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Major Depressive Disorder

Major Depressive Disorder

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Published by: Mark Bin S. Dilangalen on Jan 16, 2012
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MAJOR DEPRESSIVE DISORDER

CASE SCENARIO
‡ JIM SCARBORO, AGE 23, LIVES W/ EMILY, HIS WIFE OF 19 YEARS. HE WAS BROUGHT IN THE EMERGENCY DEPARTMENT 24 HRS AGO, FF. A SUICIDE ATTEMPT BY GUNSHOT. IN AN ATTEMPT TO SHOOT HIMSELF, JIM SHOT THE GUN, BUT DID NOT HIT HIMSELF. JIMS 21Y/O SON, TONY, WAS AT HOME W/ JIM WHEN HE HEARD THE GUNSHOT AND CALLED FOR AN EMERGENCY ASSISTANCE. JIM HAS JUST BEEN TRANSFERRED TO THE ACUTE PSYCHIATRIC IN PATIENT UNIT.

MOOD DISORDERS
‡ THE MOOD DISORDERS ARE DIVIDED INTO DEPRESSIVE DISORDERS AND BIPOLAR DISORDERS. THE DEPRESSIVE DISORDERS INCLUDE MAJOR DEPRESSIVE DISORDER, DYSTHYMIC DISORDER, AND DEPRESSIVE DISORDER NOS. THE BIPOLAR DISORDERS INCLUDE BIPOLAR I DISORDER, BIPOLAR II DISORDER, CYCLOTHYMIC DISORDER, AND BIPOLAR DISORDER NOS.

FOUR OF THE FOLLOWING SYMPTOMS ARE PRESENT: CHANGES IN APPETITE OR WEIGHT. OR ATTEMPTS. . DURING WHICH THE PERSON EXPERIENCES A DEPRESSED MOOD OR LOSS OF PLEASURE IN NEARLY ALL ACTIVITIES. SLEEP. OR PSYCHOMOTOR ACTIVITY DECREASED ENERGY FEELINGS OF WORTHLESSNESS OR GUILT DIFFICULTY THINKING. CONCENTRATING.  IN ADDITION.MAJOR DEPRESSIVE DISORDER  A MAJOR DEPRESSIVE EPISODE LASTS AT LEAST 2 WEEKS. PLANS. OR MAKING DECISIONS. OR RECURRENT THOUGHTS OF DEATH OR SUICIDAL IDEATION.

OCCUPATIONAL.MAJOR DEPRESSIVE DISORDER  THESE SYMPTOMS MUST BE PRESENT EVERY DAY FOR 2 WEEKS AND RESULT IN SIGNIFICANT DISTRESS OR IMPAIR SOCIAL.  SOME PEOPLE ALSO HAVE DELUSIONS AND HALLUCINATIONS. THE COMBINATION IS REFERRED TO AS PSYCHOTIC DEPRESSION. OR OTHER IMPORTANT AREAS OF FUNCTIONING (AMERICAN PSYCHIATRIC ASSOCIATION [APA]. . 2000).

 SINGLE AND DIVORCED PEOPLE HAVE THE HIGHEST INCIDENCE.  INCIDENCE OF DEPRESSION DECREASES WITH AGE IN WOMEN AND INCREASES WITH AGE IN MEN.DEMOGRAPHICS  MAJOR DEPRESSION IS TWICE AS COMMON IN WOMEN AND HAS A 1.  DEPRESSION IN PREPUBERTAL BOYS AND GIRLS OCCURS AT AN EQUAL .5 TO 3 TIMES GREATER INCIDENCE IN FIRST-DEGREE RELATIVES THAN IN THE GENERAL POPULATION.

.ETIOLOGY ‡ |PSYCHOSOCIAL STRESSORS AND INTERPERSONAL EVENTS APPEAR TO TRIGGER CERTAIN PHYSIOLOGIC AND CHEMICAL CHANGES IN THE BRAIN. WHICH SIGNIFICANTLY ALTER THE BALANCE OF NEUROTRANSMITTERS} .

GENETIC THEORIES  GENETIC STUDIES IMPLICATE THE TRANSMISSION OF MAJOR DEPRESSION IN FIRST-DEGREE RELATIVES. ALTHOUGH HEREDITY IS A SIGNIFICANT FACTOR. FIRST-DEGREE RELATIVES . .3% TO 8% RISK GENERAL POPULATION ­ 1% RISK  MONOZYGOTIC (IDENTICAL) TWINS HAVE A CONCORDANCE RATE (BOTH TWINS HAVING THE DISORDER) 2 TO 4 TIMES HIGHER THAN THAT OF DIZYGOTIC (FRATERNAL) TWINS. 2000). SO GENETICS ALONE DO NOT ACCOUNT FOR ALL MOOD DISORDERS (KELSOE. WHO HAVE TWICE THE RISK OF DEVELOPING DEPRESSION COMPARED WITH THE GENERAL POPULATION. THE CONCORDANCE RATEFOR MONOZYGOTIC TWINS IS NOT 100%.

