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Psych (NURS 353) > Mood disorders: depression > Flashcards

Mood disorders: depression Flashcards

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1
Q

depressive disorders

A

disturbance in psychological, physiological and social functioning

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2
Q

what are the symptoms associated with depressive disorders that disturb daily patterns

A
  • sleep, appetite, ADLs, weight, attention, memory, libido
  • impulse control, suicidal ideation, social withdraw
  • physical symptoms: H/A, stomachache, muscle tension
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3
Q

levels of depression

A

transient depression

depressive disorder

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4
Q

transient depression

A
  • a normal reaction to loss

- sadness directly attributable to a situation or disappointment - reactive or secondary depression

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5
Q

depressive disorder

A
  • a sad mood related to external events or not
  • symptoms range with dissatisfaction with life to sudden and abrupt changes to function that suppress or take away the will to live
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6
Q

incidence and prevalence

A
  • major depression is most common
  • affects all ages and backgrounds
  • currently leading cause of disability in U.S. in age range 15-44 and projected to be the 2nd leading cause of disability for all ages by 2020
  • affects 14.8 million people aged 18 years or older (6.7% of the population)
  • average age: 32 years old
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7
Q

what is the most common illness of medical or psych

A

MAJOR DEPRESSION

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8
Q

what % of population experience major depressive disorder die from suicide

A

15%

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9
Q

prevalence in pre-puberty, adolescents, elderly community, nursing home

A 
respectively 
1-2%
3-8%
3.5%
15-20%
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10
Q

what group is depression a major health problem for

A

ELDERLY

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11
Q

why is depression a major health problem for older adults/elderly

A
  • its difficult due to comorbid physical diseases (heart, DM)
  • due to social limitations, losses, physical limits, HCP frequently conclude incorrectly that depression is a normal consequence of getting old
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12
Q

frequently accompanies other psych disorders

A
  • schizophrenia
  • substance abuse
  • eating disorders
  • anxiety problems
  • personality disorders
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13
Q

risk factors for depressive disorders

A
  • higher in women than men
  • past episodes of depression
  • family history
  • stressful life event
  • current substance use
  • medical illness
  • limited social supports
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14
Q

etiology

A
  • combination or interaction of:
  • genetics (increased risk if first degree relatives suffer from depression, NTs)
  • environment
  • individual life history
  • development
  • neurobiological
    irregularities in the thyroid are seen especially important
  • unknown
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15
Q

what NTs are involved

A
  • deficiency in biogenic amines
  • dopamine
  • norepinephrine
  • serotonin
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16
Q

regions of the brain affected by depression

A
  • the brain of a depressed individual is generally underactive, certain areas display overactivity
  • thalamus, amygdala, cingulate gyrus, prefrontal cortex
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17
Q

what happens in the thalamus region

A
  • changes in emotion

- increased levels of activity in depressed individuals

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18
Q

what happens in the amygdala region

A
  • responsible for negative feelings

- displays overactivity in depressed people

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19
Q

what happens in the cingulate gyrus

A
  • overactivity
  • area helps to associate smells and signs with pleasant memories of past emotions
  • it also takes part in the emotional regulation to pain and the regulation of aggression
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20
Q

what happens in the prefrontal cortex

A
  • people who are depressed have DECREASED activity in this section
  • help regulate emotion
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21
Q

major depressive disorder parts

A
  • potential for pain and suffering in all aspects of life
  • affects children, teens, adults and elderly
  • depressed mood or inability to feel pleasure from previously enjoyed activities
  • many symptoms
  • lasts over a min 2 weeks
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22
Q

symptoms associated with major depressive disorder (4/7)

A

four out of the seven symptoms must be present:
suicidal ideations, disruptions in sleep, disruptions in appetite/weight, disruption in concentration, disruption in energy level, psychomotor agitation/retardation, or excessive guilt/feelings of worthlessness
- may include psychotic, catatonic, melancholic features
- OVER A MINIMUM 2 WEEKS

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23
Q

persistent depressive disorder

A
  • dysthymia
  • chronic depressed mood
    > 1 year for children and adolescents
    > 2 years for adults and elderly
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24
Q

symptoms of persistent depressive disorder

A
  • poor appetite/overeating
  • insomnia/excessive sleep
  • low energy
  • fatigue
  • low self esteem
  • poor concentration
  • difficulties making decisions
  • feelings of hopelessness
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25
Q

clinical signs and symptoms of MDD

A

MUST HAVE

  • depressed mood or loss of interest
  • average length of time 4-12 months
26
Q

clinical signs and symptoms of dysthymic disorder

A
  • less severe than MDD
  • presents as lifelong struggle against depression
  • chronic negativity and irritability
  • average more days than not with s/s for at least 2 years
27
Q

