Flashcards in Quiz #2: Depression Deck (48)
-Subjective state that follows loss. -Grief is universal; however, the way in which it is expressed is culturally determined.
-Clinical disorder that is severe, maladaptive, and incapacitating.
-Extreme sadness, hopelessness, worthlessness and lack of motivation.
Elevated, expansive, or irritable mood, extreme sense of wellbeing with grandiosity.
How does culture affect depression?
Affects symptomatic expression, clinical presentation and effective treatment. (Most people now believe in a biological basis for this disorder)
Statistics for Depression
-Lifetime risk for MDD is 7 – 12% for men and 20 – 30% for women
-More than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent MDD
-1/3 of all people with MDD seek help, are accurately diagnosed, and obtain appropriate treatment
-High incidence of MDD is found among patients hospitalized for medical illness
MDD high prevalent in primary care settings
Who is important to screen for MDD?
Women of reproductive age. Especially those who have children or plan to become pregnant
Etiology of Depression
1. Biological Theories
2. Cognitive Theory
3. Learned Helplessness
4. Diathesis Stress Model
Etiology of Depression: Biological Theories
-No single biochemical model explains the causes of depression
-Dominant theory is the dysregulation hypothesis
-Dysregulation in the amount or availability of 5-HT, the sensitivity of its receptors in relevant regions of the brain, and its balance with other neurotransmitters
-5-HT has important brain functions such as aggression, mood, psychomotor activity, irritability, appetite, sexual activity, etc.
-5-HT has an important role in the secretion of growth hormone, prolactin, and cortisol, all of which are found to be abnormal in people with depression
-Most effective antidepressant agents, such as ECT and medications, have been found to enhance neurotransmission of 5-HT
Depression Etiology: Diathesis-Stress Model
-Psychological / biological theory, and is basically the culmination of stress from life experiences (stress) and the vulnerability (diathesis) of a person, such as genetics, psychological, biological, or situational factors, that can lead to depression.
-Example: A child who has a family history of depression (vulnerability / diathesis) and who has been exposed to a particular stressor, such as exclusion or rejection by his peers (stress) would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers.
Depression Etiology: Cognitive Theory
Depression is seen as a cognitive problem arising from a person’s negative view of self, the world, and the future.
Depression Etiology: Learned Helplessness
-Theory proposes that it is not trauma that produces depression but the belief that one has no control over important outcomes in life.
-It is a behavioral state and a personality trait of one who believes that control over reinforces in the environment has been lost.
-These negative expectations lead to hopelessness, passivity, and an inability to assert oneself.
Primary Risk Factors for Depression Include
-Low socioeconomic class
-Early childhood trauma
-Presence of negative life event, especially loss and humiliation
-Ineffective coping ability
-Postpartum time period
-Absence of social support
-Alcohol or substance abuse
Depression DSM-5 Criteria
What is an affect?
Outward expression of emotion
Depression Affects include
Depression: Moods Include
Depression: Physical Behavior and Appearance Include
-Older than stated age
-Loss of libido
Depression: Thought Processes Include
- Intrusive, negative thoughts
What is SIG-E-CAPS?
Rapid screening for depression
What does SIG-E-CAPS stand for?
-Sleep changes: increase during day or decreased sleep at night
-Interest (loss): of interest in activities that used to interest them
-Guilt (worthless): depressed elderly tend to devalue themselves
-Energy (lack): common presenting symptom (fatigue)
-Cognition/Concentration: reduced cognition &/or difficulty concentrating
-Appetite (wt. loss); usually declined, occasionally increased
-Psychomotor: agitation (anxiety) or retardations (lethargic)
-The most commonly used screening questionnaire for depression.
Expected outcomes for patients with depression
Patient will be emotionally responsive and return to pre-illness level of functioning
What actions by the nurse can be done to help the patient reach their expected outcomes?
-Allow patient to recognize feelings
-Analyze stressors and strengthen patient’s self-esteem
-Increase patient’s sense of control, awareness of choices, and responsibility for behavior
-Encourage healthy interpersonal ties with others
-Promote understanding of maladaptive emotions and to acquire adaptive coping responses to stressors
Planning of care for patients with depression
-Safety is the highest priority!
-Risk Assessment: Self harm or harm to others
-Environment of Care: Suicide Prevention and Therapeutic Milieu
-Patient Care: Safety, Therapy and Medications, Emotional Response And Social Functioning.
Depression Implementation: Nurse-Patient Relationship
-Patient may resist involvement through withdrawal and nonresponsiveness
-Nurse needs to be quiet, warm and accepting
-Develop rapport through shared time, even if patient talks little, and through supportive companionship
Physiological Treatments for Depression Include
-May need to monitor diet
-Self-Care needs, such as bathing and dressing
Depression Implementation: Expressing Feelings
Should reinforce that depression is self-limiting and that the future will get better
Depression Implementation: Cognitive Strategies Include
-Help patient explore feelings and their view of the problem.
-Focus on modifying the patient’s thinking (they tend to focus on negative thinking)
-Help patient examine accuracy of perceptions, logic and conclusions (move them from unrealistic to realistic goals; increase self-esteem; involve patient in productive tasks or activities