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59 Cards in this Set
- Front
- Back
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What is mood disorders? |
Disturbances of emotional regulation Recurrent disturbances or alterations in mood that cause psychological stress & behavioral impairment Alterations in mood but not thought or perception |
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What is the impact of mood disorders? |
Associated with high levels of impairment Less than 50% receive treatment |
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What is mood? |
Pervasive & sustained emotion that colours one's perception of the world & how one functions in it |
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What is restricted or constricted affect? |
Mildly decrease in range & intensity |
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What is blunted affect? |
Moderate decrease in intensity or emotional expression |
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What is flat affect? |
Absent or nearly absent, emotional expression |
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What is inappropriate affect? |
Discordant emotional expression |
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What is labile affect? |
Varied, rapid & abrupt shifts in expression |
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What is major depressive disorder? |
Depressed mood, emotional, cognitive, physical, & behavioral symptoms and impairing functioning Lasts minimum 2 weeks 3 million Canadians |
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What is the lifetime course of MDD? |
56% will have 1 episode 29% will experience 2 15.4% will expereince 3+ |
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What are the subtypes of MDD? |
Psychotic features Melancholic features Atypical features Catatonic features Postpartum onset Seasonal features |
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What is dystymic disorder (persistent depressive disorder)? |
Milder but more chronic form than MDD |
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What is major depressive disorder? |
Progressive, recurrent illness Over time episodes are more frequent, severe & longer in duration Average age is 40 y.o. Untreated episodes last 6-13 months Suicide is the most serious complication |
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What are aspects of depression in children? |
Less likely to experience psychosis More likely to manifest symptoms of anxiety Mood may be irritable, not sad Suicide is a major risk during mid-adolescence Mortality rate increases in teen years |
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What are aspects of depression in the elderly? |
Most don't meet criteria of depression 8-20% of older adults in community 37% in primary care setting Associated with chronic illnes Highest group for suicide rate (>80 y.o.) |
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What is the epidemiology of depression? |
Leading cause of disability Lifetime prevalence of 10.8% > rates in low income, unemployed populations and unmarried/divorce Affects 2x more women as men Prevalence unrelated to race |
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What are risk factors for depression? |
Prior depression Family hx Lack of social supports Stressful life event Current substance abuse Medical comorbidity Economic difficulty |
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What are the genetics of depression? |
> in first degree relatives |
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What are the 5 psychological aspects of depression? |
Psychodynamic Behavioural Developmental Cognitive Feminist Theory |
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What are the psychodynamics related to depression? |
Deprivation of love, loss Guild Unexpressed & unconscious anger Unmet dependency needs |
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What are the behavioural psychological related to depression? |
Reduction in pleasant activities |
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What are the developmental psychological related to depression? |
Premature loss of parent |
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What are the cognitive aspects related to depression? |
Learned helplessness Irrational beliefs Distorted or unrealistic attitudes Errors in thinking |
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What is the feminist theory? |
Discrepancy between personal aspirations & the reality of cultural definitions & gender boundaries |
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What are the goals of interdisciplinary treatment? |
Suicide assessment: safety is priority Reduce, remove symptoms Improve occupational & psychosocial functioning Reduce likelihood of relapse |
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What is the nursing process related to depression? |
Assessment of suicide potential is priority Assessment tools (MSE, PSA) Age considerations Self assessment |
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What are biological assessments of a depressive disorder? |
Systems review Physical exam- palpation of the neck for thyroid abnormalities Appetite and weight Sleep disturbances Decrease energy Decreased libido Anhedonia |
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What does anhedonia mean? |
Inability to gain pleasure from activities |
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What are potential nursing diagnoses? |
Risk for suicide, ineffective coping, decisions conflict, spiritual distress, grieving, hopelessness, low self esteem, social isolation |
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What does the recovery model include? |
Focus on patient's strengths Treatment goals mutually developed Based on patient's personal needs & values |