post partum depression

A
  • more serious and persistent lasting weeks/months after end of pregnancy, can emerge any time during the first year after childbirth
  • higher incidence if they have a previous psych history
  • untreated can become dangerous for family and affected individual
  • HCP need to screen for and is treatable
  • obvious in some women where other clients may not as readily share their feelings
28
Q

assessment tools

A
  • beck depression inventory
  • Hamilton depression scale
  • geriatric depression scale
  • zung depression scale
    SAFETTY FIRST
    ALWAYS ASSESS SUICIDAL RISK, IDEATION AND INTENT
29
Q

key symptoms to look for during an assessment

A
  • depressed mood
  • anhedonia - without pleasure
  • anxiety
  • psychomotor agitation or retardation
  • somatic complaints
  • vegetative state - physical and mental inactivity
30
Q

areas to assess

A

Mood- subjective report of clients emotional state that impacts current life situation
Affect- emotional tone the client projects– physical appearance, posture, mood, eye contact, speech, withdrawn, blunted & flat
Thought processes- Insight & judgment, decision making, memory & concentration & delusions
Feelings- anxiety, hopeless, helpless, guilt, anger & listless
Physical Behaviors- hygiene and grooming, sleep patterns, appetite, bowel habits, libido & anorexia
Communication- maybe soft spoken, mute, cadence, rate, response time

31
Q

nursing diagnosis

A
  • risk for suicide
  • hopelessness
  • powerlessness
  • disturbed thought process
  • ineffective coping
  • risk for violence
  • ineffective health maintenance
  • impaired social interaction
32
Q

interventions

A
  • THERAPEUTIC COMMUNICATION
  • counsel, encourage engagement in treatment
  • encourage self-care activities
  • maintain therapeutic milieu
  • health teaching
  • administer medications per physician/NP
  • assess effects of meds + treatment
  • educate on coping skills & medication
33
Q

therapeutic communication types

A

communication
therapeutic communication
nontherapeutic communication

34
Q

communication

A

conveying information through verbal and nonverbal behaviors. sending and receiving messages

35
Q

therapeutic communication

A
  • nurse demonstrates empathy, effective communication skills and responds to client’s thoughts, needs and concerns
36
Q

nontherapeutic communication

A
  • nurse responds in ways that cause defensive feelings, misunderstood, controlled, minimized, alienated, discouraged from expressing self, thoughts, feelings
37
Q

therapeutic techniques

A 
Giving Broad Openings
Paraphrasing
Offering General Leads
Reflecting Feelings
Voicing Doubts
Clarifying
Placing Events in time Sequence
Giving Information
Encouraging formulation of Plan
Testing Discrepancies
38
Q

non-therapeutic

A 
Social Responding
Asking Closed Ended Questions
Changing the Subject
Belittling
Making Stereotyped comments
Offering False Reassurance
Moralizing
Interpreting
Advising
Challenging
Defending
39
Q

listening

A
  • focus on ALL behaviors that the client expresses
  • watch for clients verbal and non-verbal communication
  • requires energy, concentration, specific skills to ask the right questions and allows the client the time to determine content and level of disclosure
40
Q

active listening involves

A
  • maintain eye contact
  • close proximity
  • projecting a relaxed environment
  • focus on what the client is saying, interpret interactions and respond objectively
  • remember to use non-verbal’s when communicating with a client
41
Q

confronting and setting limits

A
  • skill of pointing out in a CARING way discrepancies between what the client does and says
  • describe the behavior that is inconsistent and confusing
  • offer at least two possible interpretations of the behavior
  • ask for feedback
42
Q

self disclosure (9)

A

Personal information only if therapeutic purpose- generally not a good idea
Use self disclosure to help client open up not to meet your needs
Keep disclosure brief
Do not imply your experience is the same as the client
Only disclose the situations you have mastered
Do not use to discuss painful situations
Curb your talk about yourself
Needs to be appropriate and comfortable
Monitor nonverbal behaviors to see if the client is receptive

43
Q

treatments

A
  • provide safety
  • psychotherapy and medications - most effective combination to treat depressive disorders
  • group therapy/counseling
  • family therapy/involvement
  • ECT
  • cognitive behavioral therapy
  • social skills training & milieu therapy
44
Q

Antidepressants

SSRIs

A
  • prozac, zoloft
  • First generation serotonergic agents which are considered first line drugs for depression, unless patients medical history or condition warrants use of a different medication
  • Generally have fewer side effects than other antidepressants
  • possible lethal reaction is serotonin syndrome
  • SARIs and SNRIs are also common first line drugs
45
Q

side effects of SSRIs

A
  • nausea
  • headache
  • loss of libido
  • serotonin syndrome
  • minimal anticholinergic and cardiotoxic side effects
46
Q

serotonin syndrome occurrence

A
  • This typically follows use of SSRIs, TCAs, tryptophan, dextromethorphan or meperidine alone or with a monoamine oxidase inhibitor (MAOIs)
  • Serotonin Syndrome can also be seen with use of the popular herbal medication, St. John’s wort
47
Q

