NURS309 Study Guide - Winter 2018, Comprehensive Midterm Notes - Major Depressive Disorder, Anxiety, Schizophrenia
12 Oct 2018
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Department
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NURS309
MIDTERM EXAM
STUDY GUIDE
Fall 2018
Tertiary Prevention of Depressive Disorders
•MDD Additional Information
•Co-morbidity
•Anxiety – symptoms occur in 60 to 90% of those with depression (presence has negative
impact on illness) – and increased risk for suicide
•Often present in borderline personality disorder, anxiety disorders, eating disorders and
substance abuse
•Secondary to medical conditions such as Parkinson’s Disease, inflammatory disorders
(AIDS), MS, Neoplastic disorders, abuse of alcohol and other substances (cocaine and
benzos, barbiturates)
•Etiology
•Diathesis-Stress Model – interplay of biology and life events
•1. Born with predisposition
•2. Early life trauma sensitizes CNS to long term hyperactivity of corticotrophin-
releasing factor – causes release of cortisol and norepinephrine – neurotoxic to
hippocampus and causes neuronal loss – sensitizes body to CRF release even
with mild stress
•Etiology
•Cognitive Theory
•Psychological predisposition to depression due to early life experiences
•Affects our inner core or basic assumptions about the self
•May remain dormant until a stressful event occurs
•Beck Cognitive Triad
•Involves negative views of self, world and future
•Found in those with depression
•View of self as self-deprecating
•World as a negative place
•Future is hopeless or negative reinforcement to the self will continue
•Etiology
•Learned Helplessness
•Seligman proposed anxiety maybe the initial response to stress, but if the person
feels no control then depression may result
•Attributes blame to the self for an undesired event
•Etiology
•Biochemical
•Serotonin and norepinephrine (attention and behavior) implicated
•Dopamine, GABA and acetylcholine are also implicated
•Depression may result from an interplay of several neurotransmitters
•Etiology
•Genetic
•Monozygotic twins – 37%
•Genetic causes associated with earlier age of onset, greater rate of co-morbidity,
increased of recurrence
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•Must also have environmental factors for depression to occur
•Etiology
•Inflammation
•Past few decades mounting evidence supports idea that depression maybe
associated with not only increase in cortisol but also with activation of key
inflammatory pathways in peripheral blood mononuclear cells – overall leads to
increases in circulating pro-inflammatory cytokines such as interleukin
•Findings are extensive to support the role of inflammation in development of
depression such as from post-mortem brain samples of individuals who died
from suicide and from PET scans (Miller & Raison, 2016)
•Secondary – Screening instruments
•Beck Depression Inventory– very commonly used in psychiatry (for example, prior to
start of ECT and after 6 to 12 treatments) – provides an objective way of assessing
symptoms – is self –report and all self-report are subject to bias of trying to present self
in a positive manner
•21 items scored from 0 to 3 for each question
•Total score possible is 63 – meaning severe depression
•Other versions have been created by Beck – including a 7 item scale used for primary
care outpatients – this has 97% sensitivity for identifying patients with MDD
•Secondary – Screening instruments
•Hamilton Depression Rating Scale –21 items
•Administered by interviewer
•Scores of 0-7 are normal
•>20 indicate moderately severe depression
•Secondary – Screening instruments
•Patient Health Questionnaire
•Self administered
•9 questions to establish the diagnosis of depression and used to track the severity of
symptoms over time
•Has a sensitivity of 88%
•5, 10, 15, 20 are mild, moderate, moderately severe, and severe
•Nursing Diagnosis
•Risk for suicide (self-directed violence)
•Disturbed thought processes
•Chronic low self-esteem
•Spiritual Distress
•Impaired Social interaction
•Self-care deficit
•Hopelessness
Tertiary Prevention of Depressive Disorders
Canadian Mental Health Association
Peer Connections
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Tertiary prevention of depressive disorders: mdd additional information. Co-morbidity: anxiety symptoms occur in 60 to 90% of those with depression (presence has negative impact on illness) and increased risk for suicide, often present in borderline personality disorder, anxiety disorders, eating disorders and substance abuse. Secondary to medical conditions such as parkinson"s disease, inflammatory disorders (aids), ms, neoplastic disorders, abuse of alcohol and other substances (cocaine and benzos, barbiturates) Psychological predisposition to depression due to early life experiences: affects our inner core or basic assumptions about the self, may remain dormant until a stressful event occurs. Involves negative views of self, world and future. View of self as self-deprecating: world as a negative place. Future is hopeless or negative reinforcement to the self will continue. Seligman proposed anxiety maybe the initial response to stress, but if the person feels no control then depression may result: attributes blame to the self for an undesired event.
