depression ppt and readings Flashcards
*
what is major depressive disorder?
what is nec for dx of major depressive disorder according to DSM V
it can occur as single episode but is gen recurrent and progressiv
Depressed mood or a loss of interest or pleasure in nearly all activities must be present for at least 2 weeks
Plus, 4 out of 7 additional symptoms Disruption in sleep, (this is v important assessment for depressed pt) appetite (or weight), loss of energy Loss of concentration, psychomotor agitation or retardation Excessive guilt, feelings of worthlessness, suicidal ideation
what is dysthymic disorder
- diagnostic criteria for dysthymic disorder
milder but more chronic form of major depressive disorder
Feeling sad or low most days for at least 2 weeks Plus, 2 or more of the following: Poor appetite or overeating Insomnia or oversleeping Low energy or fatigue Low self-esteem Difficulty concentrating or making decisions Feelings of hopelessness
*outcome!!
risk factors of depression
Prior episode of depression Family history of depressive disorder Lack of social support Stressful life event Current substance use Medical comorbidity Economic difficulties
*which med categories are used for tx of depression *
ppt says SSRIs, TCA, MAOI
- outcome!!
* which med categories are used for tx of depression and what is the drug name associated with it
imipramine-TCA
sertraline-SSRI
phenelzine-MAOI
venlafaxine-second gen
*what is the focus of physical care for depressed pt
Sleep hygiene, exercise
if a pt was very tired what would you investigate other than sleep (which is imp) *
endocrine fx
t or f depressed pts are often still, not moving*
• Fidgeting all the time can be sign of depression
how to help pt with nutrition*
o Nutrition-eating can be effort for v depressed pt. Give them easy foods to handle. Comforting nurturing foods. Dont expect too much fromt hem.
which pop often has nausea and GI symptoms of depression
o Nausea-children have very GI symptoms for depression. Tx with simple foods or antiemetic.
what should you tell pt to start with if they are incredibly depressed and you want them exercsing
Exercise and being in nature can be very difficult-start slow with 5min walk
what is the primary role of the nurse for the psych domain
Role for psych domain is more counsellor and support.-may be beneficial to have family counselling. Pills wont be enough
pt is regaining their energy from hospitalization, what is a risk
• Suicide is high risk when pt might have enough energy to fulfill suicidal plan-caution when people are giving away their things and getting their affairs in order
*outcome!!
diagnoses fr spiritaul domain
Distress of the spirit Disturbances in one’s belief system Loss of hope Loss of meaning of life and suffering Discouragement and despair
outcome!!
interventions for spiritual domain
Get appropriate help! Contact the chaplain.
Guided conversations, life storytelling, ritual experiences
Encourage prayer, reading of comforting texts, meditation, attendance at devotional services or ceremonies and so on.
Promote and nurture hope
• We aren’t spiritual counsellors. Assess them and then bring in someone who cna help them
outcome says identify physiology of depression….not sure where this comes up but the most likely answer is in etiology so here goes
etiology
what role do genes play
- More common in 1st degree biologic relatives, suggesting “gene-env’t”
- Findings demonstrating potential interactions between genetic, neurochemical, and cognitive influences in establishing a disposition to the experience of depression
maybe not nec?
what do neurobiologic theories guess is the cause of depression
depression is caused by a def or dysregulation in CNS concentration of norepinephrine, dopamine and serotonin
-there may be hyperactivity of the amygdala contributing to negative processing of stimuli
maybe not nec?
neuroendocrine and neuropeptide hypotheses
basically depression is assoc with the following endocrine systems being altered
(Hypothamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothamic-growth hormone axis and the hypothalamic-pituitary-gondal axis)
• Evidence suggests that the sec of these hypothalamic and growth hormones are controlled by the neurotransmitters
maybe not nec?
psychoneuroimmunology as etiology of depression
didnt include any other psych, soc, spir etiologies
basically, cell signalling via cytokines may be assoc
- Diverse group of proteins called chemical messengers between immune cells
- Cytokines signal to the brain and erve as mediators bween immune and nerve cells.
- The connection between brain-immune interactions and susceptibility to depression is complex
priority care for depressed pt
safety
suicide risk
who can be interviewed regarding depressed pt
-it may be helpful to interview a family member or close friend in addition to pt. They can give info about day to day fx and specific symptoms etc
what are you assessing/trying to rule out when assessing biologic domain
- Hx of medications with special attention to CNS function, endocrine function, anaemia, chronic pain, autoimmune, diabetes, or menopause
- Medical hospitalizations: head traumas, episodes of LOC, pregnancies, abortions, childbirth, miscarriage
which labs to assess
do full Px with VS
, Hgb CBC, thyroid fx tests, uirnalysis, ECG
