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Psychiatric Mental Health Nursing > Depressive Disorders/Suicide > Flashcards

Depressive Disorders/Suicide Flashcards

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1
Q

what is depression?

A

alteration in mood that is expressed by feelings of sadness, despair, pessimism
loss of intent in usual activities
somatic symptoms
changes in appetite and sleep- eating too much or too little; sleeping too much or too little

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2
Q

what are the different types of mood disorders?

A

persistent depressive disorder
premenstrual dysphoric disorder
substance/medication-induced depressive disorder
depressive disorder due to another medical condition
major depressive disorder
seasonal affective disorder (SAD)

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3
Q

how long does a person with persistent depressive disorder having feelings of low level depression?

A

most of the day
majority of days- for at least 2 years

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4
Q

what are the symptoms of persistent depressive disorder?

A

in order to be diagnosed a person needs to have 2 of the following

poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self-esteem
poor conentration or difficulty making decisions
feelings of hopelessness

NOT severe enough for hospitalization

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5
Q

what are the essential features of premenstrual dysphroic disorder (PMDD)?

A

at least 5 symptoms appear in last week prior to menses, start to improve at menses onset

mood swings
marked irritability or anger or increased conflict
marked depressed mood, feeling of hopelessness or slef-deprecation
marked anxiety, tension, feeling of being keyed up or on edge
decreased interest in usual activities
difficulty concentrating
lethargy, easy fatigue marked lack of energy
marked change in appetite
hypersomnia or insomnia
breast tenderness, aching, bloating, weight gain

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6
Q

what is the major depressive disorder?

A

symptoms cause significant distress in employment, social or other areas of functioning

not attributed to other medical conditions or substance abuse

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7
Q

what are the diagnostic criteria for major depressive disorder?

A

5 or more must be present for two weeks with a change from previous functioning

depressed mood most of the days or nearly every day
anhedonia- unable to experience pleasure
weight/appetite loss of gain
insomnia/hyersomnia
psychomotor agitation or retardation
anergia/fatigue
feel worthless, inappropriate guilt
trouble thinking, concentrating, indecisiveness
recurrent thoughts of death, suicide thoughts, and plans

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8
Q

what are the major depressive disorder episode specifiers in the DSM-IV?

A

single episode or recurrent episode

mild, moderate, or severe

with or without psychotic features

with catatonic features

with postpartum onset

with seasonal pattern

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9
Q

what are biological risk factors for depression?

A

genetic
biochemical- deficiency of serotonin, norepinephrine, glutamate, GABA, dopamine, and acetylcholine
hormonal
chronic inflammation

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10
Q

what are psychological risk factors for depression?

A

cognitive theory- views primary disturbance in depression as cognitive rather than affective
depression is product of negative thinking; to improve mood, need to change the way a person thinks

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11
Q

what are three cognitive distortions that serve as the basis for depression?

A
  1. negative expectations of the environment
  2. negative expectations of the self
  3. negative expectations of the future
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12
Q

what needs to be observed in the assessment for depression?

A

affect
mood/anhedonia
thought process- indecisive; trouble making decisions
feelings- hopeless/despair/worthless/inappropriate guilt
cognitive changes- trouble learning and concetrating
physical behavior- anergia, pscyhomotor agitation or retardation. vegetative/catatonic signs of depression

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13
Q

what should the patient/family education include?

A

nature of illness
management of the illness
support service

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14
Q

what are treatments and interventions for depression?

A

therapeutic communication
group therapy
family therapy
cognitive therapy
pharmacology
ECT= electroconvulsive therapy, where this utilized inthose note repsonding to treatment or in a severe catatonic state
brain stimulation therapy

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15
Q

what are examples of antidepressant medications?

A

monoamine oxidase inhibitors (MAOIs)
tricyclic
selective serotonin reuptake inhibitors (SSRI)
serotonin-norepinephrine reuptake inhibitors (SNRI)
serotonin antagonist and reuptake inhibitors (SARI)
norepinephrine-dopamine reuptake inhibitors (NDRI)
noradrenergic and specific serotonergic antidepressants (NaSSAs)
serotonin partial agonist reuptake inhibitors (SPARI)
serotoin modulators

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16
Q

what was the first medications specialized to treat depression?

A

monoamine oxidase inhibitors (MAOIs)

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17
Q

what are examples of MAOIs?

A

selegiline transdermal (Emsam)
phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)

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18
Q

what are the foods that needed to be avoided when taking MAOIs?

A

avoid tyramine containing foods, such as:

aged cheeses
raisins, fava beans, flat Italian beans
red wines
smoked or processed meats/caviar
soy sauce/soy products/fermented foods

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19
Q

what are the foods that needed to be limited when taking MAOIs?

A

limit amount of:

gouda cheese, American cheese, mozzarella cheese
yogurt, sour cream
avocados
bananas or any over ripe fruit
beer, white wine, coffee, colas, teas, hot chocolate
chocolate
meat extracts= monsodium glutamate, meat tenderizers

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20
Q

what happens when tyramine containing foods and MAOIs are combined?

