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NR 547 FINAL STUDY GUIDE – PMHNP
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When do you consider Unipolar versus Bipolar depression - Accurate answers Unipolar major depression (major depressive disorder) is characterized by a history of one or more major depressive episodes (table 3) and no history of mania (table 1) or hypomania Geriatric Depression Scale (GDS) - Accurate answers Scoring Instructions. Score 1 point for each bolded answer. A score of 5 or more suggests depression. Self-reporting tool that may be used to diagnose and treat depression Geriatric Depression Scale - Accurate answers The Geriatric Depression Scale (GDS) is a self-report measure of depression in older adults. Users respond in a "Yes/No" format. The GDS was originally developed as a 30-item instrument. Since this version proved both time-consuming and difficult for some patients to complete, a 15-item version was developed. The shortened form (GDS-S) is comprised of 15 items chosen from the Geriatric Depression Scale-Long Form (GDS-L). These 15 items were chosen because of their high correlation with depressive symptoms in previous validation studies Geriatric Depression Scale: Targeted Population - Accurate answers he GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults. It has been extensively used in community, acute care, and long-term care settings. Geriatric Depression Scale (GDS): Score - Accurate answers Pharmacologic, psychotherapeutic, or combination treatment indicated of the 15 items, 10 indicated the presence of depression when answered positively, while the rest (question numbers 1, 5, 7, 11, 13) indicated depression when answered negatively. Scores of 0-4 are considered normal, depending on age, education, and complaints; (No Treatment) 5-8 indicate mild depression; (Pharmacologic or psychotherapeutic treatment may be indicated Base treatment on duration of symptoms and functional impairment 9-11 indicate moderate depression; (Pharmacologic, psychotherapeutic, or combination treatment indicated) 12-15 indicate severe depression.(Pharmacologic, psychotherapeutic, or combination treatment indicated Geriatric Depression Scale (GDS): Indication for Intervention - Accurate answers The presence of depression warrants prompt intervention and treatment. The GDS may be used to monitor depression over time in all clinical settings.
Any positive score above 5 on the GDS Short Form should prompt an in-depth psychological assessment and evaluation for suicidality. Patient Health Questionnaire [PHQ-9] - Accurate answers A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression. The Beck Depression Inventory (BDI) - Accurate answers Widely used to screen for depression and to measure behavioral manifestations and severity of depression. The BDI can be used for ages 13 to 80. The inventory contains 21 self-report items which individuals complete using multiple choice response formats. The BDI takes approximately 10 minutes to complete. Validity and reliability of the BDI has been tested across populations, worldwide. Center for Epidemiologic Studies Depression Scale (CES-D) - Accurate answers Designed for use in the general population and is now used as a screener for depression in primary care settings. It includes 20 self-report items, scored on a 4-point scale, which measure major dimensions of depression experienced in the past week. The CES-D can be used for children as young as 6 and through older adulthood. It has been tested across gender and cultural populations and maintains consistent validity and reliability. The scale takes about 20 minutes to administer, including scoring. EQ-5D - Accurate answers The EQ-5D is a standardized, non-disease specific instrument for describing and evaluating health-related quality of life. The instrument measures quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Hamilton Depression Rating Scale (HAM-D) - Accurate answers Mood Disorders: Depression - Accurate answers Sadness, lethargy, inactivity and feelings of helplessness and hopelessness Genetic link Behavioral changes: slower motor reactions Cognitive changes: cognitive distortions Physical changes: alters immune functioning PQ9 Scores - Accurate answers Depression Severity 5 - 9Mild 10 - 14Moderate 15 - 19Moderately Severe 20 - 27Severe scores current depression severity and to follow up treatment response.
Depression Prevalence in older adults - Accurate answers Depression is the second leading cause of disability in older adults after cardiovascular disease and impacts around 7% of the geriatric population Biologic factors, including changes in brain structure and neurotransmitters after a cerebrovascular accident (CVA) or with a neurodegenerative disease such as Parkinson's or Alzheimer's disease, may increase the risk of depression. Examine the image below for additional risk factors. Depression in Older Adults - Accurate answers Depression is the second leading cause of disability in older adults after cardiovascular disease and impacts around 7% of the geriatric population. Depression often presents as a comorbidity with other physical or cognitive disease processes in older adults and may present differently than in adolescents or younger adults. Depression risk factors - Accurate answers Chronic illness Disability/ loss of mobility Change in living situation Role transitions Loss of independence Bereavement Economic hardships Pertinent Information for an Interview: Depression - Accurate answers socialization, including recent changes or loss ability to complete activities of daily living (ADLs) typical physical activity appetite changes weight loss or gain psychotic symptoms suicidal thoughts or ideations Independent risk factor for dementia - Accurate answers Depression therefore it is important to evaluate cognitive function when depression is suspected. Older clients may have associated memory loss, slowed processing, or impaired executive functioning. Assessing Depression in Patients with Dementia - Accurate answers Self-reporting scales, such as the GDS, may be inappropriate. Cornell Scale for Depression in Dementia can be used to screen not diagnose. The goal of treatment for older adults experiencing depression - Accurate answers Symptom remission First Choice of Treating Depression in Older Adults - Accurate answers SSRI & SNRI's Escitalopram, citalopram, and sertraline have fewer drug-drug interactions than other medications and are appropriate choices for initial therapy in older adults taking multiple medications.
