ANCC Certification PMHNP Chapter 7. Top Questions & Answers. 100% Accurate.

ANCC Certification PMHNP Chapter 7. Top Questions & Answers. 100% Accurate. Mood Disorders - -Most common psych illnesses Primary characteristic is persistent disturbance in mood - -Major Depressive Disorder Often occurs without precipitating event - -MDD Object loss theory - -Fairbairn, Winnicott & guntrip Aggression turned inward theory of MDD - -Freud Cognitive Theory - -Beck Learned Helplessness-Hopelessness Theory - -Seligman Genetic predisposition - -Strong genetic load for depression for child of depressed parent -having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before age 18. Endocrine dysfunction Theory - -Probably related to etiology of MDD Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are neurovegitative symptoms that are related to functions of the - -Hypothalamus and pituitary gland secretions Endocrine dysfunction and pregnancy - -A high incidence of postpartum mood disturbances is suggested with this Hypothalamic-pituitary-adrenal axis (HPA) - -A theory of MDD, may be a result of an abnormal stress response related to dysregulation of this system HPA axis - -Controls the physiological response to stress and is composed of interconnective feedback pathways between the hypothalamus, pituitary gland, and adrenal gland. Hypothalamus releases - -corticotropin-releasing hormone (CRH) Adrenocorticotropin hormone (ACTH) - -Released by pituitary in response to CRH by hypothalamus Cortisol - -Released by adrenal glands in response to ACTH by pituitary gland Hyperactivity of the HPA axis - -Demonstrated to be present in individuals with MDD. May also have elevated cortisol levels Elevated cortisol levels - -Over time damages the CNS by altering neurotransmission and electrical signal conduction. Cortisol over time can cause changes in size and function of brain tissue Dexamethasone suppression test (DST) - -Not commonly used in clinical practice for screening of depression as it is too non specific. Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions - -Abnormalities demonstrated by neuroimaging in individuals with chronic and severe depression Brain damage, including that from stroke and trauma - -Depression is a acommon comorbidity in individuals who have experienced these events What is the Chronobiological theory of MDD - -Desynchronization of the circadian rhythms produces the symptom constellation collectively called MDD Circadian rhythms control these biological processes that are frequent problems with depressed individuals - -Sleep-rest cycle disturbances * Increased cortisol secretions * REM abnormalities Increased emotional reactivity Frequent waking More intensified dreaming Diurnal variations to circadian-related behaviors Decreased arousal and energy levels Decreased activity patterns * Incidence of MDD - -5% of U.S. population ages 18 and older each year. About 9.9 million Americans Most common psychiatric illness seen in primary care practices; only 50% of people receive treatment - -MDD 25% women, 12% men - -Risk during reproductive years Risk of MDD is ________ for both genders below puberty and after menopause - -equal MDD is (greater) or (lesser) source of morbidity for women than other illnesses. - -Greater Fifteen percent (15%) - -Of people with MDD will commit suicide People with MDD - Four times greater risk of premature death - -Than normal control population Episodes of MDD do not vary -