1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 13 Depressive Disorders

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Major Depressive Disorder History of one or more major depressive episodesHistory of one or more major depressive episodes No history of manic or hypomanic episodesNo history of manic or hypomanic episodes Symptoms interfere with social or occupational functioningSymptoms interfere with social or occupational functioning May include psychotic featuresMay include psychotic features

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Major Depressive Disorder Subtypes Psychotic featuresPsychotic features Melancholic featuresMelancholic features Atypical featuresAtypical features Catatonic featuresCatatonic features Postpartum onsetPostpartum onset Seasonal features – seasonal affective disorder (SAD)Seasonal features – seasonal affective disorder (SAD)

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Proposed Subtypes Premenstrual dysphoric disorderPremenstrual dysphoric disorder Mixed anxiety-depressionMixed anxiety-depression Recurrent brief depressionRecurrent brief depression Minor depressionMinor depression

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Dysthymic Disorder Chronic depressive syndromeChronic depressive syndrome Present for most of the dayPresent for most of the day More days than notMore days than not At least 2 yearsAt least 2 years

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Epidemiology Leading cause of disability in the United StatesLeading cause of disability in the United States Children and adolescentsChildren and adolescents Older adultsOlder adults ComorbidityComorbidity

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Etiology Biological factorsBiological factors –Genetic –Biochemical –Alterations in hormonal regulation Diathesis-stress modelDiathesis-stress model Psychological factorsPsychological factors –Cognitive theory –Learned helplessness

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Nursing Process AssessmentAssessment –Self-assessment –Unrealistic expectations of self –Feeling what the patient is feeling –Assessment tools –Assessment of suicide potential –Key assessment findings

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Nursing Process Continued Areas to assessAreas to assess –Affect –Thought processes –Mood –Feelings –Physical behavior –Communication –Religious beliefs and spirituality

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Which question would be a priority when assessing for symptoms of major depression?Which question would be a priority when assessing for symptoms of major depression?

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 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?”

12. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Nursing Process Continued Nursing DiagnosisNursing Diagnosis –Risk for suicide – safety is always the highest priority –Hopelessness –Ineffective coping –Social isolation –Spiritual distress –Self-care deficit

13. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Nursing Process Continued Outcomes IdentificationOutcomes Identification Recovery modelRecovery model –Focus on patient’s strengths –Treatment goals mutually developed –Based on patient’s personal needs and values

14. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Nursing Process Continued PlanningPlanning Geared towardsGeared towards –Patient’s phase of depression –Particular symptoms –Patient’s personal goals

15. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Nursing Process Continued ImplementationImplementation Three phasesThree phases –Acute phase (6 to 12 weeks) –Continuation phase (4 to 9 months) –Maintenance phase (1 year or more)

16. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Nursing Process Continued Basic Level InterventionsBasic Level Interventions –Counseling and communication –Health teaching and health promotion –Promotion of self-care activities –Milieu therapy

17. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Nursing Process Continued Advanced Practice InterventionsAdvanced Practice Interventions –Psychotherapy Cognitive behavioral therapy (CBT)Cognitive behavioral therapy (CBT) Interpersonal therapy (IT)Interpersonal therapy (IT) Time-limited focused psychotherapyTime-limited focused psychotherapy Behavior therapyBehavior therapy –Group therapy

18. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Psychopharmacology AntidepressantsAntidepressants –Selective serotonin reuptake inhibitors (SSRIs) First-line therapyFirst-line therapy IndicationsIndications Adverse reactionsAdverse reactions Potential toxic effectsPotential toxic effects

19. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19 Psychopharmacology Continued –Tricyclic antidepressants (TCAs) Neurotransmitter effectsNeurotransmitter effects IndicationsIndications Adverse effectsAdverse effects ContraindicationsContraindications

20. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20 Psychopharmacology Continued –Monoamine oxidase inhibitors (MAOIs) Neurotransmitter effectsNeurotransmitter effects IndicationsIndications Adverse/toxic effectsAdverse/toxic effects InteractionsInteractions –Drug –Food ContraindicationsContraindications

21. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21 Other Treatments for Depression Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT) Transcranial magnetic stimulationTranscranial magnetic stimulation Vagus nerve stimulationVagus nerve stimulation Light therapyLight therapy St. John’s wortSt. John’s wort ExerciseExercise

22. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 22 Nursing Process Continued EvaluationEvaluation –Short-term indicators and outcome criteria –Reassess and reformulate care plan as necessary –Future of treatment