Depression

Question 1

Etiology of depressive disorders

Answer 1

Biological Factors
genetics
neurotransmitter abnormalities
increased cortisol
hormonal disturbances ( thyroid problems)
inflammatory processes
diathesis stress model (predisposition to depression and stress can bring it out)
psychological factors
cognitive theory- psychological predisposition
negative or unrealistic expectations
unrealistic perceptions leads to recurrent dissatisfaction
learning theory- learned helplessness, lack of coping skills

Question 2

contributing factors of depression: child

Answer 2

Common thread is loss
genetic predisposition for a mood disorder and stress may cause depression
physical or emotional detachment to primary care giver
parent separation/divorce
death of loved one/pet
relocation
academic failure
physical illness

Question 3

contributing factors of depression: Teens

Answer 3

conflicts between independence and maturation
role confusion
grief/loss
relationships breakups
abandonment

Question 4

contributing factors of depression: older adults

Answer 4

bereavement overload (loss of spouse, friends, home, independence)
chronic pain
financial problems
life changes (job ending/ retirement/ relocation)
societal attitudes may lead to decreased self esteem; helplessness; hopelessness

Question 5

Identify the 5 types of depressive disorders

Answer 5

Major depressive disorder
disruptive mood disorder
persistent depressive disorder (formerly dysthymia)
premenstral dysphoric disorder
substance/medication induced depressive disorder

Question 6

all 5 depressive disorders share what 5 symptoms

Answer 6

sadness, irritability, emptiness, somatic concerns, and impairment of thinking, all of which affect ability to function

Question 7

anhedonia

Answer 7

loss of pleasure or interest in things

Question 8

depressive symptoms of children 0-3

Answer 8

FTT
feeding problems
lack of playfulness
lack of emotional expression
delay in speech or motor development

Question 9

depressive symptoms of children 3-5

Answer 9

prone to accidents
phobias
aggressiveness
excessive self-reproach for minor infractions

Question 10

depressive symptoms of children 6-8

Answer 10

vague physical complaints
aggressive behavior
cling to parents
avoid new people and challenges
behind in social skills/ academic performance

Question 11

depressive symptoms of children 9-12

Answer 11

morbid thoughts
excessive worry
lack of interest socially
think they have disappointed parents

Question 12

Major Depressive Disorder

Answer 12

anhedonia or depressed mood
chronic lasting 2 years
recurrent episodes
symptoms cause distress or impaired function
wt loss, fatigue, sleep disturbances, psychomotor agitation or retardation
recurrent thoughts of death

Question 13

DMDD (disruptive mood dysregulation disorder)

Answer 13

only children
ages 6-18
onset before age 10
symptoms include anger, constant severe irritability
temper tantrums with verbal and behavioral outburst atleast 3x weekly
displays irritability, anger, and temper tantrums in at least 2 settings (home, school, with peers)

Question 14

Persistent Depressive Disorder

Answer 14

formerly dysthymia
low-level depressive feelings
symptoms for at least 2 years in adults, 1 year child/adolescents
must have 2 of the following (decreased appetitie or overeating, insomnia or hypersomnia, low energy, poor self esteem, difficulty thinking, and hopelessness

Question 15

Premenstrual Dysphoric Disorders

Answer 15

symptoms 1 week prior to onset of period
mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating
SSRI’s given 1 week prior to period
symptoms decrease significantly or disappear with onset of menstration

Question 16

substance induced depressive disorder

Answer 16

only depressed when using substances
does NOT experience symptoms when not using

Question 17

affect

Answer 17

observed responsiveness of a person’s emotional state.
ex: flat, blunted, constricted, congruent, sad

Question 18

mood

Answer 18

persons emotional state or feelings expressed in own words
document patients description

Question 19

lability

Answer 19

mood swings
happy one moment and sad the next

Question 20

psychomotor retardation

Answer 20

visible slowing of physical activity
slow talking, long pauses before speaking, taking log time to cross a room, slow food chewing, waiting longer than usual between bites
associated with severe depression

Question 21

psychomotor agitation

Answer 21

increased activity and mental tension
restlessness, pacing, tapping of fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around.

Question 22

phases of treatment

Answer 22

acute phase (6 to 12 weeks)
continuation (4-9 months)
maintenance phase (1 year or more)

Question 23

general antidepressant medication education

Answer 23

takes 4-6 weeks to see improvement
physiological symptoms improve before psychological
increased risk of SI
discontinuing med as soon as you feel better may result in relapse
meds usually needed 6-9 months past relief of symptoms, up to 12-24 months
do not drink alcohol
non medical interventions include exercise and less caffeine

Question 24

SSRI’s

Answer 24

first line therapy
rare risk of serotonin syndrome
tine, pram, done
fluoxetine, paroxetine, sertraline, citalopram, escitalopram, vortioxetine, vilazodone

