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53 Cards in this Set

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Describe depression
Often describes unpleasant feelings as sadness and loss, which are normal feelings
Depression goes beyond sadness

Can seriously affect an individual's feelings about future and erode the most basic attitudes about self.
Describe Mood
Prolonged or pervasive emotional state that colors one's perception of the world and how one functions in it.
Influences whole personality and functioning
Normal mood variations, such as sadness, euphoria, and anxiety, are time limited and not associated with significant functional impairment
Normal mood change in proportion to life situations
Describe Affect
Term closely related to mood.
- Refers to the feelings that are reflected on our faces, in our expression, and by our demeanor.
-Affect is fleeting, more variable and more reactive than underlying mood

Types:
Blunted--significantly reduced intensity of emotional expression.
Flat--absent or nearly absent expression.
Inappropriate--discordant affective expression accompanying content of speech or ideation.
Labile-Varied, rapid, and abrupt shifts in affective expression.
Restricted or constricted--mildly reduced in range and intensity of emotional expression.
Length of grief process
-Complete resolution
-Abruptness
-Preparation for loss
-Nature of lost object
-Past and recent losses
Altered responses to loss
-Delayed reaction
-Distorted Reaction
-Prolonged reaction
Biological theories of alterations in mood
•Genetic
•Biochemical
-Biogenic amines
• Neuroendocrine
•Circadian Rhythm
Biological theories of alterations in mood
• Physiological
• Physiological
-Medication Side effects
-Neurological
-Electrolyte
-Hormonal
-Nutritional
-Other physiological conditions
Psychosocial Theories of Alterations
•Psychodynamic influences & life events
•Cognitive Theory
•Learned Helplessness
Classifications of Mood Disorders
Major Depressive Disorder
Severe loss of interest in usual activities
Can begin at any age, usually mid twenties & thirties
Types of Major Depressive Disorders
•Single Episode or recurrent
• Mild, Moderate, Severe
• With Psychotic features
•Chronic
•With seasonal pattern
• With postpartum onset
-Postpartum blues
-Postpartum depression
-Postartum psychosis
Dysthymic Disorder
•Symptoms less severe than Major depression
•no psychotic features
Premenstrual Dsysphoric disorder
•Mood swings, depressed mood
•Decreased interest during week prior to menses
•Subsides shortly after onset of menses
Bipolar Disorders
• Bipolar 1
•Bipolar 2
• Cyclothymic disorder
Other Mood Disorders
•Mood disorder due to general medical disorder
-Diabetes
-Strokes
-Dementia
•Substance-induced mood disorders
-Direct result of substance use
Depression risk factors
Prior episodes of depression
Family History
Prior Suicide Attempt
Female Gender
Age Onset <40
Postpartum period
Medical Comorbidity
Lack of Social Support
Stressful Life Events
Sexual Abuse History
Current Substance Abuse
Alterations in Functioning
• Affect
• Thought Patterns
• Somatic Sensations
• Motor Activity
• Communication
• Socialization
Levels of depression
• Transitory Depression-Life's Everyday Disappointments
• Mild Depression-Normal Grief Response
• Moderate Depression-Dysthymic disorder
• Severe Depression-Major depression
Transient Level of Depression-Describe
•Affect-Sadness, dejection, feeling down, having the blues
• Some crying
• Some problem keeping mind of disappointment
• Feeling tired
Mild level of Depression
• Affect-Denial of feelings, anger, anxiety
• Normal grief response
Moderate level of Depression
Affect:
Thoughts (cognitive)
Physiologic
Affect:
Sadness, Dejection, Helplessness, Powerlessness, Gloomy, Pessimistic
Thoughts (cognitive)
Slowed and repetitive, Difficulty Concentration
Physiologic
Weakness, fatigue, Bodily concerns, Changes in eating and sleeping, Feels worse as the day progresses
Suicidal Ideation
Moderate level of Depression
Motor Activity (Behavioral)
Communication:
Social Participation
Motor Activity (Behavioral)
Psychomotor Retardation
Posture slumped
Decreased sexual interest
Communication:
Slowed speech, limited verbalization
Social Participation
Narcissistic
Isolated
Egocentric
Severe level of depression
Affect:
Thoughts (Cognitive):
Affect: Total despair, Helplessness, Hopelessness, Worthlessness, Nothingness, Emptiness
Thoughts (Cognitive): Delusional, Misinterpretations of reality
Severe level of depression
Somatic:
Motor Activity:
Communication:
Somatic: Constipation, Urinary retention, Feeling worse in the morning, Get better as day progresses, need help to eat, no energy.
Motor Activity: Vegetative state, posture slumped, fetal position
Communication: Mostly nonexistent, Social Participation: None
Age Group Depressions:

