chapter 21: Depression and other mood disorders

Most depressive responses in children are tied to:

A specific event or situation

Which of the following theoretical models focuses on depression as a group of learned responses?

According to the behavioral model, all behavior is learned, and depression results from learned responses. According to the interpersonal model, behavior is motivated by avoidance of anxiety and attainment of satisfaction. According to the psychoanalytical model, mood disorders result from anger turned inward. According to the social model, depression results from faulty social interactions.

Depression in adolescence usually is related to what factors?

Depression in adolescence usually is related to four factors: self-esteem, loneliness, family strengths, and parent-teen communications.

Describe the difference between bipolar I disorder and bipolar IIdisorder

Bipolar I disorder is characterized by episodes of depression that alternate with episodes of mania. It is the more severe and incapacitating form of bipolar illness. Delusions are common during periods of mania. Hallucinations can occur. Individuals with bipolar II disorder experience major episodes of depression that alternate with periods of hypomania. Bipolar II disorder often leads to 1 to 2 weeks of severe lethargy, withdrawal, and melancholy. This is followed by several days of elevated or irritable mood, constant activity, and risky decision making.

What drugs are used most commonly to treat mood disorders?

Drugs that are used most commonly to treat mood disorders include antidepressants and mood-stabilizing drugs known as antimanics.

Which client would the nurse expect to prepare for electroconvulsive therapy (ECT)?

ECT is an appropriate intervention for major depression with risk of suicide. ECT is not used for dysthymic disorders. ECT is contraindicated in persons with heart disease and in persons with tumors of the nervous system.

Which instruction should the nurse give a client who is prescribed lithium carbonate (lithium)?

Encourage client to maintain a stable fluid intake daily to promote adequate excretion of the medication. Exercising in hot weather would cause sodium depletion, which would alter serum lithium levels. Encourage client to maintain a stable fluid intake daily to promote adequate excretion of the medication. Restriction of salt may increase lithium levels in the blood.

Which of the following individuals is more likely to experience depression?

High rates of depression occur in older medically ill adults. The highest rates of depression in older adulthood occur in elderly women, medically ill persons, and individuals in long-term care facilities. Older adults living alone are not associated with higher rates of depression.

Clients who are taking lithium must monitor their water and salt intake because:

Lithium competes with sodium, so increase in salt decreases lithium. decrease salt increases lithium

client comes in demonstrating increased activity and agitation and gives much more importance to thoughts and ideas. This client is demonstrating ________.

Mania refers to an emotional state in which a person has an elevated, expansive, and irritable mood accompanied by loss of identity, increased activity, and grandiose thoughts and actions

Explain how social factors can influence mood disorders

Many social factors have an influence on the development of mood disorders. Family relationships are important. Adults who were not nurtured as children are at higher risk for depression. Losses, role changes, and physical illnesses have an impact on the development of emotional problems. Poor social support, such as few friends and no significant others, heightens the loneliness of individuals, and repeated reactions to stress and crises wear down one's emotional resistance.

Compare and contrast mild depression and moderate depression.

Mild depression is short-lived and usually is triggered by life events or situations outside the individual. With mild depression, individuals frequently complain of feeling lost, let down, or disappointed. Drug or alcohol use may increase during this time. Mild depression usually is self-limiting and subsides as interest in life returns to normal. In contrast, moderate depression persists over time. Feelings of depression begin to seriously interfere with activities of living because individuals lack the energy to make it through the day. Persons with moderate levels of depression are at higher risk of suicide as their depression increases.

How do older adults express their feelings of depression?

Older adults often express their feelings of depression in more subtle ways than younger persons do. Most do not complain or volunteer to share their feelings. Signals of depression in the elderly population include changes in daily routine, eating, sleeping, or activity patterns; decreased concentration, communications, and motivation; feelings of envy, failure, indecision, guilt, and hopelessness; loss of interest, self-confidence, and self-esteem; and worry or talk about death.

