major depressive disorder Flashcards
major depression characteristics
Loss of ambition, motivation, ability to perform ADLs = Avolition
Loss of interest in usual activities (including sexual activity) & ability to experience pleasure = Anhedonia
Loss of energy = Anergia
Feelings of sadness, fear, boredom
major depression etiology
Physiological – neurotransmitter dysfunction, especially serotonin & norepinephrine
Psychological – dysfunctional coping with actual or perceived loss
New research seems to implicate the dysfunction stems from a genetic-defect which may be triggered by psychological stressors
Depression is a lethal disease with a high risk for suicide
3 levels of depression
mild
major
severe
mild depression
•usually triggered by loss -> deep sadness of limited duration
AKA grief response – can -> deeper depression if unresolved
Cognitive ∆’s = ↓alertness, ↓ability to concentrate, verbalizations of sadness
Affective ∆’s = sadness, downcast appearance, tearful
Behavioral ∆’s = social withdrawal, irritability, sleep disturbances
May use substances to “anesthetize” or diminish feelings
moderate depression
• depressive symptoms that persist over time-generally > 6 mo
Cognitive ∆’s = slowed thoughts, difficulty concentrating, indecisiveness, ruminative thoughts, narrowed interest (almost obsessive in nature), self-blame, self-doubt, pessimism
All lead to hopelessness & thoughts of suicide
Affective ∆’s = despondence, ↓self-esteem, helplessness, powerlessness, ineffectiveness, covert anger/rage, anxiety,
anhedonia
Cognitive ∆’s = slowed thoughts, difficulty concentrating, indecisiveness, ruminative thoughts, narrowed interest (almost obsessive in nature),
self-blame, self-doubt, pessimism
All lead to hopelessness & thoughts of suicide
Affective ∆’s = despondence, ↓self-esteem, helplessness, powerlessness, ineffectiveness, covert anger/rage, anxiety,
anhedonia
Behavioral ∆’s = social withdrawal, tears, irritability, ∆’s in oersonal hygiene, psychomotor retardation (slowing movement/speech)
Physiological ∆’s = may include HA, chest/back pain, indigestion/nausea, appetite ∆’s , ↓sexual desire, insomnia/hypersomnia/fatigue
Pt may seek Rx for physiological sx not connecting them with mood ∆’s
severe depression
•intense/pervasive/persistant manifestations of depression – life comes to a standstill
Cognitive ∆’s = confusion, inability to concentrate/make decisions – self-blame, self-deprication
Suicide is believed to be the only solution BUT pt rarely has the energy or thought clarity to organize & act on suicidal thoughts
SUICIDE RISK IS EXTREMELY HIGH WHEN ENERGY INCREASES AS DEPRESSION BEGINS TO LIFT
Affective ∆’s = despair, hopelessness, flat/blunted affect, feelings of worthlessness, guilt, isolation, loneliness – overwhelmed by any task
“bottomless emptiness”
Cognitive + Affective ∆’s = delusions of condemnation – worthlessnes, guilt, powerless to “fix” what is wrong or to atone for some “sin”
May experience auditory hallucinations = harsh sounds
Behavioral ∆’s = psychomotor activity comes to near standstill, robot-like appearance, may exhibit aimless, frantic activity i.e. pacing, pulling hair, rubbing skin – poverty of speech w/frequent pauses, low, monotonous tone of voice – pronounced inattention to personal hygiene – social withdrawal from even family & close friends
Physiological ∆’s = insomnia, sluggish digestion, constipation, anorexia, amenorrhea
avolition
inability to perform adl’s
loss of ambition, motivation
anhedonia
Loss of interest in usual activities (including sexual activity) & ability to experience pleasure
anergia
loss of energy
ruminative thoughts
same thought over and over.
broken record thoughts
make sure family knows
when patient starts to gain energy, this is when suicide risk is at the highest
possible nursing diagnosis of major depression
•Powerlessness
•Ineffective Coping
•Anticipatory or Dysfunctional Grieving
•Hopelessness
•Sleep Pattern Disturbance
•Potential for Violence – Self Directed
•Potential for Injury
•Self Care Deficit
•Anxiety
•Constipation
•Altered Nutrition
•
•HIGHEST PRIORITY IS ALWAYS POTENTIAL FOR VIOLENCE - SUICIDE
planning for major depression
•Establish realistic goals with pt – unrealistic goals are often unmet -> further ↓ self-esteem which then serves to rienforce worthlessness, hopelessness
interventions for major depression
•Safety
–Institute suicide precautions
–Help pt develop safety plan (both in-pt & after d/c)
•Health promotion/disease prevention
–Teach early warning signs of depression
–Help pt develop coping skills – i.e. journaling, relaxation, guided imagery, exercise
•Rest & Sleep
–Promote night-time sleeping
–Teach/promote sleep hygiene i.e. ↓caffeine, quiet/comfortable milieu
–Teach relaxation techniques
–Use hypnotics with caution
•Nutrition
–↑ fiber, ↑fluids - promote elimination
–↑ fluids – counters anti-cholinergic SE of meds
–Promote intake – favorite foods, provide safe social interaction
•Self-Care
–Assist with ADLs as necessary
antidepressant medications
•Advantage
–Can help alter withdrawal, vegetative symptoms, activity level; improve self-concept
•Drawback
–Can take 1-3+ weeks to note improvement
•Safety considerations
–Concerns about relationship between use of antidepressant drugs and suicide; however, no conclusive evidence to support this
