TOPIC 4 - depressive disorders Flashcards

(62 cards)

1
Q

comorbidity and risk factors

A

prior history ox depression or family history
member of vulnerable groups
female
age 40 or under
active substance use
history of sexual abuse
postpartum period
stressful life events
history of other chronic mental or medical illness

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2
Q

DMDD is only diagnosed …

A

in childhood (before age 10)

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3
Q

percent of children less than 3 who have depression

A

15% (often under diagnosed and has a high recurrence rate)

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4
Q

percent of older adults with depression

A

20%

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5
Q

manifestations of depression

A

sadness, despair, empty, negative, pessimistic, anhedonia, anergia, avolition, low self esteem, apathy, social with-drawl, excessive emotional sensitivity, low frustration, irritable, insomnia, disrupted concentration, excessive guilt, indecisiveness

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6
Q

avolition

A
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7
Q

anhedonia

A
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8
Q

anergia

A
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9
Q

most common presentation of depressive symptoms in children

A

irritable (less likely to be sad or withdrawn)

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10
Q

assessing for depression

A

MSE
psychosocial assessment
physical assessment
standardized scales (Hamilton or SAD PERSONS)

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11
Q

assessing suicide risk

A

SADPERSONAS scale
SAFE-T

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12
Q

different types of suicidality

A

suicidal ideation, suicide attempt, completed suicide, parasuicidal behavior

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13
Q

monitoring and documentation guidelines for suicidal risk

A

1:1 continuous monitoring
document every 15 minutes (observations, statements, activities, behaviors)

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14
Q

biopsychosocial model

A

social / biological / psychological factors are all interlinked and important for regarding and promoting health

mind and body are not separate

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15
Q

biological factors

A

endocrine, immune, and neurosystem functioning

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16
Q

stress diathesis model

A

diathesis - predisposing cause or underlying vulnerability
stress - precipitating cause or triggering circumstance
= disorder

accounts for relationship between early life trauma and later development of vulnerability

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17
Q

cognitive theory triad

A

negative view of self + pessimistic view of world + belief that negative reinforcement will continue

people acquire a psychological disposition to depression from early life experiences

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18
Q

learned helplessness

A

condition of a human or animal that has learned to behave helplessly, failing to respond even though there are opportunities for help

(initial response to event is anxiety but then is replaced by depression- believed they are at fault)

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19
Q

depressive disorders

A

major depressive disorder
persistent depressive disorder
disruptive mood dysregulation disorder

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20
Q

major depressive disorder

A

depressed most of the day, most days of the week

significant distress or impairment in functioning due to symptoms

not attributable to substance use or other medical condition

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21
Q

persistent depressive disorder

A

chronic depression
less severe symptoms than in MDD
symptoms must have persisted for at least 2 years
able to function in life roles greater than those with MDD

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22
Q

DMDD (disruptive mood dysregulation disorder)

A

onset before age 10

s/s : severe temper outburst, inconsistent developmental level persistent irritability or anger

treatment: family supportive therapy, behavioral modification therapy, meds (stimulant, antidepressant, mood stabilizer)

