NURS 663 Exam 1: Key Points 2023 with complete solution

NURS 663 Exam 1: Key Points 2023 with complete solution Exam 1: Key Points Depressive Disorders Depressive Disorder Due to Another Medical Condition • Prominent & persistent disturbance in mood • Characterized by: o Depressed mood o Diminished interest or pleasure in all or almost all activities • Evidence is found from the history, physical examination, or lab findings of: o Disturbance is the direct pathophysiological consequence of another medical condition • Can mimic or mask symptoms of depression o Infectious mono in adolescents o Thyroid dysfunction (labs to diagnose) o Adrenal dysfunction (labs to diagnose) o HIV o Covid-19 o Post CVA ▪ Left frontal stroke o Huntington’s ▪ Neuropsych symptoms are FIRST symptoms to occur o Parkinson’s motor symptoms o TBI ▪ Mood symptoms can be episodic or recurring o Temporal lobe epilepsy ▪ If epileptic focus is on right side o Cancer Disruptive Mood Dysregulation Disorder (DMDD) • Severe Inconsistent Temper outbursts (SIT) o Three or more times per week • Irritable mood in between outbursts • Duration: o Outbursts occur at least 3 times/week o Occurs for at least 1 year o No more than 3 months during that time when criteria is not met • Onset: o Between ages 6 and 10 years old ▪ Occurs more in boys o Criteria must be met BEFORE 18 years old • Symptoms: o Recurrent inappropriate outbursts ▪ Verbal or behavioral ▪ Occurs 3 times/week for at least 1 year in at least two different settings • Home • School o Developmentally inappropriate o Irritable/angry most days in between outbursts o Irritable and mad most days ▪ Must have all symptoms to diagnose • Can occur with: o ADHD o Major depressive disorder (MDD) o Anxiety o Autism spectrum disorder (ASD) • Cannot occur with (differential diagnoses): o Oppositional defiant disorder o Intermittent explosive disorder o Bipolar disorder • Criteria: OI VEY Major Depressive Disorder (MDD) • Duration: o Must have symptoms for at least 2 weeks • Must have at least 5 symptoms within the 2-week period • Symptoms: o At least 1 symptom must be DEPRESSED MOOD or ANHEDONIA ▪ Loss of interest or pleasure in things ▪ Lack of motivation o Depressed mood ▪ Sad ▪ Empty ▪ Hopeless o Weight loss/poor appetite o Insomnia or hypersomnia o Psychomotor agitation/retardation o Fatigue/loss of energy o Feelings of worthlessness or guilt o Decreased concentration o Recurrent thoughts of death or suicide • Symptoms cause significant distress to: o Social life o Occupation o Other areas of functioning • Difference between MDD and bereavement/grief: o MDD: ▪ Feelings of worthlessness ▪ Self-loathing • Exclusions: o Medical illness o Substance use o Other psychiatric disorders o History of mania or hypomania • MDD subtypes o With anxious distress  must have 2 of the 5 symptoms ▪ CAR LoT • Concentration difficulty • Awful or apprehension • Restless • Lose control • Tense or keyed up o With atypical features ▪ RAILS • Reactivity in mood • Appetite increase • Interpersonal rejection sensitivity • Leaden paralysis • Sleep increase o With melancholic features ▪ PRe MED GAP • Pleasure loss • Reactivity loss o Must have 1 of the 2 • Morning worsening • Early morning awakening • Distinct quality of mood • Guilt • Anorexia • Psychomotor changes o Agitation or retardation • Other MDD Specifiers o Mixed features ▪ Three manic or hypomanic symptoms + full MDD symptoms o Peripartum onset ▪ Onset of symptoms occur while pregnant OR in the 4 weeks after delivery o Seasonal pattern ▪ Regular pattern between depressive symptoms & time of year (fall & winter) with remission in spring/summer ▪ Pattern must have occurred in the last 2 years • Prevalence/Epidemiology/Comorbidities o Depressed individuals admitted to a nursing home  increased risk of death within 1st year o 18-29 years have highest prevalence ▪ Three-fold higher prevalence than in 60+ years old ▪ 50% of people have 1st depressive episode between 20-50 years old o Females risk is twice as high as males ▪ Highest risk between menarche & menopause • Peaks in adolescence then stabilizes o Risk factors for MDD ▪ Temperament • Negative affectivity  neuroticism ▪ Genetics • Having a 1st degree relative with MDD increases risk of developing MDD • Differential diagnoses for MDD o Bipolar disorder o Depressive disorder due to medical condition o Substance/medication induced depressive disorder o Persistent depressive disorder o PMDD o DMDD o Schizoaffective disorder o ADHD o Bereavement Persistent Depressive Disorder  Dysthymia Disorder • Hallmark feature: Depressed mood most of the day o All day/every day • Adults must have depressed mood for 2 years o No more than 2 months symptom-free for 2 years • Must have depressed mood PLUS 2 or more other symptoms • Children and adolescents: o Must have 1 year of persistent depressive mood • Symptoms: HE’S 2 SAD o Hopelessness o Energy loss or fatigue o Self-esteem is low o 2 years minimum of depressed mood most of the day  more days than not o Sleep is increased or decreased o Appetite is increased or decreased o Decision making or concentration is impaired Premenstrual Dysphoric Disorder (PMDD) • FIVE symptoms must be present before onset of menstrual cycle • Symptoms will improve a few days after onset of menses & become minimal/absent in the week post menses • Symptoms: SAIL Over CASPIAn SEA 5 Times In 2 Months o Five symptoms total ▪ One MUST be from SAIL ▪ One MUST be from Over ▪ One MUST be from CASPIAn o Sad o Anxiety o Irritability o Lability o Overwhelmed or out of control o Concentration o Appetite changes o Sleep changes o Physical symptoms o Interest decreased o Anergia  energy loss ▪ Symptoms are not an Exacerbation of another disorder or Attributable to effects of substance or another medical condition ▪ 5  Must have at least 5 symptoms present ▪ Times  final week before onset of menses then improves within a few days of onset and is minimal or absent week post menses ▪ In  Interference with work or causing distress ▪ 2 months  Confirmed during at least two symptomatic menstrual cycles • Key feature to confirm diagnosis: o Daily ratings of the woman’s symptoms/mood for at least 2 cycles/2 months ▪ Can use DRSP  Daily record of severity of problems • Only scale recognized by DSM for PMDD ▪ Can also use: • Visual Analogue Scales for Premenstrual Mood Symptoms • Premenstrual Tension Syndrome Rating Scale • Premenstrual Symptom Diary • Differential diagnoses for PMDD: o Premenstrual syndrome (PMS) ▪ Symptoms overlap with PMDD ▪ Does not meet symptom criteria of 5/11 symptoms must be present ▪ No affective symptom requirement