Ch. 11 Depressive Disorders

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies prevalence is A. "That is a good observation. Depression does mostly strike people older than 50 years." B. "Depression is seen in people of all ages, from childhood to old age." C. "Depression is most often seen among the middle adult age group." D. "The age of onset for most depressive episodes is given as 18 years."

"Depression is seen in people of all ages, from childhood to old age."

A nurse caring for a nearly mute depressed client wishes to show acceptance of the client. An intervention that would meet this objective would be to say A. "I will be spending time with you each day to try to improve your mood." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "It is important for you to share your thoughts with someone who can help you evaluate whether your thinking is realistic."

"I would like to sit with you for 15 minutes now and again this afternoon."

Which patient statement indicates learned helplessness? 1. "I am a horrible person." 2. "Everyone in the world is just out to get me." 3. "It's all my fault that my husband left me for another woman." 4. "I hate myself."

"It's all my fault that my husband left me for another woman."

A female patient tells the nurse that she would like to begin taking St. John's Wort for depression. What teaching should the nurse provide? 1. "St. John's wort should be taken several hours after your other antidepressant." 2. "St. John's wort has generally been shown to be effective in treating depression." 3. "This supplement is safe to take if you are pregnant." 4. "St. John's wort is regulated by the FDA, so you can be assured of its safety."

"St. John's wort has generally been shown to be effective in treating depression."

MDD Signs and Symptoms

5 or more s/s for at least 2 weeks. sad mood, sleep pattern disturbances, increased fatigue, increased agitation, feelings of guilt or worthlessness, anhedonia, decreased ability to think, remember, or concentrate, recurrent thoughts of death or suicide.

Depression

A state wherein the person experiences profound sadness.

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? 1. A low starting dose of a tricyclic antidepressant 2. An SSRI given initially with an MAOI 3. Electroconvulsive therapy to treat suicidal thoughts 4. Elavil to address the patient's agitation

An SSRI given initially with an MAOI

Theories of Depression

Biochemical theories: alterations in hormonal regulation (norepinephrine & serotonin), may be result of inherited or environmental factors, genetic links. Psychological theories: personal history of deprivation, trauma, & significant loss(exaggerated stress response) Psychoanalytic theory views depression as the reaction to the loss of a significant person who has been both hated and loved. Also be prone to low self- esteem & a sense of helplessness due to environmental factors & have a tendency toward depression.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Block the reuptake of serotonin and norepinephrine; often used as 2nd line treatment if pt does not respond to SSRIs; Important considerations: monitor for insomnia & restlessness.

Heterocyclics

Blocks the reuptake of norepinephrine and dopamine; Monitor for dizziness, headache, & tachycardia.

Examples of Heterocyclics

Bupropion (Wellbutrin) mirtazapine (Remeron) trazodone (Oleptro)

stages of grieving:

Denial Anger Bargaining Depression/resignation Acceptance

What statement about the comorbidity of depression is accurate? A. Depression most often exists in an individual as a single entity. B. Depression is commonly seen among individuals with medical disorders. C. Substance abuse and depression are seldom seen as comorbid disorders. D. Depression may coexist with other disorders but is rarely seen with schizophrenia.

Depression is commonly seen among individuals with medical disorders.

Predisposing Factors

Family hx of depression Having experienced recent negative stressors Having childhood experiences in a negative home environment Lacking a social support system Having significant physical disease

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with postpartum depression. A. Impaired parenting B. Ineffective role performance C. Health-seeking behaviors D. Risk for impaired parent/infant/child attachment

Health-seeking behaviors

Major depressive disorder with seasonal pattern (previously called SAD)

Indicates that episodes mostly begin in fall or winter and remit in spring. These patients have reduced cerebral metabolic activity. SAD is characterized by anergia, hypersomnia, overeating, weight gain, and a craving for carbohydrates; it responds to light therapy

Psychotic features

Indicates the presence of disorganized thinking, delusions or hallucinations

deliberating illness that often recurs in one's lifetime

Major depressive disorder

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. Onset of action is from 1 to 6 weeks. B. They tend to be more effective for men. C. They may cause recent memory impairment. D. They often cause the client to have diurnal variation.

Onset of action is from 1 to 6 weeks.

