Mood Disorders - Depression Flashcards
Depression is a __________ rather than one disease
syndrome
Syndrome is
collection of s/s frequently appear together, but without a specific cause.
Depressive disorders represent
group of syndromes that share some common symptoms but with different etiologies, courses and treatments
MDD affects
how you feel, think and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities.
What depressive disorder is the most common expression
MDD
PDD
person experiences depression without ever experiencing an excessive elevated mood or mania
MDD stands for
Major DEpressive Disorder
PDD stands for
Persistent Depressive Disorder
Unipolar means
no maic episodes
PDD is usually there for how long before it is considered PDD and chronic
2 years
In older adults depression is expressed by
feeling tired and have trouble sleeping
Seem grumpy or irritable
Confusion or attention problems appears to be brain
disorders
- can lead to self-medication
Risk Fcators of Depression
Hx - episodes of depression
Family history of depressive disorder,
especially in first-degree relatives
History of suicide attempts or family history of suicide
Member of the (LGBTQ) community
Female gender
Age 40 years or younger
Postpartum period
Chronic medical illness
Absence of social support
Negative, stressful life events, particularly
early trauma
Active alcohol or substance use disorder
History of sexual abuse
Gentic Fcators for depression
if parent(s) have it even in adopted families
first-degree family member with depression are 2-4 times more likely to become depressed
must interact with environment and neurobiological preconditions for depression to develop.
earlier age of onset, comorbidities, occurence
Depression Changes in receptor-neurotransmitter relationships in the following areas of the brain
Limbic system
Hypothalamus
Prefrontal cortex
Hippocampus
Amygdala
In depression, the neurotransmitters do
Decreased levels of serotonin
Decreased levels of norepinephrine
Decreased levels of dopamine
Decreased glutamate
Decreased GABA (y-aminobutyric acid)
Decreased acetylcholine
Stress-Diathesis Model of Depression
environment, interpersonal, and life events
- predisposition
Stress - ACEs can cause neurophysiological and neurochemical changes in the brain.
- neurotransmitters to over work and causes permanent damage leading to depressive states
Cognitive Theory in DEpression by Beck
predispoition though ealry experiences
- negative thought processes activate in stress
Triad of Cognitive Theory in Depression
– automatic negative thoughts
A negative, self depreciating view of self
A pessimistic view of the world
The belief that negative reinforcement will continue.
Goal of cognitive behavior theory (CBT) is to change the way a patient thinks reducing negative thoughts
Identify the distortion and challenge the distortion by reframing
way a patient thinks reducing negative thoughts
- Identify the distortion and challenge the distortion by reframing
Filtering
Taking negative details and magnifying them while filtering out all positive aspects of a situation.
Personalization
A distorted belief that everything others do or say is somehow about us.
Control falicies
We see ourselves as helpless, a victim of fate, having no control, or we assume total responsibility for the pain and happiness of everyone around us (overcontrol).
Global labeling
We generalize one or two qualities into a negative global judgment. For example, “I’m a loser” verses “In one situation, I failed.”
According to Seligman, Depression is a ______________ helplessness
learned
- initially anxiety replaced with depression
- no control and the situation their fault
MDD S/S mnemonic
SIG E CAPS
MDD S/S
Sleep disturbance (TOO MUCH OR TOO LITTLE)
Interest diminished in pleasurable activities (guilt, worthless) - anhedonia
Guilt feeling; feelings of worthlessness (no self-esteem)
Energy decreased or fatigue and Esteem loss - anegia
Concentration diminished and indecisiveness
Appetite changes
Psychomotor retardation or agitation
Suicidal thoughts and behaviors and thoughts of death
Anhedonia
inability to experience pleaure from past things
Anegia
loss of energy
With MDD, it needs to have what to dx someone with MDD
5+ SYMPTOMS IN A 2+ WEEKS
PDD compared to MDD is
less severe but present for 2+ years
PDD is sometimes taken as the person’s
normal behavior
PDD does not require
hospitalization
PDD age of onset
adolescence or with severe stress can manifest in adulthood
PDD s/s
Daytime fatigue
Functions at work and in social settings but not optimally
Chronic low-level depressed/irritable mood
Eating too much or too little
Usually has trouble falling asleep and once asleep, hypersomnia (sleep too much)
Loss of energy, chronic tiredness
Decreased ability to experience pleasure, enthusiasm or motivation
Irritability
Negative, pessimistic thinking
Low self esteem
HE’S 2 SAD
MDD psychotic ft
hallucinations
delusions
MDD catatonic ft
Nonresponsive, psychomotor retardation, withdrawal
MDD peripartum ft
: During pregnancy and following delivery. May include psychotic features and risk to infant
MDD SAD ft
fall or winter, remits in spring. Includes overeating, anergia, hypersomnia
- ABSENT OF VITAMIN D
Disruptive mood dysregulation disorder
Children
Chronic, severe, persistent irritability with outbursts
Premenstrual dysphoric disorder
Depressive symptoms are present in the week before the onset of menses and gradually improve after onset of menses
Substance medication induced depressive disorder
during or soon after exposure to a substance or medication
Premenstrual dysphoric disorder occurs in the
luteal phase of cycle
Premenstrual dysphoric disorder s/s
emotional labile
anger/irriatble
depressed
- no energy, overeating, sleep disturbance, pshycial symptoms
(PMS)
Baby Blues
Feels depressed, anxious. Cries for no reason, sleep problems
Occurs in 70-80% of new moms.
Improvement within 1-2 weeks without treatment
Postpartum Depression
Strong feelings of sadness, anxiety, despair, guilt, difficult coping.
Symptoms DO NOT subside.
May have thoughts of self-harm or harm to baby
Occurs in about 10% of new moms, within 1-3 weeks PP.
May occur up to a year after birth.
Nursing Interventions for PP Women
Routine PPD screening of mothers for at least 2 years after delivery
Pay close attention to younger, low-income, limited educated moms and those with more than 1 child
PP Psychosis
extremely high with each subsequent delivery with more severe episodes
Onset fairy rapid, within 3 days to one week after delivery
Agitated, anxious, disorganized behavior
Delusions are baby focused
Nurisng Assessment tools for depression
Beck Depression Inventory
Hamilton Depression Scale
Geriatric Depression Scale
Zung’s Self-Rating Depression Scale
The Patient Health Questionnaire (PHQ-9) for the primary care setting
The Edinburgh Post Natal Depression Scale
In mood disorders and depression the nurse should assess for
homicide and suicide potential
medical and neuro exam
triggering events
support systems
psychosocial assessment
Detailed mood-affect assessment shows
Feelings of worthlessness
Guilt
Helplessness
Hopelessness – negative expectations for the future
Anger and irritability
Anxiety – 60-90% of depressed patients has anxiety as well
Affect
Physcial changes to assess in depression
Poor posture
Appears older than they are
Sees world through gray colored glasses (negative)
Facial expression conveys sadness and dejection
Frequent bouts of weeping
Anergia 97% (psychomotor retardation)
Psychomotor agitation
Grooming and hygiene neglected
Vegetative signs of depression: physical (somatic) is lazy
Pain 50-75%
Cognitive and Though Content assessment for a depressed person consists of
Thinking is slow
Memory and ability to concentrate may be affected
Ruminate: think deeply about something (event – breakup or death)
Decrease in problem solving
Poor judgment
Indecisiveness
Delusional thinking with psychotic features
Ruminate
think deeply about something (event – breakup or death)
