depressive disorders (2)

Question 1

alteration in mood that is expressed by feelings of sadness, despair, pessimism
-loss of intrest
-somatic symptoms
-changes in appetite and sleep

Answer 1

depression

Question 2

when is depression normal?

Answer 2

the symptoms are a transient and healthy response to loss or change

Question 3

when is depression pathological?

Answer 3

when adaptation fails to occur or is ineffective, unable to care for self

Question 4

which disorders fall under persistent depressive disorder

Answer 4

-premenstrual dysphoric disorder
-substance/medication-induced depressive disorder
-depressive disorder due to other med condition (hypothyroid)

Question 5

how do you help depressive disorder due to another medical condition

Answer 5

fix the condition

Question 6

what kind of depression does seasonal affective disorder fall under

Answer 6

major depressive disorder

Question 7

what kind of depression consists of feelings of low-level depression for most of the day and a majority of days over 2 years (plus 2 other symptoms)

Answer 7

persistent depressive disorder

Question 8

what are some of the symptoms that can be used to indentify persistent depressive disorders

Answer 8

-poor apetite / overeating
-insomnia/hypersomnia
-low energy/fatigue
-poor concentration or difficulty making decisions
-hopelessness

Question 9

is persistent depressive disorder severe enough for a hospital

Answer 9

no

Question 10

what are some symptoms of premenstrual dysphoric disorder (PMDD)

Answer 10

-mood swings
-irritability or anger
-depressed mood
-anxiety, tension, on edge
-decreased interest
-difficult concentration
-lethargy, lack of energy
-appetite change
-hypersomnia, insomnia
-breast tenderness

Question 11

what are the 2 manin diagnostic criteria for major depressive disorder

Answer 11

-derpessed mood most of the day nearly every day
-anhedonia (lack of pleasure)

Question 12

how many symptoms must be present to diagnose MDD and how long do they need to last

Answer 12

5 or more, last for at least 2 weeks with change in functioning

Question 13

what is used to specify episodes of MDD?

Answer 13

diagnostic specifiers (single or recurring, mild/mod/severe, with or without psychotic or catatonic features, etc.)

Question 14

what are the 2 main neurotransmitters in depression

Answer 14

serotonin and norepinephrine

Question 15

what are the 3 cognitive distortions that serve as the basis for depression

Answer 15

1) negative xpectations of the environment
2) negative expectations of the self
3) negative expectations of the future

Question 16

what aspects of life does mild depression affect?

Answer 16

diet, sleep, hygeine

Question 17

what aspects of life does moderate depression affect?

Answer 17

put on medication, risk for suicide

Question 18

what are the 4 kinds of treatment fro depression

Answer 18

-psych treatment (therapy)
-pharmacology
-ECT
-brain stimulation therapy

Question 19

what is the older kind of antidepressant med

Answer 19

MAOIs

Question 20

what were the first drugs made specifically for depression

Answer 20

MAOIs

Question 21

examples of MAOIs

Answer 21

Phenelzine (NArdil), tranylcypromine (PARnate), isocarboxazid (MARplan)

Question 22

what is important to restrict in people taking MAOIS?

Answer 22

tyramine containing foods

Question 23

examples of food to RESTRICT in people taking MAOIs

Answer 23

aged cheese, raisin, fava beans, red wine, caviar, smoked/processed meat, soy

Question 24

examples of food to LIMIT in people taking MAOIs

Answer 24

gouda /american / mozzarella, yogurt, sour cream, avocado, banana, over-ripe fruit, beer, white wine, coffee, cola, tea, hot chocolate, choclate, meat extracts

Question 25

what can happen when you eat tyramine when on MAOIs

Answer 25

hypertensive crisis

Question 26

what are symptoms of hypertensive crisis

Answer 26

headache, n/v, tachycardia, fever, diaphoresis, epistaxis, CP, SOB, vision changes

Question 27

treatment of hypertensive crisis

Answer 27

gastric lavage (NG) / activated charcoal, IV vasodilators

Question 28

what other meds should you not take with MAOIs

Answer 28

-other antidepressants!!! (fatal) -sympathomimetics (cold meds), stimulants, antihypertansives, meperidine / opioids, antiparkinson

Question 29

how long do you have to wait before starting a new antidepressant after being on MAOIs

Answer 29

14 days

Question 30

examples of tricyclic antidepressants

Answer 30

ending in "mine" Imipramine

Question 31

what is important to rememebr in suicidal patients on MAOIs or tricyclic antidepressants?

