UNIT 2- DEPRESSION

Question 1

What is depression?

Answer 1

Depression is a syndrome rather than one specific disease. Depression disorders represent a group of syndromes that share some common symptoms but with different etiologies, courses and treatments

Question 2

What is major depressive disorder (MDD)

Answer 2

Affects how you feel, think and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activites
Most common expression of depressive symptoms

Question 3

What is Peristent Depressive Disorder (dysthmyia) PDD

Answer 3

Also known and unipolor depression. A person experiences depression without every experiencing an excessive elevated mood or mania

Question 4

True or false: Confusion or attention problems in older adults may often be misdiagnosed for things like dementia?

Answer 4

True- depression can cause confusion and attention problems in older adults

Question 5

What should we keep in mind with older adults and depression?

Answer 5

1. Complaints of sadness are less prominent
2. excessive concern with physical health compared
3. Complain of feeling tired and have trouble sleeping
4. Seem grumpy or irritable

Question 6

What should we keep in mind with children & adolescents and depression?

Answer 6

1. Children presents as irritability, phsyical complaints, decline in school performance, or social withdraw and may start to use drugs and alcohol at a younger age
2. After puberty, girls are twice as likely to develope depression
3. Adolescents may present with sulkking, being negative grouchy, getting introuble, feeling misunderstood, withdrawing from others, or running away from home
4. Major depression in adolescents is associated with substance use disorders, behavior problems and other mental illnessess

Question 7

What are risk factors for depression?

Answer 7

1. Histor of prior episodes od depression
2. Family hx of depressive disorder esp. in first degree realitives
3. History of suicide attempts, or family hx of suicide attempts
4. Memebers of the LGBTQ community
5. Female gender
6. postpartum period
7. age 40 or younger
8. Chonic medical illness
9. absence of social support
10. negative, stressful life evens, particulary early trauma
11. Active alcohol or substance use disorder
12. hx of sexual abuse

Question 8

What are biochemical factors that affect depression?

Answer 8

Changes in receptor-neurotransmitter relationship in the following areas
1. limbic system
2. hypothalmus
3. prefrontal cortex
4. hippocampus
5. amygdala

Neutrotransmitters
1. decreased levels of serotonin
2. decreased levels of norepinephrine
3. decreased levels of dopamine
4. decreased levels of glutamate
5. decreased gaba
6. decreased acetylcholine

Question 9

What should we know about the stress-diathesis model of depression?

Answer 9

1. Environmental,interpersonal and life evens
2. biological vulnerability and predisposition
3. stress can cause neurphysiological and neurochemical changes in the brain
   4. Early life trauma can result in long-term hyperactivty of the corticotropin-releasing factor (CRF) and norepinephrine systme of the central nervious system leading to neuronal loss and damage

Question 10

what should we know about the cognitive theory? (depression)

Answer 10

Aaron T. Beck
1. people acquire a psycholgical predisoostion to depression through early life expereinces
2. Contributing to negative, illogical and irrational thought processes which are activated when stressed
3. what you think = what you feel (and do)
4. Triad- automatic negative thought
- A negative, self depreciating view of self
- A pessimistic view of the world
- The belief that negative reinforcement will continue
5. **GOal of cognitive behavior theory (CBT) is to change the way a patient thinks reducing negative thoughts. **

Question 11

What is filtering?

Answer 11

Taking negative details and magnifying them while giltering out all the postive aspects of a situation

Question 12

What is polorized thinking for “black and white” thinking

Answer 12

Things are either “black or white”. We have to be perfect or we are a failure there is no middle ground

Question 13

What is personalization?

Answer 13

A distorted belief that everything others do or say is somehow about us

Question 14

What is control fallacies?

