Quiz #2: Depression Flashcards Preview

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Flashcards in Quiz #2: Depression Deck (48)
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1

Grief

-Subjective state that follows loss. -Grief is universal; however, the way in which it is expressed is culturally determined.

2

Depression

-Clinical disorder that is severe, maladaptive, and incapacitating.
-Extreme sadness, hopelessness, worthlessness and lack of motivation.

3

Mania

Elevated, expansive, or irritable mood, extreme sense of wellbeing with grandiosity.

4

How does culture affect depression?

Affects symptomatic expression, clinical presentation and effective treatment. (Most people now believe in a biological basis for this disorder)

5

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

6

Who is important to screen for MDD?

Women of reproductive age. Especially those who have children or plan to become pregnant

7

Etiology of Depression

1. Biological Theories
2. Cognitive Theory
3. Learned Helplessness
4. Diathesis Stress Model

8

Etiology of Depression: Biological Theories

-No single biochemical model explains the causes of depression
-Dominant theory is the dysregulation hypothesis

9

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

10

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.

11

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.

12

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.

13

Primary Risk Factors for Depression Include

-Female
-Unmarried
-Low socioeconomic class
-Early childhood trauma
-Presence of negative life event, especially loss and humiliation
-Family history
-Ineffective coping ability
-Postpartum time period
-Medical illness
-Absence of social support
-Alcohol or substance abuse

14

Depression DSM-5 Criteria

Add later

15

What is an affect?

Outward expression of emotion

16

Depression Affects include

-Sad
-Flat
-Blunted

17

Depression: Moods Include

-Anxious
-Sad
-Worthless
-Helpless
-Angry
-Hopeless

18

Depression: Physical Behavior and Appearance Include

-Psychomotor retardation
-Disheveled
-Insomnia
-Older than stated age
-Loss of libido
-Fixed gaze

19

Depression: Thought Processes Include

-Poor Judgement
-Indecisive
- Intrusive, negative thoughts
-Poor memory
-Poor Concentration

20

What is SIG-E-CAPS?

Rapid screening for depression

21

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)
-Suicide/death preoccupation

22

PHQ-9

-The most commonly used screening questionnaire for depression.

23

Expected outcomes for patients with depression

Patient will be emotionally responsive and return to pre-illness level of functioning

24

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

25

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.

26

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

27

Physiological Treatments for Depression Include

-May need to monitor diet
-Sleep Disturbances
-Self-Care needs, such as bathing and dressing
-Psychopharmacology

28

Depression Implementation: Expressing Feelings

Should reinforce that depression is self-limiting and that the future will get better

29

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

30

Therapeutic Communication Techniques Include

-Listening
-Broad openings
-Restating
-Clarifying
-Reflection
-Silence