Childhood Depression
Childhood Depression
Contrary to earlier beliefs, persistent depression occurs & becomes progressively more common after puberty. Up to 14% of children will experience an episode of major depression before age 16. It seriously affects social, emotional, and educational development.
It is the most important predictor of suicidal behavior in ages 15-24.
Childhood Depression
Etiological Factors
Genetic predisposition, then precipitated by stressful situation
Prolonged or permanent separation from parent
Death of loved one or pet
Childhood Depression
Symptoms
School phobias
Appearing bored, angry, or sad
Eating or sleeping disturbances
Being rejected by or rejecting others
Psychosomatic complaints
Seeming tired or listless, needing to rest.
Crying for no apparent reason
Irritable, moody, or hyperactivity, fighting with others.
Stomachaches & headaches.
Adolescent Depression
Symptoms of depression in children and adolescents may be similar as in adults: feelings of sadness, pessimism, hopelessness, social withdrawal, & thoughts of suicide
Normal occurrences may be perceived as losses.
Adolescent Depression
Symptoms
Symptoms
(Difficult to recognize)
Restlessness, apathy
Inappropriately expressed anger
Sleeping and eating disturbances
Aggressive behavior
Sexual acting out, running away
Delinquency
Social Withdrawal
Substance Abuse
Psychosomatic complaints
Factor to adolescent suicide
Threat of imminent abandonment by parents or closest peer relationship losses.
Depression in Elderly
Most common psychiatric disorder of elderly
Numerous losses—Bereavement overload
Not very different from those of younger adults
Syndrome sometimes confused with other illnesses associated with aging process.
Depression in Elderly
Treatment Modalities
Treatment Modalities
Antidepressants
MAO Inhibitors
Electroconvulsive Therapy
Other treatments
Antidepressants
action and types
Increase norepinephrine and/or serotonin in brain area that controls mood.
Types
•Selective serotonin reuptake inhibitors
•Tricyclics
•Other non-MAOI Antidepressants
•Monoamine Oxidase inhibitors.
TCA Antidepressant Side Effects
Anticholinergic
Dry Mouth and nasal passages
Blurred Vision
Constipation
Urinary Retention
Esophageal Reflux

Side Effects Related to TCA’s
Sedation
Orthostatic hypotension
Photosensitivity
Weight gain
Decreased Seizure threshold
Possible Life Threatening Side Effects of Antidepressants
Reduction of Seizure threshold,
Arrhythmias
Hypertensive Crisis (MAOI only)
Serotonin Syndrome
Anticholinergic Crisis
MAOI Antidepressants-special diet-why
MAOI Antidepressants
Typramine
Typramine Restricted diet
Avoidance of certain meds
Hypertensive Crisis
• Severe occipital headache
• Palpitations
• Nausea/Vomiting
• Stiff Neck
• Fever
• Sweating
• Elevated Blood Pressure
• Chest Pain
Serotonin Syndrome
• Seen when combining 3 or more serotonin enhancing drugs and taking at same time
• Such as SSRI+MAOI, MAOI+ L-tryptophan, and clomipramine (Anafranil) + MAOI
Electroconvulsive Therapy
Use of electric current to produce grand mal seizure
Indications:
Severely depressed, Catatonic Stupor, Schizophrenia, Mania
Procedure for ECT
Informed consent, NPO after midnight, Patient void, Dress in loose gown, Dentures, glasses, ect., removed, ½ hr prior to ECT give anticholinergic
Immediately following ECT Treatment
Anesthesiologist administer oxygen
Patient is suctioned if required
Turn Patient’s head to side
Take vital signs q. 15 minutes (1st hr.)
Reassure and orient patient
Explain what has occurred.
Side Effects to electroconvulsive therapy
Potential Risks
Side Effects to electroconvulsive therapy
Temporary memory loss, Confusion
Potential Risks
Severe memory loss, death
Other treatments of depression
Individual psychotherapy
Group therapy
Family therapy
Cognitive Therapy
depression
Nursing Diagnosis
Risk for self-Directed violence
Self esteem disturbance
Social Isolation/Impaired Social Interaction
Powerlessness
Altered thought processes
Altered Nutrition, less than body requirements
Sleep Pattern Disturbance
Suicide
Demographics of Suicide
• Males commit at rates 3-4 times those of females
• Women try—men succeed
• Suicide rate increases with age
• Single People
• Youth between 15-24 years
• Serious problem among elderly
Suicide risk factors
• Hopelessness
• Caucasians, Eskimos, Native Americans
• Religion
• Living alone
• Male Gender
• Advanced Age
Assessing potential for suicide
• History
• Presenting symptoms
• Assessing risk factors for suicide
Suicide risk factors (Taken from History)
• Prior suicide attempts
• Family history of suicide
• Family history of substance abuse
• General medical illness or history of chronic pain, recent surgery, chronic physical illness
• Psychosis
• Unemployed or financial problems
• Patient is experiencing bereavement or other significant loss (divorce, job, home)
Suicide
Presenting with symptoms

Presents with:
Suicide ideation: thoughts of harming self
Suicide threat: Communicates desire to harm/kill herself
Suicide attempt, Failed—Attempted to kill self
Deliberate Self-harm Syndrome---Clients who mutilate their bodies
High degree of hopelessness, helplessness, anhedonia which are crucial factors in suicide.

Clues to suicide
Cries for help, verbal clues, behavioral clues
Teenage suicide
• Episodes of depression
• Abuse of drugs
• Non Participation
• Especially quit
• Sudden changes in behavior
• Extreme anxiety or perfectionism
• Write or talk about killing self
• Hinting at suicide
• Complain of having no fun
• Doing poorly in school
Nursing diagnoses
High risk for self-Directed violence
Hopelessness
Self esteem disturbance
Social Isolation
Powerlessness
Altered Nutrition, less than body requirements
Sleep Pattern Disturbance
Assessment of suicidal Patients
Assess suicidal potential of mentally disordered patients because they are at higher risk of suicide
Plan
Method
Rescue
Nursing interventions
suicidal Patients
Safety
Continuous observation
History and assessment
Physician involvement
Controlled Environment
Documentation
Patient interaction
Follow up care
Alternative therapies
suicidal Patients
depressed pts
Botanic Therapies (St. John’s Wort)
T’a; Chi Chuam
Aromatherapy
Acupuncture