Depressive Disorders

Question 1

examples of SSRIs

Answer 1

–fluoxetine
–paroxetine
–sertraline
–citalopram
–escitalopram

Question 2

examples of SNaRIs

Answer 2

–venlafaxine
–duloxetine

Question 3

examples of tricyclic antidepressants

Answer 3

–imipramine
–doxepin
–amitriptyline

Question 4

examples of MAOIs

Answer 4

–phenelzine
–tranylcypromine
–selegiline

Question 5

epidemiology of depression

Answer 5

–women 2x more likely
–more common in White people
–worse in decreased light
–high recovery rate in kids when receiving treatment

Question 6

biological factors of depression

Answer 6

–genetic
–biochem abnormalities (neurotransmitter imbalances, increased cortisol)
–hormonal disturbance
–inflammatory process
–Diathesis - stress model (predisposition to depression and stress can bring it out)

Question 7

Psychological factors for depression

Answer 7

–cognitive theory (negative/unrealistic expectations of environment, self and future; unrealistic expectations lead to recurrent dissatisfaction)
–learning theory (learned helplessness, lack of coping)

Question 8

contributing factors for depression in kiddos

Answer 8

–physical or emotional detachment by primary caregiver
–parental separation
–divorce
–death of loved one
–relocation
–academic failure
–physical illness

Question 9

contributing factors for depression in teens

Answer 9

–conflicts between independence and maturation
–grief/loss = abandonment

Question 10

contributing factors to depression in older adults

Answer 10

–social attitudes can lead to decreased self-esteem, helplessness, hopelessness
–financial problems
–life changes
–physical illness
–grief/loss (bereavement overload)

Question 11

necessary symptoms for diagnosing MDD

Answer 11

Five (or more) in 2 week period:
–weight loss and appetite changes
–sleep disturbances
–fatigue
–psychomotor agitation or retardation
–worthlessness or guilt
–loss of ability to concentrate
–recurrent thoughts of death
PLUS one:
–depressed mood
–loss of interest or pleasure

Question 12

chronic MDD

Answer 12

lasting more than 2 years

Question 13

MDD specifics

Answer 13

–recurrent episodes common
–episode not attributed to psych effects
–absence of manic or hypomanic episode

Question 14

additional symptoms in children and teens with MDD

Answer 14

–frequent vague, non-specific physical complaints
–frequent absences or poor performance in school
–being bored
–alcohol or substance abuse
–increased anger or hostility
–reckless behavior

Question 15

depression symptoms in children up to 3 years old

Answer 15

–failure to thrive
–feeding problems
–lack of playfulness
–lack of emotional expression
–delay in speech or motor development

Question 16

depression symptoms in children from ages 3-5

Answer 16

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

Question 17

depression symptoms in children ages 6-8

Answer 17

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

Question 18

depression symptoms in children ages 9-12

Answer 18

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

Question 19

DMDD specifics

Answer 19

–ages 6-18 years old
–onset before age 10
–anger and constant, severe irritability
–more common in men and children than adolescents
–temper tantrums with verbal and behavioral outbursts at least 3x weekly
–display irritability, anger, and temper tantrums in at least 2 settings

Question 20

former name of persistent depressive disorder

Answer 20

dysthymia

Question 21

symptoms for persistent depressive disorder

Answer 21

–low level depressive feelings most of the day, the majority of days
–symptoms for at least 2 years in adults
–at least 1 year in children and adolescents
MUST have 2 or more of:
–decreased appetite or overeating
–insomnia or hyperinsomnia
–low energy
–poor self-esteem
–difficulty thinking
–hopelessness

Question 22

PMDD symptoms and timing

Answer 22

–symptoms in week prior to onset of woman’s menstruation
–mood swings
–irritability
–depression
–anxiety
–feeling overwhelmed
–difficulty concentrating
–lack of energy
–overeating
–hyperinsomnia or insomnia
–breast tenderness
–aching
–bloating
–weight gain
symptoms decrease significantly or disappear with onset of menstruation

Question 23

primary care screening for depression

Answer 23

–patients presenting with somatic complaints

Question 24

areas to assess patients for depression

Answer 24

–affect
–thought processes/content
–mood
–judgment/insight
–physical behavior/activity
–communication
–religious beliefs and spirituality

Question 25

affect

Answer 25

observed responsiveness of a person's emotional state

Question 26

constricted affect

Answer 26

a little less than normal

Question 27

blunted affect

Answer 27

limited expression

Question 28

flat affect

Answer 28

does not demonstrate emotion

Question 29

congruent/incongruent

Answer 29

do mood and affect match?

