Chapter 14

Depressive Disorders

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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

Major Depressive Disorder

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Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual dysphoric disorder Substance abuse depressive disorder Depressive disorder associated with another

medical condition

Depressive Disorders Classified

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Leading cause of disability in the United States Children and adolescents Older adults

Comorbidity

Epidemiology

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Biological factors Genetic Biochemical

• Stressful life events

Alterations in hormonal regulation Inflammatory process Diathesis-stress model

Etiology

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Psychological factors Cognitive theory Learned helplessness

Etiology (Cont.)

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Assessment Assessment tools Assessment of suicide potential Key assessment findings

Nursing Process

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Areas to assess Affect Thought processes Mood Feelings Physical behavior Communication Religious beliefs and spirituality

Nursing Process (Cont.)

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Age considerations Children and adolescents Older adults

Self assessment Feeling what the patient is feeling

Nursing Process (Cont.)

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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?”

Question 1

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D. “Do you ever find that you don’t remember where you’ve been or what you’ve done?”

Question 1 (Cont.)

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Nursing diagnosis Risk for suicide—safety is always the highest priority Hopelessness Ineffective coping Social isolation Spiritual distress Self-care deficit

Nursing Process (Cont.)

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Outcomes identification Recovery model

Focus on patient’s strengths Treatment goals mutually developed Based on patient’s personal needs and values

Nursing Process (Cont.)

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Planning Geared toward

Patient’s phase of depression Particular symptoms Patient’s personal goals

Nursing Process (Cont.)

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Implementation Three phases

Acute phase (6 to 12 weeks) Continuation phase (4 to 9 months) Maintenance phase (1 year or more)

Nursing Process (Cont.)

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Counseling and communication Health teaching and health promotion Promotion of self-care activities Teamwork and safety

Nursing Process (Cont.)

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Antidepressants Selective serotonin reuptake inhibitors (SSRIs)

• First-line therapy• Indications• Adverse reactions• Potential toxic effects

Psychopharmacology

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Tricyclic antidepressants (TCAs)• Neurotransmitter effects• Indications • Adverse effects• Toxic effects• Adverse drug interactions• Contraindications• Patient and family teaching

Psychopharmacology (Cont.)

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Monoamine oxidase inhibitors (MAOIs) • Neurotransmitter effects• Indications• Adverse/toxic effects• Interactions

Drugs Food

• Contraindications

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Psychopharmacology (Cont.)

Your patient was just diagnosed with a major depressive disorder.

What medication do you anticipate the health care provider will start the patient on?

Case Study

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What side effects might the patient experience?

Case Study (Cont.)

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Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy St. John’s wort Exercise

Other Treatments for Depression

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Psychotherapy• Cognitive-behavioral therapy (CBT)• Interpersonal therapy (IPT)• Time-limited focused psychotherapy• Behavior therapy

Group therapy

Advanced Practice Interventions

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Evaluation Suicide ideation Intake Sleep pattern Personal hygiene and grooming Self-esteem Social interaction

Nursing Process (Cont.)

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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

Audience Response Questions

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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

Audience Response Questions

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