The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which type of major depressive disorder (MDD)? 1. Catatonic 2. Atypical 3. Melancholic 4. Psychotic

Psychotic

The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be the priority on the nurse's discharge plan of care? 1. Pharmacological teaching 2. Safety risk 3. Awareness of symptoms increasing depression 4. The need for interpersonal contact

Safety risk

light therapy

Treats seasonal affective disorder (SAD); scientifically proven to be effective, exposure to daily doses of intense light. Increases activity in the adrenal gland and the superchiasmatic nucleus.

Examples of Tricyclics

amitriptyline (Elavil) nortriptyline (Pamelor) desipramine (Norpramine)

Dysthymia cannot be diagnosed unless it has existed for A. at least 3 months. B. at least 6 months. C. at least 1 year. D. at least 2 years.

at least 2 years.

major depressive disorder (MDD)

characterized by a combination of symptoms that severely interfere with a person's ability to work, sleep, study, eat, & enjoy once pleasurable activities. disabling & prevents a person from functioning normally. Lasts at least two weeks. Represents a change from previous functioning.

Monoamine Oxidase Inhibitors (MAOIs)

dietary restrictions and potential drug interactions make this drug less desirable Contraindicated in people taking other antidepressants Tyramine-rich food could bring about a hypertensive crisis

Examples of SNRIs (serotonin norepinephrine reuptake inhibitors)

duloxetine (Cymbalta) venlafaxine (Effexor)

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions she will take the medication along with the St. John's wort she uses daily. The nurse should A. agree that taking the drugs at the same time will help her remember them daily. B. caution the client to drink several glasses of water daily. C. suggest that the client also use a sun lamp daily. D. explain the high possibility of an adverse reaction.

explain the high possibility of an adverse reaction.

A depressed client tells the nurse "There is no sense in trying. I am never able do anything right!" The nurse can identify this cognitive distortion as an example of A. self-blame. B. catatonia. C. learned helplessness. D. discounting positive attributes.

learned helplessness.

dysthymic disorder (DD)

less severe form of depression that is characterized by its chronic nature; present for more than 2 yrs in an adult (or 1 yr in a child or adolescent); persistent depressive disorder

Beck suggests that the etiology of depression is related to A. sleep abnormalities. B. serotonin circuit dysfunction. C. negative processing of information. D. a belief that one has no control over outcomes.

negative processing of information.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client A. has poor retention of recent events. B. has weight loss of 10 lb or more from anorexia. C. obtains no pleasure from previously enjoyed activities. D. has difficulty with tasks requiring fine motor skills.

obtains no pleasure from previously enjoyed activities.

Postpartum depression;Postpartum onset depression

occurs up to 6 months & is a serious condition. It is common for psychotic features to accompany this depression. Patient suffering from this disorder needs intensive treatment with medication and psychotherapy.

Examples of SSRIs (selective serotonin reuptake inhibitors)

parixetine (Paxil) sertraline (Zoloft) fluoxetine (Prozac)

Examples of MAOIs (monoamine oxidase inhibitors)

phenelzine (Nardil) tranylcypromine (Parnate) isocarboxazid (Marplan)

DD Signs and Symptoms

poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, feelings of hopelessness...And often begins in childhood, adolescents or early adulthood

Nursing care of the depressed patient should include

promotion of self esteem and socialization

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with A. senile dementia. B. hypertensive crisis. C. psychomotor agitation. D. central serotonin syndrome.

psychomotor agitation.

Assessment of thought processes of a client with depression is most likely to reveal A. good memory and concentration. B. delusions of persecution. C. self-deprecatory ideation. D. sexual preoccupation.

self-deprecatory ideation.

It is likely that a client with seasonal affective disorder will begin to feel better in the A. fall. B. winter. C. spring. D. summer.

spring.

A depressed client tells the nurse "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by A. suggesting "Let's look at what you just said, that you can 'never do anything right.'" B. querying "Tell me what things you think you are not able to do correctly." C. asking "Is this part of the reason you think no one likes you?" D. saying "That is the most unrealistic thing I have ever heard."

suggesting "Let's look at what you just said, that you can 'never do anything right.'"

A depressed client tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment: A. for more than 4 months B. that is directed toward relapse prevention C. that focuses on prevention of future depression D. to reduce depressive symptoms

to reduce depressive symptoms

When the nurse remarks to a depressed client "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to A. wait quietly for the client to reply. B. prompt the client if the reply is slow. C. repeat the question if the client does not answer promptly. D. seek information from the client's significant others.

wait quietly for the client to reply.

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client with severe depression. The most reliable evaluation of outcomes will be based on A. energy level. B. weekly weights. C. observed eating patterns. D. client statement of appetite.

weekly weights.