Depression

DEPRESSION NURSING

1. DEPRESSION

2. MOOD DISORDERS : Mood/affective Disorders are characterised by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome, which is not due to any other physical and mental disorder.

3. CLASSIFICATION F 30 : MANIC EPISODE F 31: BIPOLAR AFFECTIVE DISORDER F32 : DEPRESSIVE EPISODE F33 : RECURRENT DEPRESSIVE DISORDER F34: PERSISTENT MOOD DISORDER F38 : OTHER MOOD DISORDERS F39 : UNSPECIFIED MOOD DISORDERS

4. DEFINITION Oxford textbook of psychiatry (1997) defines depressive disorders as syndromes of depressed mood, pessimistic thinking , lack of enjoyment, reduced energy and slowness.

5. ICD-10 CLASSIFICATION F30-39- mood ( affective disorder) F 32 -Depressive episode F 32.0 -Mild depressive episode F 32.1 - Moderate depressive episode F 32.2 - Severe depressive episode without psychotic symptoms F 32.3 - Severe depressive episode with psychotic symptoms F 32.8 - Other depressive episode – atypical depression F 32.9 - Depressive episode , unspecified F 33 - Recurrent depressive disorder.

6. EPIDEMIOLOGY lifetime prevalence of about 15% perhaps as high as 25% for women. Sex : more in women. Age : The mean age of onset is about 40 years, 50% of all the patients have an onset between 20-50 years of age. Marital status Socioeconomic and cultural considerations : rural areas than in urban.

7. ETIOLOGY Biological Theories Genetics: twin studies, family studies and Adoption studies.

8. ETIOLOGY Biochemical influences ( NE,SERO.,DOP,A.CH) Neuroendocrine disturbances Hyperactivity of adrenal gland Decreased level of thyroid hormone

9. ETIOLOGY Physiological influences Medication side effects: steroids, hormones, sedatives, antineoplastics , antibacterials Neurological disorders: Nutritional deficiencies:

10. ETIOLOGY PSYCHOSOCIAL THEORIES Psychoanalytic theory: loss of loved object . Behavioral theory: conditioned by repeated losses in past. Cognitive theory: depression is due to negative cognitions Sociological theory: Stressful life events

11. CLINICAL FEATURES DEPRESSED MOOD : Sadness of mood, loss of interest and loss of pleasure in almost all activities. Pervasive and persistent pattern of sadness.

12. CLINICAL FEATURES DEPRESSIVE COGNITIONS Hopelessness : no hope in future due to pessimism. Helplessness : no help is possible Worthlessness : feeling of inadequacy and inferiority. Unreasonable guilt Self blame

13. CLINICAL FEATURES SUICIDAL THOUGHTS: PSYCHOMOTOR ACTIVITY: Psychomotor retardation Thinks, walks and acts slowly Monotonous Delay in answering questions

14. CLINICAL FEATURES PSYCHOTIC FEATURES Delusions and hallucinations

15. CLINICAL FEATURES Somatic symptoms Significant decrease in appetite or weight Early morning awakening Pervasive lack of interest and lack of reactivity to pleasurable stimuli Posture is stooped Reddened eyes from crying Persons look 10 years older than their chronological age. Constipation and anorexia dry mouth, headache, sleep disturbance, fatigue and lowered libido

16. MAJOR DEPRESSIVE DISORDERS SINGLE EPISODE OR RECURRENT MILD/MODERATE/ SEVERE WITH PSYCHOTIC FEATURES WITH CATATONIC FEATURES WITH MELANCHOLIC FEATURES CHRONIC WITH SEASONAL PATTERN WITH POSTPARTUM ONSET DYSTHYMIC DISORDER PREMENSTRUAL DYSPHORIC DISORDER

17. DIAGNOSIS ICD 10 diagnostic criteria Psychological tests- Beck depression inventory, Hamilton rating scale Dexamethazone suppression test Based on signs and symptoms

18. TREATMENT Pharmacotherapy

19. PHARMACOTHERAPY antidepressants

20. PHYSICAL THERAPIES ELECTROCONVULSIVE THERAPY : severe depression with suicidal risk . LIGHT THERAPY : seasonal depression REPETITIVE TRANS CRANIAL MAGNETIC STIMULATION .

21. PSYCHOSOCIAL THERAPIES Cognitive therapy Psychoanalytic therapy Supportive psychotherapy Group therapy Family therapy Behavioral therapy

22. NURSING MANAGEMENT  

23. ASSESSMENT

24. NURSING DIAGNOSIS High risk for self directed violence related to depressed mood, feelings of worthlessness and anger turned inward on the self Dysfunctional grieving related to real or perceived loss as evidenced by denial of loss, inappropriate expression of anger.

25. Powerlessness related to dysfunctional grieving process as evidenced by feeling of lack of control over life situations. Self esteem disturbance related to learned helplessness , negative view of self as evidenced by expression of worthlessness and sensitivity to criticism Altered sleep and rest related to depressed mood as evidenced by difficulty in falling asleep and early morning awakening.

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