Download Final Exam: NR547 / NR 547 (Latest Update 2025 / 2026) Differential Diagnosis in Psychiatr and more Exams Nursing in PDF only on Docsity!
Final Exam: NR547 / NR 547 (Latest Update
2025 / 2026) Differential Diagnosis in
Psychiatric-Mental Health across the
Lifespan Practicum | Questions & Answers |
100% Correct | Grade A - Chamberlain
When do you consider Unipolar versus Bipolar depression - ANSWER 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) - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 Geriatric Depression Scale (GDS): Indication for Intervention - ANSWER 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] - ANSWER 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.
Mood Disorders: Depression - ANSWER 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 - ANSWER Depression Severity 5 - 9Mild 10 - 14Moderate 15 - 19Moderately Severe 20 - 27Severe scores current depression severity and to follow up treatment response. Depression: Anxious distress Modifier - ANSWER Depression with unusual restlessness or worry about possible events or loss of control Depression: Mixed features - ANSWER Simultaneous depression and mania, which includes elevated self-esteem, talking too much and increased energy Depression: Melancholic features - ANSWER 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 - ANSWER 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 - ANSWER Depression accompanied by delusions or hallucinations, which may involve personal inadequacy or other negative themes Depression: Catatonic Features - ANSWER Depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture Bipolar I and II disorders - ANSWER 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) - ANSWER Involves highs and lows that are milder than those of bipolar disorder. mood disorders - ANSWER Psychological disorders characterized by emotional extremes that occur across a spectrum from depression to mania. Disruptive Mood Dysregulation Disorder (DMDD) - ANSWER This mood disorder in children includes chronic and severe irritability and anger with frequent extreme temper
Depression risk factors - ANSWER Chronic illness Disability/ loss of mobility Change in living situation Role transitions Loss of independence Bereavement Economic hardships Pertinent Information for an Interview: Depression - ANSWER 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 - ANSWER 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. Assessing Depression in Patients with Dementia - ANSWER 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 - ANSWER Symptom remission First Choice of Treating Depression in Older Adults - ANSWER 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 - ANSWER 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 - ANSWER Engagement Social support Exercise Relaxation Mini-Cog Test - ANSWER Assess Dementia: Step 1: Three Word Registration. Step 2: Clock Drawing. Step 3: Three Word Recall. If abnormal, screen further w/MMSE
MDD statistics - ANSWER 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) - ANSWER 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 - ANSWER 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... Depression Education: Older Adult - ANSWER Emphasize that medications should be taken as prescribed but that they may not "cure" depression; remission of symptoms is the goal but changes to therapy may need to occur to achieve remission.
Medications take 4-8 weeks to alleviate symptoms in older adults. To best treat depression, concurrent nonpharmacologic interventions are indicated. The United States Preventive Services Task Force (USPSTF) recommends depression screening
- ANSWER ·Adults 18 years of age or older and adolescents ages 12-18 years old. The American Academy of Family Physicians Recommendation - ANSWER Screening for depression in the general adult population, including pregnant and post-partum women. The American Academy of Pediatrics Recommendation - ANSWER Maternal screening for postpartum depression at infants' 1, 2, and 4- month visits. Bright Futures program recommends annual screening in adolescent clients for emotional and behavioral problems Medicaid's child health component, the Early and Periodic Screening, Diagnosis and Treatment program - ANSWER screening to detect physical and mental conditions at various age intervals. If a risk is identified, the provider should follow up with diagnosis and treatment. Cause of Depression - ANSWER Though the exact cause is unknown, depression is influenced by genetic and environmental factors. Stressful life events, such as giving birth or experiencing emotional trauma, can contribute to the development of depression.
Immuno-Psychiatry - ANSWER Macrophages are the centurions of the immune system. Macrophages warn the immune system of a potential threat by secreting cytokines alerting more macrophages to come to the injured site. These macrophages "eat" the infection and output bacterial fragments and digestive remnants into the surrounding tissues, leading to inflammation. How does your diet affect your mood? - ANSWER Cytokines (inflammatory proteins in the blood) can send signals across the blood-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 movement, and altered sleeping and eating patterns. Inflamed nerve cells cannot effectively transmit 5-hydroxytryptamine (5HT) or serotonin receptors. Persons with inflammatory conditions are significantly more depressed than the general population. Eating foods known to cause inflammation (carbs) will more likely to exhibit depressive symptoms due to imflammation. Medical Diagnoses that Mimic Depressive Disorders - ANSWER Hypothyroidism, vitamin D deficiency, hypoglycemia, anemia, vitamin B12 deficiency, chronic fatigue syndrome, and hypotension.
Medications with side effects mimicking depression - ANSWER Cannabis, alcohol, clonidine, antidepressants, anticonvulsants, antimigraine agents, corticosteroids, contraceptives, and varenicline (Chantix). Withdrawal from certain substances, such as cocaine or caffeine, can also lead to depressive symptoms. Antidepressant medications used to treat depressive symptoms - ANSWER SSRI SNRI TCS MAOI's SSRI: Action, Type and side effects used for Depression - ANSWER Action: inhibits the reuptake of serotonin Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline Common Side Effects: nausea, agitation, headache, and sexual dysfunction SNRI: Action, Type and side effects used for Depression - ANSWER Action: inhibits the reuptake of serotonin and norepinephrine Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine Common Side Effects: nausea, sweating, insomnia, tremors, sexual dysfunction TCA's: Action, Type and side effects used for Depression - ANSWER Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors Examples: amitriptyline, clomipramine, desipramine, doxepin Common Side Effects: dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction
Work-up to exclude other causes for Depression - ANSWER Initial tests include thyroid function tests, metabolic panel, and complete blood count. Serum vitamin B12 and folate levels, and 24-hour urinary cortisol may also be informative. Depression has a documented adverse effect of which medications? - ANSWER Corticosteroids Interferon Propranolol Oral contraceptives Levodopa Isotretinoin Differentials for Depressed Mood - ANSWER Adjustment disorder with depressed mood Substance-/medication- or medical illness-associated and other depressive disorders Bipolar disorder Premenstrual dysphoric disorder (PMDD) Grief/bereavement Dementia Anxiety disorders Alcohol-use disorder Anorexia nervosa Hypothyroidism Medication adverse effects Cushing disease Vitamin B12 deficiency Obstructive sleep apnea (OSA) Severe depression - ANSWER