Symptoms of serotonin syndrome

A
  • confusion and disorientation
  • mania and restlessness
  • rigidity
  • diaphoresis
  • tremors
  • coma even could rarely lead to death
48
Q

treatment of serotonin syndrome

A
  • stop all serotonergic drugs, give anticonvulsants if ordered or possibly a serotonin antagonist
49
Q

atypical antidepressants

A
  • considered safer than TCAs or MAOIs
  • second line
    examples: trazodone or remeron
50
Q

tricyclic antidepressants

A
  • Before SSRIs and Atypical antidepressants, Tricyclic antidepressants (TCA’s) were the first line drugs for depression. Example: Elavil
  • Not used frequently any more due to cardiotoxic effects and a narrow therapeutic window. Not used with suicidal patients
  • Current uses are when patients have been unsuccessful on SSRIs or Atypical antidepressants or have documented past success with TCA’s
  • TCA’s can be used for patients whom also have certain GI disorders such as peptic ulcer disease
51
Q

Monoamine Oxidase Inhibitors (MAOIs)

A
  • Not used frequently since development of SSRIs. Example: Nardil
  • May be used to treat atypical depression or for patients not showing responses to other antidepressants
  • MAOIs increase tyramine. Need to educate patients taking MAOIs to not eat foods high in tyramine. These foods include yogurt, aged cheeses, beef or chicken liver, canned meats, fish, sausage, avocado, eggplant, alcoholic beverages, chocolate and meat tenderizer. High levels leads to hypertensive crisis
52
Q

counseling

A
  • help client identify and question cognitive distortions
  • encourage activities that improve self esteem
  • encourage exercise
  • encourage supportive relationships
  • provide referrals for spiritual interventions when needed
53
Q

family therapy

A
  • Assessment, intervention and evaluation of family functional and dysfunctional patterns of behavior
  • Need to examine interactions between parents and children
  • Goal is to help family members identify and change behaviors that maintain depression and dependence among family members.
54
Q

ECT (electroconvulsive therapy)

A
  • used if psychopharmacology and all other tx’s are ineffective
  • Produces seizure- thought to modify neurotransmissions
  • Few long term side effects
  • Can cause memory loss, confusion lasting a few weeks or months after series complete
55
Q

How does ECT work?

contraindications?

A
  • Short acting anesthesia and muscle-paralyzing agents used
  • No absolute contraindications, but some conditions pose risk: recent MI, CVA or intracranial mass.
  • ECT not usually used for these clients unless need is compelling.
  • Additional high risk consent and skill required for these clients
56
Q

when is ECT useful?

A
  • Major Depression and Bipolar Disorders, especially when psychotic features present
  • Depression with psychomotor retardation or stupor
  • Rapid Cycling Bipolar Disorder
  • Schizophrenia (especially catatonic)
  • Schizoaffective Syndromes
  • Pregnant psychotic clients
  • Clients with Parkinson’s
57
Q

nursing care with ECT

A
  • Routine pre and post anesthesia care
  • May need to orient client after awakening
  • Provide supportive care for memory loss (may last for a few weeks; occasionally does not recover)
  • Inform that this is not a permanent cure
  • Watch for falls as patients are a high fall risk after procedure
58
Q

cognitive behavioral therapy

A
  • Common treatment for depressive disorders
  • Completed in group or individual setting.
  • Goal is to help clients identify and correct distorted, negative and catastrophic thinking, therefore relieving symptoms.
  • Hope is to work actively with clients to change faulty though patterns.
59
Q

Milieu Therapy

A
  • Supportive group activities
  • Protection from suicide intent
  • Assertiveness training
  • Assistance with grooming and hygiene
  • Brief and frequent interpersonal contacts
  • Ensure adequate nutrition
  • Prevent constipation
  • Discourage daytime sleep
60
Q

self - assessment of the nurse

A
  • Unrealistic expectations for outcomes
  • Understanding of depression as a systemic illness with a complex interaction of causes and is treatable
  • Depressed clients can cause feelings of depression, frustration, anger & hopelessness
  • Nurses need to care for themselves as well as the client
61
Q

health teaching

A
  • Teach client and family that depression is a legitimate illness
  • Teach signs & symptoms
  • Review medications
  • Relaxation techniques
  • Appropriate humor
62
Q

outcome criteria

A
  • Remains safe
  • Reports hope for future
  • Identifies precursors of depression
  • Reports improved mood
  • Plans strategies to reduce effects of precursors of depression

Psych (NURS 353) (4 decks)

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