Question 30

sad affect

Answer 30

--body language implies sadness --eye contact downcast --stooped posture --facial expression

Question 31

mood

Answer 31

person's emotional state or feeling expressed in own words

Question 32

psychomotor retardation

Answer 32

visible slowing of physical activity such as movement and speech having a mental, not organic, cause

Question 33

examples of psychomotor retardation

Answer 33

--slow talking or long pauses before beginning to talk --taking long time to cross a room or slow food chewing and waiting longer than usual between bites

Question 34

what is psychomotor retardation associated with?

Answer 34

severe depression

Question 35

psychomotor agitation

Answer 35

an increase in activity brought on by mental tension

Question 36

examples of psychomotor agitation

Answer 36

--restlessness --pacing --tapping fingers or feet --abruptly starting and stopping tasks --meaninglessly moving objects around

Question 37

what is psychomotor agitation associated with?

Answer 37

agitated depression

Question 38

recovery model

Answer 38

--focus on patient's strengths to improve health and reach full potential --treatment goals mutually developed --based on patient's personal needs and values --measurable

Question 39

general antidepressant medication education

Answer 39

--may not see improvement for 4-6 weeks --physiological symptoms before psychological --improved sleep --discontinuing meds may cause relapse --not addictive --abrupt stoppage will cause withdrawal --NO ALCOHOL

Question 40

SSRI indications

Answer 40

--first line therapy --rare risk of serotonin syndrome

Question 41

TCA warning

Answer 41

anticholinergic adverse reactions

Question 42

possible side effects of SRIs

Answer 42

--drowsiness --nausea --insomnia --diarrhea --nervousness, agitation, or restlessness --dizziness --sexual problems --tension headache --blurred vision

Question 43

SRI nursing implications

Answer 43

--effectiveness = 4-8 weeks --side effects diminish in 4-6 weeks --monitor for SI, agitation, fever, increased BP, mania --sleep hygiene --avoid caffeine if anxious --relaxation techniques

Question 44

serotonin syndrome symptoms

Answer 44

--agitation --confusion --restlessness --lethargy --delirium --irritability --dizziness --hallucinations --diaphoresis --flushing --fever --tachycardia --mydriasis --myoclonus --hyperreflexia --tremors --N/V/D

Question 45

when does serotonin syndrome usually set in?

Answer 45

develop symptoms within 6 hours of either first dose of new med, a change in dosing, or intentional overdose

Question 46

how to treat serotonin syndrome

Answer 46

--stop or reduce meds causing it --benzos (agitation, seizures, muscle stiffness) --oxygen --IV fluids --meds to control HR, BP

Question 47

tricyclic antidepressant statistics

Answer 47

--increased danger of death by OD --increased and potentially fatal CNS depression with ETOH --less expensive

Question 48

nursing implications for TCAs

Answer 48

--before initiating: check ECG and hx of seizure --early treatment symptoms include early morning awakening, feeling worse in AM, worry and anxiety

Question 49

nursing interventions for TCAs

Answer 49

--dry mouth --GI upset --diarrhea --constipation --insomnia --orthostasis --sexual side effects --urinary hesitancy

Question 50

action of MAOIs

Answer 50

blocks enzyme Monoamine oxidase which is used to metabolize the monoamines SE, NE, and dopamine

Question 51

common MAOI side effects

Answer 51

--dry mouth --nausea --diarrhea or constipation --HA --drowsiness --insomnia --dizziness or lightheadedness --skin reaction at patch site

Question 52

less common MAOI side effects

Answer 52

--involuntary muscle jerks --low BP --reduced sexual desire or orgasm --weight gain --difficulty starting urine flow --muscle cramps --prickling or tingling sensation in skin

Question 53

MAOI nursing implications

Answer 53

avoid tyramine rich foods to prevent hypertensive crisis --aged, smoked meats --aged cheese --beans --beers/ales/liquors --rarely used with SSRIs due to possible serotonin syndrome --avoid high consumption of caffeine

Question 54

hypertensive crisis symptoms

Answer 54

--occipital headache --palpitations --N/V --dyspnea/SOA --mental status changes --blurred vision --sweating --neck stiffness or soreness --dilated pupils --photophobia --tachycardia or bradycardia --CP

Question 55

treatment of hypertensive crisis

Answer 55

--phentolamine (vasodilator) --sublingual nifedipine (CCB) --symptomatic and supportive

Question 56

bupropion

Answer 56

--contraindicated in eating disorders and hx of seizures --less sexual side effects --considered energizing --used in smoking cessation

Question 57

trazodone

Answer 57

often given at bedtime for sedative effect as adjunct with another AD

Question 58

mirtazapine

Answer 58

good for sleep

Question 59

SSRIs for children and teens

Answer 59

--BB warning: increased risk of SI --fluoxetine = first line --low S/E --improvement in 1-2 weeks --up to 12 weeks for full effect