1. Depressive Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2.  Assess behaviors in a patient with depression in regard to each of the following areas:  Affect  Thought process  Feelings  Physical behavior and  Communication  Compare and contract major depressive disorder and dysthymic disorder  Recognize vegetative signs of depression  Understand the advantages of why SSRI are used over the tricyclic antidepressant (TCA).  Discuss the benefits of ECT vs. medications  Know at least 5 nursing interventions to aid these patients. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

3.  Affect  Anergia  Anhedonia  Dysthymic disorder (DD)  Electroconvulsive therapy (ECT)  Hypersomnia  Major depressive disorder  Mood disorders  Psychomotor agitation  Psychomotor retardation  Vegetative signs of depression Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3

4.  Persistently depressed mood lasting a minimum of 2 weeks which last longer than “normal” sadness or grief.  - Symptom include:  Anhedonia the inability to experience pleasure  Fatigue  Sleep disturbances  Changes in appetite  Feelings of guild, hopelessness or worthlessness  Suicide ideations that won’t stop  Poor concentration or can’t make decision  Change in physical activity Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.4

5.  It is the leading cause of disability in the US.  Depression in older adults is common, but it is not a normal result of aging.  It profoundly alters a person’s social, family and occupational function.  Suicide is the most serious complication and can occur when patient has feelings of worthlessness, guilt or hopelessness. They see no point in living.  Nearly 15% of patients with untreated depression commit suicide. Women will make more attempts but men usually follow through and die.  Most of these individuals sought help from a doctor one (1) month prior to their death. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

6.  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.6

7.  Biological factors ◦ Genetic ◦ Biochemical  Stressful life events ◦ Alterations in hormonal regulation ◦ Inflammatory process ◦ Diathesis-stress model  Psychological factors ◦ Cognitive theory ◦ Learned helplessness Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.7

8.  Assessment  Assessment tools – examples  Beck Depression Inventory  Hamilton Depression Scale  Geriatric Depression Scale  Assessment of suicide potential  Priority assessment determination  Risk for suicide increases with severe hopelessness, overuse of alcohol, recent loss or separation, history of past suicide attempts and acute suicidal ideations.  Key assessment findings  Anhedonia (lack of pleasure)and depressed mood are the key symptoms  Lack of Anergia (lack of energy or physical passivity  Anxiety Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.8

9.  Areas to assess  Affect – looks sad wit blunted affect.  Thought processes – judgment is poor and indecisiveness, poor concentration  Mood – feeling reported are anxiety, worthlessness, guilt  Feelings – guilt is common accompaniment to depression  Physical behavior – lethargy and fatigue  Communication – slow; allow time for a response  Religious beliefs and spirituality –in a study done by Sreevani and Reddemma (2012) the found depression keeps individuals from engaging in spiritual rituals. They concluded that this is could be beneficial in patients with depression. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.9

10.  Age considerations ◦ Children and adolescents ◦ Older adults  Self assessment  Feeling what the patient is feeling Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.10

11.  Nursing diagnosis ◦ Risk for suicide—safety is always the highest priority ◦ Hopelessness ◦ Ineffective coping ◦ Social isolation ◦ Spiritual distress ◦ Self-care deficit Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.11

12.  Outcomes identification  Recovery model ◦ Focus on patient’s strengths ◦ Treatment goals mutually developed ◦ Based on patient’s personal needs and values Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.12

13.  Planning  Geared toward ◦ Patient’s phase of depression ◦ Particular symptoms ◦ Patient’s personal goals Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.13

14.  Implementation  Three phases ◦ Acute phase (6 to 12 weeks) ◦ Continuation phase (4 to 9 months) ◦ Maintenance phase (1 year or more) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.14

15.  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.15

16.  Antidepressants ◦ 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.16

17. ◦ 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.17

18. ◦ 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.18

19.  Your patient was just diagnosed with a major depressive disorder.  What medication do you anticipate the health care provider will start the patient on?  What side effects might the patient experience? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.19

20.  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.20

21. ◦ Psychotherapy  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.21

22.  Evaluation ◦ Suicide ideation ◦ Intake ◦ Sleep pattern ◦ Personal hygiene and grooming ◦ Self-esteem ◦ Social interaction Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.22

23. 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. 23

24. 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. 24

25. 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?” D.“Do you ever find that you don’t remember where you’ve been or what you’ve done?” Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.25