.  DEFICITS OF SEROTONIN. COGNITION. ITS PRECURSOR TRYPTOPHAN. AGGRESSIVENESS AND IRRITABILITY. OR A METABOLITE (5HIAA) OF SEROTONIN FOUND IN THE BLOOD OR CEREBROSPINAL FLUID OCCUR IN PEOPLE WITH DEPRESSION.NEUROCHEMICAL THEORIES  SEROTONIN (5-HT) HAS MANY ROLES IN BEHAVIOR: MOOD. AND PROLACTIN LEVELS ARE ABNORMAL IN DEPRESSION). BIORHYTHMS. PAIN. AND NEUROENDOCRINE PROCESSES (THAT IS. GROWTH HORMONE. ACTIVITY. CORTISOL.

‡ THIS CATECHOLAMINE ENERGIZES THE BODY TO MOBILIZE DURING STRESS AND INHIBITS KINDLING.‡ NOR EPINEPHRINE LEVELS MAY BE DEFICIENT IN DEPRESSION AND INCREASED IN MANIA. .

 POSTPARTUM HORMONE ALTERATIONS PRECIPITATE MOOD DISORDERS SUCH AS . MOOD DISTURBANCES HAVE BEEN DOCUMENTED IN PEOPLE WITH ENDOCRINE DISORDERS SUCH AS THOSE OF THE THYROID. PARATHYROID. ADRENAL. AND EVIDENCE OF INCREASED CORTISOL SECRETION.  ELEVATED GLUCOCORTICOID ACTIVITY IS ASSOCIATED WITH THE STRESS RESPONSE. AND PITUITARY.NEUROENDOCRINE INFLUENCES HORMONAL FLUCTUATIONS ARE BEING STUDIED IN RELATION TO DEPRESSION.

THE PERSON WAS NOT ABLE TO ACHIEVE THESE IDEALS ALL THE TIME. BIBRING BELIEVED THAT ONES EGO (OR SELF) ASPIRED TO BE IDEAL (THAT IS. PEOPLE BECAME ANGRYWHILE BOTH LOVING AND HATING THE LOST OBJECT. . AND THAT TO BE LOVED AND WORTHY. ONE MUST ACHIEVE THESE HIGH STANDARDS. DEPRESSION RESULTS WHEN. GOOD AND LOVING. FEELING ABANDONED BY THIS LOSS.PSYCHODYNAMIC THEORIES  MANY PSYCHODYNAMIC THEORIES ABOUT THE CAUSE OF MOOD DISORDERS SEEMED TO |BLAME THE VICTIM} AND HIS OR HER FAMILY : FREUD LOOKED AT THE SELF-DEPRECIATION OF PEOPLE WITH DEPRESSION AND ATTRIBUTED THAT SELF-REPROACH TO ANGER TURNED INWARD RELATED TO EITHER A REAL OR PERCEIVED LOSS. IN REALITY. SUPERIOR OR STRONG).

. WITH THE ID TAKING OVER THE EGO AND ACTING AS AN UNDISCIPLINED.± MOST PSYCHOANALYTICAL THEORIES OF MANIA VIEW MANIC EPISODES AS A |DEFENSE} AGAINST UNDERLYING DEPRESSION. HEDONISTIC BEING (CHILD).

± MOST PSYCHOANALYTICAL THEORIES OF MANIA VIEW MANIC EPISODES AS A |DEFENSE} AGAINST UNDERLYING DEPRESSION. MUCH LIKE A POWERFUL AND SADISTIC MOTHER WHO TAKES DELIGHT IN TORTURING THE CHILD. WITH THE ID TAKING OVER THE EGO AND ACTING AS AN .PSYCHODYNAMIC THEORIES ± JACOBSON COMPARED THE STATE OF DEPRESSION TO A SITUATION IN WHICH THE EGO IS A POWERLESS. HELPLESS CHILD VICTIMIZED BY THE SUPEREGO.

AND THE FUTURE. THESE DISTORTIONS INVOLVE . THE WORLD. MAKING THEM SUSCEPTIBLE TO DEPRESSION AND HELPLESSNESS. EARLY EXPERIENCES SHAPED DISTORTED WAYS OF THINKING ABOUT ONES SELF.PSYCHODYNAMIC THEORIES ± MEYER VIEWED DEPRESSION AS A REACTION TO A DISTRESSING LIFE EXPERIENCE SUCH AS AN EVENT WITH PSYCHIC CAUSALITY. ± HORNEY BELIEVED THAT CHILDREN RAISED BY REJECTING OR UNLOVING PARENTS WERE PRONE TO FEELINGS OF INSECURITY AND LONELINESS. ± BECK SAW DEPRESSION AS RESULTING FROM SPECIFIC COGNITIVE DISTORTIONS IN SUSCEPTIBLE PEOPLE.

