A mood disorder may include symptoms of depressed mood, feelings or hopelessness and helplessness, decreased interest in usual activities, disinterest in relationship with others or cycles of depression and mania.
Depression is often concurrent with other psychiatric diagnoses. Almost have of clients with major depressive disorders have histories of non-mood psychiatric disorders.
A high incidence exists for persons with chronic illness or prolonges hospitalization or institutional care.
Biological factors – brainchemicals
Family genetics – parent with depression, child 10-13% risk of depression.
Gender – higher rate for women
Age – often less than 40 when begins
Marital status – more frequently single, widowed
Season of year – Seasonal Affective Disorder (SAD) occurs when client experiences recurrent depression that occurs annually at the same time.
Environmental factors – lack of social support, stressful life events.
Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current substance abuse are especially prone to becoming depresses.
Signs and Symptoms
Suicidal and homicidal ideations
Decrease in personal hygiene
Tearfulness, crying, and melancholy
Altered thought process; difficulty concentrating, self-destructive behavior.
Loss of energy or restlessness
Anhedonia or loss of pleasure
Gain or loss of weight
Psychomotor retardation or agitation
Insomnia or hypersomnia
Feelings of hopelessness, worthlessness, and helplessness.
Risk for violence, self-directed or directed at others
Impaired verbal communication
Altered role performance
Deficit in diversional activity
Altered thought processes
Therapeutic Nursing Management
Individual psychotherapy – long –term therapeutic approach or short term solution-oriented, may focus on in-depth exploration, specific stress situations, or problem solving.
Behavioral therapy – modifying behavior to assist in reducing depressive symptoms and increasing coping skills.
Behavioral contacts – focus on specific client problems and need to help the client resolve them.
Milieu therapy – incorporates day to day living experiences in a therapeutic environment to expect changes in perception and behavior.
Family therapy – aimed at assisting the family cope with the client’s illness and supporting the client in therapeutic ways.
Group therapy – focuses on assisting clients with interpersonal communication, coping, and problem-solving skills.
Psychopharmacologic and Somatic treatments
Administer antidepressant medications
Continued assessment by monitoring client’s mental health status is critical, particularly interms of agitation and suicidal ideation.
Priority for care is always the client’s safety.
Use of behavioral contacts. Use this technique to meet outcomes relating to “no self-harm” or no suicidal ideation or plan.
Assess regularly for suicidal ideation or plan.
Observe client for distorted, negative thinking.
Assist client to learn and use problem solving and stress management skills.
Avoid doing too much for the client, as this will only increase client’s dependence and decrease self-esteem.
The nurse’s role in the physical care of the client experiencing major depressive disorder is to provide assessment and interventions related to appropriate nutrition, fluids, sleep, exercise, and hygieme, and to provide health education.
Explore meaningful losses in the client’s life.
Help the client and family to identify the internal and external indicators of major depressive disorder.