Depression

Depressive Disorders

disturbance in psychological, physiological, and social functioning

wide range of symptoms with disturbance in daily patterns

ex: sleep, appetite, ADLs, weight, attention, memory, and libido

impulse control, suicidal ideation, social withdraw

physical symptoms → headache, stomachache, muscle tension

Transient Depression

a normal reaction to loss

sadness directly attributable to a situation or disappointment

reactive or secondary depression

Depressive Disorder

sad mood can be related to external events or not

symptoms range from dissatisfaction with life to sudden and abrupt changes in function that suppress or take away the will to live

Incidence

major depression most common illness of any type (medical or psychiatric)

affects all ages and backgrounds

affects 14.8 million people aged 18+ and average age is 32

1-2% are pre-puberty children and 3-8% of adolescents at any point in time

depression is a major health problem for the elderly → difficulty to diagnosis du to comorbid diseases

elderly causes → social limitation, losses, physical limits

Comorbidities

schizophrenia

substance abuse

eating disorders

anxiety disorders

personality disorders

Risks

higher in women than men

past episodes of depression

family history

stressful life events

current substance use

medical illness

limited social supports

Etiology

combo of genetics, environment, individual life history, developmental, neurobiological, and thyroid irregularities

genetics → increased risk if first degree relatives suffer from depression, neurotransmitters (deficiency in biogenic amines), dopamine, and norepi and serotonin

thyroid most generally affects major depressive disorders

Major Depressive Disorder

potential for pain and suffering in all aspects of life

affects children, teenagers, adults, and elderly

depressed mood or inability to feel pleasure from previously enjoyed activities

four of these seven symptoms must be present → suicidal ideations, sleep disruptions, disruptions in appetite/weight, concentration issues, energy level changes, psychomotor agitation/retardation, excessive guilt/feelings of worthlessness

symptoms may include psychotic, catatonic, and melancholic features

over a minimum of 2 weeks

Persistant Depressive Disorder

aka dysthymia

chronic depressed mood → over 1 year for kids and adolescents and over 2 for adults and elderly

symptoms → poor appetite or over eating, insomnia or excess sleep, low energy, fatigue, low self esteem, poor concentration, difficulty making decisions and feelings of hopelessness

Major Depressive Symptoms

must have depressed mood or loss of interest

average time length → 4-12 months

Persistant Depressive Symptoms

less severe symptoms than major depressive

present as life long struggle against depression, chronic negativity, and irritability

average more days than not with symptoms for at least 2 years

Post Partum Depression

more serious and persistant lasting weeks or months after end of pregnancy, can emerge any time during the 1st year after childbirth

higher incidence with previous psych history

untreated can become dangerous for family and affected individual

HCP needs to screen for and is treatable

obvious in some women where other clients may not as readily share their feelings

Assessment

beck depression inventory

hamilton depression scale

geriatric depression scale

zung depression scale

safety first

always assess suicidal risk, ideation, and intent

Assessment Symptoms

depressed mood

anhedonia → without pleasure

anxiety

psychomotor agitation or retardation

somatic complaints

vegetative state → physical and mental inactivity

Areas to Assess

mood → subjective report of clients emotional state that impacts current life situation

affect → emotional tone that clients project - physical appearance, posture, mood, eye contact, speech, withdrawn, blunted and flat

thoughts → insight and judgment, decision making, memory and concentration, and delusions

feelings → anxiety, hopeless, helpless, guilt, anger, and listless

physical behaviors → hygiene and grooming, sleep patterns, appetite, bowel habits, libido, and anorexia

communication → maybe soft spoken, mute, cadence, rate, and response time

NANDA

risk for suicide

hopelessness

powerlessness

disturbed thought process

ineffective coping

risk for violence

ineffective health maintenance

impaired social interaction

Therapeutic Communication

nurse demonstrates empathy, effective communication skills, and responds to clients thoughts, needs, and concerns

counsel and encourage engagement in treatment

encourage self care activities

maintain therapeutic milieu

health teaching

administer meds per MD or NP

assess effects of meds and treatments

educate on coping skills and meds

Communication

conveying info through verbal and nonverbal behaviors

sending and receiving messages

Nontherapeutic Communication

nurse responds in ways that cause defensive feelings, misunderstood, controlled, minimized, alienated, and is discouraged from expressing self, thoughts, and feelings