgery. An electrode is implanted with the intent of stimulating brain function. The implant is deeper than that used in VNS and requires craniotomy. DBS is reserved for patients with severe, incapacitating depression or obsessive-compulsive disorder who have not responded to any other more conservative treatments

Answer 44

- Light therapy, or exposure to light, has been shown, in several studies, to be an effective short-term treatment for Seasonal Affect Disorder. - One theory suggests that SAD is related to the presence of the hormone melatonin, which plays a role in the regulation of biological rhythms for sleep and activation. It is produced during the cycle of darkness and shuts off in the light of day.During the months of longer hours of darkness, there is increased production of melatonin, which seems to trigger the symptoms of SAD in susceptible people - Light therapy is administered by a 10,000-lux light box, which contains white fluorescent light tubes covered with a plastic screen that blocks UV rays. The individual sits in front of the box with the eyes open (although the client should not look directly into the light). - The mechanism of action is believed to be related to retinal stimulation, which triggers a reduction of melatonin and an increase in serotonin in the brain - Side effects appear to be dosage related and include headache, eyestrain, nausea, irritability, photophobia (eye sensitivity to light), insomnia (when light therapy is used late in the day), and (rarely) hypomania

Answer 45

These include tricyclic, tetracyclic, and heterocyclic antidepressants; monoamine oxidase inhibitors (MAOIs); SSRIs; SNRIs; and SSRI/SNRI combination drugs. Ketamine is increasingly being used off-label for the treatment of depression.

Answer 46

Amitriptyline Amoxapine Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin Imipramine (Tofranil) Nortriptyline (Aventyl; Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil)

Answer 47

Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac; Serafem) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Vilazodone (Viibryd) Vortioxetine (Brintellix)

Answer 48

Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) Selegiline Transdermal System (Emsam)

Answer 49

Bupropion (Wellbutrin) Maprotiline Mirtazapine (Remeron) Nefazodone Trazodone

Answer 50

Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine (Effexor)

Answer 51

Olanzapine and fluoxetine (Symbyax) Chlordiazepoxide and fluoxetine (Limbitrol) Perphenazine and amitriptyline (Etrafon)

Answer 52

■ Continue to take the medication even though the symptoms have not subsided. The therapeutic effect may not be seen for as long as 4 weeks. ■ Use caution when driving or operating dangerous machinery. Drowsiness and dizziness can occur. ■ Not discontinue use of the drug abruptly. To do so might produce withdrawal symptoms, such as nausea, vertigo, insomnia, headache, malaise, nightmares, and return of symptoms ■ Use sunblock lotion and wear protective clothing when spending time outdoors. ■ Immediately report occurrence of any of the following symptoms to the physician: sore throat, fever, malaise, yellowish skin, unusual bleeding, easy bruising, persistent nausea/vomiting, severe headache, rapid heart rate, difficulty urinating, anorexia/weight loss, seizure activity, stiff or sore neck, and chest pain. ■ Rise slowly from a sitting or lying position to prevent a sudden drop in blood pressure. ■ Take frequent sips of water, chew sugarless gum, or suck on hard candy for dry mouth. Good oral care (frequent brushing, flossing) is very important. ■ Not to consume certain foods while on MAOIs ■ Avoid smoking while receiving tricyclic therapy ■ Avoid drinking alcohol while taking antidepressant therapy. ■ Avoid use of other medications (including over-the-counter medications) without the physician’s approval while receiving antidepressant therapy. ■ Notify the physician immediately if inappropriate or prolonged penile erections occur while taking trazodone. ■ Not “double up” on medication if a dose of bupropion (Wellbutrin) is missed. ■ Follow the correct procedure for applying the selegiline transdermal patch ■ Be aware of possible risks of taking antidepressants during pregnancy. ■ Be aware of the side effects of antidepressants. ■ Carry a card or other identification at all times describing the medications being taken.

Answer 53

- Aged cheese - Wine (esp Chianti); beer - Chocolate; colas - Coffee; tea - Sour cream; yogurt - Smoked and processed meats - Beef or chicken liver - Canned figs - Caviar - Raisins - Pickled herring - Yeast products - Broad beans - Soy sauce - Cold remedies - Diet pills Overripe and fermented foods Could cause hypertensive crisis

Answer 54

Between 30 and 50% of patients do not respond to first antidepressant prescription. Patients and family members often express frustration as prescriptions are changed in an effort to find the right antidepressant and dose that are most effective for each individual. A study is needed to identify benefits of routine testing, cost effectiveness, and ability to provide timely results.