Question 25

possible side effects of SSRI's

Answer 25

dry mouth sex problems, tension headaches, blurred vision drowsiness nausea insomnia diarrhea nervousness, agitation, restlessness dizziness

Question 26

nursing implications of SSRI's

Answer 26

takes 4-8 weeks to work most side effects diminish after 4-6 wks may cause increase in SI, agitation, fever, increased BP, manic symptoms sleep hygeine avoid caffeine teach relaxation techniques electrical surges, brain shivers, pins and needles on skins, blackouts, short term memory loss, feeling like on the verge of unconciousness

Question 27

Serotonin syndrome

Answer 27

mental status changes (agitation, confusion, restlessness, lethargy, delirium, irritability, dizziness, hallucinations diaphoresis, flushing, fever, tachycardia, mydriasis myoclonus( muscle twitching, jerking), hyperreflexia, tremors n/v/d

Question 28

what happens if serotonin meds not stopped during serotonin syndrome?

Answer 28

worsening myoclonus, HTN, rigor, acidosis, respiratory failure, rhabdomyolysis 60% pts will develop symptoms within 6 hours of either first dose or new med, change in dosing, or intentional overdose can be fatal

Question 29

treating serotonin syndrome

Answer 29

stop or reduce med benzodiazepines- diazepam or lorazepam to control agitation, seizures, and muscle stiffness oxygen IV fluids provide symptomatic and supportive care usually resolves within 24 hours but can take several weeks to go away drugs to control HR and BP serotonin production blocking agents- cyproheptadine HCL

Question 30

TCA's

Answer 30

old/cheap -ine, in imipramine, desipramine, doxepin, amitriptyline start low and go slow increased danger of death by overdose can lead to fatal CNS depression anticholinergic side effects

Question 31

nursing implications of TCA's

Answer 31

before initiating TCA check EKG, and for hx of seizures NO pregnant or getting pregnant initial early symptoms may include early morning awakening, feeling worse in AM, worry and anxiety risky to give in patients with CV or older adults

Question 32

anticholinergic side effects

Answer 32

hot as a hare, dry as a bone, blind as a bat, red as beet, mad as a hatter also: sedation and WT gain

Question 33

nursing interventions for TCA's

Answer 33

dry mouth: SF gum or hard candy GI upset: take with food Diarrhea: frequent small meals Constipation: increase fiber and fluids insomnia: sleep hygiene/ change dosing time/ take in AM orthostasis: keep hydrated; get up slowly sex side effects: erectilie dysfunction meds urinary hesitancy: run water, check amount of void

Question 34

MAOI's

Answer 34

Pheneizine, isocarboxazid, tranylcpromine, selegiline transdermal patch blocks MAO usually third choice to treat depression, anxiety, panic, bulimina NO tyramine foods

Question 35

side effects of MAOI's

Answer 35

dry mouth n/d/c HA drowsiness insomnia dizziness/ lightheadedness skin reaction to patch site involuntary muscle jerks low BP sex side effects WT gain urinary hesitancy muscle cramps prickling or tingling sensation in skin

Question 36

MAOI nursing implications

Answer 36

avoid tyramine rich foods to prevent HTN crisis aged, smoked, fermented, marinated and processed meats aged cheeses overripe fruits and vegetables beans condiments beers/ales/liquors/red wine/ non-alcoholic wines and beers avoid using with demerol; otc cold meds rarely used with SSRI avoid high consumption of caffeine limited amounts of avocado's and chocolate

Question 37

hypertensive crisis

Answer 37

occipital headache palpitations nausea vomiting HTN but orthostatic hypotension is possible dyspnea/SOA mental status changes blurred vision sweating neck stiffness and soreness dilated pupils photophobia tachycardia or bradycardia chest pain disrupted cardiac rate/rhythm

Question 38

treatment of HTN crisis

Answer 38

regitine (phentolamine) alpha adrenergic blocker; vasodilator procardia (sublingual nifedipine) calcium channel blocker; relaxes cardiac muscle symptomatic and supportive care

Question 39

bupropion (NDRI)

Answer 39

contraindicated with eating disorders and hx of seizures less sexual side effects used for smoking cessation

Question 40

trazodone

Answer 40

chemically similar to TCA given at bedtime for sedative effect

Question 41

mirtazapine

Answer 41

NaSSAs good for sleep

Question 42

meds for depression in children and teens

Answer 42

SSRI fluoxetine 1st line BLACK BOX: increased risk of SI venlafaxine off label use improvement may be seen in 1-2 weeks, takes up to 12 weeks to see full effect TCA's more s/e potential for dysrhythmias! potentially lethal overdose

Question 43

Other tx of depression

Answer 43

photo/light therapy ECT vagal nerve stimulator or DBS transcranial magnetic stimulation acupuncture or massage St. Johns wart. SAMe, omega 3 fatty acid exercise decrease caffeine and ETOH relaxation techniques