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Chapter 12

Chapter 12. Mood Disorders: Depression. Depression. Defined as a depressed mood or loss of interest that lasts at least 2 weeks & is accompanied by symptoms such as weight loss & difficulty concentrating Prevalence & Comorbidity 4 th leading cause of disability in US

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Chapter 12

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  1. Chapter 12 Mood Disorders: Depression

  2. Depression • Defined as a depressed mood or loss of interest that lasts at least 2 weeks & is accompanied by symptoms such as weight loss & difficulty concentrating • Prevalence & Comorbidity • 4th leading cause of disability in US • Projected to be 2nd leading cause disability by 2020 • Frequently accompanies other psychiatric disorders • Mixed anxiety-depression most common psychiatric presentation • Pts with medical disorder at high risk for depression • Occurs in children, adolescents, adults and older adults • Cultural Considerations • Rate is lowest in Asians as compared to Caucasians, African Americans & Hispanics

  3. Theory • Heterogeneous, systematic illness involving an array of different neurotransmitters, neurohormones, & neuronal pathways • Biological: Genetic link • Biochemical: Neurotransmitter abnormalities can probably cause depression • Serotonin: regulator if sleep, appetite & libido • Norepinephrine: decreased levels can result in anergia (lack energy) anhedonia (inability to find meaning or pleasure) decreased concentration & decreased libido • Neuroendocrine: evidence of increased cortisol secretion • Image Findings: CAT & MRI show ventricular enlargement, cortical atrophy, & sulcal widening

  4. Theory • Cognitive Theory • Developed by Aaron T. Beck • Applied CBT to depression • Proposed that people acquire psychological predisposition to depression through early life exp • Becks Cognitive Triad • A negative self-depreciating view of self • A pessimistic view of world • A belief that negative reinforcement will continue • Learned Helplessness • Seligman (1973) stated that although anxiety is initial response to stress, anxiety is replaced by depression if person feels no control over outcome

  5. Depressiove disorders • Major Depressive Disorder • Defined as 1 or more major depressive episodes and no history of manic or hypomanic episodes • Subtypes • Psychotic features • Catatonic features • Melancholic features • Postpartum onset • Seasonal features • Atypical features

  6. Depressive disorders • Dysthymia Disorder • Chronic depressive syndrome usually present for most day, more days than not, for at least 2 yrs • Early and insidious onset • Depressive mood disturbance cannot be distinguished from person’s usual pattern of functioning • Age of onset is usually early childhood and teenage years to early adulthood

  7. Application of the nursing process • Assessment • Undiagnosed & untreated depression often associated with more severe presentation of depression, greater suicidality, somatic problems, & severe anxiety • Assessment Tools • Beck Depression Scale, Hamilton Depression Scale, Geriatric Depression Scale • Assessment of Suicide Potential • Areas to Assess • Mood, physical changes, cognition • Assessment Guidelines • Diagnosis: risk for suicide • Outcomes Identification: Goal for safety • Planning

  8. Application of nursing process • Implementation • Communication Guideline • Health Teaching and Promotion • Milieu Therapy • Psychotherapy: CBT and Behavioral therapy • Group: widespread modality for treatment • Pharmacological/Biological/Integrative: ECT, Antidepressant drugs (SSRI’s, TCA, Atypical, MAOs)

  9. Application of the nursing process • Somatic Treatments • Electroconvulsive therapy (ECT) • Vagus Nerve Stimulation • Integrative Therapies • Light Therapy • St. John’s Wort • Exercise • Future Treatment • Transcranial Magnetic Stimulation • Brain Imaging • Evaluation • Short term indicators and outcome criteria are frequently evaluated

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