Answer 14

1. we see ourselves as helpless a victim of fate, having no control or we assume total responsibility for the pain and happiness of everyone around us (overcontrol)

Question 15

What is fallacy of fairness

Answer 15

1. we feel resentful because we think we know what is fair but other people wont agree with us

Question 16

What is shoulds

Answer 16

we have a list of ironclad rules about how we and others should and must behave

Question 17

Using SIGECAPS what is the clinical picture of MDD?

Answer 17

S- sleep distrubances
I-interest diminshed in pleasurable activites
G- guilt feeling; feeling of worthlessness
E- energy decreased or fatiuge and esteem loss
C- concentration diminished and indecisiveness
A- appetite changes
P- Psychomotor retardation or agitation
S- Suicidal thought and behaviors and thoughts of death

Question 18

What is the clincial picture for PDD?

Answer 18

1. Less severe symptoms than MDD
2. Depressive symptoms that have been present for atleast 2 years
3. Somtimes taken as the persons normal behavior
4. Usually dosent require hosptialization
5. Age of onset is usually adolescene or with severe stress can manifest in adulthood
6. daytime fatigue
7. Functions at work and insocial settings but not optimally
8. chronic low-level depressed/irritable mood
9. Eating too much or too little
10. usually has trouble falling asleep and once asleep, hypersomnia
11. loss of energy, chornic tiredness
12. Decreased ability to experience pleasure, enthusiasm or motivation
13. Irritablity
14. Neagtive, pestimistic thnking
15. low self esteem

Question 19

What are some pychotic features that you might have with MDD?

Answer 19

Hallucinations and delsuions

Question 20

What should we know about MDD and peripartum onset?

Answer 20

During pregnancy and following delievery. May include psychotic features and risk to infant

Question 21

What is seasonal affective disorder?

Answer 21

SAD, most commonly occurs in fall or winter. Remits in spring includes overeating, angeria, hypersomnia – linked to the absence of sunlight

Question 22

What are catatonic features that we might see in MDD?

Answer 22

1. nonresponsive, psychomotor retardation and withdrawl or aggitated or physically active.

Question 23

What is disruptive mood dysregualtion disorder?

Answer 23

seen in children, chronic severe persistent irritability with outbursts

Question 24

What is premenstrual dysphoric disorder?

Answer 24

1. Depressive symptoms are present in the week before the onset of menses and gradually improve afte the onset of menses

Question 25

What should we know about premenstrual dysphoric disorder?

Answer 25

1. Occurs in luteal phase of cycles 2. emotionally liable 3. anger or irritable 4. depressed mood 5. may also include lack of energy, overeating, sleep distrubances, physical symptoms

Question 26

What is PPD?

Answer 26

Postpartum depression includes 1. Baby blues- feels depressed anxious. cries for no reason, sleep problems. occurs in 70-80 % of new moms, improvement within 1-2 weeks without treatment 2. PPD- strong feelings of sadness anxiety, despair, guilt, difficult coping. Symptoms DO NOT subside. May have thoughts of self harm, or harm to the baby.

Question 27

What is Postpartum psychosis?

Answer 27

1. Rare 2. Recurrance is extremely high with each pregnancy with more severe episodes 3. Onset is fairly rapid within 3 days to 1 week after delivery 4. agitated, anxious, disorganized behavior 5. delusions are baby foucsed think of the story where the mom killed her 4 children because she thought they were not pure

Question 28

What are some examples of stadardized screening tools for depression?

Answer 28

1. Beck depression inventory 2. Hamilton depression scale 3. Geriatric depression scale 4. Zung's self-rating depression scale 5. The patient health questionare 6. the Edinburgh post natal depression scale

Question 29

Our detailed mood and affect assessment for depression disorders should look for?

Answer 29

1. feeling of worthelessness 2. guilt 3. helplessness 4. hopelessness-negative expectations for the future 5. anger and irritablity 6. anxiety-60-90% of depressed patients experience anxiety as well 7. affect

Question 30

What are some phsycial changes-clinical symptoms we should assess for when assessing for depression?

