1. RNSG 1163 Summer 2014 http://www.youtube.com/watch?v=- Qe8cR4Jl10

2.  Prolonged emotional state that influences the person’s whole personality and life functioning Knutson, 2007

3.  2.5% of the population is at risk over their lifetime  Risk for women 70% more likely to develop depression  >65 17%-18% have chronic depression  Rates peak between adolescence and early adulthood Varcarolis, 2013

4.  Depression  4 th leading cause of disability in US  Children as young as 3 years old have been diagnosed.  Major health problem in elderly (Varcarolis, 2013)

5.  Substance Abuse  Schizophrenia  Panic disorder  Obsessive-compulsive disorder  Eating disorders (Varcarolis, 2013)

6.  DSM-IV Criteria  Change in previous function  Symptoms cause clinically significant stress or impair social, occupational, or other areas of functioning  Over a 2-week period 5 or more symptoms occur nearly every day for most waking hours (Varcarolis, 2014)

7.  History of prior episodes of depression  Family history of depressive disorder, especially in first degree relatives  History of suicide attempts and/or family history of suicide  Female gender  Age 40 years or younger  Postpartum period  Medical illness  Absence of social support  Negative, life stressful events  Active alcohol or substance abuse (Varcarolis, 2013)

8.  Thorough Medical Exam to determine if depression is primary or secondary.  PMHX of depression  Risk for Self Harm  Coping mechanisms  Triggering events (Varcarolis, 2013)

9.  Mood  Affect  Thought Processes  Feelings  Physical Behavior  Communication (Varcarolis, 2013)

10.  The risk of suicide in people with a major depressive disorder is about 20 times that of the general population.  All depressed patients MUST be assessed for suicidal ideations and the means to complete the act

11.  If there are any verbal or behavioral cues of suicide, ask!!!  Suicidal plan lethality will influence the degree of suicidal risk:  How detailed?  How lethal?  Are the means available?

12.  Dysfunctional grieving related to death of sister e/b insomnia & depressed mood  Hopelessness related to loss of job e/b feelings of despair and development of ulcerative colitis  Powerlessness related to new role as parent e/b apathy & overdependency  Spiritual distress r/t loss of child in utero e/b self-blame & somatic complaints  Potential for self-directed violence r/t rejection by boyfriend e/b self-mutilation

13.  Establish trusting relationship  Monitor self-awareness  Protect the patient and assist PRN  Modify the environment  Provide supportive companionship  Plan therapeutic activity  Set limits for manic pts  Administer medication  Recognize opportunities for emotional expression and teaching coping skills

14.  Physical care  Psychopharmacology-Antidepressant medications  Somatic therapy-  Electroconvulsive therapy (ECT) for severe depression resistant to drug therapy  Phototherapy (light therapy) for mild to moderate seasonal affective disorder (SAD) (Varcarolis, 2013)

15.  Medical needs evaluated: eg. Resolution of insomnia  Short Term Indicators  Outcomes r/t thought processes, self- esteem and social interactions common (Varcarolis, 2013)

16.  Which of the following is the most therapeutic response when interviewing a patient with a flat affect?  A. Maintain eye contact during interview, and allow the patient some extra time to answer before moving on to the next question.  B. Move quickly to the next question when the patient seems uncomfortable during the interview.  C. If the patient becomes emotional interrup and move on to the next question.  D. Respond to the patient using sympathetic phrases so they know you understand what they are going through.

17. Electroconvulsive Therapy (ETC): (select all that apply) 1. Is useful in treatment of patients with depressive disorders. 2. Can cause memory deficits. 3. Has a usual course of therapy that includes 2-3 treatments. 4. Can achieve 90% remission rate in 1-2 months.