Answer 31

very fatal in overdose, cardiac arrythmias like vfib / vtach

Question 32

example of SSRIs

Answer 32

-fluoxetine (prozac) -sertraline (zoloft) -paroxetine (paxil) -citalopram (celexa) -escitalopram (lexapro) -fluvoxamine (luvox)

Question 33

which SSRI causes the least amout of sexual dysfunction

Answer 33

escitalopram

Question 34

big side effects of SSRI

Answer 34

sexual dysfunction, discontinuation syndrome

Question 35

can you stop SSRIs abrupt?

Answer 35

no

Question 36

what occurs when more than 1 drug is used that increases serotonin levels or when high doses are used

Answer 36

serotonin syndrome

Question 37

serotonin syndrome triad symptoms

Answer 37

1) altered mental status 2) autonomic hyperactivity (tachycardia, fever/flushing, dry mucous mems, hyper/hypotension) 3) neuromuscular abnormality (tremor, hyperreflexia, myoclonus, shivering)

Question 38

what can serotonin syndrome lead to

Answer 38

-seizures, coma, death if not recognized

Question 39

which kind of antidepressant increases norepi and serotonin

Answer 39

SNRIs

Question 40

which SNRI has a lot of effects

Answer 40

venlafaxine (effexor)

Question 41

which SNRI is good for menopause

Answer 41

desvenlafaxine (pristiq)

Question 42

what is an example serotonin partial agonisy reuptake inhibitor (SPARI)

Answer 42

vilazodone (viibryd)

Question 43

describe dosing and frequency of viibryd (SPARI)

Answer 43

decreased dose, once daily with food, dreams/nightmares

Question 44

describe the progressive dosing of the SPARI drug viibryd

Answer 44

starting dose is not therapeutic, then progresses to therapeutic dose, then the max dose 10 -> 20 -> 40

Question 45

what med helps with treatment resistance

Answer 45

serotonin modulator (vortioxetine (trintellix))

Question 46

what effects do serotonin modulators do?

Answer 46

help with resistance (decrease aggression, increase sex drive, increase cognition, onset 2-4 weeks)

Question 47

example serotonin antagonist and reuptake inhibitor (SARI)

Answer 47

trazodone (desyrel)

Question 48

why is trazodone (SARI) so commonly used?

Answer 48

#1 prescribed, helps with sleeping, good with old people

Question 49

which med is used as adjunctive antidepressant therapy "booster", can help with sexual dysfunction and apathy from SSRI

Answer 49

norepinephrine dopamine reuptake inhibitor (NDRI), bupropion (wellbutrin)

Question 50

which med can be given at HS to sedate, stimulates appetitie, often used in alzheimers

Answer 50

noradrenergic and specific serotonergic antidepressants (NaSSAs), mirtazapine (remeron)

Question 51

what is the black box warning of antidepressanbts?

Answer 51

may cause increase suicidal thoughts and behaviors

Question 52

what new med is for resistant depression, adjunctive use

Answer 52

NMDA antagonist, esketamine intranasal (GIVEN IN HEALTHCARE ONLY)

Question 53

why should patients continue to take antidepressants even if they dont seem to work?

Answer 53

can take a while to work (4-6 weeks)

Question 54

describe the med plan for antidepressants (3 steps)

Answer 54

-give each med a 3 month trial -stay on med 6-9 months after s/sx stop -3rd reoccurence = lifelong therapy recommended

Question 55

describe what ECT is

Answer 55

induction of a grand mal seizure through the application of electrical current to brain

Question 56

are people undergoing ECT put on anesthesia?

Answer 56

yes

Question 57

how long should an ECT seizure last?

Answer 57

25 sec - 1 min

Question 58

describe frequency and duration of ECT treatment

Answer 58

2-3 times per week for 4-6 weeks

Question 59

indications of use for ECT

Answer 59

-severe depression -vegetative symptoms with derpession -psychotic -mania -schizo

Question 60

what is the only absolute contraindication for ECT

Answer 60

increased intracranial pressure

Question 61

should patients be NPO before ECT

Answer 61

yes

Question 62

pre-op role of nursing

Answer 62

safety / IV / meds

Question 63

role of nurse during ECT

Answer 63

-connect devices -airway -oxygen -VS -record and observe

Question 64

which form of brain stimulation uses bursts of magnetic energy applied to the brain, no seizure activity

Answer 64

transcranial magnetic stimulation (TMS)

Question 65

which brain stimulation implants an electrode onto the vagus nerve and sends electrical impulse to vagus nerve and thus to brain, all implanted surgically

Answer 65

vagus nerve stimulation

Question 66

which brain stimulation implants electrodes in the brain and generators subcutaneously: electrical impulses are continuously generated and sent to the brain. it was used first in parkinsons, shows promise for depression and OCD treatment

Answer 66

deep brain stimulation (DBS)

Question 67

what is the relevance of st johns wort with depression?

Answer 67

can not take SSRIs while using