Term
| 4th leading cause of disability in the US |
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Definition
| depression (suppose to be 2nd by 2020) |
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Term
| percentage of lifetime prevalence of major depressive episode is.... |
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Definition
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Term
| T or F: studies find that major depressive disorder is twice as common in women than men |
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Definition
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Term
| dysthymic disorder (chronic mild depression) occurs in about how much of the population? |
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Definition
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Term
| MDD occurs in how many adolescents |
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Definition
| 18% (girls are twice as likely to experience a MDD) |
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Term
| MDD in adolescents is associated with... |
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Definition
| substance abuse and antisocial behavior (which can obscure accurate diagnosis) |
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Term
| depressice syndromes frequently accompany other d/o's like.... |
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Definition
| psychiatric d/o's like anxiety, schizophrenia, substance abuse. eating d/o's and schizoaffective d/o |
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Term
| comorbidity is shown to have a high rate in... |
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Definition
| suicide, severity in depression, greater impairment in social and occupational function, and poorer response to tx |
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Term
| depression is often ________ to a medical condition |
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Definition
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Term
| pts with Major depressive disorder (MDD) experience... |
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Definition
| substantial pain and suffering, as well as psychological, social, and occupational disability during the depression. |
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Term
| a pt with MDD presents.... |
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Definition
| history of one or more major depressice episodes w. no history of manic or hypomanic |
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Term
| ___% of people can expect to have another episode of MDD |
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Definition
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Term
| dythymic disorder (DD) has what kind of onset? |
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Definition
| early and insidious onset |
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Term
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Definition
| 2 year peroid of depressed mood (present most of the days, more days than not) ---makes it hard to distinguish for persons normal pattern |
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Term
| main difference from MDD and DD |
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Definition
| differences in durations and severity of symptoms |
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Term
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Definition
| psychotic, catatonic, melancholic, postpartum, seasonal, and atypical |
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Term
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Definition
| has hallucinations, delusional |
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Term
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Definition
| peculiar voluntary movements, echopraxia, echolalia, and negativism |
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Term
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Definition
| anorexia, weight loss, diurnal variations, w/ symtpoms worst in the morning |
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Term
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Definition
| within 4 weeks post partum, w/ severe anxiety and possible psychotic features |
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Term
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Definition
| generally occuring in fall or winter and remitting in spring |
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Term
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Definition
| appetite changes, hypersomia, extreme sensitivity to percieved interpersonal rejection |
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Term
| increased heritability is associated(in according to theories) |
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Definition
| with earlier age onset, greater rate of comorbidity, and increase reacurrent episodes |
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Term
| biological theories of depression: |
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Definition
| genetics, biochemical factors, alterations in hormonal regulation, sleep abnomalities, |
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Term
| CNS neurotransmitters that may affect depression |
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Definition
| serotonin, norepinephrine, dopamine, acetycholine, and GABA |
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Term
| two main neurotransmitters that are thought to cause depression |
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Definition
| serotonin and norepinephrine (also effect pain mediators |
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Term
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Definition
| sleep, appetite, and libido |
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Term
| decreases epinephrine can cause: |
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Definition
| anergia, anhedonia, decreased concentration, and diminished libido in depression |
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Term
| ____ _____ events seem to play a significant factor in the development of depression |
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Definition
| stessful life events.... norepinephrine serotonin, and acetylcholine play a role in stress regulation |
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Term
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Definition
| the stress sensitive version of the serotonin transporter gene, put you at higher risks of depression |
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Term
| alterations in hormone regulation (theory of causes of depression) |
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Definition
| relation of the hyperactivity of the hypothalamic-pituitary-adrenal cortical axis |
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Term
| aleep abnormalities (causes of depression) BIOLOGICAL causes |
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Definition
| depressed ppl have a premature loss of deep slow wave sleep and altered REM latency. REM sleep associated w. dreaming occurs earlier in 2/3's of pts w/ bipolar and MDD (reduced REM latency) |
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Term
| psychodynamic influences and life events that MAY cause depression |
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Definition
| psychosocial stressors and interpesonal events trigger certain neurophysical and neurochemical changes in the brain. Early life trauma my result in hyperactivity of the CNS including CRF and norepinephrine systems w/ neurotoxic effect on hippocampus that leads to neuronal loss |
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Term
| Cognitive theory of depression |
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Definition
| include becks cognitive triad, cognitive behavioral therapy, and automatic negative thoughts |
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Term
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Definition
| biological, psychodynamic influences and life events, cognitive thoery, and learned helplessness |
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Term
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Definition
1. a neg., selt deprecating veiw of self
2. a pessimitstic veiw of the world
3. the belief that neg. reinforcement will continue in the future |
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Term
| automatic negative thoughts: |
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Definition
| refers to thoughts that are repetitive unintended and not readily controllable |
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Term
| cognitive behavoiral therapy |
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Definition
is to change the way clients think and thus releive the depressive syndrome. by doing the followuing:
1. identify and testing neg. cognition
2. developing alternative thinking patterns
3. rehearsing new cognitive and behavioral responses |
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Term
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Definition
although anxiety is the initial response to a stressfull situation, ansiety is replaced by depression if the person feels that the self has no control over the outsome of a situation.
