Depression

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A,
Mr.LOGANATHAN.N

Lecturer
M.Sc (Mental Health

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SLASSIKTISATIORNT

F32-DEPRESSIVE EPISOD

F32.0 - Mild depressive episode
.00 - without somatic syndrome
.01 - with somatic syndrome

F32.1 - Moderate depressive epi
.10 - without somatic syndrome
.11 - with somatic syndrome

F32.2 - Severe depressive episode without
psychotic symptoms.

F32.3 - Severe depressive episode with

psychotic symptoms
32.8 - Other depressive episodes

3. A AE

Depression is a
common mental disorder,
characterised by sadness,
loss of interest or pleasure,
feelings of guilt or low self-
worth, disturbance in sleep or
appetite, feelings of tiredness
and poor concentration.

WHO

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INCIDENCE
»The life time risk of depression in

males is 8-12% and in females it is
20-26%

Depression occurs twice as frequently
in women as in men

»The median age at onset of bipolar

disor Se a 20yrs in
wome | A.

~ a

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ETÓDLOGY
1. Biological theories

I) Neurochemical
Nor-epinephrine and serotonin are decrea
& deregulation of acetylcholine and GABA

ll) Genetic theories
Major depressive disorder occurs more than
often in first degree relatives than they do in the
general population
Studies of identical twins show that when
one twin is diagnosed with major depression, the other
twin has a greater than 70% chance of developi

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111) Endocrine theories
Normally, the hypothalamic- pituitary- adrenal
(HPA) axis is a system that mediates the stress
response
However, in some depressed people this
system malfunctions and creates cortisol, thyroid and
hormonal abnormalities.

IV) Changes in brain anatomy

Loss of neurons in the frontal lobes, cerebellum and
hasal ganglia has been identified in depression. if

7. V) Circadian rhythm theories

Individual experiencing circadian rhythm
changes are at increased risk for developing
depressive symptoms and other
symptoms.

This changes might be caused by
medications, nutritional deficiencies, physical or
psychological illness, hormonal fluctuations.

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2. Psychosocial theories —
I) Psychoanalytic theory
According to freud (1957)

Depression results due to loss of a “loved
object” and fixation in the oral sadistic phase of
development.

II) Behavioural theory

This theory of depression connects
depressive phenomena to the experience of
uncontrollable events.

According to this model, depression, if?

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Ill) Cognitive RAM 4 rush, emery
1979)

According to this theory depression is due to
h includes:

N egATive ofthe environment
EXPECTATIONS TRE

of the future

IV) Sociological theory
Stressful life events,

eg: death, marriage, financial loss before the’?
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+ Sadness of mood

+ Loss of interest and loss of pleasure in almost all
activities (pervasive sadness), present throughou
t sad :

DEPRESSIVE COGNITIONS
+ Helplessness
+ hopelessness
» Worthlessness
+ unreasonable guilt
+ Self-blame over trivial matters in th >

— 1

11. Psychomotor activity
+Psychomotor retardation
is frequent — pt’s thinks,
walks and act slowly

Other symptoms
» Difficulties in thinking
and concentration

+ Subjective poor
memory

» Decreased libido
+ Spontaneous crying
+ passiveness

Somatic symptoms
Decrease in appetite or
weight

» Early morning
awakening at least 2 or
more hours before the
usual time of waking up.
»Diurnal variation, with
Psychotic features
+Some patients have
delusions & hallucination (
psychotic depression)

12. aa EN WT ON 4 <a AS

EPISODE /DISORDER
DSMIYW-SRITERTLA

A. Five or more of the followin ng during the same 2-week period
that re Teen a change from usual faredpnirig including
either (1) depressed bad or (2) loss of interes

Sad, depressed mood, most of the day, nearly every day for two weeks
Loss of interest and pleasure in usual activities

Difficulties sleeping

Shift in activity level

Changes in appetite and weight loss/gain

Loss of energy. fatique

Negative self-concept, self-blame, quilt, worthlessness

Difficulty concentrating
Recurrent thoughts of death or suicide if

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> + . . A
B. The symptoms do not meet criteria for a Mixed
Episode

C. Impairment in social, occupational, or other important
areas of functioning.

D. The symptoms are not due to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical
condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by
Bereavement, i.e., after the loss of a loved one,
the symptoms persist for longer than 2 months or
are characterized by marked functional @
impairment, morbid preoccupation j

