Depressive Disorders Flashcards
Mood
- A pervasive and sustained emotion that colours ones perception of the world and how one functions in it
- Normal variations occur as responses to specific life experiences
- Variations, such as sadness, euphoria are time limited and are not associated with significant functional impairment
- varies within and between cultures
Mood disorder
- recurrent disturbances or alterations in mood that cause psychological and behavioural impairment
- moods can be categorized as: depressive (typified by feelings of sadness, hopelessness, loss of interest, and fatigue)
- manic (typified by exaggerated feelings of elation or irritability)
- starts in the emotions but influences the thinking and the acting part of the body
Fluctuations in Mood
- Fluctuations in mood (a person’s overall emotional status), especially during times of loss, change, and other social stressors are normal as one’s mood is non static
- Fluctuations occurring for a sustained period of time are suggestive of an affective disorder
- Affective disorders influence a person’s thoughts, emotions, and behaviour and can be seen as on a continuum
Affective Disorders
- Major depressive disorder
- Dysthymic disorder (a milder but more chronic form of major depressive disorder)
- Bipolar disorder: types I and II
- Cyclothymic disorder (a term used to describe periods of hypomanic and depressive episode that do not meet full criteria for a major depressive episode)
Historical Perspectives
- Affective disorders were described as early in the Old Testament - Job
- 4th century B.C in Greek medical literature
- 17th and 18th centuries: “insane or lunatic asylums”
- 19th century: hypnosis
- 20th century: ECT and psychopharmacology
- 21st century: psychopharmacology and CBT/talk therapies
Epidemiology
Major depressive disorder is a leading cause of disability in the United States and Canada, affecting greater numbers of women than men
Predisposing factors
- Genetics
- Aggression turned inward (Freud)
- Object loss theory: separation
- personality organization theory:
- external locus of control: I am here and whatever that person does has influence on me. “you make me angry” other people make the decisions over how I feel. I stay here and the world is influencing me
- goals not accomplished, lower self-concept
- constant mode of feelings of emptiness
- continuous stress
- cognitive model (negative thinking, tunnel vision, pessimism)
- learned hopelessness-helplessness model (have not control over own life)
- Behavioural model (decide to act negatively)
- Biological model (hormones, endocrine systems - hypothyroidism/lack of iron, neurotransmitters)
Major Depressive Disorder
Must include depressed mood or loss of interest or pleasure for at least two weeks in conjunction with at least four other symptoms
- significant weight loss/gain
- hypersomnia or insomnia
- psychomotor agitation or slowness
- fatigue or energy loss
- difficulty concentrating or indecisiveness
- recurrent thoughts of death
Dysthymic Disorder
- Dysthymia is considered a milder chronic form of depression
- involves depressive symptoms that are chronic and must be present for a least two years for adults or one year for children and adolescents
Suicide
suicide is considered a behaviour and not a disorder. The DSM-5 does not identify diagnostic criteria for this behaviour
- ambivalence is frequently the underlying theme involved with suicide
Cyclothymic Disorder
a term used to describe periods of hypomanic and depressive episode that do not meet full criteria for a major depressive episode
If you have cyclothymia, you’ll have periods of feeling low followed by periods of extreme happiness and excitement (called hypomania) when you do not need much sleep and feel that you have a lot of energy. The periods of low mood do not last long enough and are not severe enough to be diagnosed as clinical depression.
Recognition of depression
Generally we do not always recognize depression or sadness because:
- it can present itself as tiredness or anger
- individuals hide because “no one wants to be around someone who is sad all the time”
- individuals do not recognize it in themselves
- We do not want to “see” depression after an individual experience trauma
- We want to help others and often we do not know how to help someone who is sad
Risk Factors
- Prior episodes of depression
- Family history of depressive disorder
- Lack of social support
- Stressful events (adverse childhood experiences)
- current substance use
- medical co-morbidity
- economic difficulties
Strategies for Optimal assessment
- low feelings of enjoyment
- thoughts of suicide
- disorganized thinking, perceptual disturbances
- low ability to think, concentrate
- difficulty making decisions
- difficulty regarding memory
- single syllabus talking
- minimal interpersonal relations
- low sexual functioning
- ineffective occupational functioning
Diagnosing and Planning Appropriate Interventions
- Meeting the patient’s focused needs
- Nurse and patient collaboratively determine the outcomes to be achieved
