Term
| "affect" might also be described as ______ or ______ reaction to an experience |
|
Definition
|
|
Term
| Examples of affect: depression, ____, ____, ____ |
|
Definition
| depression, joy, anger, anxiety |
|
|
Term
| ______ is the oldest, most frequently described psychiatric illness |
|
Definition
|
|
Term
| ______ symptoms are normal, healthy responses to every day disappointment |
|
Definition
|
|
Term
| _______ depression occurs when an adaptation is ineffective |
|
Definition
|
|
Term
| _______ ________ is the consequence of dysfunctional grieving |
|
Definition
|
|
Term
| Major depression affects almost __% of the population. Depression is higher in _______ (men/women) by about _ to _. Its is more common in ____(young/older) _______. |
|
Definition
| 10% of the population, higher in women by 2 to 1, more common in older woman (than younger) |
|
|
Term
| In terms of social class, there is an ________ ________ between social class and report of depressive symptoms. ______ social status is more likely to report. The ________ is true of ________. |
|
Definition
| Inverse relationship, higher social status is more likely to report, opposite of bipolar. |
|
|
Term
| Who is most likely to be depressed: single, divorced, or married people? |
|
Definition
|
|
Term
| Which season is most often associated with seasonal depression? What are some reasons this might be true? |
|
Definition
Spring and fall. "Turning points" in lives may trigger depression (starting school, graduating).
Also, variations in serotonin produced in spring and fall. |
|
|
Term
| Incidence of depression is __ higher in first relatives of people diagnosed. People with _______ _______ usually have a relative with it. |
|
Definition
3 times higher.
Bipolar disorder. |
|
|
Term
| What are the three types of depressive disorders? |
|
Definition
Major depressive disorder
Dysthymic disorder
Premenstrual dysphoric disorder |
|
|
Term
| To be diagnosed with Major Depressive disorder (MDD), a person must have __(#) symptoms present in the same _ _____ period and symptoms must represent a _____ from ______ _________. |
|
Definition
| 5, same 2 week period, change from previous functioning |
|
|
Term
**Of the 5 symptoms present in MDD, what MUST be one of them?
The person must have |
|
Definition
| Decreased/depressed mood or loss of interest in pleasure. |
|
|
Term
| There are nine possible symptoms of MDD, of which four MUST be present. What are the nine? |
|
Definition
1. Depressed most of the day, nearly every day
2. Decreased interest in most activities, nearly every day
3. 5% weight loss or gain in one month period*
4. Insomnia or hypersomnia most days
5. Psychomotor agitation or retardation most days
6. Fatigue or low energy most days
8. Feeling worthless or guilty most days
9. Impaired concentration most days
10. Recurrent thoughts of death or suicide most days |
|
|
Term
| In addition to the qualifying symptoms of MDD, _______ may be present. This is NOT present in DD. |
|
Definition
|
|
Term
| To be diagnosed with MDD, the patient must have no history of ____ ______, and it cannot be attributed to use of __________ or a ______ _______ ______. |
|
Definition
| No history of manic behavior, cannot be attributed to use of substances or general medical condition |
|
|
Term
| MDD may be ____ _____ or just a ______ _______. |
|
Definition
| Long term or just a single episode |
|
|
Term
| Dysthymic Disorder is similar to major depression, but with ____ symptoms. |
|
Definition
|
|
Term
| There is NO evidence of ________ ________ in DD. |
|
Definition
|
|
Term
| The essential feature of DD is a chronically depressed mood for ___________, more __________, and for at least __ _____. Though some people may have it ___________-- maybe every ______ for __ years. |
|
Definition
Most of the day, more days than not, for at least 2 years.
Some may have it seasonally, like every spring for at least two years. |
|
|
Term
| Some various symptoms of DD are: decreased ________, _____ disturbances, low ____ ______, difficulty ________. |
|
Definition
| Decreased appetite, sleep disturbances, low self-esteem, difficulty concentrating |
|
|
Term
The essential features of Premenstrual Dysphoric Disorder (PMDD) are: ______ _______, _____, mood _____, decreased interest in _______.