A

it causes a hypertensive crisis

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21
Q

what are the signs and symptoms of a hypertensive crisis?

A

headache
N/V
tachycarida
fever
diaphoresis
epistaxis
chest pain
SOB
vision changes

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22
Q

what is the treatment for hypertensive crisis?

A

gastric lavage/activated charcoal
IV vasodilators- nitroprusside sodium (Nipride)

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23
Q

what are the drug-to-drug interactions with MAOIs?

A

any other antidepressant (fatal)
sympathomimetics- cold and congestion tx
stimulants- amphetamines, cocaine
antihypertensive- methyldopa, reserpine
meperidine and opioid narctoics- morphine, codeine
antiparkinsonian agents- levodopa

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24
Q

how many days should someone be discontinued or potentially be starting on MAOIs before/after starting a different antidepressant?

A

14 days

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25
what are examples of tricyclic antidepressants?
amitriptyline doxepin (Silenor) clomipramine (Anafranil) desipramine (Norpramin) nortriptyline (Pamelor) imipramine (Tofranil)
26
what happens if a patient either taking an MAOIs or tricyclic antidepressant, if there is an overdose?
both can cause cardiac arrhythmias, such as V Tach and V Fib
27
what are examples of SSRIs?
fluoxetine (Prozac) sertraline (Zoloft) paroxetine (Paxil) citalopram (Celexa) escitalopram (Lexapro) fluvoxamine (Luvox)
28
what are the side effects of SSRIs?
most common is sexual dysfunction (except Lexapro)- can add Buspar/Wellbutrin to help insomnia fatigue headache N/V/D agitation dizzy dry mouth hyponatremiaw
29
what is the discontinuation syndrome from SSRIs?
dizzy insomnia nervous irritable nausea agitation
30
what is serotonin syndrome?
it is rare; occurs most often when more than one drug is used that increases serotonin levels or when high doses are used
31
what are the symptoms of serotonin syndrome?
abdominal pain/diarrhea sweating/fever/shivering tachycardia/HTN/arrhythmia AMS- delirium myclonus- muscle spasms and rigid increased motor activity hyperactivity- restless irritability/mood swings
32
what can serotonin syndrome progress to?
seizures, coma, death if not recognized and drug withheld
33
what is the treatment for serotonin syndrome?
stop the medication supportive care- adjunctant medications and IV fluids
34
what is the mechanism of action of SNRI?
increases norepinephrine and serotonin levels
35
what are examples of SNRI?
duloxetijne (Cymbalta)- also used in chronic pain and cognitive symptoms venlafaxine (Effexor) desvnlafaxine (Pristiq)- also used for menopause levomilnacipran (Fetizma)
36
what is an example of SPARI?
vilazodone (Viibryd)
37
what are some aspects about vilazodone?
start at low dose needs to be taken with food d/t causing nausea the maximum dose is 40 mg need to be within the therapeutic dose to understand if it is working causes vivid dreams/nightmares
38
what is an example of a serotonin modulator?
vortioxetine (Trintellix)
39
what are some aspects about vortioxetine?
decreases aggression increases sex drive increase cognition
40
what is the onset of vortioxetine?
2-4 weeks, so it is faster than some other antidepressants
41
what are the side effects of vortioxetine?
nausea, where it usually passes within 3-4 weeks
42
what is an example of SARI?
trazadone (Desyrel)
43
what are the aspects of trazadone?
helps with insomnia most common anti-depressant prescribed
44
what is an example of NDRI?
bupropion (Wellbutrin)
45
what are some aspects about buproprion?
uses as adjunctive therapy can help with sexual dysfunction and apathy from SSRI cannot take if hx of seizures can make anxiety worse decrease appetite good for helping to quit smoking
46
what is an example of an NaSSAs?
mirtazapine (Remeron)
47
what are some aspects with mirtazapine?
give before meals sedates stimulates appetite and weight gain utilized in elderly patients, especially in Alzhemier's disease
48
what is the antidepressant black box warning?
antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of MDD and other psychiatric disorders.
49
what are some new therapies for treatment resistant depression?
esketamine intranasal (Spravato) association of testosterone treatment with alleviation of depressive symptom in men, especially older men
50
what is an example of an NMDA antagonist?
esketamine intranasal (Spravato)
51
what are some aspects of esketamine?
it can be very addictive administer nasal corticosteroid or decongestant 1 hour before watch BP d/t causing HTN N/V given in healthcare setting
52
what are patient teachings for antidepressant medications?
continue to take the meds even if symptoms don't seem to be getting better. can take up 4-6 weeks to see improvement do not discontinue drug abruptly avoid alcohol while taking antidepressants- can worsen the symptoms avoid smoking get up slowly d/t orthostatic hypotension photosensitivity notify phsycian with any symptoms of side effects
53
what is the medication plan for depression?
give each med a 3 month trial stay on medications for 6-9 months after signs and symptoms stop 3rd recurrence- lifelong therapy recommended
54
what is electroconvulsive therapy (ECT)?
the induction of grand mal (general) seizure through the application of electrical current to brain
55
what are the methods for ECT?