Why must clients be carefully monitored during the first weeks of lithium therapy?

Once the client is no longer manic, the need for lithium drops dramatically. Toxicity may set in rapidly unless the dose is reduced.

Assessment of a client reveals severe and sudden mood swings from mania to depression. Which diagnosis should the nurse suspect?

Persons with bipolar disorder live in a world that fluctuates between the emotional extremes of mania and depression. Dysthymic disorder and major depressive disorders do not involve mania. Emotional extremes of mania and depression are not indicative of a personality disorder.

Summarize the characteristics of a person who suffers from bipolar disorder.

Persons with bipolar disorder live in a world that seesaws between the emotional extremes of mania and depression. Thoughts, moods, and behaviors swing from normal to grandiose to depressed. A return to normal functioning follows (the "in-between time"), and then the cycle begins again. Time intervals between manic episodes vary. Individuals who cycle rapidly have a poorer prognosis.

List the possible causes of mood disorders.

Possible causes of mood disorders include genetic susceptibility, biochemical imbalance, environmental and other stressors, childhood and adult experiences, and social circumstances.

The client has recently started antidepressant drug therapy. He approaches the nurse complaining of a headache, palpitations, and stiffness in the neck. What is the nurse's priority action?

Report signs to physician. These are serious side effects.

A client characteristically experiences fatigue, gloom, and loss of energy during the winter months. Which diagnosis should the nurse suspect?

Seasonal affective disorder. Levels of mild to moderate depression are experienced during long winter days, especially from October to April. A cyclothymic disorder does not involve seasonal depression. Mild depression is short-lived and usually is not triggered by seasonal change. A mood disorder does not involve seasonal depression.

A depressed client has been prescribed a selective serotonin reuptake inhibitor. Which medication may have been prescribed?

Sertraline (Zoloft). Selective serotonin reuptake inhibitors are more often prescribed for the treatment of depression because of their low incidence of side effects. Amitriptyline (Elavil) is a tricyclic antidepressant. Clonazepam (Klonopin) is a mood-stabilizing medication. Lorazepam (Ativan) is a benzodiazepine.

Feelings of worthlessness, guilt, and despair are expressed in a female client's every thought, movement, and activity. Her physical appearance has declined, and she is commonly unable to eat. What is the client experiencing?

Severe depression

Depression in adolescence usually is related to loneliness, family strengths, self-esteem, and which of the following?

Teens who can discuss their concerns with understanding parents have lower rates of depression. Peer relationships, academic issues, and teacher-teen communication are important, but parent-teen communication is more influential with teens with regard to depression

Identify and describe the phases of a therapeutic plan for a client with a mood disorder

The therapeutic plan for clients with mood disorders is divided into three phases. The acute treatment phase lasts 6 to 12 weeks. Inpatient hospitalization may be required when clients are too impaired to continue with activities of daily living or are too suicidal to be left alone. The continuation phase usually lasts 4 to 9 months, and treatment is provided on an outpatient basis. Medications and psychotherapy are continued. Clients are educated about the nature of their condition and their medications and are encouraged to try new coping behaviors. The maintenance treatment phase concentrates on preventing recurrences in clients with prior episodes of depression or mania. Maintenance psychotherapy and medications help to prevent new episodes or recurrences.

A middle-aged man has lost all sources of income. He is unable to function, cares about nothing, and feels powerless. His feelings of worthlessness and despair have lasted 3 weeks. He is suffering from which of the following?

When depression is severe and lasts longer than 2 weeks, it is a major depressive episode. Dysthymia, or moderate depression, persists over time, and feelings of depression begin to seriously interfere with daily living. Mild depression is short-lived and usually is triggered by life events or situations outside the individual. Dysthymia, or moderate depression, persists over time, and feelings of depression begin to seriously interfere with daily living.

Clients with bipolar I, bipolar II, or cyclothymic disorders exhibit different types of:

mania