DEPRESSION Flashcards by Eydrianne M

Depression is an an alteration in mood that is expressed by EXTREME feelings of?

sadness, despair, and pessimism.

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TWO MAJOR TYPES OF DEPRESSION

MAJOR DEPRESSION
DYSTHYMIA (Persistent Depressive Disorder)

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Disorder of SEVERITY
The lowest of the low
May have psychotic features

MAJOR DEPRESSION

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psychotic features manifested by major depression

hallucinations/illusions/delusions

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Level of Depression of Major Depression

Mild to Severe

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Less severe form of depression, lesser symptoms
Disorder of CHRONICITY
No psychotic features

DYSTHYMIA (Persistent Depressive Disorder)

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TWO MAJOR TYPES OF DEPRESSION

Acute - Last at least 2 weeks to a few months

MAJOR DEPRESSION

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TWO MAJOR TYPES OF DEPRESSION

Chronic – last at least 2 years (more than 50% of
the time, the patient experiences sadness)

DYSTHYMIA (Persistent Depressive Disorder)

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Level of Depression of DYSTHYMIA

Mild

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ETIOLOGY OF DEPRESSION - PHYSIOLOGICAL THEORY

Hormonal imbalances:

Addison’s, Cushing’s Disease, Thyroid Problem (hypo /
hyperthyroidism)

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ETIOLOGY OF DEPRESSION - PHYSIOLOGICAL THEORY

Neurovascular Conditions:

Stroke, Parkinson’s Disease

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ETIOLOGY OF DEPRESSION - PHYSIOLOGICAL THEORY

Medications

Steroids, chemotherapeutic agents, antihypertensive medications (propranolol), hormones (pills - can alter the neurochemicals in your brain), antianxiety & antipsychotic.

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ETIOLOGY OF DEPRESSION - NEUROCHEMICAL THEORIES

Related to neurotransmitters.
What are the increased neurotransmitters
What is the decreased?

DECREASE - Serotonin, Dopamine and Norepinephrine

INCREASE - Cortisol

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ETIOLOGY OF DEPRESSION - CHANGES IN BRAIN ANATOMY

Decreased brain mass
* There is decreased brain metabolism/activity in
some parts of the brain than a normal patient

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ETIOLOGY OF DEPRESSION - CHANGES IN BRAIN ANATOMY

What does the Blue and green areas of the brain in PET scans means?

there is a decreased brain activity.

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ETIOLOGY OF DEPRESSION - PSYCHOLOGICAL THEORY

Learned helplessness.
Common in people who experienced a series
of failures.

Behavioral Theory

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ETIOLOGY OF DEPRESSION - PSYCHOLOGICAL THEORY

Thinking
Depression is a product of negative thinking

Cognitive Theory

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ETIOLOGY OF DEPRESSION - PSYCHOLOGICAL THEORY

Patients with depression think negatively. They have negative thoughts about everything.

Pessimism

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ETIOLOGY OF DEPRESSION - PSYCHOLOGICAL THEORY

Loss of a loved object
Anger turned inwards - Common to people
with depression experienced being dormant.
Unconsciously, they want to hurt
themselves.
Superego that is overdeveloped/harsh
Hypercritical of themselves. This is why they are always negative.

Psychoanalytic theory

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CLINICAL MANIFESTATIONS of depression
(DEPRESSED)

D - Depressed Mood
E – Energy Loss
P – Psychomotor Retardation
R – Recurrent thoughts of death / suicide
E – Excessive Sleep / Diminished Sleep
S – Social Isolation – have no energy to socialize
S – Significant weight loss/gain
E – Excessive Guilt
D - Diminished Pleasure

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Among these, which are the are the main requirements for diagnosis of depression?

2 D’s

D - Depressed Mood
D - Diminished Pleasure

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Among these, which one is the PRIORITY?

R – Recurrent thoughts of death / suicide

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CLINICAL MANIFESTATIONS of depression

Inability to experience pleasure in pleasurable
activities

Diminished Pleasure (Anhedonia)

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CLINICAL MANIFESTATIONS of depression

Dysphoria

Depressed Mood

first manifestation to be noticeable Among these, which first manifestation to be noticeable? D - Depressed Mood E – Energy Loss P – Psychomotor Retardation R – Recurrent thoughts of death / suicide E – Excessive Sleep / Diminished Sleep S – Social Isolation – have no energy to socialize S – Significant weight loss/gain E – Excessive Guilt D - Diminished Pleasure

Excessive Sleep / Diminished Sleep

NURSING DIAGNOSIS for depression

* Imbalanced nutrition * Risk for violence directed to self* - Suicide; Priority * Ineffective Coping * Low self-esteem * Impaired Social Interaction * Self-care Deficit

What is the PRIORITY Nursing Diagnosis? (NANDA Based)

Risk for Violence directed to SELF (may/may not have the intention of killing yourself)

What is the PRIORITY Nursing Diagnosis? (Specific)

Risk for Suicide (with intention of killing yourself)

Risk for self-harm/self-mutilation

Borderline Personality Disorder

TREATMENTS for depression

Antidepressants Cognitive Behavioral Therapy(CBT) Electroconvulsive Therapy (ECT)

TREATMENTS - Antidepressants Which among these are the safest, most dangerous and most potent? a. SSRI b. TCA c. MAOI

a. SSRI- safest b. TCA - most potent c. MAOI - most dangerous

TREATMENTS - Antidepressants - What food must be avoided when taking MAOI?

