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53 Cards in this Set
- Front
- Back
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Describe depression
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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. |
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Describe Mood
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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 |
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Describe Affect
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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. |
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Length of grief process
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-Complete resolution
-Abruptness -Preparation for loss -Nature of lost object -Past and recent losses |
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Altered responses to loss
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-Delayed reaction
-Distorted Reaction -Prolonged reaction |
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Biological theories of alterations in mood
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•Genetic
•Biochemical -Biogenic amines • Neuroendocrine •Circadian Rhythm |
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Biological theories of alterations in mood
• Physiological |
• Physiological
-Medication Side effects -Neurological -Electrolyte -Hormonal -Nutritional -Other physiological conditions |
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Psychosocial Theories of Alterations
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•Psychodynamic influences & life events
•Cognitive Theory •Learned Helplessness |
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Classifications of Mood Disorders
Major Depressive Disorder |
Severe loss of interest in usual activities
Can begin at any age, usually mid twenties & thirties |
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Types of Major Depressive Disorders
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•Single Episode or recurrent
• Mild, Moderate, Severe • With Psychotic features •Chronic •With seasonal pattern • With postpartum onset -Postpartum blues -Postpartum depression -Postartum psychosis |
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Dysthymic Disorder
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•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 |
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Bipolar Disorders
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• Bipolar 1
•Bipolar 2 • Cyclothymic disorder |
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Other Mood Disorders
•Mood disorder due to general medical disorder |
-Diabetes
-Strokes -Dementia |
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•Substance-induced mood disorders
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-Direct result of substance use
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Depression risk factors
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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 |
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Alterations in Functioning
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• Affect
• Thought Patterns • Somatic Sensations • Motor Activity • Communication • Socialization |
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Levels of depression
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• Transitory Depression-Life's Everyday Disappointments
• Mild Depression-Normal Grief Response • Moderate Depression-Dysthymic disorder • Severe Depression-Major depression |
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Transient Level of Depression-Describe
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•Affect-Sadness, dejection, feeling down, having the blues
• Some crying • Some problem keeping mind of disappointment • Feeling tired |
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Mild level of Depression
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• Affect-Denial of feelings, anger, anxiety
• Normal grief response |
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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 |
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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 |
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Severe level of depression
Affect: Thoughts (Cognitive): |
Affect: Total despair, Helplessness, Hopelessness, Worthlessness, Nothingness, Emptiness
Thoughts (Cognitive): Delusional, Misinterpretations of reality |
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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 |
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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. |
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Childhood Depression
Etiological Factors |
Genetic predisposition, then precipitated by stressful situation
Prolonged or permanent separation from parent Death of loved one or pet |
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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. |
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Adolescent Depression
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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. |
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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 |
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Factor to adolescent suicide
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Threat of imminent abandonment by parents or closest peer relationship losses.
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Depression in Elderly
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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. |
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Depression in Elderly
Treatment Modalities |
Treatment Modalities
Antidepressants MAO Inhibitors Electroconvulsive Therapy Other treatments |
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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. |
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TCA Antidepressant Side Effects
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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 |
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Possible Life Threatening Side Effects of Antidepressants
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Reduction of Seizure threshold,
Arrhythmias Hypertensive Crisis (MAOI only) Serotonin Syndrome Anticholinergic Crisis |
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MAOI Antidepressants-special diet-why
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MAOI Antidepressants
Typramine Typramine Restricted diet Avoidance of certain meds |
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Hypertensive Crisis
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• Severe occipital headache
• Palpitations • Nausea/Vomiting • Stiff Neck • Fever • Sweating • Elevated Blood Pressure • Chest Pain |
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Serotonin Syndrome
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• 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 |
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Electroconvulsive Therapy
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Use of electric current to produce grand mal seizure
Indications: Severely depressed, Catatonic Stupor, Schizophrenia, Mania |
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Procedure for ECT
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Informed consent, NPO after midnight, Patient void, Dress in loose gown, Dentures, glasses, ect., removed, ½ hr prior to ECT give anticholinergic
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Immediately following ECT Treatment
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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. |
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Side Effects to electroconvulsive therapy
Potential Risks |
Side Effects to electroconvulsive therapy
Temporary memory loss, Confusion Potential Risks Severe memory loss, death |
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Other treatments of depression
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Individual psychotherapy
Group therapy Family therapy Cognitive Therapy |
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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 |
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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 |
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Suicide risk factors
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• Hopelessness
• Caucasians, Eskimos, Native Americans • Religion • Living alone • Male Gender • Advanced Age |
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Assessing potential for suicide
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• History
• Presenting symptoms • Assessing risk factors for suicide |
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Suicide risk factors (Taken from History)
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• 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) |
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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 |
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Teenage suicide
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• 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 |
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Nursing diagnoses
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High risk for self-Directed violence
Hopelessness Self esteem disturbance Social Isolation Powerlessness Altered Nutrition, less than body requirements Sleep Pattern Disturbance |
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Assessment of suicidal Patients
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Assess suicidal potential of mentally disordered patients because they are at higher risk of suicide
Plan Method Rescue |
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Nursing interventions
suicidal Patients |
Safety
Continuous observation History and assessment Physician involvement Controlled Environment Documentation Patient interaction Follow up care |
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Alternative therapies
suicidal Patients depressed pts |
Botanic Therapies (St. John’s Wort)
T’a; Chi Chuam Aromatherapy Acupuncture |