What time must these symptoms occur and end? |
|
Definition
Depressed mood, anxiety, mood swings, decreased interest in activities.
*Symptoms appear the week before menses and end shortly after. |
|
|
Term
| Bipolar disoered is characterized by mood swings that vary from _____ _______ to _______ _______, with intervening periods of _______. The "high" period may be a _____-high, or it may be ______ and _________. |
|
Definition
Profound depression to extreme euphoria, with periods of normalcy.
*The high period may be a happy-high or it may be irritation and aggressiveness. |
|
|
Term
| _____ or ______ may or may not be present in bipolar disorder. |
|
Definition
| Delusions or hallucinations may or may not be present. |
|
|
Term
| Symptoms of bipolar may occur at what time? |
|
Definition
|
|
Term
| To be diagnosed as having mania, the patient MUST have: a distinct period of abnormally ________ or _________ mood lasting __ ____ or more AND _ of the following: _______ self-esteem, decreased _____ ___ ______ (< _ hours/night), extreme _________, ______ thoughts, destructibility, very _____-______ behavior, craving _____ behavior without _______________. * |
|
Definition
Expansive or irritable moor lasting 7 days or more.
3 of the following: increased self-esteem, decreased need for sleep, (<3 hours night), extreme talkativity, racing thoughts, distractability, very goal-directed behavior, craving pleasurable activities without worry about consequences* |
|
|
Term
| The difference between bipolar I and II is that bipolar I has less severe ______. However, the ___ are just as ___. |
|
Definition
| Bipolar I has less severe mania, the lows are just as low, though. |
|
|
Term
| Between episodes, both ______ _ and _ have a ______ period that lasts up to years until there is a ______. |
|
Definition
| Bipolar I and II, euthymic period lasts up to years until there is a trigger. |
|
|
Term
| ______ _____ is a chronic mood disturbance that lasts at least 2 years*. There are numerous episodes of ______ and ____ _____, and the breaks in symptoms are __ 2 _____*. |
|
Definition
| Episodes of hypomania and depressed mood with breaks in symptoms less than or equal to 2 months. |
|
|
Term
Other mood disorders may be due to a _____ ______ condition like __________.
A mood disorder may also be ______-induced, like _____/_____ from drugs or _____. A mood disorder may also be from environmental exposure like ____ such as ____ in the job. |
|
Definition
General medical condition like hypothyroidism
substance-induced mood disorder like intoxication or withdrawal from drugs or alcohol. Metals such as mercury in the job. |
|
|
Term
| Some nutritional deficiencies that could contribute to mood disorders are in: low ___ or ___ vitamins, or low ___ ____. |
|
Definition
| B or C vitamins, low folic acid |
|
|
Term
| State the "Learned helplessness theory." |
|
Definition
| Repeated heartbreak or failure to control life leads to defeat and dependence on others, resulting in predisposition to depression |
|
|
Term
| What is the object loss theory? What does the patient feel? What is an example? |
|
Definition
Person experiences a loss of a significant other during the first 6 months of life. The person feels helplessness and despair. The early loss or trauma may predispose client to episodes of depression in response to losses later in life.
An example is loss or detachment from mother in babies that weren't held enough in the first 6 months. |
|
|
Term
| What is the Cognitive theory? |
|
Definition
| Views that primary disturbances in depression as cognitive, rather than affective. Negative thinking causes depression. In this theory, 3 cognitive distortions serve as a basis for depression: negative expectations about environment, self, future. |
|
|
Term
| ___ _____ is probably the best etiological theory about mood disorders |
|
Definition
| Theoretical integration (multiple influences) |
|
|
Term
| Symptoms of depression age < 3: ______ problems, _______, lack of ______ and emotional _______. |
|
Definition
| Feeding problems, tantrums, lack of playfulness and emotional expressiveness, |
|
|
Term
| Symptoms of depression in ages 3-5: ______ proneness, _______, excessive _____-_____. |
|
Definition
| Accident proneness, phobias, excessive self-reproach ("I was bad, mommy" a lot) |
|
|
Term
Symptoms of depression ages 6-8.