EX: aged people living in ghettos and women |
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Term
| why is it so important to assess depression in the elderly? |
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Definition
| depression is often missed and they alot of times have coexisting medical problems. |
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Term
| some assessment tools for depression |
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Definition
| initial assessment guide, Zung depression scale (score of 50 or above=depression) |
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Term
| first assessment made is: |
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Definition
| SAFETY FIRST! assessment of suicide potential...assess for a plan |
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Term
| key symptoms of an assessment |
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Definition
| depressed mood and anhedonia are key symptoms...along with anxiety, anergia, slowed thinking, decreased concentration, exaggerated percieved faults, delusions, and feelings of worthlessness, guilt, anger, and helplessness and SOMATIC COMPLAINTS |
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Term
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Definition
| constant pacing and wringing of hands |
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Term
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Definition
| slowed movements....very common |
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Term
| vegetative signs of depression |
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Definition
| change in bowel movements and eating habits, sleep disturbances, and disinterest in sex |
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Term
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Definition
| affect, thought processes, feelings, physical behavoir, and communication |
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Term
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Definition
| poor posture, facial expressions convey sadness and dejection, fequesnt bouts of weeping, feelings of hopelessness and despair and frequent signing. |
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Term
| assessing thought processes |
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Definition
| identify the presence of suicidal thoughts (priority) , judgement may be poor and indecisiveness, memory, and concentration is poor. may be evidence of delusional thinking |
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Term
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Definition
| anxiety, worthlessness, guilt, helplessness, hopelessness, anger and irratibility |
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Term
| feelings of anxiety in depression: |
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Definition
| present in 60% of depressed persons, |
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Term
| feelings of woththlessness in depression |
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Definition
| range from feeling inadequate to having unrealistic evaulation of self-worth....this reflects low self esteem |
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Term
| feelings of guilt in depression |
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Definition
| person may ruminate over present or past failings |
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Term
| feelings of helplessness in depression |
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Definition
| evidenced byu inability to carry out simple tasks, accompanies hopelessness |
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Term
| feelings of hopelessness in depression: |
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Definition
| once of the care characteristics of depression and suicide, its a cognitive and emotional state that includes neg expectations for future, loss of control over future outcomes, passive acceptance of planning goals. and emotional negativism |
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Term
| anger and irritability in depression: |
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Definition
| these are the natural outcome of profound feelings of helplessness and is often expressed inappropriately |
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Term
| assessing physical behavoir |
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Definition
| look for psychomotor retardation, psychomotor agitation, changes in eating patterns, vegetative signs of depression, changes in sleeping patterns (awaking at 3 or 4 in morning) |
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Term
| self assessment when dealing with depressed pts |
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Definition
1. recognize unrealistic expectations
2. identify feelings they are experiencing that originate w. pt
3. understanding the part of neurotransmitters play in precipitation and maintenance of a depressed mood. |
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Term
| regarding unmet expectations... |
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Definition
| usually result in the nursing feelings anxious, hurt, angry, helpless, or incompetent----contributes to staff burnout |
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Term
| 1# assessment to do on a depressed person: |
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Definition
| evaluate pts risks of harm to self or others!!!!!!!! |
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Term
| key nursing diagnosis for depression: |
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Definition
| risk for suicide, hopelessness, ineffective coping, social isolation, and self care deficit. |
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Term
| the 3 phases of depression: |
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Definition
1. acute (6-9 wks)
2. continuation (4-9 months)
3. maintenance (1 or more years) |
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Term
| acute phase of depression: |
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Definition
| directed at reduction of depressice symptoms and restoration pf psychosocial and work function |
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Term
| continuation phase of depression: |
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Definition
| directed towards prevention of relapse though pharmacological education and depression specific therapy |
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Term
| continuation phase of depression: |
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Definition
