Depressive Disorder & Anxiety & Obsessive-Compulsive Disorders
Depressive Disorder
Objectives of Depression
Identify symptoms of various depressive disorders:
Disruptive Mood Dysregulation Disorder
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Discuss the epidemiology of Major Depressive Disorder
Discuss biological and cognitive risk factors for the development of Major Depressive Disorder
Discuss treatment options including medication
Discuss nursing interventions related to depressive disorders
Disruptive Mood Dysregulation Disorder
Diagnosed in children ages 6 to 18
Symptoms:
Constant and severe irritability and anger
Temper tantrums that are out of proportion to the situation occurring at least 3 times per week
Exhibits symptoms in at least two settings (e.g., home, school, with peers)
Management strategies:
Symptomatic medications
Cognitive Behavioral Therapy (CBT)
Parent training
Persistent Depressive Disorder (Dysthymia)
Formerly known as Dysthymia
Characterized by low-level depressive feelings present throughout most of each day for the majority of days
Duration:
At least 2 years in adults
At least 1 year in children and adolescents
Must have two or more of the following symptoms:
Decreased appetite or overeating
Insomnia or hypersomnia
Low energy
Poor self-esteem
Difficulty thinking
Feelings of hopelessness
Other Depressive Disorders
Substance-Induced Depressive Disorder
Characterized by the absence of depressive symptoms when not experiencing drug or alcohol use or withdrawal.
Depressive Disorder Associated With Another Medical Condition
Examples include:
Cerebrovascular Accident (CVA)
Parkinson's Disease
Huntington's Disease
Alzheimer's Disease
Traumatic Brain Injury (TBI)
Cushing's Disease
Hypothyroidism
Arthritis
Back Pain
Metabolic Conditions
HIV
Diabetes
Infections
Cancer
Autoimmune Issues
Premenstrual Dysphoric Disorder
A symptom cluster appearing in the last week prior to the onset of a woman’s menstrual period, including:
Mood swings
Irritability
Depression
Anxiety
Feeling overwhelmed
Difficulty concentrating
Symptoms significantly decrease or disappear with the onset of menstruation
Major Depressive Disorder
Diagnosis requires the presence of five (or more) of the following symptoms in a 2-week period:
Weight and appetite changes
Sleep disturbances
Fatigue
Feelings of worthlessness or guilt
Loss of ability to concentrate
Recurrent thoughts of death
Psychomotor agitation
Additionally, at least one symptom must be either:
Depressed mood
Loss of interest or pleasure (anhedonia)
Duration:
Persistent for a minimum of 2 weeks to 6 months
Chronic: Lasting more than 2 years
Recurrent episodes are common
Symptoms must cause distress or impaired functioning
Episode cannot be attributed to physiological effects
Must have an absence of manic or hypomanic episodes
Treatment of Major Depressive Disorder
Medication Options
First-line therapy: Selective Serotonin Reuptake Inhibitors (SSRIs)
Rare risk of serotonin syndrome
Most common SSRIs:
Sertraline (Zoloft)
Paroxetine (Paxil)
Escitalopram (Lexapro)
Citalopram (Celexa)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
SSRIs may be better tolerated
Most common SNRIs:
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Tricyclic Antidepressants:
Associated with anticholinergic adverse reactions
Monoamine Oxidase Inhibitors (MAOIs)
Particularly effective for unconventional depression
Nursing Interventions for Depressive Disorders
Assess for patient safety
Focus on the patient’s strengths
Promote self-care and self-esteem
Assist with individual, family, and/or group therapy
Treatment goals to be mutually developed based on patient’s personal needs and values
Objectives of Anxiety Disorders
Define anxiety and its risk factors
Discuss different levels of anxiety
Identify defense mechanisms relevant to anxiety
Discuss clinical manifestations of various anxiety disorders:
Separation Anxiety Disorder
Specific Phobia
Social Anxiety Disorder
Panic Disorder
Agoraphobia
Generalized Anxiety Disorder
Identify risk factors contributing to anxiety disorders
Identify nursing interventions for anxiety disorders
Discuss treatment options including medications
Generalized Anxiety
Anxiety is characterized by apprehension, uneasiness, uncertainty, or dread from real or perceived threats
Fear is a reaction specifically to danger
Normal anxiety is essential for survival
Possible causes of anxiety include:
Genetic factors
Biological factors
Psychological factors
Cultural influences
Levels of Anxiety
Mild Anxiety
Moderate Anxiety
Severe Anxiety
Panic Anxiety
Case Study 1
Scenario: Anita, 34, experiences anxiety when shopping and realizes her child is missing.
Query: What level of anxiety would this likely result in?
Options:
Mild
Moderate
Severe
Panic
Defense Mechanisms Against Anxiety
Defense mechanisms are automatic coping styles that protect individuals from anxiety and maintain self-image by blocking feelings, conflicts, and memories.
Types of defense mechanisms:
Adaptive
Maladaptive
Other Anxiety Disorders
Separation Anxiety Disorder
Characterized by developmentally inappropriate levels of concern over being away from a significant other
Specific Phobias
Defined as a persistent irrational fear of a specific object, activity, or situation leading to avoidance behavior
Social Anxiety Disorder
Involves severe anxiety or fear provoked by exposure to social or performance situations that may be negatively evaluated by others
Panic Disorder
Defined by panic attacks characterized by an abrupt surge of intense fear or discomfort reaching a peak within minutes
Agoraphobia
Excessive anxiety or fear regarding places or situations from which escape may be difficult or embarrassing
Case Study 2
Scenario: Anita recalls struggles with panic disorder and her coping.
Query: What level of anxiety might be beneficial during a nursing exam?
Options:
Mild
Moderate
Severe
Panic
Treatment of Anxiety Disorders
Biological Approaches
Pharmacotherapy:
SSRIs and SNRIs
Antianxiety drugs
Other categories:
Beta blockers
Antihistamines
Anticonvulsants
Antipsychotics
Children & Adolescents:
Few drugs approved for children; Duloxetine/Cymbalta for ages 7-17; other medications prescribed off-label
Integrative Medicine
Herbal and dietary supplements
Behavioral Therapy
Techniques include:
Modeling
Systematic Desensitization
Flooding
Thought Stopping
Cognitive-Behavioral Therapy
Nursing Interventions for Anxiety Disorders
Stay with the patient when experiencing anxiety
Encourage patients to discuss their feelings
Reduce environmental stimuli
Teach relaxation techniques such as:
Progressive Muscle Relaxation
Guided Imagery
Deep Breathing
Make appropriate referrals as needed
Obsessive-Compulsive Disorder (OCD)
Symptoms
Cleaning: Fears of contamination leading to excessive cleaning rituals
Symmetry: Obsessions with symmetry that result in repeating, ordering, or counting actions
Characterized by repetitive thoughts that cause stress and repetitive behaviors demonstrating a perceived need for perfection
Treatment of OCD
Pharmacologic Therapy
SSRIs are commonly used for treatment
Deep Brain Stimulation (DBS) is an option for severe cases
Psychological Therapy
Various therapy options are available; specifics were not detailed in the provided transcript
Nursing Interventions for OCD
Assess for patient safety
Maintain a nonjudgmental attitude
Allow the patient time to perform ritualistic behaviors
Set reasonable limits
Encourage active diversions and coping skills
Assist in identifying progress and setting realistic expectations
Knowledge Check
Priority assessment question for major depression symptoms:
“Tell me about any special powers you believe you have.”
“You look really sad. Have you ever thought of harming yourself?”
“Your family says you never stop. How much sleep do you get?”
“Do you ever find that you don’t remember where you’ve been or what you’ve done?”