________ ______
________ and/or _______ behavior |
|
Definition
| Physical complains, aggressive and or clinging behavior. |
|
|
Term
| Symptoms of depression ages 9-12 |
|
Definition
| Morbid thoughts and excessive worrying |
|
|
Term
| Situations that may precipitate childhood depression |
|
Definition
| Death of a parent or pet, divorce, academic failure, major illness like cancer |
|
|
Term
| The focus of therapy in depression in children is to ________ ________ and strengthen ________ _____. Two good therapies are _____ therapy, ______ and ______ therapy. |
|
Definition
| Alleviate symptoms and strengthen coping skills. Talk therapy, parental and family therapy. |
|
|
Term
Symptoms of depression in adolescence.
What is the best indicator |
|
Definition
Inappropriate anger, aggressiveness
Running away repeatedly
Delinquency
Sexual acting out
Substance abuse
Restlessness
Apathy
*the best indicator is social withdrawal. These kids have been very social and suddenly want to stay in their room all the time. They don't want to see friends or family. |
|
|
Term
| What is the best clue that differentiates depression from normal, stormy adolescent behavior? |
|
Definition
| A visible manifestation of behavioral changes that lasts for several weeks |
|
|
Term
| What is the most common precipitant to adolescent suicide? |
|
Definition
| A perception of abandonment by parents or close peer relationship |
|
|
Term
| Usually, children are not treated with _____ because they can increase ______ ________. ________ is the one ______ that is approved by the FDA. |
|
Definition
| Not treated with medication because they can increase suicidal thoughts. Prozac is only med approved by FDA for children. |
|
|
Term
| In the older population, depression is often confused with ______ |
|
Definition
|
|
Term
| _____ ______ is what happens as a person ages and many peers, friends, and family start dying around you. |
|
Definition
|
|
Term
| In elderly, there is a ___ _____ or suicides. |
|
Definition
|
|
Term
| Postpartum depression may last for __ ____ to ___ ____. It is associated with ______ changes, _______ metabolism or ____ alterations. One major symptoms is a concern about what? |
|
Definition
May last a few weeks to several months, associated with hormonal changes, tryptophan metabolism, or cell alterations.
Concern about ability to care for infant. |
|
|
Term
| While assessing a person with ____ depression, the nurse may note the "blues," reports crying from time-to-time, has difficulty getting mind off their own disappointment, and feeling tired and listless |
|
Definition
|
|
Term
_____ _______ is associated with normal grieving.
The person may feel anger, anxiety and sadness. They may be tearful and regress to an earlier stage of development. Preoccupation with loss, blame of self and others, anorexia and overeating, sleep disturbances, somatic symptoms.
What is the treatment |
|
Definition
| Mild depression. No treatment at this level. |
|
|
Term
| ________ depression is associated with Dysthymic Disorder |
|
Definition
|
|
Term
| With moderate depression, how does the client feel and present? |
|
Definition
Helpless, powerless, slow physical movement, slumped posture, limited verbalization, *may "self-medicate" with alcohol and drugs. Their thinking is retarded and they have difficulty concentrating.
