NR 547 Final Exam
1. MDD by severity: mild, moderate, or severe: Mild: The intensity of symptomsis
manageable with minimal impairment in functioning. There are few symptoms beyond those
required for diagnosis.
Moderate: The number of symptoms, intensity, or impairment in functioning is be-tween mild
and severe.
Severe: The intensity of symptoms is unmanageable and distressing. Symptoms interfere with
functioning. The number of symptoms is beyond what is required fordiagnosis.
2. melancholic features: Symptoms worse in the morning, excessive guilt, signif-icant weight
loss
3. atypical features: Weight gain, hypersomnia, heavy feeling in arms or legs
4. Screening tools for depression severity: -Patient Health Questionnaire(PHQ)
-Beck Depression Inventory-II (BDI-II)
-Hamilton Depression Rating Scale (HAM-D)
-Edinburgh Postnatal Depression Scale (EPDS) in post-partum and pregnantwomen
-Children's Depression Inventory (CDI)
-Children's Depression Rating Scale (CDRS)
-Geriatric Depression Scale (GDS) in older adults
5. The United States Preventive Services Task Force (USPSTF) recommends depression
screening:: for adults 18 years of age or older and adolescents ages12-18 years old.
6. The American Academy of Family Physicians recommends screening for depression in::
the general adult population, including pregnant and post-partumwomen.
7. The American Academy of Pediatrics recommends maternal screening for postpartum
depression at:: infants' 1, 2, and 4- month visits.
8. The American Academy of Pediatrics' Bright Futures program recom- mends: (screenin):
annual screening in adolescent clients for emotional and be-havioral problems.
9. Medicaid's child health component, the Early and Periodic Screening, Diagnosis and
Treatment program recommends:: screening to detect physicaland mental conditions at various
age intervals. If a risk is identified, the provider should follow up with diagnosis and
treatment.
10. Immuno-Psychiatry (neuroimmunology): explores how the immune systeminteracts with
the brain and the mind
,-This interaction can affect both physical and mental health
-The immune system protects the body from infection
• Macrophages are the centurions of the immune system. Macrophages warn the im- mune system
of a potential threat by secreting cytokines alerting more macrophagesto come to the injured site
• Cytokines (inflammatory proteins in the blood) can send signals across theblood-brain
barrier.
• Nerve cells exposed to cytokines are more likely to die than regenerate
• In rat studies, rats injected with cytokines exhibited social withdrawal, less move-ment, and
altered sleeping and eating patterns.
• Inflamed nerve cells cannot effectively transmit 5-hydroxytryptamine (5HT) orserotonin
receptors.
• Persons with inflammatory conditions are significantly more depressed than thegeneral
population.
*People who frequently eat foods known to cause inflammation (carbs) are morelikely to
exhibit depressive symptoms
• People tend to feel better when they eat clean, possibly due to the decreasedinflammation
11. Medical Diagnoses that Mimic Depressive Disorders: hypothyroidismvitamin D
deficiency
anemia
chronic fatigue syndrome
12. Medications with side effects mimicking depression include:: cannabis, alcohol,
clonidine, antidepressants, anticonvulsants, antimigraine agents, corticos-teroids,
contraceptives, and varenicline (Chantix)
13. Depression treatment: pharmacological: Selective Serotonin Reuptake In-hibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
14. Must Not Miss Diagnosis: BD: Clients with bipolar disorder may present duringthe
depressive phase
-may not report any symptoms of hypomanic or manic episodes
• provider must obtain a careful history from the client and/or family members todifferentiate
between bipolar disorder and depression
-Bipolar disorder should be ruled out as a cause of depression before prescribing
,medication as certain antidepressant medications can precipitate a manic episodeor induce
rapid-cycling bipolar depression
*may contribute to the increased incidence of death by suicide in children and adultsyounger
than 25
15. Ameeta, a 42-year-old female, presents to the primary care clinic with a three-month
history of "feeling low and sad" with poor energy, inability to concentrate, and irritability. She
indicates that the symptoms were initially present once per week but have increased to 4-5
times per week. She reportsmaking an error last week at the grocery store where she works as
a cashierand snapping at the customer when the error was brought to her attention. She is
concerned about her loss of interest in her usual social activities and a20-pound weight gain.
She also reports frequent headaches, difficulty gettingout of bed in the morning, feeling
worthless, and low libido. She acknowledgesthat she feels guilty daily as she has not visited her
son in 6 months and believes that she has "let him down".Thinking about it keeps her "up at
night".She has difficulty falling and staying asleep every night. She denies suicidal ideation.
