©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
NURS 5461 Depression Study Guide.
Limbic System. amygdala - Answers✔Gauge and modulate emotions/ thoughts of death and
guilt,
Limbic system hippocampus - Answers✔Affects memory/concentration less size/ neurogenesis
in depression
Frontal cortex - Answers✔Linked to depressed mood and problems concentrating. Reduced in
size and hyopactive in D, difficulty in thinking/planning-->rely on amygdala so response is
emotion based
Basal ganglia - Answers✔Linked to psychomotor agitation or retardation
Hypothalamus - Answers✔r/t loss of appetite, weight loss anhedonia (loss of pleasure) --
neurovegetative signs.
Neurotransmitters and depression - Answers✔↓Serotonin: mood, sleep, impulsivity symptoms
↓Dopamine: pleasure, reward, psychomotor activity, fatigue, low energy, cognition
↓Norepinephrine: mood, arousal, appetite , planning, concentrating ↓ GABA: anxiety, agitation
of depression ↑glutamate & NMDA receptors in frontal lobe (↑ neuronal cell death
Glial cells - Answers✔↓ in number and density in depression Glial cells protect neurons by
stabilizing glutamate & supplying glucose to the neurons (stick like glue)
Synthesize & release neurotropic factors (Brain Derived Neurotropic Factor: BDNF)
these can stabilize with ADM-
Extra cellular glutamate accumulates - Answers✔Excess of glucocorticoids (HPA axis)
Decreased GLIA PFC Fewer glial glutamate transporters Neurons get exposed to glutamate and
can no longer function Progressive depression Damage to neurons (neurotoxicity) 2x greater risk
of dementia with depression! not enough stabilization with GABA
PFC hyperactivity - Answers✔↑CRF released from hypothalamus ACTH released from pituitary
Glucocorticoids (cortisol) released from adrenal cortex Excessive glucocorticoid release may
cause hippo-campal atrophy Atrophy leads to chronic activation of HPA axisDepression, anxiety
result. Antidepressants can reverse
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Hypothalamic Dysregulation Circadian Rhythms of Sleep - Answers✔Delayed sleep onset
Shortened REM latency
Increased length of 1st REM period
Abnormal delta sleep
May be reported as lack of sleep or atypical feature
of hypersomnia
Antidepressant meds treat circadian dysregulation
and can restore normal sleep architecture
If you do not use standardized tool - Answers✔Use two screening questions instead: Over the
past 2 weeks, have you felt down, depressed, or hopeless?" • and "Over the past 2 weeks, have
you felt little interest or pleasure in doing things?"
History and clinical interview - Answers✔Do full interview if screening indicates symptoms •
Assess target symptoms: sleep, appetite, anhedonia, mood , suicidal thinking, guilt,
concentration, low energy, etc • Onset, course & duration, severity of symptoms; recent or
chronic stressors • New or occurred before? • Impact of these symptoms -on job, education,
family, friends • Current & past psych history (e.g. hospitalized?) • All medications-OTC, herbs
(past and current) • Substance abuse? (current, past)
Objective data - Answers✔Physical exam, wt, ht, labs (thyroid, anemia, nutritional deficiency,
UTI?), screening tools • Mental Status exam: • Appearance, mood, affect, psychomotor, attitude,
thought process, thought content, perception, judgment, insight, memory, concentration, fund of
knowledge, full Mental Status exam
Major Depressive Disorder DSM 5 criteria - Answers✔• At least one major depressive episode
and no manic or hypomanic episode (ever) • Depressed mood or anhedonia every day for 2
weeks or longer • Change from previous functioning • Significant distress or impairment in
social or occupational or other area of functioning • Not schizophrenia or other psychosis • R/O
substance abuse, medication, medical conditions to make diagnosis
MDD symptoms-DSM 5 criteria - Answers✔1.Depressed mood: sadness, empty, hopeless
reported or observation by others (e.g. tearful) most of the day nearly every day (children and
teens, mood can be irritable) • 2. Markedly diminished interest or pleasure in all or almost all
activities most of the day, nearly every day (reported or observed) • Depressed mood or
anhedonia must be present • Then....
4 additional symptoms nearly every day x 2 weeks to make the diagnosis - Answers✔Neuro-
vegetative symptoms: sleep, appetite, psychomotor activity • Significant weight loss when not
ALL RIGHTS RESERVED.