They may have anorexia or overeating, sleep disturbances, somatic symptoms, feel best early in the morning and get worse as day progresses*
May be angry ant self and others |
|
|
Term
| Severe depression involves symptoms of ____ and _____. |
|
Definition
| MDD and bipolar disorder. |
|
|
Term
| A person with severe depression may have a ____ affect, feelings of _____ _____, _______, apathy and anhedonia. ______ retardation. They may be in the _____ __ position. May not ____ or ______. They may have ________ ______, but usually don't have the energy to carry out a plan. They feel worse in the _____ than the _____*. |
|
Definition
| Flat affect, feelings of total despair and worthlessness, apathy, psychomotor retardation, curled-up position, may stop moving or speaking, suicidal thoughts, they feel worse in the morning than the evening. |
|
|
Term
| In severe depression, _____ may be present |
|
Definition
|
|
Term
| Four classifications of antidepressants |
|
Definition
1. Tricyclics
2. Monoamine Oxidase Inhibitors (MAOIs)
3. Selective Serotonin Reuptake Inhibitors
4. Atypical Antidepressents |
|
|
Term
| Tricyclic antidepressants are used to treat symptoms of _______, as well as for _____ disorders |
|
Definition
| Symptoms of depression. Also used for anxiety disorders like panic attacks, phobic disorders, OCD. |
|
|
Term
| Half-life for tricyclic antidepressants |
|
Definition
| 20-126 hours. They are given once daily. |
|
|
Term
| Tricyclic antidepressents work by blocking _____ of neurotransmitters at _______ neurons. |
|
Definition
| Block re-uptake of neurotransmitters at presynaptic neurons. |
|
|
Term
| At what level does a person develop a tolerance to tricyclic antidepressants? |
|
Definition
| NEVER! The level must be therapeutic, but tolerance does not develop. OVERDOES IS LETHAL. |
|
|
Term
| Tricyclics are used with caution in ____ because of ______ effects like _____. |
|
Definition
| Caution with elderly because of cardiac effects like arrhythmias. |
|
|
Term
| Tricyclics are widely used for _____, but are not approved by the FDA for such use. |
|
Definition
|
|
Term
| Tricyclics are not recommended during ________ and _______. |
|
Definition
|
|
Term
| CONTRAINDICATION for tricyclic use? (6) |
|
Definition
| Cardiovascular disease, glaucoma, BPH, liver disease, renal disease, seizure disorder (lowers the seizure threshold) |
|
|
Term
| Prior to taking tricyclics, what test should the patient have? |
|
Definition
| Baseline ECG is recommended |
|
|
Term
| When taken with warfarin, tricyclics may cause increased ____ |
|
Definition
|
|
Term
| Tricyclics should NEVER be given with ____ due to _______ ____, _______ _____, and _____ ______. |
|
Definition
| Hypertensive crisis, hyperpyretic crisis, and severe seizures |
|
|
Term
What are some common anticholenergic side effects from tricyclics?)
What is some patient teaching to prevent/treat antocholinergic side effects? |
|
Definition
Urinaty retention, dry mouth, constipation, blurred vision.
Tell client to report bladder fullness, assess for distention (may want to do I&O), H2O mouth rinses, sugarless gum/candy, drink H20, increase fiber and exercise, avoid driving or operating heavy machinery until blurred vision subsides |
|
|
Term
| Common cardiovascular side effects (tricyclics) and patient teaching |
|
Definition
Arrhthmias, prolonged QRS, heart failure: teach client to report lightheadedness, dizziness, racing pilse, assess radial and apical pulses, teach client and family to take pulse*
Hypertension: monitor BP
Postural hypotension: change positions slowly, assess orthostatic BP |
|
|
Term
|
Definition
| Sedation, ataxia, agitation, stupor, coma, convulsions, respiratory depression, death |
|
|
Term
| Treatment for TCA overdose: |
|
Definition
| Maintain airway, cathartics or gastric lavage with activated charcoal, give Antilirium (physostigmine), monitor VS and ECG |
|
|
Term
| Which drug do we give for TCA overdose? |
|
Definition
| physostigmine (Antilirium) |
|
|
Term
| Agranulaocytosis, seizures, and serotonin syndrome are ______ side effects of ___s. You need to ____ ___ ____ ASAP. |
|
Definition
| Serious side effects of TCAs. Stop the drug ASAP. |
|
|
Term
| What are the symptoms of serotonin syndrome? |
|
Definition
| Hypothermia, hyperflexia, tachycardia, diaphoresis, decreased LOC (due to increase of serotonin bioavailability) |
|
|
Term
| If a patient is switching between MAOIs and SSRIs, the nurse must ensure there is a ___ ____ "_____ period" to let tricyclics out of the system |
