What's another term for a mood disorder?
What does the World Health Organization (WHO) estimate as leading cause of disability worldwide?
major depressive disorder
What percentage of the world's population in any given year is affected by major depressive disorder?
How many women are affected by depression, compared to men?
twice as many woman
Depression affects all age categories. What is the average age of onset?
Which clients have the highest risk of recurrence of depression?
individuals who have an onset before 25; have had more than 16 weeks of depression and had a recurrence within 2 months
What is the 3 factors which cause of depression (etiology)?
genetic factors, physiologic factors (neurochemical imbalance and hormonal influences) and psychological factors (conflict between wanting to be loved and fear of rejection, anger turned inward, learned helplessness and feminist theory)
According to DSM IV criteria, a diagnosis of depression requires over 2 weeks in functioning with depressed mood or decreased interest or pleasure and at least 4 of these symptoms, which cause distress or impair social, occupational, or other functioning and are not caused by a substance or a general medical condition.
significant with loss/gain or markedly, decreased/increased appetite, hypersomnia or insomnia, psychomotor agitation or slowness, fatigue or energy loss, feelings of worthlessness or guilt, difficulty concentrating or indecisiveness and recurrent thoughts of death with or without suicide ideation
What is the general appearance and motor behaviour of a client with depression?
look sad or sometimes ill, slouched posture, head down, minimal eye contact, psychomotor retardation, minimal responses (1 or 2 words), latency of response and psychomotor agitation
What is the mood and affect of a client with depression?
feeling hopeless, helpless, down, anxious; may say they are burden on others; failure at life; easily frustrated, angry at themselves and sometimes others; anhedonia, apathetic, sad or flat affect, overwhelmed by noise, people making demands and withdraw from stimulation of others
What is the thought process and content of a client with depression?
slow thinking process, may not respond verbally, tend to be negative, pessimistic in thinking, believe they will always feel this way (nothing will ever get better and nothing will help), make self-depreciating remarks, rumination and may have delusions, thoughts of dying or committing suicide
What is the sensorium and intellectual processes of a client with depression?
may or may not be orientated to person, place or time; memory impairment, extreme difficulty concentrating or paying attention and may have auditory hallucinations (degrading, belittling or commands)
What is the judgement and insight of a client with depression?
impaired judgment, difficulty making decisions and choices and may have some insight or very limited insight (unaware of their behaviour, feelings and illness)
What is the self-concept of a client with depression?
low self-esteem, often feel guilty, may personalize events, may take responsibility for incidents over which they have no control and often believe others would be better off without them
What is the role and relationships of a client with depression?
difficulty fulfilling roles/responsibilities at home, work and school, may avoid family and social relationships, relationships may be strained and as strain increases the more they isolate themselves
What is the physiologic and self-care considerations of a client with depression?
lack of appetite (disinterest in eating), may experience pronounced weight loss, sleep disturbances (insomnia, feel exhausted or unrefreshed no matter how much time in bed), lose interest in sexual activities, impotence in men, neglect personal hygiene, constipation, dehydration and somatic complaints
What are some nursing interventions with respect to safety and physical factors for clients with depression?
safety is the priority; assess suicide risk (increases with severity of depression); institute suicide precautions if indicated, see to physical needs; check weight, nutritional intake, hygiene, sleep, assess bowel habits; small, frequent high fibre and easily chewable meals; consider preferences; stay with patient during meals; assist in getting out of bed; encourage to initiate self-care and perform own ADLs, encourage relaxation exercises, promote sleep measures, engage in activities, productive activities (assign therapeutic tasks), assure success in establishing routine, provide opportunity and support for increased involvement in activities and increase self-esteem and sense of control over behaviour
What are some nursing interventions with respect to the feelings of clients with depression?
help client become aware of unconscious feelings; talk about the universality of feelings; modify negative experiences and explore extent of negative thinking (express doubt, question negative self statements); substitute positive thoughts for negative ones; demonstrate your concern; convey that you consider the client a worthwhile person; allow the client to cry (stay with, support client and provide privacy); provide positive feedback, but do not cut off interactions with cheerful remarks; do not belittle feelings; help identify feelings, assist in constructive expression of anger and monitor own feelings (depression can be contagious)
What are some nursing interventions with respect to listening and talking for clients with depression?
interact on topics that are comfortable and avoid probing or asking too many questions; if ruminating, talk about reality or about the client's feelings; limit attention given to repeated expressions of rumination; use silence and active listening; let client know you are available to talk but do not require this and use simple, direct sentences
What are some general nursing interventions for clients with depression?
form therapeutic relationship (spend non-demanding time); accept client, avoid actions that could be interpreted as criticism; reinforce reality (delusions/hallucinations); take matter-of-fact approach, not overly cheery (avoid superficiality, sympathy); maintain consistency of staff whenever possible; reorient to person, place and time as indicated; help enhance social skills; assist with problem solving (explore options, consider consequences, select, implement and evaluate) and assess medication effects and help establish realistic goals and provide hope
What are some topics to teach families of clients with depression?
about illness; early signs of relapse; importance of support groups; help locate resources; reinforce benefits of therapy and follow-up; actions, side effects, special instructions and methods to manage side effects
How is depression treated?
1) drug therapy (assess symptoms, age, physical health, previous drugs that worked or other meds), including antidepressants (18-24 months; taper off), trycyclics (narrow therapeutic range) and antipsychotics (if psychotic symptoms present); 2) ECT and 3) psychotherapy (interpersonal, behaviour, cognitive)