Chapter 14 Depressive Disorders Copyright 2014 2010 2006

Major Depressive Disorder Persistently depressed mood lasting a minimum of 2 weeks - Symptom

Depressive Disorders Classified Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual dysphoric disorder Substance abuse

Epidemiology Leading cause of disability in the United States Children and adolescents Ø Older

Etiology Biological factors Genetic Ø Biochemical Ø • Stressful life events Alterations in hormonal

Etiology (Cont. ) Psychological factors Cognitive theory Ø Learned helplessness Ø Copyright © 2014,

Nursing Process Assessment tools Ø Assessment of suicide potential Ø Key assessment findings Ø

Nursing Process (Cont. ) Areas to assess Affect Ø Thought processes Ø Mood Ø

Nursing Process (Cont. ) Age considerations Children and adolescents Ø Older adults Ø Self

Question 1 Which question would be a priority when assessing for symptoms of major

Question 1 (Cont. ) D. “Do you ever find that you don’t remember where

Nursing Process (Cont. ) Nursing diagnosis Risk for suicide—safety is always the highest priority

Nursing Process (Cont. ) Outcomes identification Recovery model Focus on patient’s strengths Ø Treatment

Nursing Process (Cont. ) Planning Geared toward Patient’s phase of depression Ø Particular symptoms

Nursing Process (Cont. ) Implementation Three phases Acute phase (6 to 12 weeks) Ø

Nursing Process (Cont. ) Counseling and communication Health teaching and health promotion Promotion of

Psychopharmacology Antidepressants Ø Selective serotonin reuptake inhibitors (SSRIs) • • First-line therapy Indications Adverse

Psychopharmacology (Cont. ) Ø Tricyclic antidepressants (TCAs) • • Neurotransmitter effects Indications Adverse effects

Psychopharmacology (Cont. ) Ø Monoamine oxidase inhibitors (MAOIs) • • Neurotransmitter effects Indications Adverse/toxic

Case Study Your patient was just diagnosed with a major depressive disorder. What medication

Case Study (Cont. ) What side effects might the patient experience? Copyright © 2014,

Other Treatments for Depression Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep

Advanced Practice Interventions Ø Psychotherapy • • Ø Cognitive-behavioral therapy (CBT) Interpersonal therapy (IPT)

Nursing Process (Cont. ) Evaluation Suicide ideation Ø Intake Ø Sleep pattern Ø Personal

Audience Response Questions 1. A patient with major depression walks and moves slowly. Which

Audience Response Questions 2. Which assessment finding in a patient with major depression represents

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Major Depressive Disorder Persistently depressed mood lasting a minimum of 2 weeks - Symptom include: Anhedonia, fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

Depressive Disorders Classified Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual dysphoric disorder Substance abuse depressive disorder Depressive disorder associated with another medical condition Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3

Etiology Biological factors Genetic Ø Biochemical Ø • Stressful life events Alterations in hormonal regulation Ø Inflammatory process Ø Diathesis-stress model Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

Nursing Process (Cont. ) Areas to assess Affect Ø Thought processes Ø Mood Ø Feelings Ø Physical behavior Ø Communication Ø Religious beliefs and spirituality Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8

Nursing Process (Cont. ) Age considerations Children and adolescents Ø Older adults Ø Self assessment Feeling what the patient is feeling Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9

Question 1 Which question would be a priority when assessing for symptoms of major depression? A. “Tell me about any special powers you believe you have. ” B. “You look really sad. Have you ever thought of harming yourself? ” C. “Your family says you never stop. How much sleep do you get? ” Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

Nursing Process (Cont. ) Nursing diagnosis Risk for suicide—safety is always the highest priority Ø Hopelessness Ø Ineffective coping Ø Social isolation Ø Spiritual distress Ø Self-care deficit Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12

Nursing Process (Cont. ) Outcomes identification Recovery model Focus on patient’s strengths Ø Treatment goals mutually developed Ø Based on patient’s personal needs and values Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13

Nursing Process (Cont. ) Planning Geared toward Patient’s phase of depression Ø Particular symptoms Ø Patient’s personal goals Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14

Nursing Process (Cont. ) Implementation Three phases Acute phase (6 to 12 weeks) Ø Continuation phase (4 to 9 months) Ø Maintenance phase (1 year or more) Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15

Nursing Process (Cont. ) Counseling and communication Health teaching and health promotion Promotion of self-care activities Teamwork and safety Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16

Psychopharmacology Antidepressants Ø Selective serotonin reuptake inhibitors (SSRIs) • • First-line therapy Indications Adverse reactions Potential toxic effects Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17

Psychopharmacology (Cont. ) Ø Tricyclic antidepressants (TCAs) • • Neurotransmitter effects Indications Adverse effects Toxic effects Adverse drug interactions Contraindications Patient and family teaching Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Psychopharmacology (Cont. ) Ø Monoamine oxidase inhibitors (MAOIs) • • Neurotransmitter effects Indications Adverse/toxic effects Interactions Drugs Food • Contraindications Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19

Case Study Your patient was just diagnosed with a major depressive disorder. What medication do you anticipate the health care provider will start the patient on? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20

Other Treatments for Depression Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy St. John’s wort Exercise Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 22

Advanced Practice Interventions Ø Psychotherapy • • Ø Cognitive-behavioral therapy (CBT) Interpersonal therapy (IPT) Time-limited focused psychotherapy Behavior therapy Group therapy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 23

Nursing Process (Cont. ) Evaluation Suicide ideation Ø Intake Ø Sleep pattern Ø Personal hygiene and grooming Ø Self-esteem Ø Social interaction Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 24

Audience Response Questions 1. A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 25

Audience Response Questions 2. Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 26