depression

Question 1

Major depressive disorder (MDD)

Answer 1

medical illness affecting how you feel, think, and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities

Question 1

Persistent depressive disorder (dysrhythmia) (PPD)

Answer 1

second most common presentation of depressive symptoms

Question 2

prevalence of MDD

Answer 2

lifetime prevalence- 28.2%; 12-month prevalence of MDD- 6.7%

Question 3

prevalence of PPD

Answer 3

lifetime of PPD with major depressive episode- 15.2%; lifetime of PPD with pure dysrhythmia- 3.3%

Question 4

what is PPD with pure dysrhythmia?

Answer 4

milder but more chronic form of depression

Question 6

MDD clinical manifestations

Answer 6

depressed mood; loss of interest/pleasure in usual activities; symptoms been present for a least 2 weeks; no history of manic behavior; cannot be attributed to use of other substances or another medical condition (ex. hypothyroidism, bipolar, CNS depressants); can experience psychosis; can be due to chronic pain

Question 7

PPD clinical manifestations

Answer 7

sad or “down in the dumps”; no evidence of psychotic symptoms; essential feature is chronically depressed mood for most of the day, more days than not, and for at least 2 years; most of the time people can push through and still have occupational and social experiences unlike MDD

Question 8

potential causes of depression disorders

Answer 8

other psychiatric disorders, chronic medical problems, hospitalization, certain medications, chronic pain, terminal illness

Question 9

children/adolescents and depression

Answer 9

as young as 3 years old been diagnosed with MDD; incidence in ages 12-17 is 11.93% for at least one major depressive episode; following recovery from acute depressive episode 30-70% of children relapse; 20-50% of adolescents may relapse

Question 10

older adults and depression

Answer 10

clinical depression occurs in 7% of general older population with significant disability to those affected

Question 12

predisposing factors for developing depressive disorders

Answer 12

HX of prior episodes; family HX (especially 1st degree relatives); HX of suicide or suicide in family; member of LGBTQ; female; 40 years and younger; postpartum period; chronic medical illness; absence of social support; traumatic events/early trauma; alcohol/substance use disorder; HX of sexual abuse

Question 13

the neurotransmitters involved in depression and how

Answer 13

monoamines, serotonin, norepinephrine, dopamine; abnormalities in the number of receptor sites

Question 14

PET scan and effect of medication on brain

Answer 14

positron-emission tomography showed entire brain was more active following medication for recurrent depression especially in left prefrontal cortex

Question 15

diathesis-stress model of depression

Answer 15

diathesis refers to the biological predisposition such as family HX and stress refers to psychological stressors or environmental stressor that trigger brain changes

Question 16

biological model of depression

Answer 16

due to genetics, biochemical, alterations in hormonal regulation

Question 17

bio/psychosocial theories of depression

Answer 17

cognitive theory- becks cognitive triad, learned helplessness, cultural considerations

Question 18

becks cognitive triad

Answer 18

negative self-deprecating view of self; negative (pessimistic) view of the world; negative views about the future (negative reinforcement will continue)

Question 19

assessment of pt with depression

Answer 19

suicidal assessment, ideation related to harm of others (SI/HI), detailed assessment

Question 20

detailed assessment components

Answer 20

mood and affect, physical changes- clinical symptoms, cognition and thought content, self-care for nurses

Question 21

assessment findings of someone with clinical depression

Answer 21

mood and affect- anxiety, worthlessness, guilt, anger, irritability, may not make eye contact, flat affect; thought content and processes- slow thinking, rumination on faults, indecisiveness, delusional thinking; physical signs and symptoms- psychomotor retardation, psychomotor agitation, vegetative signs of depression, sleep pattern changes; characteristic communication styles- monotone speech, require more time to respond

Question 22

assessment guidelines of depressed individual

Answer 22

evaluate pt risk of suicide or harm to others; determine if depression is primary or secondary to another disorder, assess for HX of depression, assess support systems, assess for triggering events, complete psychosocial assessment

Question 23

nursing diagnoses for depressed pt

Answer 23

depressed individuals are always at risk for suicide; others include despair, depressed mood, hopelessness, helplessness, risk for self-mutilation, self-care deficit

Question 24

planning for depressed pt

Answer 24

focused on specific symptoms, safety is highest priority, recognize and help pt tolerate medication side effects, facilitate supportive nurse-pt relationship, account for presence of depression assessment findings (ex. veg. state, change in activity level)

