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Chapter 15 / Lesson #8
Handout Questions
What two neurochemicals are most often cited?
Norephinephrine
Seratonin
Symptoms that are commonly observed with a depressed client are?
Thinking, Decision Making, Concentration, Sleeping, Anger, Loss of Pleasure, and Feeling of Worthlessness.
What classification are SSRIs?
Antidepressants
What class of medications are used as the first line of treatment for depression?
SSRIs
List three SSRIs often used to treat depression.  Include generic and brand names.
fluoxetine: Prozac
sertraline: Zoloft
citalopram: Celexa
What other class of medications is depression sometimes treated with?
Antianxiety
Where are serotonin receptors located?
In the brain but also all over the body.
SSRIs are used after ___ months of benzodiazapines.
6
How do SSRIs work in the body?
They make serotonin in the synaptic area more available.  A stimulating effect.
List three common side effects associated with the use of SSRIs.
Sexual dysfunction
Jitterness
Insomnia
What class a medications used to be the first line of defense for treatment of depression but are now used as the second line of defense?
Tricyclic Antidepressants
List three common tricyclic antidepressants.  Include generic and brand names.
amitriptyline: Elavil
amoxapine: Asendin
nortriptyline: Pamelor
What are the side effects of tricyclics?
Anticholinergic
Sedation
Orthostatic hypotension
Cardiac toxicity
What are anticholinergic side effects?
Orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, bluured near vision, dry eyes, photophobia, nasal congestion, and devreased memory.
Cardiac toxicity
Slows the conduction on the bundle of his.
List three drugs that treat depression that are considered "atypical antidepressants".
venlafaxine: Effexor
duloxetine: Cymbalta
bupropion: Wellbutrin
Atypical antidepressants
Combined neurochemicals so they don't fit into any specific class of medication.
What kind of time frame is there for most of the drugs used to treat depression before the nurse will see full therapeutic effects?
3 - 6 weeks.  It takes time for restruction of the brain with receptors  (before new neurons and receptors start performing).
What medication is rarely used in the treatment of depression and comes with dietary restrictions for wine, berr, cheese, and aged meats?
MAOIs
When on MAOIs a tyramine diet must be strictly followed or death can occur.
What does ECT stand for?
Electroconvulsive Therapy
When is ECT used?
It is used to treat pts with depression who have not reponded to antidepressant medications.
What are the Nursing Implications for a ECT procedure?
Monitor Vital Signs
NPO after midnight
Remove finger nail polish
Void before procedure
Check gag reflex after prcedure and before pt eats
May caude loss of short term memory
Expect pt confussion
What is another name for Mood Disorders
Affective Disorders
What is a Mood Disorder?
Pervasive alterations in emtions that are manifested by depression, mania, or both, and interfere with the person's ability to live life.
What is considered to common cold of psychiatric disorders?
Mood Disorders
What are the different types of Mood Disorders?
Major Depressive Disorder (MDD)
Bipolar Disorder
Etiology of Mood Disorders
Genetics
Neurochemical (serotonin, NE, and dopamine)
Neuroendocrine (hormones)
Psychodynamic Influences (life events, stressful events, depleted stores of NE, serotonin and SCH)
Cognitive Theories (a pattern of negative thinking and perceptions)
Major Depressive Disorder (MDD)
Is MDD more common in men or women?
It is twice as common in women and more common in single or divorced people.
What is MDD?
It involves 2 or more weeks of sad mood, lack of interest in life activities, and at least four other symptoms...

Changes in appetite or weight, sleep, or psychomotor activty.
Decreased energy.
Feelings of worthlessness or guilt.
Recurrant thoughts of death or suicidal ideation, plans, or attempts.
If untreated, how long can MDD last?
It can last 6 to 24 months and relapse is common.
What are the symptoms of MDD?
Critical internal voice
Demoralization
Hopelessness
Indecision
Forgetfulness
Negative thoughts
Rumination
What is the class of drug of choice for treatment of MDD?
SSRIs (Antidepressants)

Therapeutic effect 1-3 weeks with maximum effects in 6 - 8 weeks.
Assessment of MDD
History
The clients perception of the problem, behavioral changes, any previous episodes of depression, treatment, response to treatment, family history of mood disorders, suicide, or attempted suicide.
Assessment of MDD
General Appearance/Motor Behavior
Slouced posture, latency of response, psychomotor retardation or agitation
Assessment of MDD
Mood and Affect
Hopeless, helpless, down, anxius, frustrated, anhedonia, apathetic; affect is sad, depressed, or flat
Assessment of MDD
Thought Processes and Content
Slowed thinking processes, negative and pessimistic, ruminate, thoughs of dying or committing suicide
Assessment of MDD
Sensorium and Intellectual Processes
Oriented, memory inpairment, difficulty concentrating
Assessment of MDD
Judgement and Insight
Impaired judgement; insight may be intact or limited
Assessment of MDD
Self-concept
Low self-esteem, guilty, believe that others would be better off without them
Assessment of MDD
Roles and Relationships
Difficulty fullfilling roles and responsibilities
Assessment of MDD
Physiologic Considerations
Weight loss, sleep disturbances, lose interest in sexual activities, neglect personal hygiene, constipation, dehydration
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