Overall, she reports that the sad feelings have made it somewhat difficult to take care of
things at home and get along with other people. Which of the following medications is the
first-line choice for Ameeta?
citalopram 20 mg po daily
selegiline transdermal: Initia: citalopram 20 mg po daily
Rationale: Although all three drugs are appropriate to use when treating unipolardepression,
Citalopram is an SSRI and is considered a first-line choice.
16. Bipolar disorder: mental illness that causes extreme shifts in emotions, mood,and energy
levels
-Shifts in mood usually occur over several days to weeks
-classified according to the types of mood episodes exhibited
-affects approximately 2.6% of the adult population in the U.S.
-sixth leading cause of disability in the world
-most frequently diagnosed in late adolescence or early 20s
-lifelong condition
17. cause of bipolar disorder: unknown
-Individuals with family members who have bipolar disorder are more likely todevelop it
-interaction between genetic factors and the environment may be contributory
-Brain imaging reveals white matter hyperintensities, reduction in gray matter vol-ume,
, increased ventricular size, and decreased frontal cortical area volumes
18. Bipolar disorder symptoms: Depressive Symptoms
-similar to MDD
Manic Symptoms
-elevated, expansive, or irritable mood
Hypomanic Symptoms
-milder form of mania
Mixed Symptoms
-presence of symptoms of depression and mania simultaneously
19. dx manic: -elevated, expansive, or irritable mood for at least one week, moodpresent most
of the day and nearly every day
-severe enough to cause significant impairment in social or occupational functioning,to req
hospitalization to prevent harm to the client or others, or symptoms include psychotic features
-three or more of the following symptoms (APA, 2022) must be present and representa significant
change from usual behavior:
• inflated self-esteem or grandiosity
• decreased need for sleep
• increased talkativeness
• racing thoughts
• distracted easily
• increase in goal-directed activity or psychomotor agitation
• engaging in activities that hold the potential for painful consequences, e.g., unre-strained
buying sprees
20. dx hypomania: must experience symptoms for at least four consecutive dayswith
symptoms present most of the day and nearly every day.
-energy level is higher than normal but not as high as with mania
-episodes can lead to challenges but do not tend to lead to major issues with dailyfunctioning
-episodes do not involve psychotic symptoms and are less likely to lead to hospitalvisits.
21. Bipolar disorder triggers: Environmental factors can trigger
-Selective Serotonin Reuptake Inhibitors (SSRIs) can trigger manic episode
1. MDD by severity: mild, moderate, or severe: Mild: The intensity of symptomsis
manageable with minimal impairment in functioning. There are few symptoms beyond those
required for diagnosis.
Moderate: The number of symptoms, intensity, or impairment in functioning is be-tween mild
and severe.
Severe: The intensity of symptoms is unmanageable and distressing. Symptoms interfere with
functioning. The number of symptoms is beyond what is required fordiagnosis.
2. melancholic features: Symptoms worse in the morning, excessive guilt, signif-icant weight
loss
3. atypical features: Weight gain, hypersomnia, heavy feeling in arms or legs
4. Screening tools for depression severity: -Patient Health Questionnaire(PHQ)
-Beck Depression Inventory-II (BDI-II)
-Hamilton Depression Rating Scale (HAM-D)
-Edinburgh Postnatal Depression Scale (EPDS) in post-partum and pregnantwomen
-Children's Depression Inventory (CDI)
-Children's Depression Rating Scale (CDRS)
-Geriatric Depression Scale (GDS) in older adults
5. The United States Preventive Services Task Force (USPSTF) recommends depression
screening:: for adults 18 years of age or older and adolescents ages12-18 years old.
6. The American Academy of Family Physicians recommends screening for depression in::
the general adult population, including pregnant and post-partumwomen.
7. The American Academy of Pediatrics recommends maternal screening for postpartum
depression at:: infants' 1, 2, and 4- month visits.
8. The American Academy of Pediatrics' Bright Futures program recom- mends: (screenin):
annual screening in adolescent clients for emotional and be-havioral problems.
9. Medicaid's child health component, the Early and Periodic Screening, Diagnosis and
Treatment program recommends:: screening to detect physicaland mental conditions at various
age intervals. If a risk is identified, the provider should follow up with diagnosis and
treatment.
10. Immuno-Psychiatry (neuroimmunology): explores how the immune systeminteracts with
the brain and the mind
,-This interaction can affect both physical and mental health
-The immune system protects the body from infection
• Macrophages are the centurions of the immune system. Macrophages warn the im- mune system
of a potential threat by secreting cytokines alerting more macrophagesto come to the injured site
• Cytokines (inflammatory proteins in the blood) can send signals across theblood-brain
barrier.
