Mental Health - Test 1 - Ch. 13

Front 1

Criteria for MDD:
1)represents a change in previous function
2)symptoms cause significant distress/impair in social, occupational, or others important areas
3) 5 or more of the following occur nearly every day for most waking hours over the same 2 week period:

Back 1

a.depressed mood most of the day, nearly every day
b.anhedonia (loss of ability to experience joy or pleasure in living)
c.significant weight loss or gain (more than 5% of body wt in 1 month)
d.insomnia or hypersomnia
e.increased or decrease motor activity
f.anergia (fatigue or loss of energy)
g.feelings of worthlessness or inappropriate guilt (can be delusional)
h.decrease concentration or indecisiveness
i.recurrent thoughts of death or suicidal ideation (with or w/o a plan)

Front 2

subtypes of depression

-post partum depression:

Back 2

infant is at high risk. indicates onset within 4 weeks after childbirth

Front 3

subtypes of depression

disorganized, hallucinations, delusions (body rotting, punished for sins, going bankrupt)

Back 3

psychotic features

Front 4

subtypes of depression

severe apathy, weight loss, profound guilt, symptoms are worse in AM, suicidal ideation

Back 4

-melancholic features-

Front 5

subtypes of depression

people who have dominant vegetative symptoms ( overeating and oversleeping)

Back 5

-atypical features:

Front 6

subtypes of depression

marked by non responsiveness, extreme motor retardation, withdrawal, and negativity

Back 6

-catatonic features:

Front 7

subtypes of depression


-characterized by anergia, hypersomnia, overeating, weight gain, craving for carbs,

Back 7

-have reduced cerebral metabolic activity


-SAD (seasonal affective disorder)

Front 8

-dysthymic (low level depression, doesn’t require hospitalization, nagging symptoms, tends to be chronic)
1. occurs over a 2 yr period (1 yr for children and adolescents), depressed mood
2. symptoms cause significant distress in social, occupational, and other important areas of functioning)
3. 2 or more of the following are present

Back 8

-decreased or increased appetite
--insomnia or hyperseomnia
-low energy / chronic fatigue
-decreased self-esteem
-poor concentration or difficulty making decisions
-feelings of hopelessness or despair

Front 9

Epidemiology of depression

-it's under diagnosed in who?

-what is the dominant symptom in children indicating depression?

-what do elderly focus on?

Back 9

-under diagnosed in children/adults and elderly (children its acting out/irritability is the dominant symptom)
-elderly focus on physical complaints and don’t screen for depression

Front 10

Etiology of depression


what does the diathesis stress model say is the cause?

Back 10

-genetic
-stressors from envt and the dynamic interplay bring it on


-this model says that depression results from a dynamic interplay of biology and the environment
-genetic predisposition

Front 11

from a cognitive perception, what is the etiology of depression?

Back 11

- negative thoughts causes depression, you are processing it in a negative way

Front 12

Becks Cognitive triad found that people with depression process information how?

three thoughts consisted becks triad:

Back 12

in negative ways, even in the midst of positive factors. he said that automatic, negative, repetitive, unintended thoughts perpetuate depression.

1.negative self deprecating view of self
2.a pessimistic view of the world
3.belief that negative reinforcement will continue in the future

Front 13

___% of people with clinical depression commit suicide

Back 13

15%

Front 14

-helplessness is evidenced by the

Back 14

inability to carry out the simplest tasks (grooming, doing housework, working) because they seem to difficult to accomplish.

Front 15

symptoms/physical behavior of depressive disorders

(anhedonia )

Back 15

- inability to feel pleasure

Front 16

symptoms/physical behavior of depressive disorders

-guilt

Back 16

(if someone has depression its way out of proportion)

Front 17

symptoms/physical behavior of depressive disorders

- psychomotor agitation

Back 17

– pts constantly pace, bite their nails, smoke, tap fingers, can’t relax

Front 18

symptoms/physical behavior
of depressive disorders

-psychomotor retardation

Back 18

(occurs in the elderly w/ MDD) - ranges from slow and difficult movements to complete inactivity and incontinence

Front 19

symptoms/physical behavior of depressive disorders

vegetative signs:

Back 19

- refer to alterations in those activities necessary to support physical life and growth (eating, sleeping, elimination, sex) –changes in eating patterns are common - people don’t get out of bed, everything stops…

Front 20

symptoms/physical behavior of depressive disorders

-changes in ______ is a cardinal sign of depression, people can experience insomnia and sometimes people experience hypersomnia (sleep is increased)

Back 20

sleep patterns

Front 21

symptoms/physical behavior of depressive disorders

-_______ is often see in pts with psychomotor retardation

Back 21

constipation

Front 22

symptoms/physical behavior of depressive disorders

-interest in sex declines

Back 22

(loss of libido)

Front 23

-anorexia (loss of appetite) when someone loses their appetite, how do you stimulate their appetite
1- pharm
4- nonpharm

Back 23

some antidepressants stimulate it,
nonpharm way = offer them something small every 2 hours. just a little on a plate (high calorie, high protein) if they see a whole plate of food, they will feel like throwing up)
2) encourage family/friends to remain with pt during meals
3) ask pt which foods/drinks they like
4) weigh the pt weekly and observe the pts eating patterns

Front 24

how do you help the patient who is anorexic
-what can you encourage?

