NR 547 Final Study Guide – PMHNP-with 100% verified solutions-posted in 2024-2025.docx, Exams of Nursing

Download NR 547 Final Study Guide – PMHNP-with 100% verified solutions-posted in 2024-2025.docx and more Exams Nursing in PDF only on Docsity! NR 547 Final Study Guide – PMHNP-with 100% verified solutions-posted in 2024-2025 When do you consider Unipolar versus Bipolar depression 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) 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 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 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 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 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] 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) 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) 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 agitation or sluggishness Depression: Atypical features Depression that includes the ability to temporarily be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs Depression: Psychotic Features Depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes Depression: Catatonic Features Depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture Bipolar I and II disorders These mood disorders include mood swings that range from highs (mania) to lows (depression). It's sometimes difficult to distinguish between bipolar disorder and depression. Cyclothymic Disorder (Cyclothymia) Involves highs and lows that are milder than those of bipolar disorder. mood disorders Psychological disorders characterized by emotional extremes that occur across a spectrum from depression to mania. Disruptive Mood Dysregulation Disorder (DMDD) This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper outbursts. This disorder typically develops into depressive disorder or anxiety disorder during the teen years or adulthood. Persistent Depressive Disorder (Dysthymia) Less severe but more chronic form of depression. While it's usually not disabling, persistent depressive disorder can prevent you from functioning normally in your daily routine and from living life to its fullest. Depressed mood, for more days than not, for ≥2 years. Impairment compared with major depressive disorder may be less severe. During the 2 years, the patient has never been without symptoms for more than 2 months at a time. Premenstrual dysphoric disorder (PMDD) Depression symptoms associated with hormone changes that begin a week before and improve within a few days after the onset of your period, and are minimal or gone after completion of your period. Depression Prevalence in older adults 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 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 Chronic illness Disability/ loss of mobility Change in living situation Role transitions Loss of independence Bereavement Economic hardships Nonpharmacologic Interventions: Depression Older Adult Engagement Social support Exercise Relaxation Mini-Cog Test 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 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) Screening test used to identify depression during pregnancy or in the postpartum period ASQ screening 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 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. MDD statistics An estimated 4 percent of the United States' adult population has experienced at least one major depressive episode. The condition is more prevalent in women than in men. It is three times more likely for people between the ages of 18-25 to experience depression as compared to adults 60 and over. MDD frequently occurs with other medical or psychological conditions like substance abuse, anxiety, hypothyroidism and diabetes. People who have experienced cancer, a heart attack, post-traumatic stress disorder or Parkinson's Disease are likely to be diagnosed with MDD. MDD (major depressive disorder) 5 symptoms during the same two week period that are a change from previous functioning; depressed mood and/or loss of interest/pleasure must be present; exclude symptoms clearly attributable to another medical condition Adjustment disorder with depressed mood Adjustment Disorder with Depressed Mood, also called Situational Depression, may sometimes feel nearly as bleak as MDD, but a major difference is that it does not arise out of the blue. Rather, situational depression occurs after there is a specific trauma-divorce, accident, death of loved one, a major life change... Depression Education: Older Adult Emphasize that medications should be taken as prescribed but that they may not "cure" depression; remission of symptoms is the goal but 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 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 Atypical symptoms of depression (e.g., hypersomnia, hyperphagia) are not assessed HDRS Scoring 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 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? 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 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 Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it Examples: isocarboxazid, phenelzine, tranylcypromine Common Side Effects: sedation, dizziness, sexual dysfunction, and hypertensive crisis Why we have to assess for Bipolar before prescribing for depression? Certain antidepressant medications can precipitate a manic episode or induce rapid- cycling bipolar depression, which may contribute to the increased incidence of death by suicide in children and adults younger than 25. Epidemiology - Depression In people ages 18 to 44 years, depression is the leading cause of disability and premature death. In the US, major depression is the second leading cause of disability overall. The aggregate point prevalence of depression and anxiety has been reported as 12.9% and the lifetime prevalence has been reported as 10.8% In patients with an affected first-degree relative, the lifetime risk of depression increases two- to threefold First onset occurs most frequently in patients ages 12 to 24 years or older than 65 years. Etiology of Depression Heredity, low serotonin, learned helplessness, low SES, common in women, and diet. Work-up to exclude other causes for Depression Initial tests include thyroid function tests, metabolic panel, and complete blood count. Serum vitamin B12 and folate levels, and 24-hour urinary cortisol may also be informative. Depression has a documented adverse effect of which medications? Corticosteroids Interferon Propranolol Oral contraceptives Levodopa Isotretinoin Differentials for Depressed Mood Adjustment disorder with depressed mood Substance-/medication- or medical illness-associated and other depressive disorders Bipolar disorder Premenstrual dysphoric disorder (PMDD) Grief/bereavement Dementia Anxiety disorders Alcohol-use disorder Anorexia nervosa Hypothyroidism Medication adverse effects Cushing disease Vitamin B12 deficiency Obstructive sleep apnea (OSA) Severe depression