Date post: | 17-Dec-2014 |
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Depression
Major Depressive d/o Potential for pain and suffering in all aspects
of life Affects ALL ages May include: psychosis, catatonic symptoms,
and melancholy Dysthymia
Chronic Depression > 1year for children > 2 years for adults/ elderly
Premenstrual Dysphoric Depressed, anxious , moody Still being researched for data
Also to be considered: Seasonal affective disorder Postpartum depression
Depression may result from a complex interaction of causes, as evidences by high variability of: Symptoms Response to treatment and course of illness
Common Theories:-Biological-Psychosocial influences/ life events
CognitiveLearned helplessness
Tools Beck Depression Inventory Hamilton Depression Scale Geriatric Depression Scale Zung Depression Scale SAD Person’s Scale
National Mental Health Association http://www.depression-screening.org
Safety First Suicide Potential
Key Symptoms Depressed mood Anxiety Psychomotor agitation or retardation Somatic complaints Vegetative signs
Affect (sad, weeping)
Thought Processes (delusions, poor judgment)
Feelings (anger, anxiety, hopelessness)
Guilt (rumination over past failings)
Physical Behavior (lethargy, poor hygiene, posture )
Communication (slow speech, slow comprehnsion)
Transient “blues” tired, feel like your in a little slump
Mild Normal grief response, may cry, eating changes
Moderate dysthymic., a little hopeless, ?suicidal potential Losing interest in self, grooming, social etc
Severe Increased hopelessness, total despair, life
functioning affected, Suicidal? Homicidal?
Unrealistic expectations
Feelings originating from the client
Understanding of depression as a systemic illness with a complex interaction of causes
Risk for suicide
Hopelessness
Powerlessness
Disturbed thought process
Ineffective coping
Think – Pair- Share
Find a partner and come up with a one minute care plan ( ie outcome criteria/ interventions)
On you mark ..get set…go
(Prioritize your interventions)!!!
Sheila is a 35 year old IV therapist. She is grossly obese and has recently been suffering from shortness of breath on exertion. She has High BP, High Cholesterol and has noticed that a sore on her foot from a cut has not been healing. She has not been sleeping in her bed but on the couch so she can watch movies when she can’t sleep. She is tired, has a low tolerance for frustration, and feels constantly behind in all that she does.
She is divorced and is raising a teenage son. She just received an invitation to her high school reunion. She
Starts crying and con not stop all day. When her son gets home from school he calls an ambulance because his mother keeps talking about ending it all.
Client hx: she was head cheerleader in high school. She got married right out of school due to an unexpected pregnancy.
What are your priority assessments? Diagnosis? Why? Outcome Criteria for her that you would expect?
Remain safe Reports hope for the future Identifies precursors of depression Reports improved mood Plans strategies to reduce the effects of
precursors of depression
Did You get these as well???
Communication Counseling Encourage self care Therapeutic Milieu Health Teaching Medications Assess effects of Medications
Psychotherapy Cognitive Therapy Interpersonal Therapy
Social Skills Training Group Therapy
Classes of antidepressants First Line agents
Selective Serotonin Reuptake inhibitors (SSRIS) Heterocyclic antidepressants Tricyclic anti depressants (TCA)
Second line agents (interventions) Monoamine oxidase inhibitors (MAOIS) Electroconvulsive Therapy (ECT)
Block the reuptake of serotonin; thereby serotonin neurotransmission is enhanced
Indications: most widely used (Prozac, Celexa, Paxil, Zoloft)
Side Effects: Lower incidence of anticholinergic side effects than TCA’s
Adverse effects: agitation, sleep disturbance, Sexual dysfunction*
What does that mean? COMPLIANCE!!!
“Novel “ antidepressants (Wellbutrin/trazadone), They inhibit the reuptake of norepi/serotonin.
Neurotransmitters: Serotonin –norepinephrine reuptake inhibitors
(SNRI’s) ex. (Effexor/ Cymbalta) Selective norepinephrine reuptake inhibitors
(NRI’s) ex. (Vestra) Advantages Adverse Effects
Inhibit reuptake of norepinephrine and serotonin by increasing the amount of time that the neurotransmitters are available at the postsynaptic receptors
Examples: Pamelor, Tofranil, SinequanAdvantages
Adverse Effects Start low….go slow!!!! Contraindications (Cardiacs/ hx of
seizures/ pregnancy)
Neurotransmitter: increases norepi, tyramine, dopamine, serotonin in the system
This naturally raises the mood! Advantages: rare sedation, used for atypical
depression and panic d/o, OCD, PTSD Nardil, Parnate ( two most common) Adverse effects (Cardiac changes)
Avoid food with tyramine Drugs that interact with MAOI ( pg 349) Contraindications
Used when a rapid response is needed to prevent suicidal ideations, extreme agitation, poor response to a variety of meds.
Procedure Advantages Potential adverse reactions Article: Read ECT Article on Blackboard Also check out pg552 for pharmacology
chart
Integrative approaches for depression Light Therapy (First line treatment for SAD,
seasonal affective d/o) St John’s Wort ( herb) Exercise ( naturally increases mood)
Future of treatment Early screening for indicators Education for society Promotion of supplemental strategies by MD’s