• Nerve cells exposed to cytokines are more likely to die than regenerate
• In rat studies, rats injected with cytokines exhibited social withdrawal, less move-ment, and
altered sleeping and eating patterns.
• Inflamed nerve cells cannot effectively transmit 5-hydroxytryptamine (5HT) orserotonin
receptors.
• Persons with inflammatory conditions are significantly more depressed than thegeneral
population.
*People who frequently eat foods known to cause inflammation (carbs) are morelikely to
exhibit depressive symptoms
• People tend to feel better when they eat clean, possibly due to the decreasedinflammation
11. Medical Diagnoses that Mimic Depressive Disorders: hypothyroidismvitamin D
deficiency
anemia
chronic fatigue syndrome
12. Medications with side effects mimicking depression include:: cannabis, alcohol,
clonidine, antidepressants, anticonvulsants, antimigraine agents, corticos-teroids,
contraceptives, and varenicline (Chantix)
13. Depression treatment: pharmacological: Selective Serotonin Reuptake In-hibitors (SSRIs)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
14. Must Not Miss Diagnosis: BD: Clients with bipolar disorder may present duringthe
depressive phase
-may not report any symptoms of hypomanic or manic episodes
• provider must obtain a careful history from the client and/or family members todifferentiate
between bipolar disorder and depression
-Bipolar disorder should be ruled out as a cause of depression before prescribing
,medication as certain antidepressant medications can precipitate a manic episodeor induce
rapid-cycling bipolar depression
*may contribute to the increased incidence of death by suicide in children and adultsyounger
than 25
15. Ameeta, a 42-year-old female, presents to the primary care clinic with a three-month
history of "feeling low and sad" with poor energy, inability to concentrate, and irritability. She
indicates that the symptoms were initially present once per week but have increased to 4-5
times per week. She reportsmaking an error last week at the grocery store where she works as
a cashierand snapping at the customer when the error was brought to her attention. She is
concerned about her loss of interest in her usual social activities and a20-pound weight gain.
She also reports frequent headaches, difficulty gettingout of bed in the morning, feeling
worthless, and low libido. She acknowledgesthat she feels guilty daily as she has not visited her
son in 6 months and believes that she has "let him down".Thinking about it keeps her "up at
night".She has difficulty falling and staying asleep every night. She denies suicidal ideation.
Overall, she reports that the sad feelings have made it somewhat difficult to take care of
things at home and get along with other people. Which of the following medications is the
first-line choice for Ameeta?
citalopram 20 mg po daily
selegiline transdermal: Initia: citalopram 20 mg po daily
Rationale: Although all three drugs are appropriate to use when treating unipolardepression,
Citalopram is an SSRI and is considered a first-line choice.
16. Bipolar disorder: mental illness that causes extreme shifts in emotions, mood,and energy
levels
-Shifts in mood usually occur over several days to weeks
-classified according to the types of mood episodes exhibited
-affects approximately 2.6% of the adult population in the U.S.
-sixth leading cause of disability in the world
-most frequently diagnosed in late adolescence or early 20s
-lifelong condition
17. cause of bipolar disorder: unknown
-Individuals with family members who have bipolar disorder are more likely todevelop it
-interaction between genetic factors and the environment may be contributory
-Brain imaging reveals white matter hyperintensities, reduction in gray matter vol-ume,
, increased ventricular size, and decreased frontal cortical area volumes
18. Bipolar disorder symptoms: Depressive Symptoms
-similar to MDD
Manic Symptoms
-elevated, expansive, or irritable mood
Hypomanic Symptoms
-milder form of mania
Mixed Symptoms
-presence of symptoms of depression and mania simultaneously
19. dx manic: -elevated, expansive, or irritable mood for at least one week, moodpresent most
of the day and nearly every day
-severe enough to cause significant impairment in social or occupational functioning,to req
hospitalization to prevent harm to the client or others, or symptoms include psychotic features
-three or more of the following symptoms (APA, 2022) must be present and representa significant
change from usual behavior:
• inflated self-esteem or grandiosity
• decreased need for sleep
• increased talkativeness
• racing thoughts
• distracted easily
• increase in goal-directed activity or psychomotor agitation
• engaging in activities that hold the potential for painful consequences, e.g., unre-strained
buying sprees
20. dx hypomania: must experience symptoms for at least four consecutive dayswith
symptoms present most of the day and nearly every day.
-energy level is higher than normal but not as high as with mania
-episodes can lead to challenges but do not tend to lead to major issues with dailyfunctioning
-episodes do not involve psychotic symptoms and are less likely to lead to hospitalvisits.
21. Bipolar disorder triggers: Environmental factors can trigger
-Selective Serotonin Reuptake Inhibitors (SSRIs) can trigger manic episode
