Whats the difference between depression and grief?
--Normal reaction to loss
--Related to significant loss
--Stop normal activities
--Focus on present feelings & needs
--Adjustment is the outcome
Grief reaction can become abnormal:
--Depression can be a distorted grief reaction.
--Grief can become pathological grief reaction
Affective SnSs of Depression
Anger & anxiety
Apathy & bitterness
Dejection & guilt
Sad and despondent
Helpless & hopeless
Cognitive SnSs of depression
Unable to concentrate
Indecisiveness/loss of motivation
Loss of interest
Pessimism & self- depreciation
Suicidal ideation. At risk when pt has lost hope of recovery.
Behavioral SnSs of depression
Decreased activity. Requires prompting to accomplish ADLs.
Suicidal gestures & acts
Poor hygiene & lack of ADLs
Alcoholism & drug use-
Who is at risk for suicide?
Decreased 5HT (serotonin) and/or NE (norepinephrine)
People with chronic, debilitating illness
History of depression
Concurrent psychiatric illnesses:
- Substance Abuse/Dependence
- Panic disorder
- Bipolar disorder
- Obsessive-compulsive disorder
Prior suicide attempts
Negative Evaluation of Self
- Pessimism & negative evaluation of self/others/world
- Cognitive distortions and faulty thinking
Lack of social support
Stressful life events
Personal history of sexual abuse
Sexual orientation issues
People with unresolved grief
Humiliating life event
When does depression become major depression?
When it lasts more than 2 weeks.
What is anhedonia?
When a depressed pt can no longer experience pleasure in an activity they used to find pleasurable.
What is dysthymia?
When depression lasts 2 or more years. May occur in a pattern with more days depressed than not.
Symptoms are generally not as severe as with major depression.
What are some theories of depression?
Psychoanalytic: associated with loss & is anger turned inward against the self
Beck-Cognitive Therapy: Negative and faulty thinking
Neurochemical imbalance: Low levels of 5HT (serotonin)/ Low levels of norepinephrine
What are some nursing interventions for a pt with depression?
Administer Medications (See Medication Sheet):
Monitor medication side effects, especially loss of appetite. Must be getting food/fluids.
Assess suicidal ideation
1:1 for short periods
Cognitive restructuring for thinking
Deal with anger and externalize as needed
Avoid acting cheerful
Mute-make observations of patient’s response to environment & document
Use simple, concrete words and sentences
Work on problems to gain acceptance of self
Cognitive restructuring for distortions in thinking
What to do for paradoxical calm? Paradoxical calm is when pt with suicidal ideation suddenly gets better because they've come up with a plan, and having a plan makes them feel good. Do not d/c and watch closely for suicide attempts.
How do SSRIs work?
Seratonine Synapse Reuptake Inhibitor.
Blocks seratonine's ability to taken up when it does not enter a receptor.
How do you assess for suicidal ideation?
“Are you thinking about killing yourself?”
“Have you thought about hurting yourself?”
“When people are as upset as you seem to be, they sometimes wish they were dead. I’m wondering if you are thinking about harming yourself?”
Presence of a plan & lethality
“Are you thinking about hurting yourself right now? If that changes, will you promise to talk with someone before you make an attempt?”
Nurse’s role in documentation
Assess overt/covert cues
--Covert: Hoarding clues, giving things away, saying good-bye, getting affairs in order.
What are some nursing interventions for pt with suicidal ideation?
Ask directly about suicidality
Document patient safety and action taken
Unit & patient searches to provide safe environment
Remove harmful objects
15 min, 30 min. and hourly checks
72 hour holds
Monitor patient closely
Sitter for extreme suicidality
Line of site
Watch for elopement
What to do for Treatment Resistant Depression Major.
Electroconvulsive Therapy: Thought to increase dopamine, serotonin, and norepinephrine by various mechanisms
Vagus Nerve Stimulator: Placement of internal device used for epilepsy
Functional EEG: matching of medication
What is mania?
Elevated mood including 3 of the following: Inflated self-esteem or grandioseDecreased sleep
Pressured speech: speaking on top of yourself. Words cannot flow fast enough.
Flight of ideas
Increase in goal-directed activity (socially, at work or sexually)
Excessive involvement in pleasurable activity
Sexual indiscretions, buying sprees, foolish business investments
What is hypomania?
About the same as mania, but less and no psychotic symptoms.
Less severe than for mania
Less impairment in social/occupational functioning
Does not usually need hospitalization
Bipolar I vs II
I: Is predominately manic with a few depressed episodes
II: Is predominately depressed with a few manic or hypomanic episodes. Harder to diagnose
Both are genetic and are characterized by a chemical imbalance in the brain.
What is bipolar depression?
More amendable for treatment
Symptoms similar to Major Depression
Monitor for suicidal ideation
Medication used to treat are different
Use of Mood Stabilizers
Antidepressants used with caution since they can precipitate manic episodes
What are nursing interventions for pt with bipolar disorder?
Administer medications & monitor side effects (1st line intervention is Rx)
--Lithium (Therapeutic vs toxic levels)
Administer low doses of antipsychotics, to decrease impulsive behaviors.
PRN Benzodiazepines: helps to focus and relax.
Give finger foods.
Give fluids to drink
--Want high calories because they will be burning them at a tremendous rate.