Answer 30

1. Poor posture 2. Appears older than they are 3. sees world through gray colored glassess 4. facial expression conveys sadness and dejection 5. Frequent bouts of weeping 6. Anergia 97% 7. psychomotor agitation 8. grooming and hygeine neglected 9. vegitative signs of depression 10. pain 50-75%

Question 31

What is a depressed patients cognition and thought content going to look like?

Answer 31

1. Thnking is slow 2. memory and ability to concentrate may be affected 3. ruminate 4. decrease in problem solving 5. poor judgment 6. indecisivess 7. delusional thinking with psychotic features

Question 32

What might our nursing process/diagnosis be for a patient with depression disorder

Answer 32

1. Risk of harm 2. mood regulation/stability 3. withdrawn behavior leading to social isolation 4. lack of motivation leading to self care deficits 5. loss of appetite can lead to impaired nutrition 6. Distrubance of sleep 7. impairment of self esteem reduing quality of life

Question 33

What do we want our nursing outcomes to be for a pt with depression

Answer 33

1. Evidence of weight gain 2. sleep 6-8 hours per night 3. identify symptoms related to relapse 4. return to normal bowel activity 5. showers daily

Question 34

What are some interventions we can do for a patient with depression

Answer 34

1. Offering self- aka presence 2. use simple concrete words 3. allow time for response 4. Listen for covert messages 5. avid false reassurance or minimizing feelings 6. Health promotion and health taching to pt and family - explain biological, psychoscoial and cognitive changes associated with depression 7. teach covert and overt signs of SI and precautionary measures 8. Medication teaching 9. relapse prevention plan 10. nutrition 11. sleep hygiene 12. exercise 13. informatics with self help 14. elimination

Question 35

What should we know about depression intervention psychotherapy?

Answer 35

1. CBT- psychotherpay, talk therpay, grou therapy and group support 2. interpersonal psychotherapy (IPT) structred addressing socal issues 3. Problem solving therapy (PST) - define problem - develope multiple solutions - identify best one and implement - Assess effectiveness 4. CBT-1 addresses insomnia 5. Social skills training 6. Behavior activation 7. Psychodynamic therapy

Question 36

Midfulness based cognitive therapy (MBCT) used for...

Answer 36

reocurrence of MDD-- it is a combination of CBT and mindfulness based stressed reduction

Question 37

What are some pharmacological therapies that may be used to treat Depression and what will it target

Answer 37

1. Antidepressant medicaton 2. sleep distrubances 3. appetite distrubance 4. fatigue 5. decreased sex drive 6. psychomotor retardation or agitation 7. Impaired concentration/forgetfulness 8. Anhedonia 9. May take 1-3 weeks

Question 38

What are safety consideration with pharmacological therapy to tx depression

Answer 38

1. Black box warning- children, adolescents and young adults may experience suicidal ideation with SSRIs 2. Elderly-start low and go slow 3. Bith defects in pregnancy during fetal development 4. Increased cerebral microbleeds in those 45 and older

Question 39

What considerations should be looked at when using pharmacolgical tx to tx depression

Answer 39

1. Previous respose to antidepressants 2. ease of adminsitration 3. safety and medical comorbities 4. neurotransmitter specificity 5. family hx of response 6. cosedt

Question 40

What are 4 types of antidepressants used to treat depression?

Answer 40

MAOI TCA SSRI Atypical antidepressants

Question 41

What is the MOA of MAOIs

Answer 41

Monoamine oxidase breaks down norepinephrine, serotonin, dopamine and tyramine. MAOI inhibits this breakdown increase these nuerotransmitters NOT 1st- line treatment due to food interaction and drug interactions from elevated tyramine may lead to HBP, Hypertensive cirsis, CVA and death

Question 42

What are side effects of MAOIs

Answer 42

1. muscle cramps 2. weight gain 3. sexual dysfunction 4. anticholinergic effect 5. serious food/drug interactions (tyramine) - aged cheese/meats - goods with yeast - soy - beer/wine - avacados and bananas

