Depressive Disorders MH exam 2
In postpartum depression, the client may experience the "baby blues". How long until these "baby blues" should go away?
1-2 weeks
Depression is the second leading cause of death in people aged ___-____, often due to ....
15-24; due to a break up or abandoned by a close personal relationship
Therapeutic potential for tricyclics may not be reached for ____
4 weeks
Tx for depression in general
Individual psychotherapy, group therapy, meds, family therapy, cognitive therapy, ECT, transcranial magnetic stimulation, vagal nerve stimulation, light therapy
MAOI example:
Phenelzine (Nardil), isocarboxazid
A client states they have a depressed mood, mood swings, anxiety, and decreased interest in activities. Her menses is set to start in about a week. What is likely her diagnosis?
Premenstrual dysphoric disorder
what are the two most common antidepressant meds for adolescence?
Prozac (8+) and Lexapro (12+)
A loss is internalized and becomes directed against the ego (Freud)
Psychoanalytical theory
Best clue for adolescent depression:
a visible manifestation of behavioral change that lasts for several weeks
SSRIs should not be discontinued ____
abruptly (could cause rebound depression)
the four spheres of human functioning:
affective, behavioral, cognitive, psysiological
Tyramine foods
aged cheese, wine/beer, chocolate, coffee/tea, processed meats, yogurt, raisins, soy sauce, diet pills
The focus of therapy for depressed children is to
alleviate the symptoms and strengthen coping skills
Symptoms of depression in adolescence include
anger, running away, social withdrawal, delinquency, sexual acting out, substance abuse, restlessness, apathy
A loss of interest or pleasure in previously enjoyed activities is called
anhedonia
Treatment for depression in elderly includes
antidepressants, ECT (last resort), and psychosocial therapies
Depression in the elderly can often be associated with
bereavement overload (many losses)
All antidepressants carry a _____ for ____
black box warning for increased risk for suicide
Cognitive behavior therapy focuses on helping people to alter mood an behavior by:
changing the way they think
Tricyclics have worse side effects so are not usually first line tx. If taking these meds, educate the patient to:
chew gum, eat fiber, fluids, frequent tooth brush/floss
What is the essential feature for dysthymic disorder?
chronically depressed mood for 1: most of the day 2: more days than not, 3: at least 2 years (or 1 yr = children)
Underlying cause is cognitive rather than affective. Negative expectations of environment, self, and future . Depression is the product of negative thinking.
cognitive theory
What 2 neuroendocrine disturbances do we look at for depression?
cortisol and thyroid
Childhood depression may be precipitated by a loss, such as:
death, divorce, academic failure, physical illness
Deficiency of what 3 chemicals may predispose someone to depression?
deficiency of norepinephrine, serotonin, dopamine
Childhood depression is often referred t as
disruptive mood dysregulation disorder
SNRI examples:
duloxetine, effexor
A patient reports feeling "down in the dumps" with no evidence of psychotic symptoms, this patient may be diagnosed with:
dysthymic disorder (persistent depressive disorder)
Children with depression may present with these symptoms, in addition to classic symptoms:
excessive self-approach, excessive clinging, changes in grades, getting into trouble, school phobias, hyperactivity, psychosomatic complains, sleeping/eating disturbances, isolation, delusional thinking, suicidal thoughts/actions, morbid thoughts, excessive worry
complicated grieving occurs after the death of a significant other in which the experience of distress accompanying bereavement...
fails to follow normative expectations--> functional impairment
A _____ factor could be involved in depression
hereditary
If tyramine is consumed while taking and MAOI, the patient could go into
hypertensive crisis
learned helplessness, someone experiences numerous failures and learns to give up trying, conditioned to believe there is no help
learning theory
SSRIs are first line d/t favored side effects, some of these meds include:
lexapro, fluoxetine, sertraline (Zoloft)... (-pram)
florescent light that stimulates retina and increases serotonin in the brain
light therapy
A patient has depressed mood, anhedonia, no history of manic behavior, with impaired social/occupational functioning for at least 2 weeks, may be diagnosed with:
major depressive disorder
Dysthymic disorder is chronic but not severe enough to meet criteria for:
major depressive disorder
Depression can also be due to:
med side effects, neuro disorders, electrolyte disturbances, hormonal disorders, and nutritional deficiencies
Treatment for moderate depression in postpartum depression is
meds (Brexanolone/Zulresso) or psychotherapy
ECT is a last resort due to the side effects and risks including:
memory loss, brain damage, mortality
Normal grief response, may feel anger/anxiety, regression, preoccupied with the loss, anorexia/insomnia
mild depression
Dysthmia, helpless, slumped posture, slow movements, limited talking, difficulty concentration, anorexia, sleep issues, headaches
moderate depression
Symptoms of depression in the elderly are often confused with symptoms of
neurocognitive disorder
separated or abandoned during the first 6 months of life, helplessness and despair, early loss or trauma
object loss theory
Postpartum- severe depression with psychotic features may have the following symptoms:
poor concentration, no interest in baby, incapacitating symptoms (r/o suicide)
Lived experience of lack of control over a situation
powerlessness
A diminished TSH response to thyrotropin releasing factor is associated for an increased risk for:
relapse
This is when depression is more prevalent in the winter when there is less sunshine
seasonal/affective
Includes sx of major depressive disorder and bipolar depression: total despair, worthless, flat affect, psychomotor retardation, absence of communication, delusional, confusion, suicidal thoughts
severe depression
Severe depression is marked by distress that interferes with
social, occupational, cognitive, and emotional functioning
Major depressive disorder cannot be attributed to:
substance use or another medical condition
Depression that is the direct result of the effects of a substance (withdrawal/intoxication)
substance-induced depressive disorder
Treatment for adolescence is generally outpatient and includes:
supportive psychosocial intervention and antidepressant medications
With premenstrual dysphoric disorder the symptoms begin ______, the symptoms improve _______, and the symptoms are minimal or absent ______
the week prior; a few days after onset; the week postmenses
Depression is a primary diagnosis for...
those 65+ (especially white males)
The reason women are more prone to depression is because of:
thyroid issues, hormone issues, sensitivity to stress, poor coping skills
This sends short pulses to stimulate nerve cells, considered to be safe
transcranial magnetic stimulation
Lifes everyday disappointments, not dysfunctional
transient depression
Antidepressants include
tricyclics, SSRIS (first line), MAOI, Heterocyclics, SNRIs
Major depressive disorder is one of the leading causes of disability in the US. True/false
true
Medications are not any good without therapy: true/false
true
Single and divorced are more likely to be depressed: True/false
true
When a patient is taking and MAOI, they have to be aware of ___ intake.
tyramine
improves clients mood by the implantation of an electrical device that stimulates the vagus nerve
vagal nerve stimulation
Is depression more prevalent in men or women?
women