Depressive Disorder

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WELCOME

Prepared By :
Susma Limbu
BNS 2nd year
Roll no : 15
DEPRESSIVE DISORDER
INTRODUCTION

Depression is a syndrome consisting of low mood and or loss of interest


in usual activities, accompanied by psychomotor and cognitive
manifestations, and representing deterioration from the individual’s
usual level of functioning.
DEFINITION

Depression is defined as “clinically significant distress or impairment in


social, occupational, or other important areas of function. Major
depression is characterized by a change in mood or sleeping or eating
habits, low energy or fatigue, reduced concentration, feeling of
worthlessness or excessive sad and thoughts of death or suicide
(American Psychiatric Association, 2013).
CLASSIFICATION (ICD11)
1. Depressive episode:
- Mild depressive episode
- Moderate depressive episode
- Severe depressive episode without psychotic features
- Severe depressive episode with psychotic features
- Other specified depressive episodes
- Unspecified depressive episode
CONTD….
2. Recurrent depressive disorder:
- Recurrent mild depressive disorder
- Recurrent moderate depressive disorder
- Recurrent severe depressive disorder without psychotic features
- Recurrent severe depressive disorder with psychotic features
- Other specified recurrent depressive disorder
- Unspecified recurrent depressive disorder
CONTD….

3. Persistent depressive disorder:

- Persistent depressive episode (dysthymia)

- Other specified persistent depressive disorder

- Unspecified persistent depressive disorder


CONTD….
4. Other depressive disorders:

- Short duration depressive episode

- Mixed depressive anxiety disorder

- Adjustment disorder with depressive symptoms

-Other specified depressive disorder

- Unspecified depressive disorder


EPIDEMIOLOGY

 Depression among children and adolescents is a widespread issue.


According to studies, approximately 3% to 8% of children and
adolescents experience depression at any given time. The prevalence
increases with age and is higher among females compared to males
during adolescence.
CONTD….

 Depression can occur at any age, with a peak onset during


adolescence. The average age of onset for major depressive disorder
is around 15-16 years old. However, it is important to note that
depression can also develop in younger children, even as early as
preschool age.
RISK FACTORS
• Family history of depression
• Stressful situations
• Female gender
• Prior episodes of depression
• Medical comorbidity
• Past suicide attempt
• Lack of support system
• History of physical or sexual abuse
• Current substance use
CAUSES

1.Genetics and family history: Children and adolescents with a family


history of depression or other mood disorders are at a higher risk of
developing depression themselves. Genetic factors can influence the
risk by affecting the regulation of neurotransmitters and other brain
chemicals involved in mood regulation.
CONTD….

2.Biological factors: Chemical imbalances in the brain, specifically


involving neurotransmitters such as serotonin, norepinephrine, and
dopamine, can play a role in depression. Additionally, hormonal
changes during puberty can contribute to emotional and psychological
difficulties.
CONTD….

3.Environmental factors: Adverse childhood experiences, such as


trauma, abuse (physical, sexual, or emotional), neglect, loss of a loved
one, or significant life stressors (e.g., parental divorce, relocation,
academic pressure), can increase the risk of depression. Family conflict,
unstable family dynamics, and a lack of social support can also
contribute.
CONTD….

4. Psychological factors: Certain personality traits, such as a tendency


towards negative thinking, low self-esteem, perfectionism, or excessive
self-criticism, can make children and adolescents more susceptible to
depression. Additionally, poor coping skills, difficulty managing
emotions, and dysfunctional thought patterns can play a role.
CONTD….

5. Peer and social factors: Bullying and social exclusion, particularly


during adolescence, can contribute to the development of depression.
The pressure to fit in, societal expectations, and the impact of social
media can also affect mental well-being in vulnerable individuals.
CONTD….

6. Chronic health conditions: Children and adolescents dealing with


chronic medical conditions, such as diabetes, asthma, or chronic pain,
may be at higher risk for developing depression due to the emotional
and physical toll these conditions can impose.
SIGN & SYMPTOMS

1) Depression mood

2) Loss of interest

3) Poor concentration

4) Reduced self - esteem and self confidence

5) Disturb sleep

6) Irritability
CONTD….

7) Change in appetite or weight

8) Feeling of guilt or worthlessness

9) Hopelessness

10) Suicidal thought or acts

11) Tiredness

12) Depression associated with physical illness


DSM-V DIAGNOSTIC CRITERIA

A. Five (or more) of the following symptoms have been present


during the same 2-week period and represent a change from previous
functioning; at least one of the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another
medical condition.
CONTD….

1. Depressed mood most of the day, nearly every day, as indicated by


either subjective report (e.g., feels sad, empty, or hopeless) or
observation made by others (e.g., appears tearful). (Note: In children
and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation).
CONTD….

3. Significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in a month), or decrease or increase in appetite
nearly everyday. (Note: In children, consider failure to make expected weight
gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by
others; not merely subjective feelings of restlessness or being slowed down).
CONTD….

6. Fatigue or loss of energy nearly every day.


7. Feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others).
CONTD….

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal


ideation without a specific plan, or a suicide attempt or a specific plan
for committing suicide.
B. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a
substance or another medical condition.
TREATMENT

 Antidepressant drugs:
1. Tricyclic antidepressants ( TCAs)
 Imipramine
 Amitriptyline
 Clomipramine
 Dothiepin
 Mionserin
CONTD….

2. Selective serotonin reuptake inhibitors ( SSRIs)

 Fluoxetine

 Sertraline

3. Dopaminergic antidepressants

 Fluvoxamine
CONTD….

4. Atypical antidepressants

 Amineptine

5. Monoamine oxidase inhibitors ( MAOIs)

 Trazodone

 Isocarboxazid
CONTD….

Benzodiazepine
 The use of benzodiazepines in depressive disorders is generally
limited to specific situations, such as when anxiety symptoms coexist
with depression or when depressive symptoms are severe and require
immediate relief. They are usually prescribed on a short-term basis or
as an adjunct to other antidepressant medications.
 Common benzodiazepines used to treat GAD include: Alprazolam,
Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam.
CONTD….

Physical therapies
1. Electroconvulsive therapy (ECT): severe depression with suicidal risk is the
most important indication for ECT.
2. Light therapy: sometimes called phototherapy involves exposing the patient
to an artificial light source during winter months to relieve seasonal depression.
3.Repetitive transcranial magnetic stimulation (TMS) and Vagus nerve
stimulation: directly affect brain function by extensions of the brain.
CONTD….

Psychosocial treatment:
 Psychotherapy
 Cognitive therapy
 Supportive psychotherapy
 Group therapy
 Suicidal precaution
NURSING MANAGEMENT
1. Assessment:
 Obtain information about the patient's personal and family history, including
any previous episodes of depression or other mental health conditions.
 Assess the presence and severity of depression symptoms, including low
mood, irritability, decreased energy, changes in appetite and sleep patterns,
feelings of worthlessness or guilt, difficulty concentrating, and thoughts of
death or suicide.
CONTD….

 Perform a physical examination to rule out medical conditions that may

contribute to depressive symptoms. Look for signs of changes in weight,

sleep disturbances, or other physical symptoms associated with depression.

 Evaluate the patient's overall emotional well-being, including their ability

to experience joy, engagement in activities, and social interactions. Inquire

about any recent changes in behavior or withdrawal from social activities.


CONTD….

 Assess the impact of depression on the patient's academic performance,


social relationships, and participation in extracurricular activities.

 Evaluate the patient for any immediate risk of self-harm or suicide.

 Engage with the patient's family to gather information about the home
environment, family dynamics, and any significant life stressors that
could contribute to the depression
NURSING DIAGNOSIS

 Impaired social interaction related to withdrawal & decreased interest in

activities.

 Disturbed sleep pattern related to insomnia associated with depression.

 Imbalanced nutrition less than body requirement related to changes in appetite.

 Deficit knowledge related to unfamiliarity to disease condition as evidenced by

questionnaire regarding disease condition.


CONTD….

 Risk for self-harm or suicide related to depressive symptoms &

feeling of hopelessness.

 Risk for impaired academic performance related to decreased energy,

lack of motivation, & difficulty concentration.


NURSING INTERVENTION

 To improve social interaction:


 Encourage participation in group therapy or support groups. It can help them
build connections with peers who are going through similar challenges.
 Work with the adolescent to identify specific social skills they struggle with
and provide opportunities for practice. This can include role-playing
exercises or real-life scenarios where they can learn and practice effective
communication, active listening, and problem-solving skills.
CONTD….

 Encourage the adolescent to engage in activities that interest them, such


as sports, art classes, or clubs. These activities can provide opportunities
to meet new people with shared interests, promoting socialization.
 Coordinate with school counselors or teachers to ensure the adolescent's
social needs are addressed within the school environment.

 Provide guidance on social media usage.


CONTD….

 Involve the adolescent's family in their care plan and educate them about
appropriate ways to support their social interactions.

 Offer role-modeling and socialization opportunities.

 To improve sleep disturbance:


 Teach the patient relaxation techniques such as deep breathing, progressive
muscle relaxation, and guided imagery to help ease anxiety and promote sleep.
CONTD….

