Management of Patients with Depressive Disorders

Flashcards on Management of Patients with Depressive Disorders

Depression

An alteration in mood expressed by feelings of sadness, despair, and pessimism, loss of interest (anhedonia) in usual activities, and somatic symptoms.

Signs and Symptoms of Depression

Persistent feelings of sadness, loss of interest, trouble sleeping, appetite changes, fatigue, difficulty thinking, irritability, physical aches, recurrent thoughts of death or suicide.

Gender Prevalence of Depression

Women are more likely to have a major depressive episode (10.5%) compared to men (6.2%).

Types of Depression (DSM-5)

Major Depressive Disorder, Persistent Depressive Disorder, Disruptive Mood Dysregulation Disorder, Premenstrual Dysphoric Disorder, Substance/Medication-Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition

Childhood Depression (6 to 8 years)

Vague physical complaints and aggressive behavior, clinging to parents and avoiding new people/challenges, lagging classmates in social skills/academic competence.

Childhood Depression (9 to 12 years)

Morbid thoughts/excessive worrying, believing they have disappointed their parents, lack of interest in playing with friends.

Depression in Adolescence

Inappropriately expressed anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, apathy.

Depression in Senescence (Elderly)

Symptoms are not very different from those of younger adults, but may be confused with other illnesses associated with the aging process. Elderly account for approximately 16% of suicides in the United States.

Neurocognitive Disorder (NCD)

Slow progression of symptoms, progressive deficits; recent memory loss greater than remote; may confabulate for memory “gaps”; no complaints of loss,Disoriented to time and place; may wander in search of the familiar.

Depression

Rapid progression of symptoms more like forgetfulness; no evidence of progressive deficit; recent and remote loss equal; complaints of deficits; no confabulation (will more likely answer “I don’t know), Oriented to time and place; no wandering

Depression Signs and Symptoms

Depressed mood, reduced interest or pleasure, changes in appetite or weight, difficulty sleeping, diminished energy, guilt, anxiety, psychomotor functioning changes, somatic obsessions and compulsions, reduced concentration, suicidal ideation.

Columbia-Suicide Severity Rating Scale (C-SSRS)

A suicide assessment tool used to evaluate suicide ideation and behavior.

Six Goals of Suicide Prevention with C-SSRS

Reduce suicide rate, establish reliable rates, integrate proven tools for identifying patients, coordinate resources, modify risk factors, appropriate use of 1:1.

SAD PERSONS Assessment Scale

Sex (male), Age (younger than 19 and older than 45), Depression, Previous attempt, Ethanol or alcohol abuse, Rational thinking (impaired), Social support (lacking), Organized plan, No Significant Other, Sickness.

Lethality Assessment

Do they have a plan? Are the means available? Is the plan lethal? Has the patient prepared for death? Where and when does the patient intend to carry out the plan? What are her intentions toward the children?

Suicide Precautions In-Patient Setting

Provide a safe environment, remove items that can be used to attempt suicide, deny access to dangerous materials, maintain close observation of the patient.

Suicide Prevention Out-Patient Setting

Do not leave the person alone, enlist help of family and friends, schedule daily appointments, establish trusting relationship, talk directly about patient’s plans, discuss current crisis, identify areas of patient control, antidepressant medication.

Information for Family and Friends of the Patient at Risk for Suicide

Take any hint of suicide seriously, report threats immediately, be a good listener, express concern, be aware of resources, restrict access to firearms, instill hope, encourage professional help, be nonjudgmental.

Intervention with Families and Friends of Suicide Victims

Encourage them to talk about the suicide, be aware of blaming or scapegoating, listen to feelings of guilt, encourage discussion of relationship, encourage grieving at own pace, discuss coping strategies, identify support resources.

Psychopharmacology for Depression

Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Tricyclic antidepressants (TCAs), Monoamine oxidase inhibitors (MAO Inhibitors)

Serotonin Syndrome

A potentially life-threatening condition when there is excessive serotonin in the body, causing changes in LOC, neuromuscular excitement, and autonomic abnormalities.

Psychological Treatments for Depression

Individual psychotherapy, group therapy, family therapy.

Mindfulness (STOP)

Stop, Take a breath, Observe, Proceed mindfully.

Electroconvulsive Therapy (ECT)

Induction of a grand mal seizure through the application of electrical current to the brain to help alleviate symptoms of depression.

Nursing interventions following ECT

Monitor vital signs, position on side to prevent aspiration, caution with ambulation, allow patient to sleep, treat headaches symptomatically, allow patient to eat as soon as they are hungry.

Other Treatments of Depression

Transcranial magnetic Stimulation-TMS, Light Therapy, Ketamine, Psychedelics (psilocybin)

Nursing Interventions for Depression

Provide for safety, institute suicide precautions, begin a therapeutic relationship, promote ADLs, establish adequate nutrition and hydration, promote sleep and rest, engage in activities, encourage verbalization of emotions, manage medications, encourage cardiovascular exercise.

Self-Mutilating Behaviors Methods

Cutting, burning, excessive tattooing and body piercing.

Nursing Interventions for Self-Mutilating Behaviors

Take all self-harm seriously, matter-of-fact response, provide wound care, follow through during counseling sessions.