Ch. 14 Depressive Disorders

research show that when what population says they are going to kill themselves they actually do go through with an attempt?

Elderly

Affect of Person with Depression:

Feelings of hopelessness and despair Flat

Mood of Patient with Major depressive disorder:

Feelings of worthlessness

Importatnt regulator of sleep, appetite, and libido

Serotonin

Symptoms of this Toxic effect include: abdominal pain, diarrhea, fever, sweating, tachycardia, elevated BP, delirium, myoclonus (muscle spasms), irritability, hostility, mood change

Serotonin Syndrome

The two main neurotransmitters involved in mood are; and therefore play a big role in Depressive disorders are:

Serotonin and Norepinephrine

Flower that increases Serotonin, Norepinephrine, and Dopamine in the brain

St. John's Wort

Inhibit the reuptake of noreipinephrine and serotonin by the presynaptic neurons in the CNS

TCA's

Target symptoms of depression that Antidepressant drugs target:

Sleep disturbances Appetite Disturbance Fatigue Decreased Sex drive (libido) Psychomotor retardation Diurnal variations in mood impaired concentration / forgetfulness Anhedonia

Can result in apathy, reduced responsiveness, or slowed psychomotor activity

Norepinephrine Deficiency

the ability of the brain to produce new brain cells

Neurogenesis

really agitated

Psychomotor Agitation

One of the most common mental disorders, affecting approximately 13 million adults annually in the United States

Major Depressive Disorder

Which question would be a priority when assessing for symptoms of major depression?

"You look really sad. Have you ever thought of harming yourself?"(want to find out if going to harm self)

Psychological Factors - Cognitive: Beck's Cognitive Triad includes:

A negative, self-deprecating view of self A pessimistic view of the world The belief that negative reinforcement will continue in the future.

The outward representation of a person's internal state of being and is an objective finding based on the nurse's assessment

Affect

lack of energy of physical passivity

Anergia

loss of interest in pleasure or things they took pleasure in before

Anhedonia

Common Signs/Symptoms of Major Depressive Disorder:

Anhedonia fatigue sleep disturbances changes in appetite feelings of hopelessness or worthlessness persistent thoughts of death or suicide inability to concentrate or make decisions change in physical activity

common adverse effects of TCAs include:

Anticholinergic (dry mouth, blurred vision, tachycardia, constipation, urinary retention, etc.)

can positively alter poor self-concept, degree of social withdrawal, vegetative signs of depression, and activity level

Antidepressant drugs

Characterized by persistently depressed mood lasting for a minimum of two weeks

Major Depressive Disorder

Leading cause of disability in the United States

Major Depressive Disorder

treatment whereby electrodes are implanted into specific areas of the brain in order to stimulate those regions identified to be underachieve in depression

Deep Brain Stimulation

Hormonal regulation involved in this disorder

Disruptive mood dysregulation disorder

Occurs when feelings of depression persist consistently for at least two years

Dysthymic Disorder

Primary Risk Factor for Depression:

Female gender Unmarried Low socioeconomic class Early childhood trauma Presence of a negative life event (loss or humiliation) Fam history of depression Ineffective coping ability Postpartum time period Medical illness Absence of social support Alcohol or substance abuse

Common feelings in Depression:

Guilt Helplessness Hopelessness Anger Irritabilty

Severe toxic effects of Serotonin Syndrome include:

Hyperpyrexia (excessively high fever), cardiovascular shock, or death

Which assessment finding in a patient with major depression represents a vegetative sign?

Hypersomnia (Never get out of bed)

Reason why MAOIs are not first line treatment for Depression?

Increases Tyramine (high BP, cerebrovascular accident) so people must decrease their intake of foods and drugs that contain tyramine. With depression strict adherence to diet limitations not realistic.

First Line Treatment for SAD (Seasonal Affective Disorder)

Light Therapy

Risk of Serotonin syndrome seems to be at its greatest when combined with what other type of drug?

MAOIs

Modulates attention and behavior

Norepinephrine

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?

Psychomotor retardation

recommended first line therapy for most types of depression:

SSRIs (Selective Serotonin Reuptake Inhibitors

What two adverse effects of TCAs warrant immediate medical attention?

Urinary Retention Severe Constipation Weight gain also common complaints

almost compatose

Vegetative State/Sign

Common adverse reactions of SSRIs:

agitation Anxiety Sleep Disturbances Tremor Sexual Dysfunction (anorgasmia) tension headache

minor type depression

dysthymic disorder

What is accomplished with ECT (Electroconvulsive Therapy)?

jumbles around neurotransmitters to get more serotonin into brain, etc.