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Depression (Assessment (Evaluate the risk of suicide or harm to others,…
Depression
Assessment
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hx of depression "Have you ever gone through or felt anything like this before?" "What seemed to help you at that time"
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Prevalence
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chronic medical problems: HTN, backache, arthritis, CA
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Nursing Interventions
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Pharmacological
Antidepressants
combo of psychotherapy reduce relapse. Antidepressants improve core symptoms of depression & quality-of-life measures improve with certain psychotherapies.
Safety:
Can increase risk of suicide/violence.
SSRIs in older adults can cause stroke, fxs, epilepsy, death. SSRI in pregnancy can cause autism or lung HTN.
Cerebral microbleeds
Classes First line:
Cyclic antidepressants (TCAs)
Dual Action Antidepressants SSRIs, SNRIs, and NDRIs
Atypical Antidepressants
Classes 2nd line: Monoamine Oxidase Inhibitors (MAOIs)
Presentation
often accompanies other psych dx: anxiety, PTSD, schizophrenia, etc
Risk factors
Hx of previous episodes.
Family hx.
Member of LGBT.
Female.
40 or younger.
postpartum period.
chronic medical illness.
absence of social support.
negative,
stressful life event.
Alcohol abuse.
hx of sexual abuse
Symptoms
Mood of sadness, despair, emptiness.
Negative pessimistic thinking.
Anhedonia, low self-esteem.
Apathy, low motivation, & social withdrawal.
excessive emotional sensitivity.
irritability or frustration tolerance.
Insomnia.
Disruption in [ ].
Suicidal Ideation.
Excessive guilt.
Indecisiveness
Feelings of Worthlessness: low self-esteem
Guilt
Helplessness/HOPELESSNESS
Anger/Irritability
PHYSICAL CHANGES:
poor posture
look older
weeping/not able to cry
not make eye contact
monotone
flat affect
sighing
psychomotor retardation
psychomotor agitation
vegetative signs of depression: changes in eating/sleeping/bowel
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Theory
Involves changes in neurotransmitter relationships in limbic system (emotional alterations).
Prefrontal cortex (decreased mood, prb [ ]).
Hippocampus (memory impairments; worthlessness).
Amygdala (anxiety and reduced motivation)
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