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Mental Health > Depression & Suicide > Flashcards

Depression & Suicide Flashcards

1
Q

What is the leading cause of disability in the US?

A

Depressive Disorder

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2
Q

What % of women suffer from depressive disorder

A

11%

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3
Q

What % of men suffer from depressive disorder

A

6%

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4
Q

What % of adolescents experience depressive disorder

A

18%

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5
Q

What % of children experience depressive disorder

A

6%

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6
Q

What % of elderly suffer depressive disorder

A

20%

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7
Q

DSM definition of Major Depressive Disorder

A

Change from previous functional level with five or more of the following symptoms present most of the day every day for at least two weeks

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8
Q

Diagnostic criteria for Major Depressive Disorder

A

Depressed mood* (sad, hopeless, empty, etc.)
Anhedonia*-inability to experience joy
Significant weight loss or gain
Insomnia-can’t sleep or hypersomnia-sleep all the time
Increased or decreased motor activity
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Decreased concentration or indecisiveness
Recurrent thoughts of death or suicidal ideation

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9
Q

Important criteria for major depressive disorder

A

Causes significant distress or impairment in social, occupational, or other important areas of functioning

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10
Q

What is Melancholic presentation

A

Classic presentation…loss of appetite, weight & insomnia

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11
Q

What is catatonic presentation

A

completely checked out, non responsive

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12
Q

What is atypical presentation

A

increased appetite, weight & excessive sleep

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13
Q

Persistent depressive disorder

A

-Depressed mood for most of the day for more days than not for at least two years
-Two or more of the following symptoms:
Decreased or increased appetite
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness

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14
Q

Other criteria possible for persistent depressive disorder

A

During the two years, symptoms never gone for more than two months
May include continuous MDD symptoms for two years
Absence of mania / hypomania / cyclothymia
Not better explained by psychotic disorder
Not due to substance or medical condition
Cause significant distress or impairment in functioning

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15
Q

Etiology of depression

A

Neurotransmitter imbalance or alteration
Primarily serotonin and norepinephrine with additional involvement of dopamine, acetylcholine, and GABA
Alterations secondary to medical disorder, substance use, etc. may produce similar S&S

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16
Q

Nursing care: Assessment

A

Standard scales such as Beck Depression Inventory and Hamilton Depression Scale-preliminary tool to identify risk, not diagnostic

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17
Q

Subjective findings persistent depressive disorder

A

Mood, feelings, self-esteem, changes in functioning, past history

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18
Q

Objective findings

A

Affect, weight, behaviors, thought precesses

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19
Q

What is the one thing to always assess for with all depression

A

Suicidal ideation

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20
Q

Possible Nursing diagnoses to use with depression

A 
Risk for suicide
Risk for self-mutilation
Hopelessness
Spiritual distress
Risk for loneliness
Ineffective coping
Self-care deficit
Disturbed sleep pattern
Nutritional imbalance
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21
Q

Pharmacological Interventions for Depression

A

First Line Therapy: SSRIs

Meds combined with therapy is most effective

22
Q

What is SSRI

A

Selective Serotonin Reuptake Inhibitors

23
Q

SSRI Mechanism of Action

A

selective inhibition of serotonin reuptake-stays in the synaptic clef longer

24
Q

SSRI used most

A 
Fluoxetine (Prozac)	
Paroxetine (Paxil)
Sertraline (Zoloft)	
Citalopram (Celexa) 
Escitalopram (Lexapro)
Fluvoxamine (Luvox)
25
Q

Early SSRI adverse effects

A 
Early
N/V/D
Anxiety
Diaphoresis
Tremor 
Fatigue
Drowsiness	
Weight loss	
Increased suicide risk-the meds are working and they have the energy to follow through when they didn’t before.
26
Q

Late SSRI adverse effects

A 
Late
Sexual Dysfunction
Decreased libido
No orgasm
Impotence
Weight Gain
Dry Mouth
Increased risk of GI bleeding
27
Q