Back 24

(whenever possible, encourage family/friends to remain with the pt during meals (rational: this reinforces the idea that someone cares, can raise the pts self esteem and serve as an incentive to eat)

Front 25

patient / anorexia

-what can you ask the pt?

Back 25

ask the pt which food/drink they like, offer choices, involve dietitian (rational: pt is more likely to eat foods provided)

Front 26

patient is anorexic, what can you do to observe their eating patterns?

Back 26

weight the pt weekly and observe their eating patterns (monitoring the pts status gives the info needed for revision of the intervention)

Front 27

-4 interventions that nurse can do for sleep:

Back 27

1 provide periods of rest after activities (rational: fatigue can intensify feelings of depression)

2 encourage the pt to get up and dress and to stay out of bed during the day (rational: minimizing sleep during the day increases the likelihood of sleep at night)

3 encourage the use of relaxation measures in the evening (tepid bath, warm milk- rational: they induce relaxation and sleep

4 reduce envt and physical stimulants in the evening – provide decaffeinated coffee, soft lights, soft music, quiet activities (rational: decreasing caffeine and epinephrine levels increases the possibility of sleep)

Front 28

self care deficits and interventions:

Back 28

-encourage the use of toothbrush, washcloth, soap, make up, shaving equipment (rational: being clean and well groomed can increase self-esteem)
-when appropriate, give step-by-step reminders such as “wash the right side of your face, now the left” (rational: slowed thinking and difficult concentrating make organizing simple tasks difficult

Front 29

The recovery model
-what does it emphasize?

-how is recovery attained? what's the focus on?

-how are treatment goals mutually met?

Back 29

-emphasizes that healing is possible and attainable for individuals with mental illnesses, including depression

-recovery is attained through partnership with health care providers who focus on the patients strengths


-treatment goals are mutually developed based on the patients personal needs and values, and interventions are evidence based

Front 30

Health teaching for depression:
-1 basic premise of the recovery model of mental illness is that

Back 30

each individual controls his or her treatment based on individual goals (it allows pt to make informed choices and provides hope)

Front 31

-biggest problem with SSRIs is serotonin syndrome (thought to be related to the over activation of the serotonin receptors caused by either too high of a does or interaction with other drugs
-common symptoms:

Back 31

abdominal pain, diarrhea, sweating, fever, tachycardia, elevated BP, altered mental state, muscle spasms, increase motor activity, irritability

Front 32

do not combine SSRIs with a second serotonin enhancing agent like MAOIs. a pt should discontinue all SSRIs for ____ weeks before starting an MAOI

Back 32

2-5

Front 33

-central serotonin syndrome (can happen if you didn’t allow enough time b/w antidepressants, or it can happen if you are taking an antidepressant and you don’t metabolize it well enough

Back 33

SSRIs

Front 34

-main reason people go off SSRIs

Back 34

is because it disturbs sexual dysfunction or lack of sex drive)

Front 35

TCA:
-Pts must take this medication how long before it works?

Back 35

therapeutic doses for 10-14 days or longer before they begin to work, full effects may not be seen for 4-8 weeks. ------take longer to work

Front 36

when you miss a dose of a TCA, what should one do?

Back 36

you take the pill within 3 hours or skip to the next day (DO NOT DOUBLE DOSE)

Front 37

what evaluation must a patient have before starting on a TCA

Back 37

cardiac work up

Front 38

MAOIs


-Symptoms of hypertensive crisis :

Back 38

h/a, stiff neck, palpation, increase or decrease in HR, chest pain, N/V, increase temp (pyrexia), and vitals in general

Front 39

MAOIs

-treatment for hypertensive crisis:

Back 39

-go to ER immediately
-BP should be checked a lot. can give phentolamine (Regitine) or SL nifedipine to promote vasodilation
-promote rapid vasodilation and can give antihypertensive meds such as calcium channel blockers (nifedipine), or alpha adrenergic blockers such as phentolamine (Regitine)

Front 40

Electroconvulsive Therapy - ECT:
-you induce
-reserved for people who

Back 40

-you induce the seizure and activates neurotransmitters and the person is better
-reserved for people who have not been responding well to antidepressant therapy

Front 41

Electroconvulsive Therapy - ECT:
-what 2 meds are given? why?

Back 41

-also given muscle relaxants to prevent muscle distress and even fractures
-given general anesthetic to induce sleep (barbiturate)

Front 42

Electroconvulsive Therapy - ECT:
-side effects
-most significant SE?

Back 42

-SE: head ache, soreness in calf muscles, elderly may be disorientation / confusion, short term memory loss is most significant SE, it is regained
-elderly might sleep after

Front 43

how do you treat someone who has constipation w/ depression

4

Back 43

1) monitor intake/output

2) offer foods high in fiber and provde exercise

3) encourage intake of fluids

4) evaluate need for laxatives and enemas

Front 44

what do you do if a pt is mute?

Back 44

use the techinque "making observations" such as

"there are many new pics on the wall"

"your wearing your new shoes"

-direct questions raise the pts anxiety level and frustrates the nurse

-pointing out commonalities in the envt draws the pt into and reinforces reality

Front 45

what to do w/ withdraw persons
-3

Back 45

1. simple words

2. allow time for pt to respond

3. listen for covert (hidden) messages and ask about suicide plans

Front 46

what should you avoid saying to patients who are severly withdrawn?

Back 46

avoid platitudes such as "things will look up" and "everyone gets down once in awhile"

--minimize the pts feelings and increase feelings of guilt/worthlessness