NR 547 PMHNP FINAL STUDY GUIDE 2025

NR 547 PMHNP FINAL STUDY GUIDE 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 NUR 547 NUR 547 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 minutes to administer, including scoring. EQ-5D - -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) - - Mood Disorders: Depression - -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 - -Depression Severity NUR 547 NUR 547 5 - 9Mild 10 - 14Moderate 15 - 19Moderately Severe 20 - 27Severe scores current depression severity and to follow up treatment response. Depression: Anxious distress Modifier - -Depression with unusual restlessness or worry about possible events or loss of control Depression: Mixed features - -Simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy Depression: Melancholic features - -Severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, 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. NUR 547 NUR 547 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 Pertinent Information for an Interview: Depression - -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 - -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. NUR 547 NUR 547 Assessing Depression in Patients with Dementia - -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 - -Symptom remission First Choice of Treating Depression in Older Adults - -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 - -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 - -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 NUR 547 NUR 547 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...