SSRI considerations

A

Serotonin Syndrome

28
Q

What is Serotonin Syndrom

A 
Can be lethal
Symptoms:
Delirium
Agitation
Tachycardia
Sweating
Hyperreflexia / clonus
Severe: Hyperthermia, seizures, renal failure
29
Q

SSRI Nursing Implications

A

Take medication in morning on a daily basis-if makes sleepy, take at night.
Therapeutic effects may 4+ weeks
Avoid stopping medication abruptly!-Brain can stop producing it’s own serotonin, so if stopped abruptly, there is little or not serotonin in the brain….bad thing.

30
Q

SSRI contraindications

A

Known Allergy

Combination with other drugs that increase serotonin

31
Q

SSRI Interactions

A

Highly bound to plasma proteins
Monoamine oxidase inhibitors (MAOI’s)
Risk of serotonin syndrome

32
Q

SNRI

A

Serotonin/Norepinephrine Reuptake Inhibitors

33
Q

Examples of SNRI

A

Effexor, Cymbalta

34
Q

NDRI

A

Norepinephrine/Dopamine Reuptake Inhibitor

35
Q

Example of NDRI

A

Wellbutrin (buproprion)

36
Q

Serotonin / norepinephrine disinhibitor example

A

Remeron (mirtazapine)

37
Q

Tricyclics TCAs general info

A

functions in a broader area of the brain then SSRI’s. Have more side effects

38
Q

What do Tricyclics do

A

Inhibit reuptake of serotonin and norepinephrine

Also blocks adrenergic, histaminergic, and muscarinic receptors

39
Q

Examples of Tricyclics

A 
Elavil (amitriptyline)
Anafranil (clomipramine)
Norpramin (despipramine)
Tofranil (imipramine)
Vivactil (protriptyline)
40
Q

TCAs: Adverse Effects

A 
Anticholinergic Effects
Sedation
Hypotension
Sexual Dysfunction
Altered libido
Lethal Overdoses
Primarily affects the CNS & Cardiac system
Confusion
Seizures
Fatal Dysrhythmias
Death
41
Q

TCAs: Contraindications

A 
Known drug allergy
Use of MAOIs in past 14 days
Pregnancy (Category C)
Acute or chronic cardiac problems
Seizures
42
Q

TCAs: Interactions

A

Anticholinergic drugs
CNS Depressants
MAOIs
Warfarin

43
Q

What are MAOI’s

A

Monoamine Oxidase Inhibitors-Not often used

44
Q

MAOI Mechanism of Action:

A

Inhibit the MAO enzyme in the CNS

Amines (serotonin, norepinephrine, dopamine) are not broken down, resulting in higher levels in the brain

45
Q

MAOI examples

A

phenelzine (Nardil)
tranylcypromine (Parnate)
selegiline (Emsam) transdermal patch

46
Q

MAOI’s: Adverse Effects

A

Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death
Avoid foods that contain tyramine(amino acids):
Aged, mature cheeses (cheddar, blue, Swiss)
Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)

47
Q

MAOI’s:Overdose info

A

Symptoms appear 12 hours after ingestion
Tachycardia, circulatory collapse, seizures, coma
Hypertensive Crisis

48
Q

What is Electroconvulsive Therapy (ECT)

A

Brief electric current applied to brain to stimulate seizure activity while patient is sedated with anesthesia and muscle-relaxants

49
Q

When is Electroconvulsive Therapy (ECT) used?

A

suicidal or homicidal
medication has failed
Marked agitation, vegetative symptoms, catatonia, or psychotic features

50
Q

Electroconvulsive Therapy (ECT) Risks

A

confusion, short term memory loss w/i 2 weeks of treatment

51
Q

Electroconvulsive Therapy (ECT) Contraindications

A

heart conditions, brain abnormalities

52
Q

Electroconvulsive Therapy (ECT) Nursing implications

A

Seizure precautions, airway management, good education for ptn & family.

Mental Health (5 decks)

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