14. Mnemonic for easy recall KK

and review of the DSM-I\WY
criteria

. Sleep (increase/decrease)

° Interest (diminished)

° Guilt/low self esteem epee
° Energy (poor/low) «os

° Concentration (pool

° Appetite (increase/decrease)

° Psychomotor
(agitation/retardation) 4

° Suicidal ideation pe

15. VID © Sad 48 NS be —

IW ENE

Other newer

> 3 antidepressant
d Séreiaremi 2 drugs
raerotonin ,
Bupropion
inhibitors Maprotilin
(SRrialine e

Fluoxeti 4 '
ne = oe

16. i) ECT- severe depression with suicidal risk
ii) Lighttherapy or photo therapy
it involves exposing the patient to an

artificial light source during winter months to
relieve seasonal depression. The light
source must be very bright, full-spectrum
light, usually 2,500 lux.

iii) Repetitive transcranial magnetic stimulation
(TMS) and Vague nerve stimulation (VNS)

directly affect brain function by stimulating?

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17. i) Psychotherapy

It is based on __ psychoanalytic
interventions emphasizes helping patients
gain insight into the cause of their
depression

ii) Cognetive therapy

It aims at correcting the depression
negative cognitive like hopelessness,
worthlessness, helplessness and
pessimistic ideas, and replacing them wit

non enrantna and hohaurinralrnennnen

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23 se

iii) Supportive psychotherapy
Various techniques are employed to
support the patient. They are reassurance,
ventilation, occupational therapy, relaxation
and other activitytherapies.

iv) Grouptherapy

It is useful for mild cases of depression.
In group therapy negative feelings such as
anxiety, anger, guilt, despair are
recognized and emotional growth is
improved through expression of their
feeling. $

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v) Family therapy

It is used to decrease interfamilial and
interpersonal difficulties and to reduce or
modify stressors, which may help in faster
and more complete recovery.

vi) Behavioral therapy

It includes social skills training, problem
solving techniques, assertiveness training,
self control therapy, activity scheduling and

decision making techniques. if

20. ao no: EN IN WY? G u AS
EEE
1. High risk of self directed violence related

to depressed mood, feeling of worthlessness
and anger directed inward on the self

Goal : patient will not harm self

Intervention :
v Create a safe environment for the patient

Y Formulate a short term verbal or written contrast that
the patient will not harm self

Y lt may be desirable to place the patient meat the
nursing station. Do not leave the patient alone.

y Close observation is especially required when the
patient is recovering from the disease

y Encourage the patient to express his feelings, if
including anaer.

21. _ A

S

2. Dysfunctional ¢ grieving r r/t real or perceived
loss, bereavement, evidenced by denial of loss,
inappropriate expression of anger, inability to
carry out activities of daily living

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Goal: patient will be able to verbalize normal behaviours
associated with grieving

Intervention :
v Assess stage of fixation in grief process

y Be accepting of patient and spend time with him,
empathy, care and unconditional, positive regard.

v Explore feelings of anger and help patient direct them
towards the intended object or person

y Provide simple activities which can be easily an
quickly accomplished >

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3. Powerlessness related to dysfunctional
grieving process, life style of helplessness,
evidenced by feelings of lack of control over
life situations, over dependence on other to
fulfil needs.

Goal: the patient will be able to take control of life
situations.
Interventions:
y Allow the patient to take decision regarding
own care
y Ensure that goals are realistic and that patient
is able to identify life situations
vEncourage the patient to verbalize feelings
about areas that are not in his ability to control

23. <

Other nursing site

4.Self esteem disturbance rt learned
helplessness, impairment in cognition, negative
view of self, evidenced by expression of
worthlessness, sensitivity to criticism, negative
and pessimistic outlook

5.Impaired communication process
related to depressive cognitions, evidenced by
being unable to interest with others, withdrawn,
expressing fear of failure or rejection

6. Disturbed sleep and rest rt depressed
mood and depressive cognitions evidenced
difficulty in falling asleen early mo

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7. imbalanced nutritional status less than
body requirement related to depressed
mood, lack of appetite or lack of interest
in food

8. Self care deficit r/t depressed mood,
feelings of worthlessness, evidenced by
poor personal hygiene and grooming