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