anesthesia must be present electrodes placed bilaterally in frontotemporal region dose of stimulation is individualized based on client's seizures threshold seizures should last 25 seconds-1 minute movements are minimal d/t muscle relaxer or anti-anxiety give 6-12 treatments 2-3 times a week for 4-6 weeks
56
what are the indications for ECT?
severe depression vegetative symptoms with depression- psychomotor retardation, disturbances in sleep, eating, and energy psychotic symptoms with depression mania schizophrenia anxiety disorders like OCD and personality disorder
57
what are contraindications for ECT?
increased intracranial pressure- the only absolute contraindication recent MI within the past 3 months recent CVA severe osetoporosis acute and chronic pulmonary disorders high-risk or complicated pregnancy
58
what are the pre-op nursing roles for ECT?
assessment- ensure screening for those conditions that make ECT contraindicated keep client NPO for 6-8 hours before procedure- decrease risk for aspiration monitor vital signs with telemetry check blood sugar if diabetic may give oral alkalinizing agents, such as sodium bicarbonate and IV anti-reflux meds, such as reglan remove dentures, glasses, hairpins, jewelry, change into gown have patient void, start IV with LR administer medications as ordered atropine or Robinul iM stay with client to help decrease anxiety
59
what are the nursing roles during the ECT?
assist in connecting to monitoring devices ensure patency or airway; provide suctioning if needed assist anesthesiologist with oxygenation- will need to be prepared to intubated if needed observe readouts on monitors- VS, pulse ox, and cardiac functioning provide support to client's extremities during seizure observe and record type and amount of movement induced by seizure
60
what are the nursing roles after the ECT?
monitor pulse, respirations, blood pressure q15 minutes for first hour- client should remain in bed position client to prevent aspiration orient client describe what occurred provide reassurances that any memory loss is temporary allow clietn to verbalize fears stay with client till fully awake, oriented, and able to perform self-care activities
61
what are other brain stimulation therapies?
transcranial magnetic stimulation (TMS) vagus nerve stimulation deep brain stimulation
62
what is transcranial magnetic stimulation?
use of burst of magnetic energy applied to brain; works like ECT usually without seizure activity; may take more treatments; can be done outpatient
63
what is vagus nerve stimulation?
implant electrode onto vagus nerve and send electrical impulses to vagus nerve and thus to brain; all implanted surgically; very invasive= higher risk for infection
64
what is deep brain stimulation?
implanted electrodes in brain and generators subcutaneously: electrical impulses are continuously generated and sent to the brain used first in Parkinson's shows some promise for depression and OCD treatment
65
what are some other recommendations for those with depression?
exercise greenspace nutrition light therapy melatonin St. John's Wort B vitamins/folic acid/SAM-e/magnesium/omega 3 fatty acids/vitamin D 5000 units per day/probiotics/zinc
66
what are the leading cause of death among suicide victims?
gunshots
67
what are some theories of suicide?
anger turned inward hopelessness desperation/guilt history of aggression/violence shame/humiliation developmental stressors biological link- someone else in their families had an attempt or died from suicide copy cat suicide psychological environmental culture society
68
what are some protective factors from suicide?
effective and appropriate clinical care for mental, physical, and substance abuse disorders- support for ongoing medical/mental health care relationships easy access to a variety of clinical interventions and support restricted access to highly lethal methods of suicide family and community support- marriage learned skills in problem solving, conflict resolution, and nonviolent handling of disputes cultural and religious beliefs hat discourage suicide- support self-preservation instincts
69
what are the risk factors for suicide?
male gender increasing age race (85-90% caucasians) alcohol or substance use disorders psychiatric disorder chronic illness/chronic pain LGBTQ+ youth family history of suicide previous attempt loss of loved one lack of employment
70
what is the assessment for suicide involve?
presenting symptoms/medical psychiatric diagnosis suicidal idea or acts- seriousness of intent, plan, means, and verbal and behavioral clues analysis of suicidal crisis- the precipitating stressor, relevant history, and life-stage issues coping strategies- interpersonal support system
71
what are nursing interventions for depression/suicide?
ask client directly if there are thoughts of suicide or a plan create a safe environment ask for short term contract/safety plan may need a sitter secure promise that client will seek out staff close observation q15 minutes observe medication administration identify something worth living for
72
what is non suicidal self-injury?
risk for self mutilation
73
what are some common self-injury behaviors?
scratching, cutting, or pinching the skin to the point of bleeding, using fingernails or a sharp object carving words or symbols into arms, wrists, legs, breasts, torso, or other body areas biting oneself to the point of bleeding or leaving marks on the skin burning the skin intentionally preventing wounds from healing imbedding objects into the skin ingesting harmful non-nutritive substances with intention to self-injure

Psychiatric Mental Health Nursing (13 decks)

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