Depressive Disorders Flashcards
Depression Epidemiology
- Women 2X more than men
- Race
- Seasonality
- Socio-economic status
Biological Factors Etiology of Depression
- Genetic
- Biochemical abnormalities (Neurotransmitter, cortisol, electrolyte, hormonal imbalances)
- Inflammatory process
- Diathesis-stress model
Psychological Factors Etiology of Depression
- Cognitive theory-psychological predisposition
- Negative and/or unrealistic expectations of environment, self and future
- Learning theory: Learned helplessness
Contributing Factors: Child
Diathesis-stress model:
* Detachment of primary caregiver
* Parental separation or divorce
* Death of loved one, including pet
* Relocation
* Academic failure
* Physical illnesses
Contributing Factors: Teens
- Conflicts with independence and maturation
- Role confusion
- Grief/loss
Major Depressive Disorder
Five (or more) in 2-week period
* Weight and appetite changes
* Sleep disturbances
* Fatigue
* Psychomotor agitation or retardation
* Worthlessness or guilt
* Loss of ability to concentrate
* Recurrent thoughts of death
PLUS at least one symptom is also either
* Depressed mood or
* Loss of interest or pleasure (anhedonia)
* Can be persistent & chronic
* Recurrent episodes common
* Symptoms cause distress or impaired function
* Episode not attributed to physiological effects
* Absence of a manic or hypomanic episode
Contributing Factors: Older Adult
- Societal attitudes
- Major stressors
- Financial problems
- Life changes- job ending/ retirement/ relocation
- Physical illness- chronic illness and chronic pain
- Grief/Loss: Bereavement overload
- *Decreased functional ability
MDD: Children and Teens
5 or more symptoms present during 2-week period
Any 3 of the following:
* Significant weight loss or decrease in appetite
* Insomnia or hypersomnia
* Psychomotor agitation or retardation
* Fatigue or lack of energy
* Worthlessness or guilt
* Loss of ability to concentrate or indecisiveness
* Recurrent thoughts of death or suicide
Plus, BOTH these:
Depressed or irritable, cranky mood
and
Loss of interest or pleasure (anhedonia)
Other Symptoms of MDD in children and teens
- Frequent vague, non-specific physical complaints
- Frequent absences or poor performance in school
- Being bored
- Alcohol or substance abuse
- Increased anger or hostility
- Reckless behavior
- Symptoms cause significant distress or impairment in functioning.
Depression Symptoms in Children up to age 3
- failure to thrive
- feeding problems
- lack of playfulness
- lack of emotional expression;
- delay in speech or motor development
Depression Symptoms in Children Aged 3-5
- prone to accidents
- phobias
- aggressiveness
- excessive self-reproach for minor infractions
Depression Symptoms in Children** Aged 6-8**
- vague physical complaints
- aggressive behavior
- cling to parents
- avoid new people and challenges
- behind in social skills/academic performance
Depression Symptoms in Children Aged 9-12
- morbid thoughts
- excessive worrying
- lack of interest socially
- think they have disappointed parents
Disruptive Mood Dysregulation Disorder
- 6-18 years old with onset before age 10
- Symptoms: anger and constant, severe irritability
- More common in males and children than adolescents
- Verbal and behavioral outbursts at least 3 X weekly
- Irritability, anger, and temper tantrums in at least 2 settings (home, school, and with peers)
Persistent Depressive Disorder
Formerly known as dysthymia
Low-level depressive feelings most of the day, the majority of days
Symptoms at least 2 years in adults
Must have two or more of the following:
Decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness
Premenstrual Dysphoric Disorders
- Symptoms in week prior to onset of a woman’s menstruation:
- Mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating
- Other physical manifestations include lack of energy, overeating, hypersomnia or insomnia, breast tenderness, aching, bloating, and weight gain.
- Symptoms decrease significantly or disappear with the onset of menstruation
Substance-induced depressive disorder
Person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal
Depressive disorder associated with another medical condition
- Can be caused by kidney failure, Parkinson’s disease, and Alzheimer’s disease for example
- Symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder
Psychomotor retardation
- visible slowing of physical activity such as movement and speech
- i.e., slow talking or long pauses before beginning to talk, taking long time to cross a room or slow food chewing and waiting longer than usual between bites.
- associated with severe depression.
Psychomotor Agitation
- increase in activity brought on by mental tension.
- i.e., Restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around
- associated with agitated depression
Nursing diagnosis / Analyze Cues
Risk for suicide—safety is always highest priority
Hopelessness
Ineffective coping
Social isolation
Self-care deficit
Recovery Model
Focus on patient’s strengths to improve health and reach full potential
Treatment goals mutually developed
Based on patient’s personal needs and values
Measurable
Plannning/Prioritizing Hypotheses
- Rank patient conditions and problems according to
- Urgency
- Complexity
- Time
Implementation/Take Action
- Use therapeutic communication skills (active listening, silence, open ended questions)
- Educate and assist patient with cognitive distortion and restructuring techniques
- Administer and provide education on scheduled medications
- Observe clients for safety
- Assist patients to identify support people and systems
- Educated patient on coping strategies
- Establish a routine for sleep at night
- Encourage participation in group therapy
