Depressive disorder

Question 1

Two broad categories mood disorders

Answer 1

Depression

Depression + Mania = Bipolar disorder

Question 2

Mood disorder continuum

Answer 2

Major depression –> Dysthymia –> Normal mood –_ Hypermania –> Severe mania

Question 3

General info Mood disorders

Answer 3

Depression is oldest and most frequently described mental illness.
Transient symptoms are normal, healthy responses to everyday disappointments.
Pathological depression occurs when adaptation is ineffective

Question 4

mood disorder epidemiology

Answer 4

Intro…and Epidemiology
Affects 10% of the population, or 19 million in a given year.
Age factors:
More common in younger women and older men
Median age of onset in Bipolar is 18 in men and 20 in women
Social class-
 lower income = higher prevalence
Bipolar more frequent in higher classes
Seasonality
Spring and fall
Race & Culture

Question 5

Primary Risk factors mood disorders

Answer 5

Female gender
Unmarried
Early childhood trauma **
Negative life event, esp. loss and humiliation
First-degree family history **
High levels of neuroticism (responds to stress poorly) **
Postpartum period
Medical illness (next slide)
Absence of social support **
alcohol or substance abuse (which came first?)

Question 6

Depressive Physiological factors

Answer 6

Physiological
Medication side-effects (more details later)
Neurological disorders
Electrolyte disturbances
Endocrine/ Hormonal disturbances (next slide)
Nutritional deficiencies

Question 7

Depressive Biological theories

Answer 7

Genetics
Biochemical: deficiencies of norepinephrine, serotonin, and dopamine
New: Gene expression/repression

Question 8

Depressive neuroendocrine theories

Answer 8

Possible failure in hypothalmic-pituitary-adrenocortical axis
Possible abnormality of TSH.

Question 9

DSM V Depression categories

Answer 9

Disruptive Mood Dysregulation Disorder (DMDD) – (seen in children)
Major Depressive Disorder (single episode or recurrent)
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Depressive Disorder Due to Another Medical Condition
Substance/Medication-Induced Depressive Disorder

Question 10

Depressive disorder due to another medical condition

Answer 10

Neurological
Infectious
Cardiac
Endocrine – (thyroid)
Inflammatory Disorders  ****
Neoplastic disorders

Question 11

Substance/Medication-Induced Depressive Disorder

Answer 11

CNS drugs
Steroids
Systemic Medications – which ones?
Lots of categories
Don’t forget alcohol/ other abused substances
Intoxication
Dependence
Withdrawal

Question 12

Major depressive disorder general def

Answer 12

Depressed mood or loss of interest or pleasure in usual activities.
Impaired social and occupational functioning for 2 weeks.
No history of manic behavior
Symptoms cannot be attributed to the use of substances or a general medical condition.

Question 13

Classifications of Major Depressive disorder

Answer 13

Single episode or recurrent
Mild, moderate, or severe
With psychotic features
With catatonic features
Psychomotor retardation
Chronic
With seasonal pattern (formerly SAD) 
With postpartum onset

Question 14

Major depressive subtypes

Answer 14

Seasonal features: episodes begin fall or winter and remit in spring, reduced cerebral metabolic activity, anergia, hypersomnia, overeating, weight gain, carb craving. Responds to light therapy.

Question 15

Persistent Depressive disorder (mild/dysthymia)

Answer 15

Sad
No evidence of psychosis
Chronically depressed mood for:
Most of the day
More days than not
For at least 2 years

Question 16

New depressive disorder

Answer 16

Premenstrual dysphoric disorder

Question 17

Depressive disorders - Psychoanalytical theory

Answer 17

A loss is internalized and directed against the ego (anger turned inward)

Question 18

Depressive disorders - Learning theory

Answer 18

Learned helplessness, i.e, gives up

Question 19

Depressive disorders - Object loss

Answer 19

eparation from sig. other in first 6 mo. leads to despair and depression in response to loss.

