Unit 5 Depressive Disorder Chapter 14

Question 1

Is depression a normal part of aging

A.Yes
B. No

Answer 1

B. No

 Depression is common, but not normal part of aging

Question 2

Depression in Older adults

Answer 2

Older Adult
 Depression is common, but not normal part of aging
 May be overlooked because they are more likely to complain of physical illness
 Subsyndromal depression
 Pseudodementia
 Geriatric Depression Scale

Question 3

Pseudodementia vs Depression

Answer 3

Pseudodementia refers to a set of symptoms that mimic those of dementia, but there is typically no degeneration in the brain. Depression in older adults may cause similar symptoms,

Question 4

What is Persistent Depressive Disorder?

Answer 4

Dysthamia , bad or low mood

is basically a lower level of depression .

MILD DEPRESSION

is diagnosed when low-level depression occurs most of the day, for the majority of days. These depressive feelings last at least 2 years in adults and 1 year in children and adolescents.

Question 5

What is the criteria for Persistent Depression Disorder

Answer 5

Depressed for most of the DAY, more days than not

 At least 2 years

 Plus, two or more of the following:

 Decreased or increased appetite
 Insomnia or hypersomnia
 Low energy or chronic fatigue
 Decreased self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness or despair

Question 6

What is the treatment for Persistent Depression Disorder

Answer 6

Treatment for this disorder is similar to that of major depres- sive disorder, which we will discuss in more depth later in this chapter. Psychotherapy, particularly CBT, is quite useful in managing the symptoms. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepi- nephrine reuptake inhibitors (SNRIs), and tricyclics (TCAs) are the other main treatments.

Question 7

What schedule of depressive episodes would indicate Perisitent Depression Disorders?

A. 1 day out of 5 days for 3 hours of those days
B. 4 out of 5 days for 12 hours of those days
C. 3 out of 4 days for 2 hours a day.
D. 1 day out of 7 days fro 5 hours a day

Answer 7

B. 4 out of 5 days for 12 hours of those days

patient with
-“always felt this way” and that being depressed seems like normal functioning.

-It is not uncommon for people with this low-level depression to also have periods of full-blown major depressive episodes.

Question 8

What is Premenstrual Dysphoric Disorder

Answer 8

Premenstrual dysphoric disorder is a relatively new addition to the diagnostic system for psychiatry. It refers to a cluster of symptoms that occur in the last week before the onset of a woman’s period.

 Serious enough to disrupt functioning
 Sx: mood swings, irritability, depression, anxiety, feeling overwhelmed difficulty
concentration

 Physical sx: lack of energy, overeating, hypersomnia or insomnia, breast
tenderness, aching, bloating and weight gain

 Tx – regular exercise, diet with complex carbs and getting sufficient sleep

 Acupuncture, light therapy, relaxation

Question 9

S/s of Premenstrual Psyphoric Disorder

Answer 9

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.

Question 10

Which of the following meals would you recommend your client to eat who has been recently diagnosed with Premenstrual Disphoric Disorder?

A. Banana , strawberries , and celery
B. Cheese stick with fruit salad
C. Bowl of rice with red beans with a side of oats
D. Cup of milk with hasborwns

Answer 10

C. Bowl of rice with red beans with a side of oats

HIGH CARB DIET, RELAXATION , EXECISE ,
 Tx –
regular exercise,
diet with complex carbs
and getting sufficient sleep

Treatment for this disorder includes regular exercise, partic- ularly aerobic exercise. Other recommendations include eating food rich in complex carbohydrates and getting sufficient sleep. Acupuncture, light therapy, and relaxation therapy have also been used to reduce symptoms.

Question 11

Drug therapy for Premenstrual Dysphoric Disorder

Answer 11

S A drospirenone and ethinyl estradiol combination (Yaz, Gianvi) is a contraceptive that improves symptoms.
* SSRIs have been used successfully and three have FDA approval. They are fluoxetine (Prozac, Sarafem), sertraline (Zoloft), and controlled-release paroxetine (Paxil CR).

• Diuretics may be useful in reducing bloating and weight gain brought on by water retention.

Question 12

What is Substance/Medication-Induced Depressive Disorder and cause

Answer 12

cause
-Substance/medication-induced depressive disorder is a result of prolonged use of or withdrawal from drugs and alcohol.

Question 13

Is Substance/Medication-Induced Depressive Disorder symptoms longterm for short term?

