Card Set Information
Life's everyday disappointments, resolves on own.
"it takes more effort" to accomplish things
Multiple symptoms start to impair one's ability to get things done.
Very symptomatic making it impossible to accomplish ADL's
Major depressive disroder (MDD)
In MDD symptoms persist for how long and include depressed mood and loss of interest in pleasure and activities and
of the following?
Increase or decrease in appetite 5% weight change
Increase or decrease in sleep
Psychomotor agitation or retardation
Fatigue and loss of energy
Decreased ability to think or concentrate
Recurrent thought of suicide - hopeless, helpless
Worthlessness or inappropriate guilt - delusional
Usually occurs in fall and winter months characterized by hypersomnia, overeating, carb-cravings and weight gain.
Seasonal affective disorder (SAD)
Symtoms occur within 4 weeks of delivery affecting 1-% of new mothers. Postpartum psychosis may occur.
Develops within three weeks of delivery - progresses from fatigue and sadness to loss of touch with reality and includes psychosis.
(psychotic features can occur with a major depression disorder)
A type of "low level" depression.
Person experiences at least
of the symptoms of MDD.
Little or no impact on social and occupationsl functioning.
Duration of at least 2 years in adults and one year in children and adolscents.
Statistics about depression:
Affects women twice as often
Tendency to reoccur
May affect up to 15% of elderly
What may cause depression?
- may make a person more vulnerable to depression and the actual illness is triggered by outside sources.
pituitary adrenal axis
- increased cortisol levels such as with the "stress response" release become chronically elevated
- deficits in norepinephrine and serotonin or difficulties with these chemicals at the synaptic level
According to Dr. Freud...
He observed that "melancholia" (sadness or depression) occurs after the loss (perceived loss) of a loved object.
According to Aaron T. Beck...
Theory states that depression is due to cognitive disorders in susceptible people.
Early influences and experiences caused their outlook to magnify negative events, traits, and expectations.
Dr. Beck is widely regarded as the father of cognitive therapy
Also developed several "tools" to assess depression including the Beck Depression Inventory
Medical illnesses/medications account for up to 10-15% of mood disorders such as
Heart attack survivors
Additional medical conditions that may cause mood disorders:
Degenerative neurological conditions such as Parkinsons
Additional medications that may cause mood disorders:
Calcium channel blockers
Anti ulcer drugs
Hormones (oral contraceptives)
How is depression diagnosed?
May present as medical problem such as headache, stomach ache, sexual problems, lack of energy, trouble sleeping.
Primary care providers often rely on "screening tools" or questionnaires when they suspect depression
: CBC, VDRL (syphilis), thyroid panel, CMP, EKG, UA, AIDS
The depressed individual may remain under the care of their primary care provider if they respond well to the first medication prescribed and if they get frequent follow up
Mild depression is often treated by the PCP
Refer to specialist for more complicated cases.
When to see a specialist or therapist:
Recovery is quicker - relapse is less likely if the patient receives an antidepressant in conjunction with therapy.
Cognitive behavioral therapy
Group of family therapy
Depression and the elderly:
Bereavement overload - grief accumulates.
Depression vs. dementia
White males over the age of 85 have the highest suicide rates in the US.
Represents a medical and mental health emergency and is the most serious complication of depression
Also requires inpatient management until stable.
Treatment for mood disorders:
Psychopharmacology - hospitalization
Mood stabilizers such as lithium and anti seizure medications
Forms of psychotherapy
Group and family therapy
Nursing process for the depressed patient:
At risk for self harm
Chronic low self esteem
Nursing interventions for the depressed patient:
Promote sleep, nutrition and
Avoid excessive cheerfulness
Promote social interactions
Deal with delusions
Teach about MDD and medication issues
Be prepared to deal with common negative cognitions:
All or nothing like thinking
Should have, could have
A world view that places them in unattractive incompetent hopeless setting.
Family Education focus:
Address knowledge deficits
Explain the disorder and treatment
Emphasize follow up
Crisis management and prevention
Avoid secondary gain
family therapy and respite issues
Community based care:
Support groups such as NAMI for families and patients
Primary detection of disorders
Consider role of co-occuring substance abuse issues
Medication compliance and affordability issues
Role of social rehab instead of physical rehab
Self-awareness issues for nurses dealing with MDD:
"I hope this mood isn't contagious - I think I'll just avoid Mr Jones it's too much"
"He's just hopeless - so negative and incompetent "Mr Jones, if I were you I'd just pull myself up by my bootstraps and get a grip on all of this..."
When Mr. Jones doesn't like my suggestions, I feel incompetent and unprofessional
What's your nursing goal with Mr. Jones?