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31 Cards in this Set
- Front
- Back
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Dysthymia |
chronic form of depression last at least and frequently more than 2 years |
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Biochemical theories about depression |
neurotransmitter imbalance
thyroid dysfunction
med side effects |
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S/S Dpression |
MUST HAVE FIVE ORE MORE OF THE FOLLOWING FOR THE SAME TWO WEEK PERIOD:
DEPRESSED MOST OF DAY EVERY DAY MARKED DIMINISHED INTEREST IN ALMOST ALL ACTIVITIES weight loss/gain >5% insomnia/hypersomnia psychomotor agitation/retardation fatigue/loss of energy lack of concentration/indecisiveness excessive guilt or feeling worthless recurrent thoughts of suicide with or without plan or attempt |
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"In Sad Cages" |
INterest- loss of pleasure Sleep disturbances Appetite changes Depressed mood Concentration difficulty Activity:agitation/retardation Guilt feelings or low self-esteem Energy loss Suicidal ideation |
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Labs for Depression/Diagnostics |
ALWAYS CHECK TSH BMP CBC LFTs U/A VDRL B12
depression screen tools |
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Management for Depression |
refer those with hallucinations, delusions, loss of reality contact and suicidal thoughts
Mild depression: weekly appts without contact by phone for backup
therapeutic communication
encourage alternate coping methods
consult regarding psychotherapy and possible antidepressants
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Categories of feelings |
mad sad glad afraid ashamed |
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Antidepressents |
SSRIs Paxil (paroxetine) Prozac (fluoxetine) Zoloft (sertraline) Celexa (celexa) Luvox (fluvoxamine)
Low overdose danger Fast symptom response No Postural HTN
Tricyclics and MAOI (not used as often due to increased effects and high overdose potential)
MAOI educate about wine+cheese= hypertensive crisis
Dry mouth and constipation with Tricyclics |
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Anxiety |
unpleasant feelings of dread, apprehension, or tension due to an unexpected threat to one's feeling of self-esteem or well-being |
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Generalized Anxiety Disorder |
excessive worry/anxiety about life circumstances |
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Panic Disorder |
morbid dread of seemingly harmless object/situation
can lead to agoraphobia |
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Obsessive/Compulsive Disorder |
repetitive thoughts (obsessions) that a person is unable to control
urge to perform an act that cannot be resisted without great difficulty (compulsions)
interferes with normal ADLs |
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Post-Traumatic stress disorder |
anxiety for at least six months after severe trauma
characterized by flashbacks, nightmares, and intrusive thoughts |
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Antianxiety meds |
Benzodiazepines: most commonly used…Ativan
Antihistamines: for those with COPD or potential for abuse
Beta blockers: to reduce tachy, palp, and breathlessness
Tricyclics and MAOIs: may be beneficial for panic attacks but not generalized anxiety disorder
BUSPAR…ONLY ANTIANXIETY MED NOT CLASSIFIED AS A TRANQUILIZER…TAKES 3-4 WEEKS TO REACH FULL EFFECT |
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S-U-I-C-I-D-A-L |
Sex Unsuccessful attempts Identified family members with attempt history CI..Chronic illness history Depression, drug abuse, drinking Age of patient Lethal method available
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Second leading cause of death among adolescents |
suicide |
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What are the risks of suicide in elderly |
loneliness and medical disability
interventions should target these |
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C-A-G-E |
C: Have you ever felt the need to cut down on your drinking?
A: Have people annoyed you by criticizing your drinking?
G: Have you ever felt guilty about your drinking?
E: Have you ever had a drink first think in the morning to steady your nerves or get rid of a hangover? |
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Who should you refer someone to who you are concerned about alcoholism? |
AA |
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Mini-Mental Status Exam |
11 components
O: orientation to place AND time R: recognition (repeat three objects) A: attention (serial 7s counting backwards from 100) L: recall (ask to recall 3 objects 5 min. later) 2: identify name of two objects (chair and clock) 3: follow 3 step command R: reading W: writing D: drawing
Score: maximum is 30 no cognitive impairment 24-30 delirium/dementia 18-23 (mild) 0-7 (severe)
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Delerium |
sudden transient onset of clouded sensorium
may occur at any age associated with physical stressor
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Dementia |
gradual memory loss with decreased intellectual functioning usually occurring over 60 years of age |
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D-E-M-E-N-T-I-A |
Helps to rule out other diseases indicative of dementia:
D: drug reactions/interactions E: emotional disorders M: metabolic/endocrine disorders E: eye and ear disorders N: nutritional problems T: tremors I: infection A: arteriosclerosis |
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Alzheimer's Disease |
characterized by both memory impairment and one or more of the following:
aphasia (difficulty with speech) apraxia (inability to perform previously learned task) agnosia (inability to recognize an object) inability to plan, organize, sequence, and make abstract differences |
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Other Alzheimer's disease findings |
limb rigidity flexion posture disorientation recent memory impairment impaired judgement gait disturbances
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Diagnostics for Alzheimer's |
CBC Electrolytes glucose BUN/CT LFTs B12 VDRL
CT or MRI to rule out tumors |
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Management of Alzheimer's |
To increase acetylcholine (acetylcholinesterase inhibitors)
Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon)
Often prescribed with NMDA receptor antagonists such as NAMENDA to improve thinking and ADLs
REFER PATIENT/FAMILY FOR COUNSELING AS APPROPRIATE |
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Cerebellar functioning |
responsible for balance and coordination |
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Romberg test |
ask patient to stand feet together, eyes close, and arms at side
+ if patient loses balance |
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Finger to nose test |
patient alternately points from his nose to examiner's finger |
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Heel-to-shin |
runs the heel of one foot along the shin of the opposite leg |