 Promote a comfortable environment; make sure that the patient's sleeping


environment is conducive to sleep. This can involve adjusting the
lighting, decreasing noise, and ensuring the temperature is comfortable.
 Encourage the patient to establish a regular sleep-wake cycle, with
consistent times for sleeping and waking.
 Monitor and manage the patient's depression levels. High levels of
depression are often associated with sleep disturbances.
CONTD….

 To improve nutritional status:


 Conduct a comprehensive nutritional assessment to identify any
deficiencies or nutritional needs specific to the adolescent. This assessment
should include measurements such as weight, height, body mass index
(BMI), dietary intake, and any changes in appetite or eating habits.
 Educate the adolescent about the importance of a balanced diet and the role
nutrition plays in mental health.
CONTD…

 Encourage the adolescent to have three balanced meals and healthy snacks
throughout the day to maintain stable blood sugar levels and provide adequate
energy.
 Recognize and address emotional eating patterns that may be present in
adolescents with depressive disorder, as they may turn to food as a coping
mechanism.
 Continuously provide emotional support and motivation to help the adolescent
adhere to their nutritional plan.
CONTD….

 To prevent self-harm or suicide:


 Conduct a thorough assessment to identify the level of suicide risk in the
adolescent or child. This may include evaluating their verbalizations, behaviors,
history of self-harm, social support, and access to lethal means. Regularly monitor
their mental status and communicate openly about their feelings and thoughts.

 Educate the child, family, and relevant caregivers about the warning signs of
suicidal ideation or self-harm.
CONTD….

 Build a trusting and empathetic relationship with the adolescent or child. Encourage
open communication and active listening, providing a safe space for them to
express their thoughts and emotions without judgment.
 Encourage and support participation in evidence-based psychological therapies,
such as cognitive-behavioral therapy or dialectical behavior therapy.
 Regularly monitor and assess the child or adolescent's mental health status, response
to interventions, and adherence to the safety plan. Provide ongoing support,
emotional validation, and reassurance.
CONTD….

 To improve knowledge deficit:


 Determine the specific areas where the adolescent lacks knowledge
and understanding about depressive disorder.
 Use clear language and provide visual aids or written materials to
enhance comprehension. Explain the symptoms, causes, and
treatment options available for depressive disorders.
CONTD….

 Create a safe and non-judgmental environment for the adolescent to


ask questions and express concerns.
 Educate the adolescent's family about depressive disorder to enhance
their understanding and support.
CONTD….

 To improve academic performance:


 Identify the specific areas where the depressive disorder is impacting
the adolescent's academic performance. This may include difficulties
with concentration, motivation, memory, or attendance.
 Collaborate with teachers and school staff about the adolescent's
condition, its impact on academic functioning, and suggestions for
accommodations or modifications that may be needed.
CONTD….

 Help the adolescent develop effective time management strategies and


organizational skills.
 Teach the adolescent self-care techniques, such as regular exercise, adequate sleep,
healthy eating, and relaxation exercises, to help manage stress and improve overall
well-being.
 Offer emotional support and teach the adolescent coping strategies to manage
depressive symptoms during challenging academic situations.
 Regularly assess the adolescent's academic performance and mental well-being.
PROGNOSIS

 The prognosis of depressive disorder in children and adolescents can vary


depending on various factors, including the severity of symptoms, the
presence of comorbid conditions, the level of social support, and the
effectiveness of treatment interventions.

 Detecting and addressing depressive symptoms early can significantly


improve the prognosis. Prompt recognition and appropriate treatment can
help prevent the condition from worsening or becoming chronic.
COMPLICATIONS

 Impaired daily functioning


 Self-harm & suicidal ideation
 Social and interpersonal problems
 Substance abuse
 Physical health problems
 Sleep disorder
REFERENCES

 Ahuja, N. (2006). A Short Textbook of Psychiatry. (6th edition). Jaypee brother's


medical publishers (P) ltd.
 Sreevani, R.(2016). A guide to Mental Health and Psychiatric Nursing (4th ed.).
Jaypee Brothers Medical Publishers Pvt.Ltd.
 Dhami, J. (2014). Essential Text Book of Mental Health and Psychiatric nursing.
(1st edition). Medhavi publication
 Gertrude, K. and Durand, K. (2005). Psychiatric Mental Health Nursing. (1st
edition). J.B. Lippincott.
CONTD….

 Kapoor, B. (2006). Textbook of Psychiatric Nursing. (1st edition). Kumar


Publishing House.
 Linda, S. (2017). Nursing Drug Reference (1st edition). Elsevier publication.
 Nettina, S.M. (2018). Lippincott Manual of Nursing Practice. (11th edition).
Wolter Kluwer
 Roth, S. (2017). Mosby’s 2017 Nursing Drug Reference. Eleviser
 Subedi, D. (2016). Mental Health and Psychiatric Nursing. (3rd edition). Sopan
press P. (Ltd.)

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