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What are the 4 pharmacologic phases during interventions? |
Acute Continuation Maintenance Discontinuation |
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What is the acute phase and how long does it last? |
Symptom reduction and stabilization 6-12 weeks |
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What is the continuation phase and how long does it last? |
Prevention of relapse 4-9 months |
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What is the maintenance phase and how long does it last? |
Sustained remission 1 year or more |
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What is the discontinuation phase and how long does it last? |
Very carefully, if at all |
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What is the go to for psychopharmacologic interventions? |
Selective Serotonin Reuptake Inhibitors (SSRI) |
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What are examples of SSRIs? |
Fluoxetine (prozac), sertraline (zoloft), fluvoxamine (luvox), paroxtine (paxil), citalopram, escitalopram |
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Which SSRIs meds can cause orthostatic hypotension? |
Fluoxetine (prozac), fluvoxamine (luvox), citalopram, escitalopram |
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Which SSRIs meds cause GI distress? |
Fluoxetine (prozac), sertraline (zoloft), fluvoxamine (luvox), paroxtine (paxil), citalopram, escitalopram |
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What are side effects of cyclic antidepressants (TCA)? |
Sedation and drowsiness, weight gain, blurred vision, dry mouth, constipation, urinary retention, sinus tachycardia, decreased memory |
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What are examples of monoamine oxidase inhibitors (MAOIs)? |
Phenelzine (Nardil), Tranylcypromine (parnate) |
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What are side effects of MAOIs? |
Hypertension crisis/interaction with food Sudden, severe pounding or explosive headache Anticholinergic Elderly- sensitive to orthostatic hypotension Sexual dysfunction Suicide potential is elevated |
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What is serotonin syndrome? |
More likely to happen if individual is taking 2 or more serotonin antagonists Usually mild, but could cause death Rapid onset (hours to days) |
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What are symptoms of serotonin syndrome? |
Mental status, agitation, myoclonus (twitching, jerks) hyperreflexia (overactive reflexes), fever, shivering, diaphoresis (sweating), ataxia (loss of full control of body movements), diarrhea |
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What are treatments of serotonin syndrome? |
Stop drug, provide supportive treatment, notify physician |
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What are teaching points for pharmacologic interventions? |
If depression goes untreated or is mistreated, episodes become more frequent, severe and longer Important to continue meds even if feeling better Avoid St. John's Wort b/c can cause serotonin syndrome if used with SSRIs |
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What are other forms of treatment for mood disorders? |
Electroconvulsive therapy (ECT) Light therapy- SAD seasonal affective disorder Sleep deprivation Transcranial magnetic stimulation Vagus nerve stimulation |
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What is ECT not indicated for? |
Somatization, personality or anxiety disorders |
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What is miilieu therapy? |
Approach using the total environment to provide a therapeutic community |
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What is persistent depressive disorder?
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Dysthymia Chronic MDD and previous dysthymic disorder |
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What is disruptive mood dysregulation disorder? |
Formulated to address concerns about potential over diagnosis an over treatment of BPD in children For children 18 y.o. or older who exhibit persistent irritability & frequent episodes of extreme behavioural discontrol |
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What does parasuicide? |
Failed attempt to kill onself |
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What is suicidal ideation? |
Thinking about or planning one's own death |
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What is lethality? |
Degree of probability that an individual will be successful in completing suicide |
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What are the risk factors for completing suicide? |
Male (4:1) Late teens, Midlife (40-5) & elderly Indigenous Gay/lesbian youth |
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What are protective factors of suicide? |
Intact social supports Active religious or faith Marriage and presence of dependent Ongoing supportive relationship with caregiver Absence of depression or substance abuse Impulse control Proven problem solving & coping skills |
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Methods of suicide? |
Suffocation Poisoning Firearms |
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What are common cues that someone may be thinking about suicide? |
Extreme behavioural changes, recklessness, withdrawal, giving away possessions, loss of interest, alcohol/ drug use, self harm, impulsivity |
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What are the levels of intervention for suicide? |
Primary- Activities that provide support, information, and education to prevent suicide Secondary- treatment of the actual suicide crisis tertiary- interventions with a circle of survivors left by individuals who completed suicide to reduce traumatic aftereffects |
