Mental Health Session 6: Depression

Session 6 Depressive disorder

 

Depression:

 

  • Persistence of symptoms for at least 2 weeks
  • Anhedonia, Sleep issues, Changes in appetite, Feeling like there is a Grey cloud over you all the time (hopelessness), suicidal thoughts, concentration issues, change in physical activity.

 

  • It is the leading cause of disability in the United States.
  • 6% of adults experience a major depressive episode, and it can be the only time in their life that this happens.
  • Children can get depression.
  • Biological factors
    • There are genetic components
    • Biochemical imbalances of serotonin and norepinephrine
    • HPT axis changes, this will decrease thyroid function and therefore the production of T hormones decreasing energy and metabolism.
  • Cognitive theory – thoughts are greater than emotions
    • Cognitive Triad: Negative view of self, pessimistic view of self, and negative occurrences
  • Nursing assessment of Depressive disorder
    • Affect, thought process, mood, feelings, physical, behaviour, communication, spirituality.
  • Nursing diagnosis
    • Risk for suicide, hopelessness, ineffective coping, self care deficit,
  • Psychopharmacology
    • Antidepressants – (do not give to a patient that has bipolar because it will make the maina worse).
      • SSRI’s are the first drug that is usually prescribed.
        • There is a low side effect profile
      • May take 4-6 weeks to be effective
      • Serotonin syndrome if the med reaches toxic levels.
        • Fever, increased HR, seizure, coma, death,
    • Tricyclic antidepressants –
      • Block histamine, and will make the patient tired
      • Anticholinergic effects
      • 8 weeks to see effect
      • Low Therapeutic index, high chance for MI and other heart issues.
    • MAOIs
      • Neurotransmitter changes
      • Interactions with tyrosine (aged cheese, red wine)
      • Hypertensive crisis if toxic
  • Persistent Depressive Disorder (Dysthymis D/O)
    • Chronic depression for at least 2 years
    • Non medical interventions
      • Transcranial magnetic stimulation (TMS)
      • ECT – medical induced seizures to shock the brain to generate different pathways that are different then the depressive ones that already exist.
  • Premenstrual Dysphoric disorder
    • Depressive symptoms that occur 1 week prior to menses
    • Serotonin meds for this, a small increase in the dose for that week before the period can be very helpful.
  • Disruptive Mood Dysregulation disorder
    • Ages 6-18
    • Outbursts, tantrums, fights, poor school performance
    • R/O medical conditions before diagnosis
  • Non-Pharmacologic treatments for Depressive disorders
    • Electroconvulsive therapy
    • Transcranial magnetic stimulation (Brainsway Deep TMS treatment for depression) not very invasive.
    • Vagus stim
    • Light therapy
    • St. John’s wort
  • Grief – when someone is dealing with loss
    • can turn into depression if not dealt with
    • Should try to treat without meds.
  • Freud psychoanalytic theory
    • Id, Ego, Superego

 

Suicide Assessment

  • Assessment
    • Subjective, objective, overt and covert statements, assessment tools,
    • Scale SAD PERSONS – Sex, age, Depression, previous attempt, ethanol, Rational thought loss, social support, organized plan, No spouse, sickness.

 

  • Command hallucinations are hallucinations that tell the person what to do.
    • Rare and can be very overwhelming and disturbing
  • Protective factors – support group, though process
  • Asking the questions:
    • Have you thought about suicide? This is ideation
    • Hove they ever thought though how they would do it?
    • How would they do it and when did they last think about it?

  • Hard and specific questions need to be asked to help the patient, and your own assessment.

 

Psychiatric pediatric emergency

  • Safety is the highest priority
  • RNs will manage the techs to a 1:1 ratio with the children
  • Try not to use restraints
  • The patients are searched for items that can harm themselves, as well as things like cell phones
  • The patients change into maroon scrubs for identification.
  • M-1 Form a 72 hour hold that requires the hospital to hold the patient for three days and the person cannot leave.
    • This also applies to medication that may need to be used to sedate or calm the patient.
  • The family may be the source of the issue and you may need to focus and support the parents as well.
  • Motivational interviewing is huge in this field.
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