Question 43

What are some examples of MAOIs

Answer 43

1. Phenelzine (nardil) 2. Tranylcypromine (PARNATE) 3. Isocarboxazid (Marplan) 4. Selegiline (EnSAM) patch

Question 44

What should we know about TCA's

Answer 44

1. Effective but frequent noncompliance due to anti-cholinergic side effect 2. Mood elevation may take up to 4-8 weeks for full effect 3. Potential for lethal overdose

Question 45

What are some examples of tricyclic antidepressants (TCAs)

Answer 45

1. amitriptyline (elavil) 2. Amoxipine (asendin) 3. Doxepin (sinequan) 4. Imipramine (Tofranil) 5. Desipramine (norpramine) 6. Nortripytyline (pamelor)

Question 46

What are side effects of TCAs?

Answer 46

1. Sedation 2. Mydriasis (dilated pupils in responce to trauma illness and drugs) 3. Weight gain 4. sweating 5. toxicity 6. sexual dysfunction 7. Decreased seizure threshold 8. Orthostatic hypotension 9. Anticholinergic effect

Question 47

What should we know about SSRIs?

Answer 47

1. Effective with fewer adverse effects & lower lethality if overdose occurs, more costly 2. Potential for serotonin syndrome

Question 48

What are examples of SSRIs

Answer 48

1. fluoxetine (prozac) 2. Sertraline (zoloft) 3. Paroxetine (paxil) 4. Citalopram (celexia) 5. Escitalopram (lexapro) 6. Fluvoxamine (luvox) 7. Vilazodone (viibyrd)

Question 49

What are s/s of serotonin syndrome? Use SHIVERS

Answer 49

S-sheivering H-Hyperreflexia I- Increased temp V- VItal sign changes E- Encephalopathy R- Restlessness S-Sweating

Question 50

What should we know about serotonin syndrome?

Answer 50

1. Discontinue offending agent; call health care provider immediately 2. Initiate symptomatic tx per orders 3. Muscle relaxants. Benzos can help control agitation, seizures, and muscle stiffness; and/or dantrolene for muscle relaxation 4. Serotonin- production blocking agents, such as cyproheptadine, can help by blocking serotin production 5. oxygen and intravenous (IV) fluids. O2 helps maintain normal oxygen blood levels, and IV fluids treat dehydration and fever 6. Drugs that control heart rate and blood pressure 7. Phenylephrine (neo-synephrine) or epinephrine (adrenalin, EpiPen) for hypotension 8. Cooling blankets for high fever 9. Use of a breathing turbe and machine and medication to paralyze muscles

Question 51

What are side effects of SSRIs?

Answer 51

1. tremors 2. nausea 3. headache 4. insomnia/drowsiness 5. sexual dysfunction 6. bruxism (teeth griding) 7. Anxiety/agitation 8. Dry mouth 9. Diarrhea 10. hyponatremia

Question 52

What are examples of atypical antidepressants?

Answer 52

1. Venafaxine (effexor)SNRI 2. Duloxetine (cymbalta) SNRI 3. Desvenlafaxine (Pristiq) SNRI 4. Bupropion (Wellbutrin) NDRI 5. Trazadone(desyrel) TSA related 6. Mirtazapine (rameron) NASSA

Question 53

What should we know about electroconvulsive Therapy ECT

Answer 53

1. Used when previous medication trails failed 2. 70-90% remission rate for depression 3. Used for tx of psychosis and schizophrenia 4. Safe during pregnancy 5. Marked agitation, begetative symptoms, catatonia not effective in the tx of personality, substancce use, or situational depression 6. Informed consent obtained 7. Course: 6-12 treatments, 2-3 times/week

Question 54

What is ECT?

Answer 54

1. Electric current passed through the brain by unilateral or bilateral electrodes placed temples producing a generalized (tonic-clonic) seizure masked by muscle relaxant. Seizure lasts 30-60 seconds 2. ECT enhances effects of neurotransmitters & increases hippocampal & amygdala volume in the brain

Question 55

What instructions should be given prior to ECT?

