Depressive Disorders

Symptoms of depression

Anhedonia (lack of ability to experience pleasure) - fatigue - sleep disturbances (trouble sleeping or over sleeping) - changes in appetite feelings of hopelessness or worthlessness persistent thoughts of death or suicide inability to concentrate or make decisions - change in physical activity

Which question would be a priority when assessing for symptoms of major depression?

"You look really sad. Have you ever thought of harming yourself?"

other treatments for depression

- ECT (electroshock therapy) - transcranial magnetic stimulation - vagus nerve stimulation - deep brain stiumulation - light therapy - st. john's wort (do not mix this wit antidepressant - exercise

3 phases of depression

- acute phase (6-12 weeks) - continuation phase (4-9 mo) - maintenance phase (1+ years)

Areas to assess

- affect - thought processes - mood - feelings - physical behavior - communicaiton - religious beliefs and spirituality

side effects of ECT

- anesthesia (slight confusion) right after procedure - temporary confusion - headache (may give Darvicet, otherwise they are NPO)

what to promote:

- counseling and communication - health teaching and promotion - promotion of self-care activities - teamwork and safety

Biological factors

- genetic - biochemical (stressful events) - alterations in hormonal regulation - inflammatory process - diathesis stress model

planning geared towards

- patient's phase of depression - particular symptoms - patient's personal goals

contraindications for ECT

- recent MI - brain tumor, increased ICP from hydrocephalus for ex

evaulation

- suicide ideation - intake - sleep pattern - personal hygiene and grooming - self-esteem - social interaction with others

Nursing Diagnosis

-risk for suicide (safety is always highest priority) - hopelessness - ineffective coping - social isolation - spiritual distress - self care deficit

Psychological factors

cognitive theory learned helplessness

ECT - length of treatment

electroconvulsive therapy - consent form has to be signed - 6-8 treatments 3 times a week

ECT procedure

hooked up to EKG and EEG, pulse ox, BP machine and HR - bilateral or unilateral electrode on head - done after 5 minutes

Which assessment finding in a patient with major depression represents a vegetative sign?

hypersomnia

medication during ECT procedure

muscle paralyzer - mouth block in the mouth to prevent from biting tongue and keep airway open - causes them not to breath on their own - to keep patient from getting fractures and jerking around

Is ECT usually the first line of treatment?

no - will first go through a series of medications first

how does ECT work?

not exactly sure, causes grand mal seizures. theory is that it rearranges the neurotransmitters in the brain

what is ECT for?

patients with extremely psychotic/manic phases - most used for depressed patients - very well for elderly patients

Major Depressive Disorder

persistently depressed mood lasting a minimum of 2 weeks

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?

psychomotor retardation

outcome identification recovery model

recovery model - focus on patient's strengths - treatment goals mutually developed - based on patient's personal values and needs

SSRI's

selective serotonin reuptake inhibitors - first line therpy for antidepressant

what medication is given before an ECT?

short acting sedative (sodium penatol or versed) - if asthma, will give them an inhaler before go under

improvement of ECT seen

usually in the first 2-3 days - meds will probably be continued