|
Definition
|
|
Term
| If a patient shows signs of serotonin Syndrome, the nurse should _____ ______ ____ (FIRST) administer ____ ____ _____, as well as ____ and meds for _________ support and prepare the client for ____ |
|
Definition
Stop the drug FIRST
administer serotonin receptor antagonist, Iv fluids and meds for cardiovascular support,
***Prepare client for transfer to ICU |
|
|
Term
| MAOIs work by _______ serotonin and _______ at the ______ |
|
Definition
| breaking down serotonin and norepinephrine at the synapse |
|
|
Term
| MAOIs have _____, _________ side effects. |
|
Definition
| Serious life-threatening side effects. They are not used often. |
|
|
Term
| Phenelzine (Nardil), isocarboxazid, tranylcypromin (Parnate) |
|
Definition
|
|
Term
| What is the serum half life for MAOIs? |
|
Definition
| Unknown. The therapeutic effect is reached in a couple of weeks. |
|
|
Term
| MAOIs and elective surgery |
|
Definition
| Discontinue at least 2 weeks due to risk of severe hypotension when anesthesia is given |
|
|
Term
| Over the counter ____ ____ may cause added ________ effects when taken with MAOIs, as well as foods that contain _____ |
|
Definition
cold peperations, sympathomimetic effects
Tyramine |
|
|
Term
| Severe headache at the back of the head (occipital), N/V, elevated BP, photophobia, dilated pupils, arrhythmias/palpatations are symptoms of ______, and the nurse should ____ ___ _____. |
|
Definition
| Hypertensive crisis. Stop the medication. |
|
|
Term
| Why shouldn't a person taking MAOIs consume beer, wine, coffee, or tea? |
|
Definition
| They interfere with MAOI activity. |
|
|
Term
| Foods containing Tyramine |
|
Definition
| Brewer's yeast, broad beans, fava beans, pickles and saurkraut (vinegar), bananas, figs, raisins, cheese, yogurt, chicken lievers, smoked salmon, snails, chocolate, licorice, soy sauce, any processed meats, grapes, oranges, pineapples, plums, leftovers!!! |
|
|
Term
| Drugs to avoid with MAOIs |
|
Definition
| over the counter cold, cough and allergy drugs, prescribed psychostimulants, street drugs such as cocaine and amphetamines |
|
|
Term
| SSRIs only effect the neurotransmitter _____, therefor they do not have the same side effects as MAOIs, TCAs, or antipsychotics |
|
Definition
|
|
Term
Half life of SSRIs?
How long does it take to reach therapeutic effectiveness |
|
Definition
| 20-168 hours. Can be given QD. 2-4 weeks |
|
|
Term
|
Definition
| NO tolerance, LOW potential for OD |
|
|
Term
| Contraindications for SSRIs |
|
Definition
Hypersensitivity reactions
Severe hepatic or renal failure
Seizure
DM |
|
|
Term
| Interactions with SSRIs. Added CNS depression: |
|
Definition
|
|
Term
| Added serotonergic effects |
|
Definition
|
|
Term
SSRIs increase the toxicity of these drugs
d____
d____
l____
c____ |
|
Definition
digoxin
dilantin
lithium
coumadin |
|
|
Term
Some common side effects and nursing interventions are:
______, for which the patient may take SSRI in the ___ and they should eliminate ____. For a ______, the patient may take_________ as RX'd. For _________, the nurse should encourage the patient to consume _______ calories. The only solution to _______ _________ is to switch to another antidepressant. |
|
Definition
Insomnia--> take SSRI in AM, eliminate caffeine.
Headache---> analgesics as RX'd
Weight loss__> adequate calories
Sexual dysfunction___> switch to another antidepressant |
|
|
Term
| Common side effects of heterocyclics |
|
Definition
N/V---> give with food, increase fulids
Restless/insomnia--->take in AM
Weight GAIN---> encourage sugar free beverages and hard candy, balanced nutrition, and exercise |
|
|
Term
| Bupropin (Zyban, Wellbutrin) |
|
Definition
| Heterocyclic, also used for smoking cessation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Serotonin-Norepinephrine Reuptake Inhibitors |
|
|
Term
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Desvenlafaxine succinate (Pristiq) |
|
Definition
|
|
Term
| COMMON side effects of SNRIs |
|
Definition
Elevated BP and pulse--->monitor vs
N/V, dry mouth---> take with food, increase p.o fluids
Drowsiness or insomnia--->time as appropriate |
|
|
Term
| Antidepressents may increase _______ _______ or behaviors in some children, teenagers, and young adults, especially in the first ______ ______ or when ______ is ________. Patients and their families and caregivers should watch for new or ______ _____ of depression. |
|
Definition
Increase suicidal thoughts, especially in the first few months of treatment or when dose is changed.