A. Short term
B. Long term

Answer 13

A. Short term

Symptoms appear within 1 month of use. Once the substance is removed, depressive symptoms usually remit within a few days to several weeks.

Question 14

What is the cause of DEPRESSIVE DISORDER DUE TO ANOTHER MEDICAL CONDITION?

Answer 14

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.

Medical disorders that are highly associated with Depressive Disorder
-Parkinson disease, Huntington disease, Alzheimer disease, and traumatic brain injury are also clearly associated with depressive disorders.
-Arthritis, back pain, metabolic conditions (e.g., vitamin B12 deficiency), HIV, diabetes, infec- tion, cancer, and autoimmune problems may also contribute to depression.

Question 15

Can chronic pain cause depression?

A. Yes
B. No

Answer 15

A. Yes

-Arthritis, back pain, metabolic conditions (e.g., vitamin B12 deficiency), HIV, diabetes, infec- tion, cancer, and autoimmune problems may also contribute to depression.

Question 16

What is Seasonal affective disorder

Answer 16

-depression and settings

Sometimes there is a regular relationship between the seasons and depressive symptoms. Commonly known as seasonal affective disorder (SAD), the exact diagnosis used in the DSM-5 is major depressive disorder with seasonal pattern.

Question 17

When does seasonal affective disorder normally occur

Answer 17

Typically, individuals with this variation experience depressive symptoms in the fall and winter and then gain a full remission in the spring.

Question 18

S/s of Seasonal affective disorder

Answer 18

Symptoms of the seasonal variety of depression are similar to what you would expect with hibernation: hypersomnia, over-eating, weight gain, and craving carbohydrates.

This disorder is more common in women and typically begins between the ages of 18 to 30. Populations that lie farthest from the equator are most affected.

Question 19

Treatment for seasonal affective disorder

Answer 19

. Treatment is similar to that of major depressive disorder, with the addition of light boxes to mimic natural outdoor light.

● First-line treatment for SAD, light therapy inhibits nocturnal secretion of melatonin.
● Exposure of the face to 10,000-lux light box 30 min/day, once or in two divided doses

along with antidepressants if needed

Question 20

What is the difference between Major Depressive Disorder vs Peristent Depressive Disorder?

Answer 20

-PDD depression symptoms last at least 2 years
-MDD depression symptoms last more than 2 years

PDD only required to meet 2 criterias for diagnoses

MDD requires at least 5 criteria for diagnoses

Question 21

Clinal Picture of MDD

Answer 21

Major depressive disorder, or major depression, is char- acterized by a persistently depressed mood lasting for a mini- mum of 2 weeks.
The length of a depressive episode may be 5 to 6 months (Parikh et al., 2019). About 20% of cases become chronic (i.e., lasting more than 2 years).

Question 22

MDD AGE CONSIDERATIONS

Answer 22

Children & Adolescents
 Core sx are the same as adults, but differ in how they are displayed

 Young child : cry,
adolescent : withdrawal,
teenager : irritable

 Older Adult
 Depression is common, but not normal part of aging
 May be overlooked because they are more likely to complain of physical illness
 Subsyndromal depression
 Pseudodementia
 Geriatric Depression Scale

Question 23

Symptoms of Major depressive disorder

Answer 23

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
B. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, it can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed
down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may
be delusional) nearly every day (not merely self-reproach or guilt about
being sick).
8. Diminished ability to think or concentrate or indecisiveness nearly every
day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan
for committing suicide.
C. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The episode is not attributable to the physiological effects of a substance
or to another medical condition.
E. Note: Criteria A through C represent a major depressive episode.

Question 24

Risk factors for depression

Answer 24

Female
 Adverse Childhood experiences
 Stressful life events
 First-degree family member with MDD(predisposition through genetics
 Negative Personality trait characterized by anxiety, fear, moodiness, envy, jealousy
 Other disorder (substance use, anxiety)
 Chronic or disabling medical conditions

Question 25

Should patients with major depressive disorder ALWAYS be screened for suicidal ideation?PRIORITY
A. Yes
B. No

Answer 25

A. Yes

Patients with major depressive disorder should always be evaluated for suicidal ideation.