Question 25

evidence-based interventions for pt with depressive disorder

Answer 25

communication; health teaching/promotion; milieu therapy; first line psychotherapy interventions- CBT (first line), IPT, PST, CBT-I; mindful-based cognitive therapy; group therapy

Question 26

CBT

Answer 26

cognitive behavioral therapy

Question 27

IPT

Answer 27

interpersonal psychotherapy

Question 28

PST

Answer 28

problem-solving therapy

Question 29

CBT-I

Answer 29

cognitive behavioral therapy for insomnia

Question 30

communication guidelines for interacting with pt with depressive disorder

Answer 30

pt may speak slow and be slow to comprehend, pt may be mute (extreme depression), sitting with pt in silences is valuable (can be very meaningful to pt)

Question 31

evidence-based practice interventions for individuals with depressive disorder

Answer 31

pharmacological, biological, and integrative therapies; brain stim therapies; complementary and integrative therapies

Question 32

pharmacological, biological, and integrative therapies

Answer 32

antidepressant medication therapy, antipsychotics, other durgsanti

Question 33

antidepressant medications for therapy

Answer 33

SSRIs, SNRIs, SDRIs- norepi. dopamine reuptake inhibitors, TCAs, MAOIs

Question 34

brain stimulation therapies

Answer 34

below are somatic treatments: ECT- electrical stim to brain, 3x a week then wean to 2x a week but never abruptly stop; Vagus nerve stim (VNS)- implant wraps around vagus nerve and does continuous stim for 30 seconds every so often during 24 hour day; transcranial magnetic stimulation (TMS)- outpatient; deep brain stimulation (DBS)- imbedded in brain

Question 35

complementary and integrative therapies

Answer 35

light therapy- seasonal depression; St johns wort- organic mood stabilizer; s-adenosylmethionine (SAMe); peer support of individual diagnosed with MI

Question 36

electroconvulsive therapy

Answer 36

induction of grand mal (gen.) seizure with application of electrical current; probes placed bilaterally in frontotemporal region or unilaterally on dominant side; dose of stim is based on pt seizure threshhold; seizure lasts about 15-25 seconds; usually every other day 3x a week; usually require 6-12 treatments

Question 37

contraindications to ECT

Answer 37

increased intracranial pressure from a brain tumor, recent CVA, or other cerebrovascular lesions, etc.; individuals with MI, CVA, aortic or cerebral aneurysm, severe HTN, and CHF within past 3-6 months are at high risk

Question 38

clinical use for ECT

Answer 38

effective in treating: treatment resistant depression, major depression with psychotic symptoms, pt with life-threatening psychiatric conditions such as salf-harm or acute mania, or pt who tried antidepressants but side effects are too bad or meds are ineffective

Question 39

when ECT may be idicated

Answer 39

need for rapid definitive response because pt is suicidal or homicidal, pt extremely agitated or psychomotor retardation and stupor (catatonia or mania), severe mania, pt develops life-threatening illness d/t refusal of food and fluids, pt has HX of poor drug response and or HX of good ECT response, standard medical treatment has no effect

Question 40

advantages of SSRIs

Answer 40

effective in depression with anxiety features and depression with psychomotor agitation, better tolerated, safer in event of OD, lower anticholinergic side effects

Question 41

side effects of SSRIs

Answer 41

headaches, GI disturbance, insomnia, fatigue, initial anxiety, sexual problems, agitation, bleediing risk, risk of serotonin syndrome

Question 42

advantages of TCAs

Answer 42

effective in depression and in symptoms like insomnia and anorexia, different TCAs effective for pt who are lethargic or who are experiencing agitation or restlessness

Question 43

side effects of TCAs

Answer 43

weight gain, sedation, nausea, anticholinergic symptoms, orthostatic hypotension, cardiotoxic side effects

Question 44

special precaution fro monoamine oxidase inhibitor (MAOI)

Answer 44

used as antidepressants for pt who have not responded to other antidepressant meds or have atypical depression; believed that MAOI prevent breakdown of norepinephrine, serotonin, and dopamine that increases levels of these amines in brain causing mood elevation; inhibit breakdown of dietary tyramine in liver (ingesting food with tyramine can cause HTN crisis and potential CVA and death)

Question 45

evaluation of treatment of pt with depression

Answer 45

ongoing; outcomes compared with stated outcome criteria and short term and intermediate treatment goals; plan of care is revised when desired outcomes not met