Watch for new or worsening depression symptoms, changes in behavior, thoughts of suicide. Report symptoms right away, especially if severe or sudden. |
|
|
Term
ECT is effective for clients who...?
It is used when ______ response is needed. Examples are if the patient is ______/________ or have extreme _______/________ |
|
Definition
Don't respond to other treatment.
When rapid response is needed, like suicidal/homicidal or extreme agitation/stupor |
|
|
Term
| What is the best treatment for depression in a woman who is in the first trimester of pregnancy? |
|
Definition
| ECT, when other meds are contraindicated |
|
|
Term
|
Definition
| It is unclear WHY it works. However, seizures increase neurotransmitters, restore circadian rhythm and restores equilibrium between brain hemispheres |
|
|
Term
| Contraindications for ECT |
|
Definition
| Brain tumors, increased intracranial pressure |
|
|
Term
| Use ECT CAUTIOUSLY (not contraindicated) in clients with: recent ___, _______, acute ______ _____, cardiac ______. thrombophlebitis, and _____. |
|
Definition
| Recent MI, aneurysms, acute respiratory infection, cardiac arrhythmia, thrombophelebitis, glaucoma* |
|
|
Term
| The current in ECT lasts less than __ ______. It is given ____ times per ____, for a total of __-__ treatments. The patient may have some _____ ____. which usually is _______/ |
|
Definition
2 seconds
Given 3 times/ week, total of 6-12 treatments
Some memory loss, which is usually temporary |
|
|
Term
| Nursing actions for ECT: keep client ____, set up _____, ____ chart, ______. Remove ____ objects, ______, jewelery. Client must _____. _______ lock in place. Connect ______ and _____ ________, EEG and EKG and _____ line. |
|
Definition
| Keep client NPO. Set up suction, code chart, defibrillator. Remove metal objects, dentures, jewelery. Client voids. Bite lock in place. Connect O2 and pulse oximetery, EEG, EKG and I.V. line. |
|
|
Term
| For ECT _____ is given to reduce secretions and bradycardia |
|
Definition
|
|
Term
| For ECT, _____ is given as a muscle relaxant |
|
Definition
|
|
Term
| in ECT ______, _____, ______ are used as short-acting anesthesia |
|
Definition
| Brevitol, Versed, pentothal |
|
|
Term
| _____(male/female) are more likely to commit suicide. |
|
Definition
|
|
Term
| The two age groups that have higher risk of suicide are____ and ________ |
|
Definition
| Adolescent and older than 50 |
|
|
Term
| Those with a previous ____ are at increased risk for suicide, along with those who abuse ______, have a presence of a _____ _____, lack of a ___ ____, a marital status of _________ (3), presence of ____ ____ ESPECIALLY *chronic ____ ______ |
|
Definition
| Previous attempt, abuse substances/alcohol, presence of a thought disorder, lack of support system, unmarried-divorced-or widowed, physical illness ESPECIALLY chronic organized pain |
|
|
Term
| Living alone, unemployment, recent loss, recent surgery including childbirth, social disgrace and family hx-- increase risk of...? |
|
Definition
| Suicide (not hereditary, but higher risk in family members) |
|
|
Term
| In terms of timing, when is suicide most likely to occur? |
|
Definition
| When going into or coming out of a depression |
|
|
Term
| To establish a supportive relationship with the client, the nurse should align himself/herself with the part of the client that ____ __ ____, as well as _____ ______ closely and using _____ precautions. |
|
Definition
| Part of client that wants to live, as well as monitoring closely and using suicide precautions. |
|
|
Term
|
Definition
| SSRI, only FDA approved antidepressant for children/teens |
|
|
