Halter chapter 14 Flashcards
Disruptive mood dysregulation disorder
individuals need to exhibit the irritability, anger, and temper tantrums in at least two of these settings: home, school, and with peers.
bipolar diagnosis as an adolescent
most of the young people who received a diagnosis of bipolar did not go on to exhibit classic bipolar symptoms as adults. In fact, most children and adolescents once diagnosed with bipolar disorder actually converted to major depressive disorder or an anxiety disorder in adulthood.
Persistent depressive disorder
diagnosed when feelings of depression occur most of the day, for the majority of days. These low-level depressive feelings last at least 2 years in adults and 1 year in children and adolescents.
Premenstrual dysphoric disorder
It refers to a cluster of symptoms that occur in the last week before the onset of a woman’s period. Premenstrual dysphoric disorder causes problems severe enough to interfere with the ability of a woman to work or interact with others.
swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating.
include lack of energy, overeating, hypersomnia or insomnia, breast tenderness, aching, bloating, and weight gain.
Substance/medication-induced depressive disorder
a depressive disorder, such as major depressive disorder, that is a result of prolonged use of or withdrawal from drugs and alcohol.
Depressive disorder due to another medical condition
may be caused by disorders that affect the body’s systems or from long-term illnesses that cause ongoing pain.
Major depressive disorder
characterized by a persistently depressed mood lasting for a minimum of 2 weeks.The length of a depressive episode may be 5 to 6 months
bereavement exclusion
until recently clinicians were advised against diagnosing a person with depression in the first 2 months following a significant loss.
Depression and Grieving
People who experience a significant loss can exhibit feelings and behaviors similar to depression. They may cry, feel hopeless about the future, have disruptions in eating and sleeping, and lose pleasure in everyday activities.
leading cause of disability in the United States
Major depressive disorder
stats
Nearly 3 million (about 11%) individuals between 13 and 18 years of age experienced depression in 2014
Comorbidity
frequently accompanies other psychiatric problems such as schizophrenia, substance abuse, eating disorders, schizoaffective disorder, and borderline personality disorder. The combination of anxiety and depression is perhaps one of the most common psychiatric presentations.
risk factors
The high variability in symptom manifestation, response to treatment, and course of the illness supports the supposition that depression may result from a complex interaction of causes.
Genetic
genetic factors play a role in the development of depressive disorders.
Primary Risk Factors for Depression
- Female gender
- Adverse childhood experiences
- Stressful life events
- First-degree family members with major depressive disorder
- Neuroticism (a negative personality trait characterized by anxiety, fear, moodiness, worry, envy, frustration, jealousy, and loneliness)
- Other disorders such as substance use, anxiety, and personality disorders
- Chronic or disabling medical conditions
Two of the main neurotransmitters involved in mood
serotonin and norepinephrine
biochemical
Research suggests that depression results from the dysregulation of a number of neurotransmitter systems beyond serotonin and norepinephrine.
hormonal
hyperactivity of the hypothalamic-pituitary-adrenal cortical axis. People with major depression have increased urine cortisol levels and elevated corticotrophin-releasing hormone.
inflammation
Inflammation is the body’s natural defense to physical injury. There is growing evidence that inflammation may be the result of psychological injury as well.
Diathesis-Stress Model
takes into account the interplay between genetic and biological predisposition toward depression and life events. The physiological vulnerabilities such as genetic predispositions, biochemical makeup, and personality structure are referred to as a diathesis.
Cognitive Theory
Cognitive theorists believe that people may acquire a psychological predisposition to depression due to early life experiences. These experiences contribute to negative, illogical, and irrational thought processes that may remain dormant until they are activated during times of stress
Assessment in Children and Adolescents
The core symptoms of depression in children and adolescents are the same as for adults, which are sadness and loss of pleasure. What differs is how these symptoms are displayed.
adolescents may engage in substance abuse or sexual promiscuity and be preoccupied with death or suicide.
general assessment
Assessment tool
suicidal ideation.
passive fantasies are thoughts of wanting to die
suicide
Patients diagnosed with major depressive disorder should always be evaluated for suicidal ideation. Risk for suicide is increased when depression is accompanied by hopelessness, substance use problems, a recent loss or separation, a history of past suicide attempts, and acute suicidal ideation.
key assessment findings
anxiety
slow thinking
bad memory and concentration
dwell on and exaggerate their perceived faults and failures and are unable to focus on their strengths and successes.
Feelings of worthlessness, hopelessness, guilt, anger, and helplessness are common.
anhedonia
Inability to feel pleasure
seen together
Depression and chronic pain
Affect
is the outward representation of a person’s internal state of being and is an objective finding based on the nurse’s assessment.
physical signs
A person who has depression sees the world through gray-colored glasses. Posture is poor, and the patient may look older than the stated age. Facial expressions convey sadness and dejection, and the patient may have frequent bouts of weeping.
thought process
the person’s ability to solve problems and think clearly is negatively affected. Judgment, or the ability to make reasonable decisions, is poor.
Mood
Mood is the patient’s subjective experience of sustained emotions or feelings.
Feelings
Feelings frequently reported by those with depression include worthlessness, guilt, helplessness, hopelessness, and anger.
Cognitive Changes
Helplessness is demonstrated by a person’s inability to solve problems in response to common concerns
This feeling of utter hopelessness can lead people to view suicide as a way out of constant mental pain.
Anger and irritability are natural outcomes of profound feelings of helplessness.
anergia
which refers to an abnormal lack of energy.
psychomotor retardation
which movements are extremely slow, facial expressions are decreased, and gaze is fixed.
psychomotor agitation
manifested in pacing, nail biting, finger tapping, or engaging in some other tension-relieving activity. Subjectively, patients commonly feel fidgety and unable to relax.
Vegetative signs of depression
refer to alterations in those activities necessary to support physical life and growth
Change in sleep pattern
cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep
Appetite changes
vary in individuals experiencing depression. Appetite loss is common, and sometimes patients can lose up to 5% of their body weight in less than a month
Changes in bowel habits
Constipation is seen most frequently in patients with psychomotor retardation. Diarrhea occurs less frequently, often in conjunction with psychomotor agitation or anxiety.