Question 26

How would you assess if your patient has potential Suicidal ideation

Answer 26

• “You said you are depressed. Tell me what that is like for you.”
• “When you feel depressed, what sort of thoughts do youhave?”
• “Have you had thoughts about ending your life?”
• “Do you have a plan?”
• “Do you have the means to carry out your plan?”
• “Is there anything that would prevent you from carrying out
  your plan?”

Question 27

Why is the risk for suicide high for patients with depression?

Answer 27

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.
-chronic pain
-congruency with affect and mood

Question 28

Communication techniques for patients with depression

Answer 28

 Silent – Making Observations
 Use simple concrete words
 Allow time for patient to respond
 Listen to the covert message, and ask about suicide plans

 AVOID: “Everything is going to be ok” “Everyone goes through hard times”

Question 29

Mood vs Affect

Answer 29

mood-Mood is a term that describes a general emotional condition or state. Asking such questions as “How do you feel?” along with observing facial cues, voice tone, and posture can help you deter- mine this general emotional condition in your patient.

affect-Affect is the outward representation of a person’s internal state and is an objective finding based on the nurse’s assessment. Feelings of hopelessness and despair are reflected in the person’s affect. Affect can be described as congruent with mood, that is, sad face and depressed mood. It can also be described as incon- gruent with mood, such as when a person is smiling despite a depressed mood.

Question 30

Affect of depressive patient

Answer 30

Patients with major depressive disorder com- monly exhibit the following types of affect:
* Constricted affect refers to a reduction in the range and intensity of normal of expression.
* Blunted (or shallow) affect is more severe than constricted and represents a significant decrease in emotional reactivity.
* Flat affect is no or nearly no emotional expression or reactiv-
ity.

Question 31

Teaching and Health Promotion for patients and patients family of depression

Answer 31

Depression is beyond voluntary control
 Chronic Illness Management
 Nutrition
 Exercise
 Coping Skills
 Education on Dx

Question 32

A patient is newly diagnosed with seasonal affective disorder. She is asking about other types of therapies aside from her prescribed antidepressants. The most appropriate response by the nurse is:
A.”An EEG may be performed to assess further.’
B.”Light therapy can be helpful for
SAD.”
C.”Sleeping during the day can relieve symptoms.
D.”Antidepressants and supplements will be most helpful.”

Answer 32

B.”Light therapy can be helpful for
SAD.”

Question 33

When counseling clients diagnosed with major depressive disorder, what therapy would an
advanced practice nurse address the client’s negative thought patterns?
a. psychoanalytic
b. desensitization
c. cognitive-behavioral
d. alternative and complementary

Answer 33

c. cognitive-behavioral

ANS: C
Cognitive-behavioral therapy attempts to alter the client’s dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The client is also taught the connection between thoughts and resultant feelings. Research shows that cognitive- behavioral therapy involves the formation of new connections between nerve cells in the brain and that it is at least as effective as medication. Evidence is not present to support superior outcomes for the other psychotherapeutic modalities mentioned.

Question 34

A client diagnosed with major depressive disorder says, “No one cares about me anymore. I’m not worth anything.” Today the client is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this client?
a. “You look nice this morning.”
b. “You’re wearing a new shirt.”
c. “I like the shirt you are wearing.”
d. “You must be feeling better today.”

Answer 34

b. “You’re wearing a new shirt.”

Clients with depression usually see the negative side of things. The meaning of compliments may be altered to “I didn’t look nice yesterday” or “They didn’t like my other shirt.” Neutral comments such as making an observation avoid negative interpretations. Saying, “You look nice” or “I like your shirt” gives approval (nontherapeutic techniques). Saying “You must be feeling better today” is an assumption, which is nontherapeutic.

Question 35

A client was diagnosed with seasonal affective disorder (SAD). During which month would this client’s symptoms be most acute?

a. January
b. April
c. June
d. September

Answer 35

ANS: A
The days are short in January, so the client would have the least exposure to sunlight. SAD is associated with disturbances in circadian rhythm. Days are longer in spring, summer, and fall.

Question 36

During a psychiatric assessment, the nurse observes a client’s facial expression is without emotion. The client says, “Life feels so hopeless to me. I’ve been feeling sad for several months.” How will the nurse document the client’s affect and mood?
a. Affect depressed; mood flat
b. Affect flat; mood depressed
c. Affect labile; mood euphoric
d. Affect and mood are incongruent.

Answer 36

b. Affect flat; mood depressed

Mood refers to a person’s self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others. When there is no evidence of emotion in a person’s expression, the affect is flat.