Avoid tyramine rich foods.

TREATMENTS for depression Targets of Cognitive Behavioral Therapy (CBT): * Cognitive: * Behavior

- Cognitive - The way a person thinks highly affects how you behave. - Behavior - it affects their actions / behavior for example they talk less, want to be isolated.

TREATMENTS for depression - Reframing the patient's thinking so that the behavior will also changed. - Positive thinking→ positive behavior

Cognitive Behavioral Therapy (CBT)

TREATMENTS for depression not allowed in the PH

Electroconvulsive Therapy (ECT)

What is the best treatment for depression?

- Combination of antidepressants and CBT.

KEY NURSING INTERVENTIONS of depression

1. Suicide Precautions 2.Spend time with the client 3.PromoteNutrition 4.Promote Completion of ADL by Assisting only PRN 5.Provide a daily schedule of activities 6.Encourage verbalization of feelings

KEY NURSING INTERVENTIONS of depression Spend time with the client - How will you spend time with the patient? - If the patient does not want to talk and requests to be left alone, what will the nurse do?

- Stay with the patient even the patient does not want to talk - the nurse will leave in the meantime and go back and state that the nurse will have an available time for them. These actions will increase the self esteem of the patient because they will feel important

KEY NURSING INTERVENTIONS of depression Promote Nutrition - Recommendation:

Small, frequent feeding - If three large meals, the patient will lose appetite. They will think they cannot finish it and consider it another failure

KEY NURSING INTERVENTIONS of depression Promote Completion of ADL by Assisting only PRN

Kung kaya ng patient, ipagawa mo sa kanya.

KEY NURSING INTERVENTIONS of depression - How will you Provide daily schedule of activities?

washing the plates, watering the plants * Simple methods of accomplishments * To keep the patient more active * The more active, the better feeling you have

KEY NURSING INTERVENTIONS of depression How will you Encourage verbalization of feelings?

Teach them assertiveness techniques * Assertiveness is expressing feelings without violation

* Intentional killing of self * A cry for help – can sometimes end their life * A way to have a sense of control * A form of escape

SUICIDE

THEORIES OF SUICIDE (SAD)

S - Shame and Humiliation A – Anger turned Inwards D – Developmental Stressors & Desperation

RISK FACTORS of suicide (SUICIDAL)

S - Sex, Single U - Unsuccessful attempts I - Imitation C - Chronic I - Illness D - Drugs A - Age L - Loss of a love object

RISK FACTORS of suicide (SUICIDAL) Identify which age is which * ↑ attempts (superficial harm) * ↑ success (deadly ways)

* Female = ↑ attempts (superficial harm) * Male = ↑ success (deadly ways)

RISK FACTORS of suicide (SUICIDAL) - What are the chronic illness?

AIDS, Cancer, Schizophrenia, Neurological conditions, Stroke

RISK FACTORS of suicide (SUICIDAL) Age - Suicide is common on:

- 15–24yrsold - 50 yrs old above (age group with highest rate of suicide)

Who is the most vulnerable to commit suicide in the population?

People with mental illness, elderly, and adolescents.

NURSING INTERVENTIONS for suicide (INFORM)

I - I will be here: N - No suicide contract F - Frequent UNSCHEDULED visits O - One-to-one supervision R - Remove items that can be use as a weapon. M - Monitor clues for suicide

NURSING INTERVENTIONS for suicide (INFORM) If the px is extremely suicidal, you need to stay with the patient in order to stop them from suicide

I will be here

NURSING INTERVENTIONS for suicide (INFORM) - It can minimize the suicidal tendencies of the patient. - Ex. It stated in the contract that the patient will call a friend or HOPE hotline numbers whenever the patient has a suicidal ideation

No suicide contract

CLUES of suicide Suicidal IDEATION: thoughts - Passive: - Active:

- Passive – patient is thinking - Active - patient is seeking ways on how to commit it

CLUES of suicide

1) Suicidal IDEATION 2) Suicidal THREATS 3) Suicidal GESTURES 4) Suicidal ATTEMPTS

CLUES of suicide Giving away valued possessions, pets, making last will and testament, writing suicidal notes, sudden increase in energy

Suicidal GESTURES

CLUES of suicide Words (can be direct or indirect)

Suicidal THREATS

What type of questioning is appropriate?

Ask DIRECT / EXPLICIT questioning: - Plan - Method - Rescue

Will you make a promise to a patient?

NEVER