Midterm study guide PMHNP I

Midterm study guide PMHNP I 1. Differentiate between depression and bipolar?: First you need to make sure its either depression or bipolar (ex: if we start on antidepressant and they become manic we would then know they are bipolar). 2. Factors that can induce depression:: chronic stress due to the hypothalamic pituitary adrenal axis which can contribute to brain changes such as a smaller hippocampus and changes in the neurotransmitters. 3. What may occur to the brain with depression?: Brain atrophy of the hip- pocampus 4. What are other factors that may influence depression?: Corticotropin-re- leasing hormone (CRH) a neuropeptide is released by the hypothalamus to acti- vate the pituitary in response to stress but is hyper-secreted in depression (cortisol levels). 5. Personality traits & depression: 6. Genetics plays a role in depression: 7. Depression may be a result with chronic life stressors: Uncontrolled life stressors can affect mood, such as not having a support system at home and because basic needs for self care are not being met. 8. Risk for suicide with depression: Men die from suicide more then women -White men complete 78% of all suicides -Contract for safety is not enough and won't prevent someone who wants to commit suicide from committing it. -Male gender, elderly with finance issues, nursing home, widowed, illness, unem- ployed, substance abuse, previous attempts and loss of financial security. 9. Protective factors against suicide?: Family (children, pets, parents and spouse) Religion (afraid to go to hell) 10. The neurobiology & pathophysiology of depression: Amines/neurotrans- mitters: serotonin, norepinephrine, and dopamine (changes correlated in depres- sion). Serotonin: depleted in depression Norepinephrine (memory & focus) : increased in flight or fight response (higher levels are seen in anxiety and restlessness) SNRI prevents depletion such as Effexor and Cymbalta (Cymbalta:used more for depression/with pain) Dopamine: decreased in depression and increased in mania & schizophrenia (***also decreased in parkinsons ***) increased in drug abuse such as ampheta- mines 11. Risk factors for major depression: It may first occur between the ages of 20-40 years old. It may be caused by bullying, social media and substance abuse. More common in women then men Postpartum depression (estrogen fluctuations) Genetics first degree relative (but environment can be another factor as well). 12. Women and depression: The fluctuations in estrogen affect depression in women. Puberty and after menopause women have same rates of depression as men. Prior hx of PMS and PMDD have a higher incidence of a mood disorder. During childbearing years estrogen is at its highest and the cycling as well so this increases women to the risk for depression 2-3 time more than men. 13. Treatment of pregos with depression: Sertraline (shitraline) is the treatment of choice in pregnant women because of the positive results, no risk for neural tube defects (de