Answer 55

1. NPOx6hours 2. Informed consent signed 3. REmove jewlry, hearing aids, eyeglassess, contacts, dentures 4. Assess vital signs & mental status 5. Atropine administed 30 mins before procedure 6. IV in place 7. EEG electrodes placed

Question 56

During an ECT what should we know?

Answer 56

1. Short acting anesthetic agent: methohexital or propofol IV bolus 2. Muscle relaxant: Succinylcholine 3. Monitor vital signs, EKG, o2 sats 4. Administer 100% o2 throughout the procedure 5. IV in place 6. EEG moinitoring

Question 57

What should we know post ECT?

Answer 57

1. Observe for everal of anesthetic agent 2. support physiologic stability 3. Place in lateral, recumbant position 4. Continue to monitor thorughout recovery should be alert in 15 mins 5. IV in place until full recovery

Question 59

What should we know about VNS?

Answer 59

Vagus ervious stimulation? 1. Surgical implant of device in left chest wall with wire threated around vagus nerve in neck that delivers electrical impulses. Requires informed consent 2. Increased levels of neurtransmitters 3. S/E include voice changes, neck pain, cough, dysphagia, dyspnea

Question 60

What is rapid transcranial magnetic stimulation r(TMS)

Answer 60

1. FDA approved for treatment of resistant depression 2. Noninvasive 3. Use magnetic impulses to stimulate focal areas of cerebral cortex may fell tapping or knocking 4. Prescribed daily, 4-6 weeks 5. S/E include HA, light-headdness, sclap tingling

Question 61

What is DBS?

Answer 61

Deep brain stimulation 1. Experimental therapy for treatment resistant depression 2. Surgical implant of pacemaker-like device implanted in sub-clavicle region, sending electric currents through a wire to electrodes implanted in the brain. It either works or makes things worse

Question 62

What is light therapy?

Answer 62

Influences melatonin, exposed to light sourced 30-60 mins/day

Question 63

What should we know about st. Johns wort and depression?

Answer 63

1. Improves mild depression, not regulated by FDA, not approved for those who have MDD, who are pregnant or children

Question 64

What are risk factors of suicide?

Answer 64

1. PRevious attempt 2. financial problems 3. End of relationship 4. new diagnois or worsening health conditon 5. refugees 6. indigenous people 7. LBGQT community 8. Someone who knew someone who comitted suicide 9. childhood trauma 10. access to means

Question 65

Suicide is linked to

Answer 65

Lowe levels of serotonin Chronically overactive noradrenergic system (stress response- fight or flight response) Hypothalamic-pituaiatry-adrenal (HPA axis (another stress response system)

Question 66

What puts youth at an increased risk of suicide?

Answer 66

1. Agression 2. disruptive behavior 3. depression 4. social isolation 5. episdoes of running away 6. expressions of rage 7. family loss or instability 8. Frequent problems with parents 9. Withdraw from family and friends 10. Talk of death or after life when sad or bored 11. dealing with sexual orientation 12. unplanned pregnancy 13. perception of school, work, social culture

Question 67

What are older adutls risk factors?

Answer 67

1. social isolation 2. SOlitary living 3. Widowhood 4. Lack of financial resources 5. Poor health 6. Feelings of hoplessness

Question 68

QPR.... means

Answer 68

question, persuade, refer 1. if a friend or loved one is threatenting, talking about or making plans for suicide, these are signs of an acute crisis 2. do not leave the person aone 3. remove from the vicinity of any firearms , drugs or sharp objecs that could be used for suicide 4. take the person to the hospital room, walk in clinic or call 911 or crisis line

Question 69

Our assessement of depression/suicide should include

Answer 69

1. suicide assessment five step evalution and triage 2. modified sad persons scale 3. identify risk factors 4. identify progective factors 5. conduct suicide inquiry 6. determine risk level intervention

Question 70

What are examples of overt verbal cues?