Question 20

Depressive disorders - Cognitive theory

Answer 20

3 distortions: negative expectations of:
•Environment
•Self
•Future

Question 21

Depressive disorders - Transactional model

Answer 21

combined effects of genetic, biochemical, psychosocial influences

Question 22

Depressive disorders - childhood factors

Answer 22

genetic predisposition
stressful situation
detachment from primary caregiver, parental separation, death (parent or pet)
a move, academic failure, physical illness.
NOTE: all are losses.

Question 23

Depressive disorders: childhood timeline

Answer 23

0-3: feeding problems, tantrums, lack of playfulness and emotional expressiveness.
3-5: accident proneness, phobias, excessive self-reproach for minor infractions.
6-8: vague physical complaints, aggressive behavior (Disruptive Mood Dysregulation Disorder - DMDD). May cling to parents, avoid new situations.
9-12: morbid thoughts, excessive worrying, “disappointed parents”

Question 24

Depressive disorders: childhood other symtoms

Answer 24

Hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping and eating disturbances, social isolation, suicidal thoughts* or actions. Perception of death

Question 25

Depressive disorder - adolescence

Answer 25

Sadness, loneliness, anxiety, and hopelessness may be perceived as “normal”.
Depression is the major cause of suicide- 3rd leading cause of death
Suicide rate has tripled in last 30 years
Suicide rate has increased in last few yrs, possibly due to black box warning on SSRI’s.

Question 26

Depressive disorder in adolescence , what to lok for

Answer 26

Inappropriately expressed anger/ aggressiveness* (DMDD?)
Running away, delinquency
Social withdrawal
Sexual acting out
Substance abuse
Restlessness and apathy
Loss of self-esteem
*Sleeping and eating disturbances
Psychosomatic complaints

Question 27

Focus of therapy in childhood and adolesence

Answer 27

Alleviate the symptoms and strengthen coping and adaptive skills to prevent future psychological problems.
Parental and family therapy

Question 28

Mood disorders - developmental implications for elderly

Answer 28

Senescence
Depression is most common psychiatric disorder
Society values youth
low self-esteem, helplessness, hopelessness increase
bereavement overload*
25% of suicides in US
ECT works well, but limited duration
Perceived losses  ***

Question 29

Nursing Assessment data - Affective and behavioral

Answer 29

Assessment data (ABC &P):
The worse the depression, the worse the symptoms – range from mild to severe
•Affective s/s: sadness to total despair, flat affect, emptiness, anxiety, anhedonia
•Behavioral s/s: crying, regression, withdrawal, psychomotor retardation, catatonia, self-destructive behavior

Question 30

Nursing Assessment data - Cognitive and Physiological

Answer 30

Cognitive s/s: some difficulty getting mind off disappointment –> total obsession with worthlessness, failure, slowed thinking, blaming self/ others, strong desire for suicide, confusion, indecisiveness
•Physiological s/s: tired/ listless, slowing of all bodily functions, eating/sleeping changes, somatic complaints (depression hurts)

Question 31

Self assessment

Answer 31

How do you feel today?
0 = worst
10 = best
Other rating scales are available

Question 32

DD Nsg Dxs

Answer 32

Nursing diagnoses:
Risk for self-directed violence/ suicide
Altered nutrition
*Sleep pattern disturbance/ Self-care deficit
Dysfunctional grieving/ ineffective coping
Self-esteem disturbance
Powerlessness/ Hopelessness
Spiritual distress
Social isolation
Altered thought processes

Question 33

DD Nsg Interventions (depend on dx)

Answer 33

Ask client re suicide
create safe environment
encourage feeling expression
develop trust
easy activities – what kind?
simple daily structure
May need to allow dependency in acute stages, but work toward independence
May have difficulties with decisions – offer simple choices
be accepting of client
promote group attendance
teach assertiveness and communication
teach problem solving – break problems into manageable pieces
explore spiritual dimensions of care
**client & family education