Answer 55

0 = Absent 1 = These feeling states indicated only on questioning 2 = These feeling states spontaneously reported verbally 3 = Communicates feeling states nonverbally (e.g., through facial expression, posture, voice, tendency to weep) 4 = Patient reports virtually only these feeling states in spontaneous verbal and nonverbal communication

Answer 56

0 = Absent 1 = Self-reproach; feels he/she has let people down 2 = Ideas of guilt or rumination over past errors or sinful deeds 3 = Present illness is a punishment; delusions of guilt 4 = Hears accusatory or denunciatory voices and/or experiences threatening visual hallucinations

Answer 57

0 = Absent 1 = Feels life is not worth living 2 = Wishes he/she were dead or any thoughts of possible death to self 3 = Suicidal ideas or gesture 4 = Attempts at suicide (any serious attempt rates 4)

Answer 58

0 = No difficulty falling asleep 1 = Complains of occasional difficulty falling asleep (i.e., more than ½ hour) 2 = Complains of nightly difficulty falling asleep

Answer 59

0 = No difficulty 1 = Complains of being restless and disturbed during the night 2 = Waking during the night—any getting out of bed rates 2 (except for purposes of voiding)

Answer 60

0 = No difficulty 1 = Wakes in early hours of the morning but goes back to sleep 2 = Unable to fall asleep again if he/she gets out of bed

Answer 61

0 = No difficulty 1 = Thoughts and feelings of incapacity, fatigue, or weakness related to activities, work, or hobbies 2 = Loss of interest in activity, hobbies, or work—either directly reported by patient or indirectly in listlessness, indecision, and vacillation (feels he/she has to push self to work or do activities) 3 = Decrease in actual time spent in activities or decrease in productivity. Rate 3 if patient does not spend at least 3 hours a day in activities (job or hobbies), excluding routine chores 4 = Stopped working because of present illness. Rate 4 if patient engages in no activities except routine chores or does not perform routine chores unassisted

Answer 62

0 = Normal speech and thought 1 = Slight retardation during the interview 2 = Obvious retardation during the interview 3 = Interview difficult 4 = Complete stupor

Answer 63

0 = None 1 = Fidgetiness 2 = Playing with hands, hair, etc. 3 = Moving about, can’t sit still 4 = Hand wringing, nail biting, hair pulling, biting of lips

Answer 64

0 = No difficulty 1 = Subjective tension and irritability 2 = Worrying about minor matters 3 = Apprehensive attitude apparent in face or speech 4 = Fears expressed without questioning

Answer 65

0 = Absent 1 = Mild 2 = Moderate 3 = Severe 4 = Incapacitating

Answer 66

0 = None 1 = Loss of appetite, but eating without encouragement; heavy feelings in abdomen 2 = Difficulty eating without urging from others; requests or requires medication for constipation or gastrointestinal symptoms

Answer 67

0 = None 1 = Heaviness in limbs, back or head; backaches, headache, muscle aches; loss of energy and fatigability 2 = Any clear-cut symptom rates 2

Answer 68

0 = Absent 1 = Mild 2 = Severe

Answer 69

0 = Not present 1 = Self-absorption (bodily) 2 = Preoccupation with health 3 = Frequent complaints, requests for help, etc. 4 = Hypochondriacal delusions

Answer 70

A. According to subjective patient history: 0 = No weight loss 1 = Probably weight loss associated with present illness 2 = Definite weight loss associated with present illness B. According to objective weekly measurements: 0 = Less than 1 lb. weight loss in week 1 = Greater than 1 lb. weight loss in week 2 = Greater than 2 lb. weight loss in week

Answer 71

0 = Acknowledges being depressed and ill 1 = Acknowledges illness but attributes cause to bad food, climate, overwork, virus, need for rest, etc. 2 = Denies being ill at all

Answer 72

0–6 = No evidence of depressive illness 7–17 = Mild depression 18–24 = Moderate depression 24 = Severe depression

Answer 73

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms of Criteria A–D. F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 or after age 18 years. H. By history or observation, the age at onset of Criteria A–E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, post-traumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia] K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

Answer 74

Blockade of norepinephrine reuptake results in side effects of tremors, cardiac arrhythmias, sexual dysfunction, and hypertension. Blockade of serotonin reuptake results in side effects of gastrointestinal disturbances, increased agitation, and sexual dysfunction. Blockade of acetylcholine reuptake results in dry mouth, blurred vision, constipation, and urinary retention. Blockade of histamine reuptake results in sedation, weight gain, and hypotension.

Answer 75

Blockade of serotonin reuptake results in side effects of gastrointestinal disturbances, increased agitation, and sexual dysfunction.

Answer 76

Blockade of norepinephrine reuptake results in side effects of tremors, cardiac arrhythmias, sexual dysfunction, and hypertension. Blockade of serotonin reuptake results in side effects of gastrointestinal disturbances, increased agitation, and sexual dysfunction. Blockade of dopamine reuptake results in side effects of psychomotor activation.

Answer 77

* Hippocampus: Memory impairments, feelings of worthlessness, hopelessness, and guilt * Amygdala: Anhedonia, anxiety, reduced motivation * Hypothalamus: Increased or decreased sleep and appetite; decreased energy and libido * Other limbic structures: Emotional alterations * Frontal cortex: Depressed mood; problems concentrating * Cerebellum: Psychomotor retardation/agitation

Ch. 16 Depressive Disorders Flashcards

(101 cards)