Answer 70

1. I cant take it anymore 2. life istn worth living anymore 3. I wish I were dead 4. Everyone would be better of I were dead

Question 71

What are examples of covert verbal cues

Answer 71

1. Its ok now everything will be okay 2. things will never work out 3. I won't be a problem much longer 4. NOthing feels good to me anymore and probably never will 5. How can I give my body to medical science

Question 72

Using the assessment SAD PERSON scale what are we looking at

Answer 72

S- male sex-->1 A: Age if <19 or >45 years-->1 D: Depression or hopelessness -->2 P: Previous suicidal attempts of psychiatric care-->1 E: Excessive ethonol or drug use--> 1 R: Rational thinking loss (psychotic or organic illness)-->2 S: Separated, widowed, or divorced-->1 O: Organized plan or serious attempt--> 2 N: No social support-->1 S: Stated future intent (determined to repeat or ambivalent)--> 0-5: may be safe to discharge depending on circumstances 6-8: Probably requires psychiatric consultation >8 Probably requires hospital admission (voluntary or involuntary)

Question 73

What are some behavior clues that could tell us that our patient is at risk for suicide?

Answer 73

1. Giving away prized possessions 2. Writing farewell noes 3. Making out a will 4. Putting personal affairs in order 5. Having gloval insomnia 6. Exhibiting a sudden improvement in mood after being depressed or withdrawn 7. neglecting peronsal hygine

Question 74

What would our nursing diagnosis or problem for a suicidal patient

Answer 74

1. Risk for suicide 2. impaired family process 3. lack of family support 4. negative self image 5. risk for self-destrucive behavior

Question 75

What would our outcomes for a suicide patients be

Answer 75

1. Patient will reamin safe 2. Family will stay overnight with patient 3. Follow up appointment with counselor or therapist 4. phone numbers of hotlines, self-help groups 5. Is enegaged in treatment 6. States feelings of isolation and loneliness are fewwer and less severe 7. Increase problem solving skill

Question 76

What are our suicide precautions/observations?

Answer 76

1. 1:1 percautions: continual observation at arms length for actively suicidal 2. Oberservation: 15mins, percautions observe every 15 min and document affect/behavior/location 3. nurse can implement then obtain orders

Question 77

What are some environmental guidlines for suicidal patients?

Answer 77

1. Besides continual observation 2. plastic eating utensils 3. do not place in private room, keep door open 4. Place close to nurse's station 5. Ensure patient swallows all oral medication 6. Minimize self harm objects on unit: electrical cords, housekeeping carts, glass unlocked windows, keep other doors on unit locked 7. Safety search: remove medications, sharps, belts, shoestring razors, matches, glassess, shampoo, 8. check visitors/gifts 9. review hopital P&P

Question 78

What is our interventions for managment of poisioning

Answer 78

1. medically stabilize; identify toxin if possible 2. prevent further absorption; give activated charcol po or ng (inital adult dose 50gm/240ml)

Question 79

What is the antidote for acetaminophen?

Answer 79

Acetylcysteine: PO,NG, or IV inital adult dose 150m/kg IVPB

Question 80

What is the antidote for benzos

Answer 80

flumazenil (romazicom) IV (inital adult dose 0.2mg IVP)

Question 81

What is the antidote for opiods?

Answer 81

Narcan IV, IM, SQ (inital adult dose 0.4mg IVP)

Question 82

What should we know about postvention?

Answer 82

1. survivors are stigmatized and isolated 2. Complicated and painful 3. mourning without normal social supports 4. Five stages of grief - denial - anger - bargaining - depression - acceptance 5. Post traumatic stress reactions - Irritability - sleep distrubances - anxiety - exaggerated startle reacion - nausea and headache - difficulty concentrating - guilt - withdrawl - reactive depressive