NURS 5461 Depression Study Guide.
Limbic System. amygdala - Answers✔Gauge and modulate emotions/ thoughts of death and
guilt,
Limbic system hippocampus - Answers✔Affects memory/concentration less size/ neurogenesis
in depression
Frontal cortex - Answers✔Linked to depressed mood and problems concentrating. Reduced in
size and hyopactive in D, difficulty in thinking/planning-->rely on amygdala so response is
emotion based
Basal ganglia - Answers✔Linked to psychomotor agitation or retardation
Hypothalamus - Answers✔r/t loss of appetite, weight loss anhedonia (loss of pleasure) --
neurovegetative signs.
Neurotransmitters and depression - Answers✔↓Serotonin: mood, sleep, impulsivity symptoms
↓Dopamine: pleasure, reward, psychomotor activity, fatigue, low energy, cognition
↓Norepinephrine: mood, arousal, appetite , planning, concentrating ↓ GABA: anxiety, agitation
of depression ↑glutamate & NMDA receptors in frontal lobe (↑ neuronal cell death
Glial cells - Answers✔↓ in number and density in depression Glial cells protect neurons by
stabilizing glutamate & supplying glucose to the neurons (stick like glue)
Synthesize & release neurotropic factors (Brain Derived Neurotropic Factor: BDNF)
these can stabilize with ADM-
Extra cellular glutamate accumulates - Answers✔Excess of glucocorticoids (HPA axis)
Decreased GLIA PFC Fewer glial glutamate transporters Neurons get exposed to glutamate and
can no longer function Progressive depression Damage to neurons (neurotoxicity) 2x greater risk
of dementia with depression! not enough stabilization with GABA
PFC hyperactivity - Answers✔↑CRF released from hypothalamus ACTH released from pituitary
Glucocorticoids (cortisol) released from adrenal cortex Excessive glucocorticoid release may
cause hippo-campal atrophy Atrophy leads to chronic activation of HPA axisDepression, anxiety
result. Antidepressants can reverse
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Hypothalamic Dysregulation Circadian Rhythms of Sleep - Answers✔Delayed sleep onset
Shortened REM latency
Increased length of 1st REM period
Abnormal delta sleep
May be reported as lack of sleep or atypical feature
of hypersomnia
Antidepressant meds treat circadian dysregulation
and can restore normal sleep architecture
If you do not use standardized tool - Answers✔Use two screening questions instead: Over the
past 2 weeks, have you felt down, depressed, or hopeless?" • and "Over the past 2 weeks, have
you felt little interest or pleasure in doing things?"
History and clinical interview - Answers✔Do full interview if screening indicates symptoms •
Assess target symptoms: sleep, appetite, anhedonia, mood , suicidal thinking, guilt,
concentration, low energy, etc • Onset, course & duration, severity of symptoms; recent or
chronic stressors • New or occurred before? • Impact of these symptoms -on job, education,
family, friends • Current & past psych history (e.g. hospitalized?) • All medications-OTC, herbs
(past and current) • Substance abuse? (current, past)
Objective data - Answers✔Physical exam, wt, ht, labs (thyroid, anemia, nutritional deficiency,
UTI?), screening tools • Mental Status exam: • Appearance, mood, affect, psychomotor, attitude,
thought process, thought content, perception, judgment, insight, memory, concentration, fund of
knowledge, full Mental Status exam
Major Depressive Disorder DSM 5 criteria - Answers✔• At least one major depressive episode
and no manic or hypomanic episode (ever) • Depressed mood or anhedonia every day for 2
weeks or longer • Change from previous functioning • Significant distress or impairment in
social or occupational or other area of functioning • Not schizophrenia or other psychosis • R/O
substance abuse, medication, medical conditions to make diagnosis
MDD symptoms-DSM 5 criteria - Answers✔1.Depressed mood: sadness, empty, hopeless
reported or observation by others (e.g. tearful) most of the day nearly every day (children and
teens, mood can be irritable) • 2. Markedly diminished interest or pleasure in all or almost all
activities most of the day, nearly every day (reported or observed) • Depressed mood or
anhedonia must be present • Then....
4 additional symptoms nearly every day x 2 weeks to make the diagnosis - Answers✔Neuro-
vegetative symptoms: sleep, appetite, psychomotor activity • Significant weight loss when not
