Depression & Depression/Psychosis-Post Partum Flashcards
Depression criteria
- major: one or more major depressive episodes (depressed mood or loss of interest or pleasure in nearly all activities) must be present for at least 2 weeks
- 4/7 of the following: sleep disruptions, change in appetite or weight, difficulty concentrating, lack of energy, psychomotor agitation or retardation, excessive guilt or feelings of worthlessness, suicidal ideation
risk factors for depression
- prior episode of depression
- family history
- lack of social support
- stressful life event
- current substance use
- medical comorbidity
- economic difficulties
what medical conditions is depression associated with
- endocrine disorders
- cardiovascular disease
- neurologic disorders
- autoimmune conditions
- viral or other infectious diseases
- certain cancers
- nutritional deficiencies
- direct physiologic effect of a substance
nursing assessment for depression
assess for neurovegetative symptoms: appetite & weight changes, dehydration in older adults, sleep disturbance, decreased energy, tiredness, fatigue, mood (anhedonia), affect (downcast), negative thought content, feelings of helplessness, cognition and memory impairment
hypersomnia
- prolonged sleep episode at night or increased daytime sleep
initial insomnia
difficulty falling asleep
middle insomnia
waking up during the night and having difficulty returning to sleep
Tricyclic
Antidepressant
- Amitriptyline
- Clomipramine
- Nortriptyline
Side effects
- anticholinergic
Tricyclic
Antidepressant
- Amitriptyline
- Clomipramine
- Nortriptyline
Side effects
- anticholinergic
SSRIs
selective serotonin reuptake inhibitors
Side effects
- Nausea
- Weight gain
- sexual dysfunction
- dry mouth
- dizziness
- tremors
- vision changes
Sertraline
Fluoxetine
Nursing interventions for depression
- Therapeutic relationship is MOST effective tool
- Establishingtrustand a supportive relationship
psychotherapy treatment for depression
cognitive therapy, behaviour therapy, interpersonal therapy, family & marital therapy, group therapy,
pharmacological treatment of depression
SSRI’s, tricyclic, SNRI, SARI, NaSSA, NDRI
- antianxiety meds (benzos), mood stabilizers, antipsychotics
side effects of depression medication
nausea, vomiting, diarrhea, changes in appetite or weight, dry mouth, yawning, dizziness, headache, anxiety, tremors, fatigue
- What are the ‘baby blues’?
Characterized by emotional lability, crying easily and for no apparent reason, a let-down feeling, restlessness, fatigue, insomnia, headache, sadness, anger
Symptoms are usually mild and short lived
The “blues” are normal.
- How long do the baby blues usually last?
Start 2-3 days after childbirth and last for up to 2 weeks (Often goes way 10-14 days after delivery)
Perinatal Depression
Some women may experience a deep and ongoing depression which lasts much longer
Risks of ECT
- Although Generally safe, risks and side effects may include:
- confusion:
Immediately after treatment for a few minutes to several hours) Rarely, confusion may last several days or longer.
More noticeable in older adults. - Memory loss
Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. - Physical side effects
Nausea, headache, jaw pain or muscle ache
what is ECT
- General anesthesia and small electric currents are passed through the brain, intentionally triggering a brief seizure
- Causes changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions
- What are the signs & symptoms of Perinatal depression
- lack of interest in baby,
- negative feelings towards baby,
- worry about hurting the baby,
- mother lacks concern for herself,
- lack of energy & motivation,
- feelings of worthlessness & guilt,
- changes in appetite or weight,
- sleeping more or less than usual,
- recurrent thoughts of death or suicide,
- loss of pleasure
- Increased anxiety due to need to care for newborn
- Trouble feeling connected to your developing baby (called poor fetal attachment)
- Crying frequently
Causes of Perinatal Depression
- exact reason unknown
- interrelated causes & risk factors contribute: hormonal changes, physical changes, stress
perinatal psychosis
- rare but serious disorder that can develop after childbirth
- characterized by loss of contact with reality
- considered a medical emergency
- high risk of suicide or infanticide, hospitalization usually required
S/S of perinatal psychosis
hallucinations, delusions, rapid mood swings, bizarre behaviour, inability or refusal to eat, extreme agitation & anxiety, suicidal thoughts & actions, confusion & disorientation, thoughts of harming or killing their baby
- When does Perinatal/Peripartum Depression usually develop?
- 50 % of major depressive episodes begin prior to delivery
- Can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
- When does Perinatal/Peripartum Depression usually develop?
- 50 % of major depressive episodes begin prior to delivery
- Can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
Other Factors that Increase Risk for Perinatal/Peripartum Depression
- Medical complications for mother or baby
- Relationship difficulties
- Lack of support from family or friends
Perinatal Depression & Attachment
- Depressed mothers interact less with their babies
- Are less likely to breastfeed, play with or read to their children
- May be inconsistent providing care to their newborn
- May be loving & attentive or may react negatively or not at all
What is the impact of Perinatal/Peripartum depression on the children?
- Behavioral problems- sleep problems, temper tantrums, aggression, & hyperactivity
- delays in cognitive development - may learn to talk and talk later than other children. may have learning difficulties and problems in school
- social problems - may have difficulty establishing relationships, have trouble making friends, be socially withdrawn or act out in destructive ways
- Depression: risk of developing major depression early in life
- ## Emotional problems: lower self- esteem, more anxious & fearful, more passive, less independent
hormonal changes in perinatal depression
- drop in estrogen & progesterone levels
- thyroid levels drop= fatigue & depression
physical changes in perinatal depression
- physical pain from delivery
- difficulty losing baby weight = insecurity with appearance & sexual attractiveness
Education for New Moms:
- Relationships are a priority: stay connected to family
- Let loved ones know what you need
- Don’t keep feelings to yourself
- Get practical help & emotional support
- Share what you are experiencing
- Join a group for new moms
- Find people to help with childcare, housework, and errands
- Make time for yourself
- Give yourself credit for things you accomplish
professional tx for Perinatal depression
- Perinatal depression responds to the same treatments as regular depression
- Support Groups
- Individualtherapy,marriagecounselling * Antidepressantmedications
- Electroconvulsivetherapy(ECT)
behavioural findings of depression
tearfulness, irritability, brooding, obsessive rumination, anxiety, phobias, excessive worry over physical health, complaints of pain, panic attacks, difficulty with intimate relationships, difficulties with sexual functioning, marital problems, occupational problems, substance abuse, suicide, increased pain & physical illness, decreased physical, social and role functioning
