Screening test for Depression:
Beck Depression Scale – measures severity of depression. Composed of 21 questions and score of above 11 is likelihood of depression.
Mood Disorder Questionnaire (MDQ) – 5- minute questionnaire that screen for presence of bipolar disease.
Geriatric Depression Scale – Use for geriatric patients.
Cornell Depression Scale – Use with older adults with Dementia. A score above 18 is highly suggestive of depression. A score of 10-17 indicates probable depression and 1 or below 6 indicates absence of depression.
Patient Health Questionnaire (PHQ) – Composed of questions: “In the last weeks have you felt down or depressed? “In the last 2 weeks have you had little interest or pleasure in doing things?”.
4. GIVE 3 NURSING INTERVENTIONS FOR THE PATIENT WITH DEPRESSION.
1. Identify the level of suicide precautions needed. Rationale: A patient with high-risk will require a constant supervision and a safe environment.
2. Identify the patients negative thinking thoughts and teach the patient to reframe/or refute negative thinking thoughts. Rationale: Negative thinking thoughts add to feelings of hopelessness and are a part of a depressed persons faulty thought process. Intervening in this process helps in healthier and more useful outlook in life.
3. Encourage the use of soap, water, toothbrush, shaving equipment, make-up, etc. Rationale: Being clean and well-groomed can temporarily increase self-esteem.
Mood Disorder: Depression
Alterations in mood and affect may be seen at any point across the life span. What most Americans think of as depression is major depressive disorder (MDD), also called unipolar depression. MDD is diagnosed when the client experiences either depressed mood or loss of interest most of the day, almost every day, for at least 2 weeks. (Pearson, 2015). Its not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:
• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the bodys balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or many other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression. (Mayo,2017)
Depressed mood or dysphoria is the primary feature of major depressive disorder (MDD). Depression may occur only once during your life, but typically people have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:
• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration
• Loss of interest or pleasure in most or all normal activities
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Suicidal ideation
• Unexplained physical problems, such as back pain or headaches
Some Clinical assessment tools are:
• Hamilton Depression Rating Scale (HDRS): is the most widely used interview scale
• Beck Depression Inventory (BDI): is a self-rating scale that is used to screen for depression
• Patient Health Questionnaire (PHQ): is a self-administered tool of 2 (PHQ2) or 9 (PHQ9) items, establishes the clinical diagnosis of depression and can additionally be used over time to track the severity of symptoms over time
• Major Depression Inventory (MDI): is a self-rating scale used for the diagnosis or measurement of depression, according to both DSM-IV major depression and ICD-10 moderate to severe depression criteria
• Center for Epidemiologic Studies Depression Scale (CES-D): is a 20-item self-rating scale that asks people to rate how often during the past week they experienced symptoms associated with depression. A score of 16 or above indicates depression. This scale is useful for a wide age range of populations including older adults
• Zung Self-Rating Depression Scale (SDS): is a 20-item self-administered test published in 1965 with the goal of developing a quick and inclusive self-administered tool. Half of the 20 items are positively worded, and half are negatively worded. This scale has been used in clinical research to monitor treatment or as a screening tool in general practice
• Geriatric Depression Scale (GDS): was specifically developed for use in geriatric populations. The questions elicit only “yes” or “no” responses, making comprehension easier compared with multiple-choice answers
• Cornell Scale for Depression in Dementia (CSDD): is designed for use in elderly patients with underlying cognitive deficits. Because this patient population may give unreliable answers, the CSDD additionally uses information from a patient informant, someone who knows and has frequent contact with the patient, and can include family members or care staff.
As a nurse the first and most important aspect in conducting an assessment is to establish a therapeutic relationship based on mutual trust. Open-ended questions should be asked, and we need to allow adequate time for their response. It is important that we remain nonjudgmental and validate the clients feelings. Weneed to encourage them to discuss all their feelings.
Some interventions to help a patient suffering from depression are:
Maintaining a therapeutic distance, exhibiting open posture.
Prevent suicide by helping them feel that life is worth living. Listen for cues of suicidal tendencies. Explain to them that a person with suicidal thoughts is not a bad person instead it is just part of the illness. Expressing their thoughts is helpful and that you could do something about it.
Listen to physical complaints and reinstall some behavior modification techniques. Help them find healthy ways to express how they are feeling. Exercising is beneficial to both the mind and can help with the physical pain they are experiencing.
What are some alternative therapies other then antidepressants that can be used to treat depression?