Depression assessment

Obtain a history of episodes of depression assess mental status and suicidal tendencies. 

Inhalation of high concentrations of monochlorotoluenes will cause symptoms of central nervous system depression. Inhalation studies produced an LC q (rat, 4 h) of 7119 ppm for o-chlorotoluene (68). o- and Chlorotoluene are both considered moderately toxic by ingestion (Table 2). A study of the relationship between the electronic stmcture and toxicity parameters for a series of mono-, di-, and tri-chlorotoluenes has been reviewed (72). A thin-layer chromatographic method has been developed to assess the degree of occupational exposure of workers to chlorotoluenes by determining j -cblorobippuric... 

Discuss important preadministration and ongoing nursing assessments you would make when giving a patient naloxone for severe respiratory depression caused by morphine. 

MONITORING AND MANAGING RESPIRATORY DEPRESSION These drugs depress the CNS and can cause respiratory depression. The nurse carefully assesses respiratory function (rate, depth, and quality) before administering a sedative, Vs, to 1 hour after administering the drug, and frequently thereafter. Toxic reaction of the barbiturates can cause severe respiratory depression, hypoventilation, and circulatory collapse. 

ANALEPTICS. When a CNS stimulant is prescribed for respiratory depression, initial patient assessments will include the blood pressure, pulse, and respiratory rate. It is important to note the depth of the respirations and any pattern to the respiratory rate, such as shallow respirations or alternating deep and shallow respirations. The nurse reviews recent laboratory tests (if any), such as arterial blood gas studies. Before administering the drug, the nurse ensures that the patient has a patent airway. Oxygen is usually administered before, during, and after drug administration. 

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

The preadministration assessments of the outpatient are basically die same as diose for the hospitalized patient. The nurse obtains a complete medical history and a history of die symptoms of the depression from die patient, a family member, or die patient s hospital records. During die initial interview, die nurse observes die patient for symptoms of depression and die potential for suicide The initial physical assessment also should include the patient s vital signs and weight. 

Mr. Hopkins has been severely depressed for several months. Two weeks ago the primary care provider prescribed amitriptyline 30 mg orally four times a day. His family is concerned because he is still depressed. They are requesting that the dosage be increased. Discuss what information you would give Mr. Hopkins and his family and what assessments you could make... 

Ms. Jefferson has been taking phenelzine for depression. She reports having a bad headache at the back of her head. Determine what assessment would be most important to make. Explain what action, if any, you would take. 

The symptoms of hypothyroidism maybe confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait. The presence of these symptoms should be thoroughly evaluated and documented in the preadministration assessment and periodically throughout therapy. 

Grant BF Comorbidity between DSM-IV drug use disorders and major depression results of a national survey of adults. J Subst Abuse 7 481 97, 1995 Hall W, Babor TF Cannabis use and public health assessing the burden. Addiction 95 485 90, 2000... 

TharrD. 1998. Rapid assessment of organophosphate-induced cholinesterase depression A comparison of laboratory and field kit methods to detect human exposure to organophosphates. Appl Occup Environ Hyg 13 265-268. 

Coupland, N, Glue, P and Nutt, DJ (1992) Challenge tests assessment of the noradrenergic and GABA systems in depression and anxiety disorders. Molec. Aspects Med. 13 221-247. 

Unlike systolic HF, few prospective trials have evaluated the safety and efficacy of various cardiac medications in patients with diastolic HF or preserved ejection fraction. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that angiotensin receptor blockade with candesartan resulted in beneficial effects on HF morbidity in patients with preserved LVEF similar to those seen in depressed LV function.25... 

Depression is a common problem in patients with epilepsy, with approximately 30% having symptoms of major depression at some point.34 Patients with epilepsy should be routinely assessed for signs of depression, and treatment should be initiated if necessary. Certain AEDs may exacerbate depression, for example levetirac-etam and phenytoin. Other AEDs (e.g., lamotrigine, carba-mazepine, and oxcarbazepine) maybe useful in treating depression. Changes in mood can be precipitated by addition or discontinuation of an AED. If treatment for depression is necessary, caution should be exercised in choosing an agent that does not increase seizure frequency and does not interact with AEDs. 

Evaluate the clinical outcomes of treatment by using the UPDRS. In addition, periodically ask patients to record the amount of on and off time they have with and without dyskinesias in a diary. There are a variety of scales that can be used to assess QOL, depression, anxiety, and sleep disorders. Patients with PD cannot be cured but treatment can delay the progression of symptoms and improve QOL. Delaying the patient s admission into a nursing home is a good outcome. 

O Patients presenting with depressive or elevated mood features and a history of abnormal or unusual mood swings should be assessed for bipolar disorder. 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Assess for secondary causes of depression (e.g., alcohol or drug use)... 

Assess patients for improvement of anxiety symptoms and for return to baseline occupational, social, and interpersonal functioning. With effective treatment, the patient should have no or minimal symptoms of anxiety or depression. While drug therapy is being initiated, evaluate patients more frequently to ensure tolerability and response. Increase the dose in patients exhibiting a partial response after 2 to 4 weeks on an antidepressant or 2 weeks on a benzodiazepine. Individualize the duration of treatment because some patients require up to one year of treatment.27... 

Mefloquine (oral) 228 mg (base) (250 mg salt) weekly Less than or equal to 15 kg 4.6 mg/kg base (5 mg/kg salt) once weekly 1 5-19 kg 1/4 tablet 20-30 kg 1/f tablet 31-45 kg 3A tablet Greater than or equal to 45 kg 1 tablet Start 1 -2 wk before departure and continue for 4 wk after leaving endemic area may start 3—4 wk earlier to assess tolerance Contraindications History of seizure, psychiatric disorders (including depression and anxiety), or arrhythmias... 

Finally, in Chapter 7, I describe some of the alternatives to medication for the treatment of depression and assess the evidence for their effectiveness. One of my aims is to provide essential scientifically grounded information for making informed choices between the various treatment options that are available. 

In 1995 Guy Sapirstein and I set out to assess the placebo effect in the treatment of depression. Instead of doing a brand-new study, we decided to pool the results of previous studies in which placebos had been used to treat depression and analyse them together. What we did is called a meta-analysis, and it is a common technique for making sense of the data when a large number of studies have been done to answer a particular question. It was once considered somewhat controversial, but meta-analyses are now common features in all of the leading medical journals. Indeed, it is hard to see how one could interpret the results of large numbers of studies without the aid of a meta-analysis. 

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