Chapter 14
Depressive Disorders
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Major Depressive Disorder
Persistently depressed mood lasting a minimum of 2 weeks - Symptom include: Anhedonia, fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Depressive Disorders Classified
Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual dysphoric disorder Substance abuse depressive disorder Depressive disorder associated with another medical condition
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Epidemiology
Leading cause of disability in the United States
Children and adolescents Older adults
Comorbidity
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Etiology
Biological factors
Genetic Biochemical
Stressful life events
Alterations in hormonal regulation Inflammatory process Diathesis-stress model
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Etiology (Cont.)
Psychological factors
Cognitive theory Learned helplessness
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Nursing Process
Assessment
Assessment tools Assessment of suicide potential Key assessment findings
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Nursing Process (Cont.)
Areas to assess
Affect Thought processes Mood Feelings Physical behavior Communication Religious beliefs and spirituality
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Nursing Process (Cont.)
Age considerations
Children and adolescents Older adults
Self assessment Feeling what the patient is feeling
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Question 1
Which question would be a priority when assessing for symptoms of major depression?
A. Tell me about any special powers you believe you have. B. You look really sad. Have you ever thought of harming yourself? C. Your family says you never stop. How much sleep do you get?
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
10
Question 1 (Cont.)
D. Do you ever find that you dont remember where youve been or what youve done?
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
11
Nursing Process (Cont.)
Nursing diagnosis
Risk for suicidesafety is always the highest priority Hopelessness Ineffective coping Social isolation Spiritual distress Self-care deficit
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
12
Nursing Process (Cont.)
Outcomes identification Recovery model
Focus on patients strengths Treatment goals mutually developed Based on patients personal needs and values
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
13
Nursing Process (Cont.)
Planning Geared toward
Patients phase of depression Particular symptoms Patients personal goals
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
14
Nursing Process (Cont.)
Implementation Three phases
Acute phase (6 to 12 weeks) Continuation phase (4 to 9 months) Maintenance phase (1 year or more)
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
15
Nursing Process (Cont.)
Counseling and communication Health teaching and health promotion Promotion of self-care activities Teamwork and safety
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
16
Psychopharmacology
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
First-line therapy Indications Adverse reactions Potential toxic effects
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
17
Psychopharmacology (Cont.)
Tricyclic antidepressants (TCAs)
Neurotransmitter effects Indications Adverse effects Toxic effects Adverse drug interactions Contraindications Patient and family teaching
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
18
Psychopharmacology (Cont.)
Monoamine oxidase inhibitors (MAOIs)
Neurotransmitter effects Indications Adverse/toxic effects Interactions
Drugs Food
Contraindications
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
19
Case Study
Your patient was just diagnosed with a major depressive disorder. What medication do you anticipate the health care provider will start the patient on?
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
20
Case Study (Cont.)
What side effects might the patient experience?
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
21
Other Treatments for Depression
Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy St. Johns wort Exercise
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
22
Advanced Practice Interventions
Psychotherapy
Cognitive-behavioral therapy (CBT) Interpersonal therapy (IPT) Time-limited focused psychotherapy Behavior therapy
Group therapy
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
23
Nursing Process (Cont.)
Evaluation
Suicide ideation Intake Sleep pattern Personal hygiene and grooming Self-esteem Social interaction
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
24
Audience Response Questions
1. A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
25
Audience Response Questions
2. Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
26