Continuation of Depression disorders

Continuation of Depression disorders 150 150 Tony Guo

Continuation of Depression disorders

  • Mild depression
    • Symptoms of mild depression are identified by clinicians as those associated with normal grieving.
      • Affective: Anger, anxiety
      • Behavioral: Tearful, regression 
      • Cognitive: Preoccupied with loss
      • Physiological: anorexia, insomnia
  • Moderate depression 
    • Symptoms associated with dysthymic disorder
      • Affective: Helpless, powerless
      • Behavioral: Slowed physical movements, slumped posture, limited verbalization
      • Cognitive: Retarded thinking processes, difficulty
        with concentration
      • Physiological: Anorexia or overeating, sleep disturbance, headaches
  • Severe depression
    • Includes symptoms of major depressive disorder and bipolar depression
      • Affective: feelings of total despair, worthlessness,
        flat affect
      • Behavioral: psychomotor retardation, curled-up position, absence of communication
      • Cognitive: prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts
      • Physiological: a general slow-down of the entire body

 

Diagnosis/Outcome Identification

  • Risk for suicide related to 
    • Depressed mood 
    • Feelings of worthlessness
    • Anger turned inward on the self
    • Misinterpretations of reality
  • Complicated grieving related to
    • Real or perceived loss 
    • Bereavement overload
  • Low self-esteem related to
    • Learned helplessness
    • Feelings of abandonment by significant others
    • Impaired cognition fostering negative view of self 
  • Powerlessness related to
    • Complicated grieving process
    • Lifestyle of helplessness
  • Spiritual distress related to
    • Complicated grieving process over loss of valued object evidenced by anger toward God, questioning meaning of own existence, inability to participate in usual religious practices
  • Social isolation/Impaired social interaction  related to
    • Developmental regression
    • Egocentric behaviors
    • Fear of rejection or failure of the interaction
  • Disturbed thought processes related to
    • Withdrawal into self
    • Underdeveloped ego
    • Punitive superego
    • Impaired cognition fostering negative perception of self or environment
  • Imbalanced nutrition less than body requirements 
    • Weight loss 
    • Poor muscle tone
    • Pale conjunctiva and mucous membrane
    • Poor skin turgor
  • Insomnia 
    • Lack of energy
    • Difficulty falling asleep
    • Difficulty staying asleep
    • Difficulty concentrating
  • Self-care deficit
    • Uncombed hair
    • Offensive body odor
    • Disheveled clothing

 

Outcomes: The Patient

  • Has experienced no physical harm to self
  • Discusses loss with staff and family members
  • No longer idealizes or obsesses about the lost entity
  • Sets realistic goals for self
  • Attempts new activities without fear of failure
  • Is able to identify aspects of self-control over life situation
  • Expresses personal satisfaction and support from spiritual practices
  • Interacts willingly and appropriately with others
  • Is able to maintain reality orientation
  • Is able to concentrate, reason, and solve problems

 

Planning/Implementation

  1. Risk for suicide: Depressed mood; feelings of hopelessness and worthlessness; anger turned inward in the self; misinterpretations of reality; suicidal ideation, plan, and available means
  • Be direct.
  • Maintain close observation at irregular intervals.
  • Encouraging verbalizations of honest feelings.
  1. Complicated grieving: Depression, preoccupation with thoughts of loss, self-blame, grief avoidance, inappropriate expression of anger, decreased functioning in life roles
  • Develop a trusting relationship with the client.
  • Encourage the client to express emotions.
  • Communicate that crying is acceptable
  1. Low self-esteem/self-care deficit: Expressions of helplessness, uselessness, guilt, and shame; hypersensitivity to slight or criticism; negative, pessimistic outlook; lack of eye contact; self-negating verbalizations
  • Be accepting of the client.
  • Encourage the client to recognize areas of change.
  • Encourage independence in the performance of activities of daily living.
  1. Powerlessness: Apathy, verbal expressions of having no control, dependence on others to fulfill needs
  • Encourage the client to take responsibility.
  • Help the client set goals.
  • Help the client identify

 

Client/Family Education

  • Nature of the illness
    • Stages of grief and symptoms associated with each stage
    • What is depression?
    • Why do people get depressed?
    • What are the symptoms of depression?
  • Management of the illness
    • Medication management
    • Assertive techniques
    • Stress-management techniques
    • Ways to increase self-esteem 
    • Electroconvulsive therapy
  • Support services
    • Suicide hotline
    • Support groups
    • Legal/financial assistance

 

Evaluation

  • Has self-harm to the client been avoided?
  • Have suicidal ideations subsided?
  • Does the client know where to seek assistance outside of the hospital when suicidal thoughts occur?
  • Has the client discussed the recent loss with the staff and family members?
  • Is he or she able to verbalize feelings and behaviors associated with each stage of the grieving process and recognize his or her position in the process?
  • Have obsession with, and idealization of, the lost object subsided?
  • Is anger toward the lost object expressed appropriately?
  • Does the client set realistic goals for self?
  • Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects?
  • Can the client identify areas of life situation over which he or she has control?

 

Treatment Modalities

  • Individual psychotherapy
  • Group therapy
  • Family therapy
  • Cognitive therapy
  • Electroconvulsive therapy
    • Mechanism of action: Thought to increase levels of biogenic amines
    • Side effects: Temporary memory loss and confusion
    • Risks: Mortality; permanent memory loss; brain damage
    • Medications: Pretreatment medication; muscle relaxant; short-acting anesthetic
  • Repetitive transcranial magnetic stimulation
  • Vagal nerve stimulation and deep brain stimulation
  • Light therapy
  • Psychopharmacology
    • Tricyclics 
    • Selective serotonin reuptake inhibitors
    • Monoamine oxidase inhibitors (M A O I’s)
    • Heterocyclics
    • Serotonin-norepinephrine reuptake inhibitors

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