Nurs 40030 Depressive disorders Notes

Depressive Disorders
Objectives:  Difficulty concentrating
 Define Mood Disorders: Major Depressive Disorder;  Lethargy, easy fatigue marked lack of energy
Persistent Depressive Disorder (old dysthymia);  Marked change in appetite
Premenstrual Dysphoric Disorder  Hypersomnia or Insomnia
 Discuss Risk Factors for Depressive Disorders  Breast tenderness, aching, bloating, weight gain
 Assess clinical manifestations of clients with Depressive
Disorders Major Depressive Disorder (MDD)
 Identify Treatment of Mood Disorders: Therapeutic Diagnostic Criteria
management, pharmacological & nonpharmacological  Symptoms cause significant distress in employment,
 Discuss the nurse’s role in ECT therapy social or other areas of functioning
 Define Suicide risk factors, assessment, & interventions Not attributed to other medical conditions or substance abuse
 5 or > must be present for TWO weeks, with a change
What is Depression? from previous functioning:
 Alteration in mood that is expressed by feelings of  ***Depressed Mood most of day nearly every day
sadness, despair, pessimism (Kids- irritable)
 Loss of interest in usual activities  ***Anhedonia – unable to experience pleasure in daily
 Somatic symptoms life
 Changes in appetite & sleep  Weight/Appetite loss or gain
 Insomnia/hypersomnia
Normal  Psychomotor agitation or retardation
Transient symptoms are healthy responses to loss or change  Anergia / fatigue
 Feel worthless, inappropriate guilt
Pathological  Trouble thinking, concentrating, indecisiveness
Occurs when adaptation fails to occur or is ineffective  Recurrent thoughts of death, suicide thoughts & plans

Types of Mood Disorders Major Depressive Episode- DSM-IV specifiers
 Persistent Depressive Disorder  Single episode or recurrent episode
 Premenstrual Dysphoric Disorder  Mild, moderate, or severe
 Substance/Medication-Induced Depressive Disorder  With or without psychotic features
 Depressive Disorder Due to Another Medical Condition  With catatonic features
 Major Depressive Disorder (MDD)  With postpartum onset
 Seasonal Affective Disorder (SAD)  With seasonal pattern
o Usually Fall / Winter – lack of sunlight, decreased
melanin Developmental Considerations
 Child – the younger that you have this disorder, the more
Persistent Depressive Disorder likely you will have this for the rest of your life
(Old Name: Dysthymia)  Adolescence – more likely to engage in substance abuse,
Feelings of low-level Depression For: aggression, lower self-esteem.
 Most of day  Elderly (Senescence) – from repeated losses, diseases,
 Majority of days – for at least 2 years decreased functioning.
 Plus – at least 2 of the following:
o Poor appetite or overeating Risk Factors: Depression
o Insomnia or hypersomnia Biological Factors
o Low energy or fatigue  Genetic
o Low self-esteem  Biochemical
o Poor concentration or difficulty making decisions  Deficiency of:
o Feelings of hopelessness o serotonin, norepinephrine, & glutamate, GABA,
dopamine? acetylcholine
o NOT sever enough for hospital
 Hormonal
 Inflammation
Premenstrual Dysphoric Disorder (PMDD)
 Essential features: Psychological Factors
At least 5 symptoms appear in last week prior to menses, start
Cognitive theory:
to improve at menses onset
 Views primary disturbance in depression as cognitive
 Mood swings
rather than affective
 Marked irritability or anger or increased conflict  Depression is product of negative thinking. To improve
 Marked depressed mood, feeling of hopelessness or self-
mood, need to change the way think
deprecation
 Marked anxiety, tension, feeling of being keyed up or on
Three cognitive distortions that serve as the basis for
edge
depression:
 Decreased interest in usual activities