Depressive Disorders PDF

Depressive Disorders Assessment ​ Mood: the way a person feels; what you cannot see ​ Affect: the observable response a person has to their own feelings; what you can see ​ What changes can you see in depression? ○​ Loss of interest in usual activities ○​ Somatic symptoms...

Depressive Disorders Assessment ​ Mood: the way a person feels; what you cannot see ​ Affect: the observable response a person has to their own feelings; what you can see ​ What changes can you see in depression? ○​ Loss of interest in usual activities ○​ Somatic symptoms ​ Stomach ache ​ GI upset ​ Headache ○​ Eating habits ​ Anorexia ​ Loss of appetite ○​ Sleeping habits ​ Insomnia ​ Oversleeping ○​ Cognition ​ Orientation ​ Awareness ○​ ALWAYS ask if they’re having these symptoms Depression ​ Biological Theories: ○​ Genetics: past through parents ○​ Biochemicals: 3 to know ​ Norepinephrine ​ Serotonin ​ Dopamine ○​ Neuroendocrine: alteration in the pituitary gland ○​ Physiological: like medications, hormones, nutrition, vitamins, electrolytes, etc ​ Psychosocial Theories: ○​ Learning Theory: seen in many people who lack control of most of their situations ​ “No matter what I do, nothing will get better.” ○​ Object Loss Theory: especially a loss of a loved one ​ This leads to helplessness and despair ○​ Cognitive Theory: results in consistent negative expectations ​ Treated with CBT ○​ Transactional Model of Stress and Adaptation: using depression as a way to cope with stress in life ​ Who’s at risk?: ○​ Women are twice as likely ​ Hormones ​ More sensitive to stress and anxiety ​ Have more responsibility and social roles ​ Higher risk of thyroid dysfunction ​ Marriage status can also be a risk factor ○​ Ages 15 - 40 and 65+ ○​ Trauma, especially in early life ○​ Genetics ○​ Lifestyle ○​ Environment ​ Factors Affecting Depression: ○​ Age ​ Childhood/adolescence: harder to diagnose depression in teenagers ​ Irritability can be a symptom of depression in teenagers ​ Senescence: depression with dementia ​ Especially at earlier onset due to feeling a loss of self ○​ Life Events: ​ Postpartum Depression ​ Scale for Depression: ○​ Transient Depression: life’s everyday disappointments ○​ Mild Depression: normal grief response ○​ Moderate Depression: dysthymic disorder; impacts enjoyment of life ○​ Severe Depression: major depressive disorder; completely impacts day-to-day life ​ DSM-V Criteria: ○​ S - sleep disturbances ○​ I - interest decreased (anhedonia) ○​ G - guilt and/or feelings of worthlessness ○​ E - energy decreased ○​ C - concentration problems ○​ A - appetite/weight changes ○​ P - psychomotor agitation or retardation ○​ S - suicidal ideation ​ Types of Depression: ○​ Persistent Depressive Disorder (Dysthymia): ​ Mild depression ​ Can last up to 2 years ​ 2 or more symptoms ​ Can become MDD if not treated  ​ Cannot be attributed to substance abuse ​ Requires no history of mania ○​ Premenstrual Dysphoric Disorder (PMDD): ​ Excessive anxiety, mood swings, and nonparticipation in activities during the week before menstruation ​ Stops when menstruation begins ​ Able to diagnose if depression happens the week before menstruation for the majority of the year ○​ Substance/Medication-Induced Depressive Disorder: ​ Caused by physiological changes due to medications, substances, or toxins ​ Linked to detoxification and withdrawal ​ Loss of function in daily living ○​ Depressive Disorder due to another medical condition: ​ Caused by alternate illness due to the changes in genetic makeup ​ Common in TBI’s, strokes, M.S., thyroid disorders, and parkinsons ○​ Major Depressive Disorder (MDD): ​ Characterized by depressed mood or loss of interest or pleasure in usual activities ​ Impaired social or occupational functioning ​ 5 or more symptoms from the DSM-V Criteria, lasting for minimum 2 weeks (most days, for most of the day) ​ Cannot be attributed to substances, schizophrenia spectrum, medications or illness, or history of manic behavior ​ Can be single or recurrent ​ Expected findings: ​ Sleep disturbances ​ Lack of appetite ​ Somatic symptoms ​ Sluggishness ​ Inability to relax ​ Loss of libido ​ Suicidal ideation ​ Physical Findings: ​ Weight changes ​ Flat affect ​ Poor hygiene ​ Psychomotor agitation or retardation ​ No eye contact ​ Stooped posture ​ Social isolation Treatment ​ What do we consider with treatment? ○​ Safety is always first ○​ Assess risk for suicide ​ First thing to ask: “are you having thoughts of suicide?” ○​ Ineffective coping: maladaptive; not having healthy or helpful coping skills ○​ Powerlessness: circumstances leading to feelings of no control ○​ Hopelessness: stems from powerlessness ○​ Maladaptive grieving: prolonged grief due to major life events or loss ○​ Low self-esteem: leads to a cycle or depression ○​ Spiritual distress: