ANCC PMHNP Chapters 9-10

object loss theory - a psychodynamic theory that assumes that early psychological developmental issues lay the foundation for depressive responses later in life; loss may be related to maternal death, illness, or emotional lack of availability and this critical loss event predisposes child to respond in similar ways to any future losses or separation aggression-turned-inward theory - psychodynamic theory that assumes that if a child undergoes loss related to maternal death, illness, emotional lack of availability then child directs anger at mother inward and anger is rationalized as assuming loss is related to something bad the child did cognitive theory of depression - theory represents a cognitive-diathesis-stress model in which developmental experiences sensitize a person to respond to stressful life events in a depressed manner; assumes that people with a tendency to be depressed think about the world differently than non depressed people; this thinking promote low self esteem and globalization of negativity learned helplessness-hopelessness theory - theory is a modified aspect of cognitive theory which assume that a person becomes depressed due to perceptions of lack of control over life events and experiences; person's behavior becomes passive and nonreactive genetic predisposition to depression - having a depressed parent is the single strongest predictor of depression; children of depressed parents are 3x more likely to experience MDD than general population endocrine dysfunction in depression - neurovegetative symptoms of depression are related to functions of the hypothalamus and pituitary hormones; dysphoria triggered by changes in levels of sex steroids during menses; deregulation of HPA axis HPA dysregulation - in response to stress, the hypothalamus releases CRH which stimulates pituitary to release ACTH which stimulates adrenals to release cortisol; hyperactivity of this axis and elevated cortisol found in MDD; elevated cortisol can damage CNS and brain tissue by altering neurotransmission structural brain changes in depression - hypovolemic hippocampus and hypovolemic prefrontal cortex-limbal striatal regions chronobiological theory - desynchronization of circadian rhythms produces the symptom constellation activity called MDD MDD age of onset - can occur at any age; avg age is mid-20s; people with first episode of major depression have approximately 60% risk of having second, risk gets higher the more episodes one has MDD mortality - high mortality; 15% commit suicide risk factors for MDD - genetic loading, prior episode of MDD, female gender, postpartum period, medical comorbidity, single, significant environmental stressors including losses prevention of MDD - provide at-risk family education, provide community education to help reduce stigma, provide early screening PHQ-9 - screens for depression; 0-4 minimal depression; 5-14 mild-moderate depression; 14 risk of severe depression Beck Depression Inventory - scale for depression; 0-13 minimal depression; 14-19 mild depression; 20-28 moderate depression; 29-63 indicate severe depression Ham-D - scale for depression; 0-7 normal; 8-13 mild depression; 14-18 moderate depression; 19-22 severe depression; 23 extremely severe depression suicide risk - high for persons with psychosis, history of past attempts, history of firstdegree relative who committed suicide, substance dependence, serious medical illness lab tests for MDD - CBC, chemistry, thyroid function tests, B12 and folate levels, drug screen SSRIs - first line tx for MDD; acts primarily to increase serotonin levels in CNS by inhibiting presynaptic reuptake; generally L2 and category C except paxil TCAs - considered 2nd line in MDD; elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake; can be deadly in overdose; has anticholinergic, antiadrenergic, antihistaminergic SEs, EKG changes; generally category C L2 (besides doxepin, notriptyline) MAOIs - elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters SNRIs - inhibit dual reuptake of norepinephrine and serotonin; action very selective on neurotransmitters; elevate serotonin and norepinephrine levels by inhibiting their presynaptic reuptake NDRIs - inhibit dual reuptake of norepinephrine and dopamine; action very selective on neurotransmitters SARIs - dual action, agonist of serotonin 5HT-2 receptors; elevate serotonin levels by inhibiting serotonin reuptake tyramine dietary considerations - avoid aged cheeses (blue, brie, Camembert, Roquefort), meats that are smoked, aged, cured (sausages, pastrami, salami), fish that are smoked, aged, cured (pickled herring, salted fish), any aged/fermented beverages (red wine, aged liquors, whiskey, beer), and avoid tofu (bean curd), soy products, sauerkraut, miso, yeast extract, MSG, ripe bananas, and avocado