LEARN STEP #2 Make the connections to key topics.
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16 Depressive Disorders
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CHAPTER 16 ■ Depressive Disorders
Introduction Depression is likely the oldest and still one of the most frequently diagnosed psychiatric illnesses. Symptoms of depression have been described almost as far back as there is evidence of written documentation. An occasional bout with the “blues,” a feeling of sadness or downheartedness, is common among healthy people and is considered to be a normal response to everyday disappointments in life. These episodes are short lived as the individual adapts to the loss, change, or failure (real or perceived) that has been experienced. Pathological depression occurs when adaptation is ineffective and the symptoms are significant enough to impair functioning. Mood is a pervasive and sustained emotion that may have a major influence on a person’s perception of the world. Examples of mood include depression, joy, elation, anger, and anxiety. Affect is described as the external, observable emotional reaction associated with an experience. A flat affect describes someone who lacks emotional expression and it is often seen in severely depressed clients. This chapter focuses on the different manifes- tations of depressive illness and implications for nursing intervention. A historical perspective and epidemiology of depression are presented. Predis- posing factors that have been implicated in the etiol- ogy of depression provide a framework for studying the dynamics of the disorder. Similarities and dif- ferences between depressive disorders and grief are discussed. CORE CONCEPT Mood and Affect Depressive illnesses specific to individuals at various developmental stages are reviewed. An explanation of the symptomatology is presented as background knowledge for assessing the client with depression. Nursing care is described in the context of the six steps of the nursing process. Various medical treat- ment modalities are explored.
evident. Changes in appetite, sleep patterns, and cog - nition are common. Severe depression may be accom - panied by suicide ideation and/or attempts.
Care of Patients With Psychiatric Disorders
Historical Perspective Many ancient cultures (e.g., Babylonian, Egyptian, Hebrew) believed in the supernatural or divine ori- gin of mood disorders. The Old Testament states in the Book of Samuel that King Saul’s depression was inflicted by an “evil spirit” sent from God to “torment” him. A clearly nondivine point of view regarding depres- sion was held by the Greek medical community from the 5th century BC through the 3rd century AD and represented the thinking of Hippocrates, Celsus, and Galen, among others. They strongly rejected the idea of divine origin and considered the brain as the seat of all emotional states. Hippocrates believed that melancholia was caused by an excess of black bile, a heavily toxic substance produced in the spleen or intestine, which affected the brain. Melancholia is currently used to describe a severe form of major depressive disorder in which symptoms are exagger- ated and interest or pleasure in virtually all activities is lost. During the Renaissance, several new theories evolved. Depression was viewed by some as being the result of obstructed air circulation, excessive brood- ing, or helpless situations beyond the individual’s control. Depression was reflected in major literary works of the time, including Shakespeare’s King Lear, Macbeth , and Hamlet . Contemporary thinking has been substantially shaped by the works of Sigmund Freud, Emil Krae- pelin, and Adolf Meyer. Having evolved from these early 20th-century models, current thinking about mood disorders generally encompasses the intrapsy- chic, behavioral, and biological perspectives. These various perspectives support the notion of multiple causation in the development of mood disorders. Epidemiology Major depressive disorder (MDD) is one of the leading causes of disability in the United States. In addition to the disability posed by the disorder itself, recent research links depression to an increased risk for several other medical conditions, including coronary artery disease (another leading cause of death), especially in women younger than age 65 (Jiang et al., 2016). In 2019, 4.7% of adults age 18
CORE CONCEPTS Mood and Affect: Depression Professional Behavior: Nursing process in caring for patients with depressive disorders Safety Clinical Judgment
CHAPTER OUTLINE
Objectives Introduction Historical Perspective Epidemiology Types of Depressive Disorders Predisposing Factors Developmental Implications Application of the Nursing Process Treatment Modalities
Summary and Key Points Review Questions Clinical Judgment Questions
Psychotic Disorders
Implications for Evidence-Based Practice Test Your Clinical Reasoning and Clinical Judgment Skills Communication Exercises Movie Connections
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KEY TERMS affect cognitive behavior therapy
mood postpartum depression premenstrual dysphoric disorder psychomotor retardation
Psychotic Disorders
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depression dysthymia melancholia
OBJECTIVES After reading this chapter, the student will be able to: 1. Recount historical perspectives of depression. 2. Discuss the epidemiology of depression. 3. Describe various types of depressive disorders. 4. Identify predisposing factors in the devel- opment of depression. 5. Discuss implications of depression related to developmental stage. 6. Identify symptomatology associated with depression and use this information in patient assessment.
7. Formulate nursing diagnoses and goals of care for patients with depression. 8. Identify topics for patient and family teaching relevant to depression. 9. Describe appropriate nursing inter- ventions for behaviors associated with depression. 10. Describe relevant criteria for evaluating nursing care of patients with depression. 11. Discuss various modalities relevant to treatment of depression.
Psychotic Disorders
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CORE CONCEPT Depression
Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism. In clinically significant depression, there is a loss of inter - est in usual activities, and somatic symptoms may be
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