how their culture impacts their depression and vice versa ​ Psychotherapy: ○​ Individual ○​ Group: if the patient doesn’t want to attend, ask them why, offer self, or educate ○​ Cognitive Behavioral Therapy (CBT): ​ Meant to change the patients perceptions ​ Helps the patient understand that thoughts, actions, and feelings are all connected ​ 1. Thoughts: what we think affects the way we act & live ​ Thought processes than impact our success ​ 2. Behaviors: how we act changes the way we think ​ Ex: getting up, brushing teeth, going to group. It all gives a better mindset throughout the day ​ 3. Emotions: what we feel impacts how we think & act ​ Electroconvulsive Therapy (ECT): ○​ Uses electrical currents to the brain to trigger a Grand Mal Seizures ​ Scrambles neurotransmitters in brain ○​ Effective in severely depressed and suicidal clients ​ Only performed if medications aren’t effective or if side effects are too bad ○​ Must have an informed consent before every session ○​ Risks: ​ Memory loss (most common) ​ Disorientation ​ Fatigue ​ General anesthesia risks ○​ Sedation and muscle relaxers are administered to reduce harm to the patient ○​ Usually 6-12 sessions, 3x a week ○​ Pre-Procedure:  ​ Monitor vital signs ​ Ensure the blood pressure cuff is on the ankle ​ Have the blood pressure cuff inflated before the paralytic is given ​ Ensure the patient hasn’t taken benzodiazepines or anticonvulsants ○​ Post-Procedure: ​ Assess gag reflex Pharmacology ​ Serotonin Syndrome: ○​ Can begin 2 to 72 hours after the start of treatment ○​ Symptoms: ​ Shivering ​ Hyperreflexia + Myoclonus ​ Increased temperature ​ Vital sign instability ​ Encephalopathy ​ Restlessness ​ Sweating ○​ If suspected, ALWAYS hold the medication and call doctor immediately ​ Selective Serotonin Reuptake Inhibitor (SSRI) ○​ Citalopram (Celexa) ○​ Escitalopram (Lexapro) ○​ Fluoxetine (Prozac) ○​ Paroxetine (Paxil) ​ MOA: inhibits the reuptake of serotonin ​ Treats depression, anxiety, and OCD ​ Complications: ​ Sexual dysfunction ​ CNS stimulation ​ Insomnia ​ Agitation ​ Anxiety ​ Weight changes ​ Withdrawal syndrome ​ Hyponatremia ​ Rash ​ GI bleed ​ Serotonin syndrome ​ Serotonin Norepinephrine Reuptake Inhibitor ○​ Venlafaxine (Effexor)  ​ MOA: inhibits the reuptake of serotonin and norepinephrine ​ Treats depression, anxiety, and neuropathy ​ Complications: ​ Nausea ​ Increased sweating ​ Insomnia ​ Tremors ​ Sexual dysfunction ​ Serotonin syndrome (less likely) ​ Tricyclic Antidepressants ○​ Amitriptyline (Elavil) ​ MOA: blocks serotonin, norepinephrine, and histamine ​ Treats pain, depression, and panic attacks ​ Complications: ​ Orthostatic hypotension ​ Anticholinergic effects ​ Sedation ​ Decreased seizure threshold ​ Excessive sweating ​ Increased appetite/weight gain ​ Sexual dysfunction ​ Cardiac toxicity ○​ First signs: dysrhythmias, agitation, confusion ○​ Worse signs: Seizures, coma, possible death ​ Heterocyclic (Atypical Antidepressants) ○​ Bupropion (Wellbutrin) ○​ Trazodone (Deseryl) ​ MOA: inhibits the transport of serotonin and norepinephrine ​ Treats depression and anxiety ​ Complications: ​ Headache ​ Dry mouth ​ GI distress ​ Increased heart rate ​ Restlessness ​ Insomnia ​ Possible weight loss ​ Seizures with high doses ​ Monoamine Oxidase Inhibitors ○​ Phenelzine (Nardil)  ​ MOA: blocks the enzyme that degrades norepinephrine and serotonin ​ Treats depression ​ Complications: ​ CNS stimulation ​ Anxiety ​ Agitation ​ Hypomania ​ Mania ​ Orthostatic hypotension ​ Hypertensive crisis ○​ Due to tyramine in diet ○​ Educate them to avoid: ​ Aged cheeses ​ Red wine ​ Smoked & processed meats ​ Not compatible with many other medications Suicidal Precautions ​ Suicidal ideations are the THOUGHTS ​ Suicidal attempt is the ACTION ​ Remember: safety comes first! ○​ Always ask your patient about their thoughts on suicide ​ Create a safe environment ○​ Remove all harmful objects from the patients possessions ​ Maintain close observation of the patient ○​ 1:1 or every 15 minute checks based on severity ○​ Rounds at irregular frequent intervals ​ Monitor the administration of all medications (cheeking) ​ Precautions: ○​ Windows locked ○​ Break proof glass & mirrors ○​ Plastic cutlery ○​ No phone cords, extension cords, or cords from curtains ○​ No belts ○​ No matches or cigarettes ○​ No sharps or razors ​ No-harm contract: ○​ Written agreement between patient and nurse ○​ Often lacks coping skills or emergency steps ○​ Less effective than safety plans ​ Safety Plans: ○​ Structured, collaborative plan that outlines warning signs, coping strategies, support systems, and emergency contacts ○​ Gives the patient concrete steps to follow in-case of suicidal ideations ○​ More effective in reducing suicide attempts ○​ Encourages active problem-solving instead of false promises