| directed towards prevention of relapse though pharmacological education and depression specific therapy |
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Term
| maintenance phase of depression: |
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Definition
| tx is directed at prevention of further episodes |
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Term
| basic level nursing interventions |
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Definition
| engages in cousiling, health teaching, promotion of self care activities, and milieu management |
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Term
| in regarding to teaching interventions |
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Definition
| teach depressed client and their families about S&S of depression, predischarge counseling which you should also include the family |
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Term
| guidelines for communication w. severely withdrawn ppl |
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Definition
1. when cleint is mute, "make observations"
2. use simple, concrete words
3. allow time for the client to respond
4. listen for covert messages and ask about suicide plans
5. avoid platutudes (everything will be ok) |
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Term
| vegetative sings of depression: |
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Definition
| nutrition (anorexia), sleep (insomnia), self care deficits, and elimination (constipation) |
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Term
| advanced practice interventions: |
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Definition
| provide psychotherapy, social skills traning, and group therapy |
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Term
| psychotherapy includes (done by advanced practice nurse): |
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Definition
CBT, interpersonal therapy, time=limited focused psychotherapy, and behavoiral therapy
(CBT and IPT work well in maintenance phase) |
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Term
| percentage of people antidepressants benefit: |
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Definition
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Term
| percentage of people antidepressants benefit: |
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Definition
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Term
| what antidepressents can do... |
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Definition
| they positively alter poor selfconcept, degree of withdrawl, vegetative signs, and activity level. |
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Term
| target symptoms of antidepressants |
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Definition
| sleep disturbance, appetite disturbance, fatigue, decreased sex drive, psychomotor retardation or agitation, diurnal variations of mood, impaired concentration or forgetfullness, and anhedonia |
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Term
| whats the problem at the begining of antidepressant therapy> |
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Definition
| may take 1-3 weeks to work, need for clinicains to monitor pts in the beginings for worsening depression. |
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Term
| primary considerations when choosing an antidepressant: |
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Definition
| side effect profile, ease of administration, history of past response, saefety and medical considerations, and specific subtypes of depression. |
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Term
| secondary considerations when considering an antidepressant: |
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Definition
| neurotransmitter specificity, family history of response, clood level considerations, and cost! |
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Term
| first line therapy for antidepressants: |
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Definition
| SSRI's, atypical antidepressants, and cyclic antidepressants. |
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Term
| second line therapy for antidepressants: |
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Definition
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Term
| SSRI's are the first line of therapy EXCEPT in: |
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Definition
| psychotic depression, melancholic depression, and mild depression |
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Term
| selective serotonin reuptake inhibitors: |
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Definition
| clock the neuronal uptake of serotonin. These drugs have a lower incidence of anticholinergic side effects, less cardiotoxicity, and faster onset of action. Also less dangerious when taken in overdose. |
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Term
| common adverse reactions with SSRI's |
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Definition
| agitation, anxiety, sleep disturbance, tremor, sexual dysfunction(BIG ONE), or tension headache. |
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Term
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Definition
| celexa, prozac, luvox, paxil, zoloft, and lexapro |
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Term
| potential toxic effects of SSRI's |
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Definition
| central serotonin syndrome |
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Term
| what is central serotonin syndrome? |
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Definition
realated to the overactivation of the cental serotonin receptors
Symptoms include abdominal pain, diarrhea, sweatring, fever, tachycardia, elevated blood pressure, altered mental state, myoclonus, irratibility, hostility, and moos chance.....CARDIOVASCULAR SHOCK=DEATH
**most at risks when taking a SSRI and a MAOI |
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Term
| atypical antidepressants: |
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Definition
| "novel antidepressants", these agents clocks different neurotransmitters and tranmitter subtypes. |
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Term
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Definition
is a benzodiazepine anxiolytic, effective for management of anxiety and mild to oderate depression. MAY LEAD TO DEPENDENCY and cause withdrawal reactions when stopped
(novel) |
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Term
| tricyclic antidepressant: |
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Definition
inhibits the reuptake of norepineephrine and serotonin by the presnatpic neurons in the CNS
