DEPRESSION NURSING

1. DEPRESSION

2. MOOD DISORDERS :
Mood/affective Disorders
are characterised by a
disturbance of mood,
accompanied by a full or
partial manic or depressive
syndrome, which is not due
to any other physical and
mental disorder.

3. CLASSIFICATION
• F 30 : MANIC EPISODE
• F 31: BIPOLAR AFFECTIVE DISORDER
• F32 : DEPRESSIVE EPISODE
• F33 : RECURRENT DEPRESSIVE
DISORDER
• F34: PERSISTENT MOOD DISORDER
• F38 : OTHER MOOD DISORDERS
• F39 : UNSPECIFIED MOOD DISORDERS

4. DEFINITION
Oxford textbook of psychiatry (1997)
defines depressive disorders as
syndromes of depressed mood,
pessimistic thinking , lack of enjoyment,
reduced energy and slowness.

5. ICD-10 CLASSIFICATION
• F30-39- mood ( affective disorder)
• F 32 -Depressive episode
• F 32.0 -Mild depressive episode
• F 32.1 - Moderate depressive episode
• F 32.2 - Severe depressive episode without psychotic
symptoms
• F 32.3 - Severe depressive episode with psychotic
symptoms
• F 32.8 - Other depressive episode – atypical depression
• F 32.9 - Depressive episode , unspecified
• F 33 - Recurrent depressive disorder.

6. EPIDEMIOLOGY
lifetime prevalence of about 15%
perhaps as high as 25% for women.
• Sex: more in women.
• Age: The mean age of onset is about
40 years, 50% of all the patients have
an onset between 20-50 years of age.
• Marital status
• Socioeconomic and cultural
considerations: rural areas than in
urban.

7. ETIOLOGY
• Biological Theories
– Genetics:
• twin studies,
• family studies and
• Adoption studies.

8. ETIOLOGY
• Biochemical influences (
NE,SERO.,DOP,A.CH)
• Neuroendocrine disturbances
– Hyperactivity of adrenal gland
– Decreased level of thyroid hormone

9. ETIOLOGY
• Physiological influences
– Medication side effects: steroids,
hormones, sedatives, antineoplastics,
antibacterials
– Neurological disorders:
– Nutritional deficiencies:

10. ETIOLOGY
• PSYCHOSOCIAL THEORIES
– Psychoanalytic theory: loss of loved
object.
– Behavioral theory: conditioned by
repeated losses in past.
– Cognitive theory: depression is due to
negative cognitions
– Sociological theory: Stressful life
events

11. CLINICAL FEATURES
• DEPRESSED MOOD: Sadness of mood,
loss of interest and loss of pleasure in
almost all activities.
– Pervasive and persistent pattern of
sadness.

12. CLINICAL FEATURES
• DEPRESSIVE COGNITIONS
– Hopelessness: no hope in future due to
pessimism.
– Helplessness: no help is possible
– Worthlessness: feeling of inadequacy and
inferiority.
– Unreasonable guilt
– Self blame

13. CLINICAL FEATURES
• SUICIDAL THOUGHTS:
• PSYCHOMOTOR ACTIVITY:
– Psychomotor retardation
– Thinks, walks and acts slowly
– Monotonous
– Delay in answering questions

14. CLINICAL FEATURES
• PSYCHOTIC FEATURES
– Delusions and hallucinations

15. CLINICAL FEATURES
• Somatic symptoms
– Significant decrease in appetite or weight
– Early morning awakening
– Pervasive lack of interest and lack of reactivity to
pleasurable stimuli
– Posture is stooped
– Reddened eyes from crying
– Persons look 10 years older than their
chronological age.
– Constipation and anorexia
– dry mouth, headache, sleep disturbance, fatigue
and lowered libido

16. MAJOR DEPRESSIVE DISORDERS
• SINGLE EPISODE OR RECURRENT
• MILD/MODERATE/ SEVERE
• WITH PSYCHOTIC FEATURES
• WITH CATATONIC FEATURES
• WITH MELANCHOLIC FEATURES
• CHRONIC
• WITH SEASONAL PATTERN
• WITH POSTPARTUM ONSET
• DYSTHYMIC DISORDER
• PREMENSTRUAL DYSPHORIC DISORDER

17. DIAGNOSIS
• ICD 10 diagnostic criteria
• Psychological tests- Beck depression
inventory, Hamilton rating scale
• Dexamethazone suppression test
• Based on signs and symptoms

18. TREATMENT
• Pharmacotherapy

19. PHARMACOTHERAPY
• antidepressants

20. PHYSICAL THERAPIES
• ELECTROCONVULSIVE THERAPY:
severe depression with suicidal risk .
• LIGHT THERAPY: seasonal depression
• REPETITIVE TRANS CRANIAL
MAGNETIC STIMULATION.

21. PSYCHOSOCIAL THERAPIES
• Cognitive therapy
• Psychoanalytic therapy
• Supportive psychotherapy
• Group therapy
• Family therapy
• Behavioral therapy

22. NURSING MANAGEMENT

23. ASSESSMENT

24. NURSING DIAGNOSIS
• High risk for self directed violence
related to depressed mood, feelings of
worthlessness and anger turned inward
on the self
• Dysfunctional grieving related to real or
perceived loss as evidenced by denial of
loss, inappropriate expression of anger.

25. • Powerlessness related to dysfunctional
grieving process as evidenced by feeling of
lack of control over life situations.
• Self esteem disturbance related to learned
helplessness , negative view of self as
evidenced by expression of worthlessness
and sensitivity to criticism
• Altered sleep and rest related to depressed
mood as evidenced by difficulty in falling
asleep and early morning awakening.

26. THANK YOU