Clinical pearls for adjusting and discontinuing pharmacotherapy for depression in older adults - Accurate answers Dose changes: start low, go slow 4-8 weeks for symptom relief reassess if partial improvement, consider adding second drug if no improvement, consider changing to a new drug class maintain pharmacotherapy for at least 1 year after remission to prevent relapse discontinue therapy gradually to reduce withdrawal syndrome (dizziness, anxiety, headache) Nonpharmacologic Interventions: Depression Older Adult - Accurate answers Engagement Social support Exercise Relaxation Mini-Cog Test - Accurate answers Assess Dementia: Step 1: Three Word Registration. Step 2: Clock Drawing. Step 3: Three Word Recall. If abnormal, screen further w/MMSE Children's Depression Inventory - Accurate answers can be used in both educational and clinical settings to evaluate depressive symptoms in children and adolescents (7-17 years old) CDI 2 can aid in the early identification of depressive symptoms, the diagnosis of depression and related disorders, as well as, the monitoring of treatment effectiveness Edinburgh Postnatal Depression Scale (EPDS) - Accurate answers Screening test used to identify depression during pregnancy or in the postpartum period ASQ screening - Accurate answers The Ask Suicide-Screening Questions (ASQ) tool is a brief validated tool for use among both youth and adults. DSM5-TR Diagnostic Criteria for Depression - Accurate answers MDD, five or more of the symptoms below need to be present for at least 2 weeks continuously. (5/9) feeling low most of the day for most days decreased interest in activities substantial weight loss, significant change in appetite fidgeting, random movement (i.e. pacing) decreased energy sense of guilt or worthlessness lack of focus or ability to make decisions repeated thoughts of death and suicide Depressed mood and/or Loss of interest/pleasure must be present.
Medicaid's child health component, the Early and Periodic Screening, Diagnosis and Treatment program
- Accurate answers screening to detect physical and mental conditions at various age intervals. If a risk is identified, the provider should follow up with diagnosis and treatment. Cause of Depression - Accurate answers Though the exact cause is unknown, depression is influenced by genetic and environmental factors. Stressful life events, such as giving birth or experiencing emotional trauma, can contribute to the development of depression. Neurotransmitters involved in Depression - Accurate answers An imbalance of specific neurotransmitters, including dopamine, serotonin, and norepinephrine, can influence brain activity and result in depression. lower levels of dopamine, serotonin, and norepinephrine and receptor binding Depressed patients often have decreased neurotransmitter activity in the prefrontal cortex (PFC) region of the brain. The prefrontal cortex controls attention, mood, and personality, among other functions. Symptoms of depression - Accurate answers Depressed mood and a loss of interest or pleasure. Physical symptoms, including fatigue, inattention, poor appetite, decreased libido, psychomotor retardation, or agitation. Clients with depression often report difficulty sleeping, lack of motivation, or trouble completing tasks. They may use words like "sad," "down," or "blue" to describe their feelings. In severe cases, depressed clients may report delusions or hallucinations. Depression may even present as catatonia. Hamilton Depression Rating Scale (HDRS) Limitations - Accurate answers Atypical symptoms of depression (e.g., hypersomnia, hyperphagia) are not assessed HDRS Scoring - Accurate answers 0-7 is generally accepted to be within the normal range (or in clinical remission), while a score of 20 or higher (indicating at least moderate severity) is usually required for entry into a clinical trial Immuno-Psychiatry - Accurate answers Macrophages are the centurions of the immune system. Macrophages warn the immune system of a potential threat by secreting cytokines alerting more macrophages to come to the injured site. These macrophages "eat" the infection and output bacterial fragments and digestive remnants into the surrounding tissues, leading to inflammation. How does your diet affect your mood? - Accurate answers Cytokines (inflammatory proteins in the blood) can send signals across the blood-brain barrier.
Nerve cells exposed to cytokines are more likely to die than regenerate. In rat studies, rats injected with cytokines exhibited social withdrawal, less movement, and altered sleeping and eating patterns. Inflamed nerve cells cannot effectively transmit 5-hydroxytryptamine (5HT) or serotonin receptors. Persons with inflammatory conditions are significantly more depressed than the general population. Eating foods known to cause inflammation (carbs) will more likely to exhibit depressive symptoms due to imflammation. Medical Diagnoses that Mimic Depressive Disorders - Accurate answers Hypothyroidism, vitamin D deficiency, hypoglycemia, anemia, vitamin B12 deficiency, chronic fatigue syndrome, and hypotension. Medications with side effects mimicking depression - Accurate answers Cannabis, alcohol, clonidine, antidepressants, anticonvulsants, antimigraine agents, corticosteroids, contraceptives, and varenicline (Chantix). Withdrawal from certain substances, such as cocaine or caffeine, can also lead to depressive symptoms. Antidepressant medications used to treat depressive symptoms - Accurate answers SSRI SNRI TCS MAOI's SSRI: Action, Type and side effects used for Depression - Accurate answers Action: inhibits the reuptake of serotonin Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline Common Side Effects: nausea, agitation, headache, and sexual dysfunction SNRI: Action, Type and side effects used for Depression - Accurate answers Action: inhibits the reuptake of serotonin and norepinephrine Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine Common Side Effects: nausea, sweating, insomnia, tremors, sexual dysfunction TCA's: Action, Type and side effects used for Depression - Accurate answers Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors Examples: amitriptyline, clomipramine, desipramine, doxepin Common Side Effects: dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction MAOI's: Action, Type and side effects used for Depression - Accurate answers Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it Examples: isocarboxazid, phenelzine, tranylcypromine
Obstructive sleep apnea (OSA) Severe depression - Accurate answers