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23
Q

therapy models

A

CBT, MBCT, ITP, bright light

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24
Q

MBCT

A

combination of CBT and mindfulness based stress reduction

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25
bright light therapy
helpful for those experiencing seasonal affect disorder light substitutes for lack of daylight in the winter months = less sleepy, more energy
26
vagus nerve simulation
invasive procedure - implant electrodes and pulse generator that stimulates vagus nerve approved for people with chronic or recurrent TRD who have failed to respond to four or more adequate treatments
27
rapid transcranial magnetic stimulation
noninvasive - magnetic fields stimulate nerve cells in the brain to improve symptoms of depression
28
deep brain stimulation
for movement disorders such as tremors, parkinsons, or OCD
29
noninvasive modes of brain stimulation vs invasive
non invasive = TMS or rTMS and ECT invasive = VNS, deep brain stimulation
30
indications for ECT
patient is suicidal or homicidal, extreme agitation, life threatening illness as a result of the refusal of nutrition, history of poor antidepressant drug response
31
side effects of ECT
nausea, dizzy, short term memory loss, weakness (procedure elicits a seizure)
32
first line antidepressants
SSRI SNRI atypical antidepressants TCAs
33
atypical antidepressants
mirtazapine bupropion ketamine & esketamine
34
second line antidepressants
MAOIs CAMs
35
FDA requires what on all antidepressant meds
black box warning
36
SSRI meds
fluoxetine fluvoxamine paroxetine citalopram escitalopram sertraline
37
side effects of SSRI
headache, nausea, sexual problems serotonin syndrome
38
onset and effectiveness of SSRI
Onset of effectiveness: 1-2 weeks (varies by drug) Full effectiveness: 2-4 weeks (varies by drug)
39
decrease dose if ...
side effects are intolerable but the medication has been effective for lessening symptoms
40
client teaching for SSRIs
allow time for symptom relief report intolerable side effects or worsening depression risk for suicide in first 1-4 weeks
41
half life of fluoxetine
5 weeks
42
how long to wait between fluoxetine and starting other meds
If changing from fluoxetine to an MAOI, the client must wait 5 weeks to begin the MAOI to avoid serotonin syndrome If changing from a different SSRI to an MAOI, the wait between meds must be 2 weeks; also 2 weeks if switching from an MAOI to an SSRI (including fluoxetine)
43
clinical presentation of serotonin syndrome
Hyperactivity or restlessness Tachycardia _ cardiovascular shock, irregular heartbeat Fever _ hyperpyrexia Elevated blood pressure Irrationality, mood swings, hostility Altered mental status (e.g., delirium) Seizures (status epilepticus) Myoclonus, incoordination, tonic rigidity Abdominal pain, diarrhea, bloating Apnea (may lead to death)
44
treatment of serotonin syndrome
Administer serotonin receptor blockade (cyproheptadine, methysergide, propranolol) Cooling blankets, chlorpromazine (for hyperthermia) Dantrolene, diazepam (for muscle rigidity or rigors) Anticonvulsants Artificial ventilation Induced paralysis
45
labs to assess evaluation of serotonin syndrome
* complete blood count (CBC) * blood culture * thyroid function tests * drug screens * kidney function tests * liver function tests
46
onset of effectiveness for SNRIs
2-4 weeks
47
side effects of SNRI
Nausea, dizziness, nervousness, anticholinergic effects Increase in blood pressure Titrate on/ taper off and use extended release to decrease side effects, do not discontinue abruptly serotonin syndrome
48
client teaching for SNRI
allow time for symptom relief, report intolerable side effects, titration of drug dose, monitor for suicidality, DON'T STOP ABRUPTLY
49
contraindications for SNRI
HTN and glaucoma
50
mirtazapine (tetracyclic antidepressant)
Good for elderly & those with severe depression Less insomnia SE, less sexual dysfunction SE COMMON SIDE EFFECTS (SE): Significant weight gain Sedation
51
bupropion (NE dopamine reuptake inhibitor)
Little effect on weight or sexual function Also marketed for smoking cessation (discussed further in Topic 10) COMMON SIDE EFFECTS (SE): Energizing (possible increased anxiety, insomnia; risk for mania induction in clients with undiagnosed bipolar disorder)
52
NMDA antagonists
ketamine and esketamine for severe treatment of resistant depression
53
admin of NMDA antagonists
nasal spray - esketamine inject - ketamine admin 1-2 times a week in the providers office
54
TCAs
dose titration onset of effectiveness : 10-14 days full effectiveness : 4-8 weeks side effects : postural hypotension, tachycardia. urinary retention, constipation, serotonin syndrome
55
TCA dosages
start low go slow
56
client teaching for TCAs
take at bedtime fall precautions do not stop abruptly
57
contraindications for TCAs
MANY drug-drug interactions! Recent MI Narrow-angle glaucoma History of seizures Pregnant women
58
MAOI side effects
Hypotension Muscle cramps Sedation, weakness, fatigue OR insomnia Anorgasmia or sexual impotence Weight gain Anticholinergic effects Hypertensive crisis
59
avoid which foods and drugs while on MAOIs
tyramine foods OTC meds, other antidepressants, narcotics, general anesthetics, stimulants, sedatives
60
2 week med break needed for MAOIs when ...
between taking MAOI and ingesting any food, drink, or product containing tyramine when switching from MAOI to or from another antidepressant 5 weeks needed for switches between fluoxetine and MAOIs
61
hypertensive crisis
excessive tyramine = can lead to CVA s/s : headache, stiff neck, tachycardia, severe nosebleeds, dilated pupils, chest pain, stroke, N/V/D
62
ER admin of meds for hypertensive crisis
if BP elevated IV phentolamine oral chlorpromazine sublingual nifedipine