**may not see full effects of meds until 4 to 8 weeks!!! |
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Term
| some things to teach a pateint about SSRI's |
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Definition
| the S/E's, should not be taken within 14 days of the last dose of a monoamine oxidase inhibitor***, avoid alcohol, meds should not be discontinued abruptly (causes serotonin withdrawal) |
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Term
| examples of Novel atypical antidepressants: |
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Definition
(zyban, wellbutrin, desyrel)
(effexor, remeron, cymbalta,)= dual action reuptake inhibitors both serotonin and norepinephrine
(vestra and edronax)= selective noreponephrine reuptake inhibitors |
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Term
| regarding to dosage of tricyclic antidepressants (TCA's) |
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Definition
| regardless of with TCA is given, the doseage should always be low initially and should be increased gradually |
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Term
| common side effects of TCA's |
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Definition
| anticholinergic side effects, (urinary retension and severe constipation warrent immediate medical attention!), they cause sedation (so give before bed, also helps to comply with therapy!!) |
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Term
| potential side effects of TCA's |
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Definition
| dysrhythmias, tachycardia, myocardial infarction, and heart block, ---so reconsider w. ppl woth cardiac issues |
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Term
| adverse drug reactions with TCA's |
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Definition
| cannot use with MAOI's, benzodiazepines, anticoagulants, barbiturates, and oral contraceptives |
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Term
| contradictions with TCA's |
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Definition
| ppl with cardias issues, those with narrow angle glaucoma, history of seizures, or if pregnant |
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Term
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Definition
| elavil, endep, asendin, norpramin, adapin, tofranil, pamelor, aventyl, vivactil, surmontil, and ludiomil |
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Term
| monoamine oxidase inhibitors (MAOI's) |
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Definition
| responsible for inactiviating certain brain amines like norepinephrine, serotonin, dopamine, and tyramine.--> these amine do not get inactivated or broken down, and there is an increase of these amines available for synaptic release in the brain. |
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Term
| how MAOIs effect the neurotransmitters.. |
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Definition
| increase in norepinephrine, serotonin, and dopamine is the desired effect b.c these can raise the mood of ppl. and increase in tyramine poses a problem b.c can lead to increase in blood pressure, hypertensive crisis and cerebrovascular accident |
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Term
| b.c you dont want alot fo tyramine while taking MAOIs, what can you do to reduce this? |
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Definition
| decrease intake by eating less avocados, bananas, cheeses, salami, bolonga, pepporoni, beer, yeast, and some soups (and soy sauce) |
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Term
| MAOIs are used as first line treatment, T or F |
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Definition
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Term
| common adverse side effects of MAOIs |
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Definition
| orthostatic hypotension, weight gain, edema, cahnge in cardiac rhythme and rate, constipation, sexual dysfunction, vertigo, overactivity, muscle twitching, weakness, fatigue, hypomanic/manic behavoir, insomnia |
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Term
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Definition
increase in BP can l/t intracranial hemorrhage, hyperpyrexia, convulsions, coma and death (may begin w. headaches, flushing cold skin, nosebleeds, stiff neck, chest pain, nausea, or increased temp.)
***medical emergancy, give regitine |
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Term
| contradictions in taking MAOIs |
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Definition
| cerebrovascular disease, hypertension, CHF, liver disease, certain meds, frequent headaches, surgery in past 10 days and if under 16 |
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Term
| electroconvulsive therapy is indicated when... |
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Definition
| a need for a rapid definitive response w. a pt thats suicidal, client is at extreme agitation or stupor, risks of tx outweighs the risks of ECT, history of poor drug response and if client prefers it |
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Term
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Definition
| 2 or 3 tx for 2-4 wks (total 6-12 txs) |
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Term
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Definition
| nardil, parnate, and manerix |
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Term
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Definition
| pt may wake up confused and disoreinted, may have memory deficiets for the first few weeks after course...NOT A PERMANENT CURE!!!! |
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Term
| integrative approaches in treating depression: |
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Definition
| light therapy, st. johns warts, exercise, trancranial magnetic stimulation |
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Term
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Definition
effective b.c the influence of light on melatonin which is secreted by pineal gland and is necessary for maintaining and shifting biological rhythmes, (light exposure supresses the noctural secretion of melatonin
**first line of tx for SAD, |
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Term
| transcranial magnetic stimulation |
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Definition
| still in early stages of clinical trials, but its electromagnetism to deliver an electrical feild to the cerebral cortices, but unlike ECT, the waves to not result in generalized seixure activity |
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