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ONSET AND CLINICAL COURSE  AN UNTREATED EPISODE OF DEPRESSION CAN LAST 6 TO 24 MONTHS BEFORE REMITTING.  DEPRESSIVE SYMPTOMS CAN VARY FROM MILD TO SEVERE. THE DEGREE OF DEPRESSION IS COMPARABLE TO THE PERSONS SENSE OF HELPLESSNESS AND HOPELESSNESS. THERE IS A 70% CHANCE OF RECURRENCE. .  FIFTY TO SIXTY PERCENT OF PEOPLE WHO HAVE ONE EPISODE OF DEPRESSION WILL HAVE ANOTHER. AFTER A SECOND EPISODE OF DEPRESSION.  SOME PEOPLE WITH SEVERE DEPRESSION (9%) HAVE PSYCHOTIC FEATURES.

PRIORITY NSG INTERVENTIONS .

‡ PROVIDE ADDITIONAL STRUCTURE BY KEEPING PATIENT RESOLVED VIA THERAPEUTIC AND PSYCHOREHABILITATIVE ACTIVITIES . AND ASSESS ENVIRONMENTAL SAFETY OF PATIENTS ROOM AND UNIT. ‡ MONITOR NEED TO REVISE LEVEL OF OBSERVATION.SAFET ‡ ASSESS CURRENT SUICIDE RISK Y ‡ IMPLEMENT APPROPRIATE LEVEL OF OBSERVATION BASED ON A FOCUSED SUICIDE ASSESSMENT ‡ EXPLAIN OBSERVATION PRECAUTION TO PATIENT ‡ REMOVE HARMFUL OBJECTS FROM PATIENT POSSESSION.HARM AND NO SUICIDE} AGREEMENT WITH THE STAFF. ‡ ENCOURAGE PATIENT TO NEGOTIATE A |NO SELF.

PSYCHOPHARMACOLOGY  MAJOR CATEGORIES OF ANTIDEPRESSANTS INCLUDE: CYCLIC ANTIDEPRESSANTS MONOAMINE OXIDASE INHIBITORS (MAOIS) SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) ATYPICAL ANTI-DEPRESSANTS. .

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PHYSIOLOGIC STABILITY ‡ ASSESSMENT DATA y INADEQUATE FOOD AND FLUID INTAKE. y LACK OF AWARENESS OF PERSONAL NEEDS. y INSOMNIA y FATIGUE .

AND SERVE LIMITED PORTIONS. SCHEDULE MEALS AND SNACKS. ‡ OBSERVE AND RECORD THE CLIENTS PATTERN OF . ‡ DO NOT TELL THE CLIENT THAT HE OR SHE WILL GET SICK OR DIE FROM NOT EATING OR DRINKING. ‡ THE CLIENT MAY NEED A HIGH-CALORIE DIET AND SUPPLEMENTAL FEEDINGS. AND MAKE THEM AVAILABLE AT MEALS AND FOR SNACKS. IF THE CLIENT IS OVEREATING. PROTEIN. AND FLUID INTAKE YOU MAY NEED TO RECORD INTAKE AND OUTPUT. LIMIT ACCESS TO FOOD.GIVE THE CLIENT POSITIVE FEEDBACK FOR ADHERING TO THE PRESCRIBED DIET.INTERVENTIONS ‡ MONITOR THE CLIENTS CALORIE. ‡ TRY TO FIND OUT WHAT FOODS THE CLIENTS LIKES.

PSYCHOTHERAPY  A COMBINATION OF PSYCHOTHERAPY AND MEDICATIONS IS CONSIDERED THE MOST EFFECTIVE TREATMENT FOR DEPRESSIVE DISORDERS. .  THERE IS NO ONE SPECIFIC TYPE OF THERAPY THAT IS BETTER FOR THE TREATMENT OF DEPRESSION.

 BEHAVIOR THERAPY SEEKS TO INCREASE THE FREQUENCY OF THE CLIENTS POSITIVELY REINFORCING INTERACTIONS WITH THE ENVIRONMENT AND TO DECREASE NEGATIVE INTERACTIONS. AND THE FUTURE AND INTERPRETS HIS OR HER EXPERIENCES.  IT ALSO MAY FOCUS ON  COGNITIVE THERAPY FOCUSES ON HOW THE PERSON THINKS ABOUT THE SELF. OTHERS. ROLE DISPUTES. AND FUNCTIONAL ABILITIES. THIS MODEL FOCUSES ON THE PERSONS DISTORTED THINKING THAT IN TURN INFLUENCES FEELINGS. INTERPERSONAL THERAPY FOCUSES ON DIFFICULTIES IN RELATIONSHIPS SUCH AS GRIEF REACTIONS. . AND ROLE TRANSITIONS. BEHAVIOR.

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