psych week 7: depressive disorders

what are mood disorders

• also called affective disorders

• pervasive alterations in emtions that are manifested by depression, mania, or both, and interfere with the persons life

etiological theories for depressive disorders

• neurobiological factors

• psychobiological factors

  • psychoanalytical

  • cognitive

  • life events and stress theory

epidemiology of depressive disorders

• oneo f the leading causes of diability in the U.S.

• “common cold” of psych disorders

types of depressive disorders

• major depression

  • with seasonal patterns (seasonal affective disorder)

  • major depression (peripartum onset)

• persistent depressive disorder

  • chronic major depressive disorder

  • previous dysthymic disorder

• premenstrual dysphoric disorder

• substance induced depressive disorder

• disruptive mood dysregulation - (child and adolescence)

what is majjor depressive disorders

• very depressed mood consistently for atleast 2 week period

• mood must represent a change from the persons normal mood and impact social and occupational functioning

• no history of mania, no other medical causes

major depressive disorder with seasonal patterns

• known as seasonal affective disorder

• change of seasons

• eacerbated during the winter months

• incr. levels of melatonin

• effective treatment - light therapy

premenstrual dysphoric disorders (PMDD)

• markedly depressed mood with aniety, mood swings, and loss of interest in usual activities during the week prior to menstruation which improved durirng menstruation and resolves post menstruation

risk factors of major depression - peripartum onset

• history of mental illness

• other life event stressors

• unstable relationships with partner and/or family

• lack of social support

what are the types of persistent depressive disorder

• chronic depressive disorder

• previous dysthymic disorder

• essential feature is a chronically depressed mood for:

  • most of the day, more days than note, for atleast 2 years

  • 1 year for children/adolescent

assessment for persistent depressive disorder

• safety, suicidal ideation, and history

• mental status

• symptoms and severity

• family history

• strengths and coping mechanisms

• self esteem

• future orientation, hope

different standardized assessment scales

• becks depression inventory (BDI)

• zungs self-rating depression scale

• hamilton depression scale (Ham-D)

• MADRAS

• Geriatric depression scale (GDS)

depressive symptoms

depression: nursing diagnoses and epected outcomes

depression: treatment

• individual psychotherpay

  • cognitive therapy

• group therapy

• family therapy

• psychopharmacology

• electroconvulsive therapy

• light therapy

• sleep depriviation therapy

psychopharmacology for depression: serotonin

• selective serotonin reuptake inhibitors (SSRI)

  • prozac (fluoetine), paroetine (pail), zoloft, celea, leapro

• selective serotonin norepinephrin reuptake inhibitors (SSNRI)

  • effeor, cymbalta, pristiq

psychopharmacology for depression: atypical

• wellbutrin (buprpion), mirtazapine (remeron), tradone (desyrel)

• concerns with these:

  • Desyrel - priapism

  • Wellbutrin - seizures

psychopharmacology for depression: tricyclic

• tricyclic antidepressant (TCAs)

  • amitriptylaine (elavil), notriptyline (pamelor), imipramine (tofranil)

• major concerns:

  • delay in action “kicking in” (can take up to 6 weeks to see the full effect)

  • cardiac side effects

  • Side effects: sedation, tachycardia, dry mouth, constipation, orthostatic hypotension, blurred vision, decr. seizure threshold, weight gain

psychopharm for depression MAOIs

• monoamine oidase inhibitors (MAOIs)

  • phenelizine (Nardil), tranylcypromine (parnate), isocarboazid (marplan)

• major conceerns:

  • risk for hypertensive crisis when consuming products containing tyramine

what is serotonin syndrome s/s

• change in mental status (confusion, agitation)

• tachycardia

• incr. body temperature

• hyperrefleia, seizures

treatment for serotonin syndrome

• stop causative agent

• supportive care

what is electroconvulsive therapy

• used when meds are ineffective or side effects are intolerable

• 6-15 treatments scheduled 3 times per week

• preparation of the patient for ECT is similar to prep for any outpatient minor surgical procedure

• the patient may eperience some short term memory loss and confusion

other nonpharm treatments dor depression

• light theapy

• transcranial magnetic stimulation