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Chapter 13

Chapter 13. Depressive Disorders. Major Depressive Disorder. History of one or more major depressive episodes No history of manic or hypomanic episodes Symptoms interfere with social or occupational functioning May include psychotic features. Major Depressive Disorder Subtypes.

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Chapter 13

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  1. Chapter 13 Depressive Disorders

  2. Major Depressive Disorder History of one or more major depressive episodes No history of manic or hypomanic episodes Symptoms interfere with social or occupational functioning May include psychotic features

  3. Major Depressive DisorderSubtypes Psychotic features Melancholic features Atypical features Catatonic features Postpartum onset Seasonal features – seasonal affective disorder (SAD)

  4. Proposed Subtypes Premenstrual dysphoric disorder Mixed anxiety-depression Recurrent brief depression Minor depression

  5. Dysthymic Disorder Chronic depressive syndrome Present for most of the day More days than not At least 2 years

  6. Epidemiology Leading cause of disability in the United States Children and adolescents Older adults Comorbidity

  7. Etiology • Biological factors • Genetic • Biochemical • Alterations in hormonal regulation • Diathesis-stress model • Psychological factors • Cognitive theory • Learned helplessness

  8. Nursing Process • Assessment • Self-assessment • Unrealistic expectations of self • Feeling what the patient is feeling • Assessment tools • Assessment of suicide potential • Key assessment findings

  9. Nursing ProcessContinued • Areas to assess • Affect • Thought processes • Mood • Feelings • Physical behavior • Communication • Religious beliefs and spirituality

  10. Which question would be a priority when assessing for symptoms of major depression?

  11. “Tell me about any special powers you believe you have.” “You look really sad. Have you ever thought of harming yourself?” “Your family says you never stop. How much sleep do you get?” “Do you ever find that you don’t remember where you’ve been or what you’ve done?”

  12. Nursing ProcessContinued • Nursing Diagnosis • Risk for suicide – safety is always the highest priority • Hopelessness • Ineffective coping • Social isolation • Spiritual distress • Self-care deficit

  13. Nursing ProcessContinued • Outcomes Identification • Recovery model • Focus on patient’s strengths • Treatment goals mutually developed • Based on patient’s personal needs and values

  14. Nursing ProcessContinued • Planning • Geared towards • Patient’s phase of depression • Particular symptoms • Patient’s personal goals

  15. Nursing ProcessContinued • Implementation • Three phases • Acute phase (6 to 12 weeks) • Continuation phase (4 to 9 months) • Maintenance phase (1 year or more)

  16. Nursing ProcessContinued • Basic Level Interventions • Counseling and communication • Health teaching and health promotion • Promotion of self-care activities • Milieu therapy

  17. Nursing ProcessContinued • Advanced Practice Interventions • Psychotherapy • Cognitive behavioral therapy (CBT) • Interpersonal therapy (IT) • Time-limited focused psychotherapy • Behavior therapy • Group therapy

  18. Psychopharmacology • Antidepressants • Selective serotonin reuptake inhibitors (SSRIs) • First-line therapy • Indications • Adverse reactions • Potential toxic effects

  19. PsychopharmacologyContinued • Tricyclic antidepressants (TCAs) • Neurotransmitter effects • Indications • Adverse effects • Contraindications

  20. PsychopharmacologyContinued • Monoamine oxidase inhibitors (MAOIs) • Neurotransmitter effects • Indications • Adverse/toxic effects • Interactions • Drug • Food • Contraindications

  21. Other Treatments for Depression Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Light therapy St. John’s wort Exercise

  22. Nursing ProcessContinued • Evaluation • Short-term indicators and outcome criteria • Reassess and reformulate care plan as necessary • Future of treatment

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