Medical Surgical Nursing : Mental Health and Neurology || Depression

 

Mental Health and Neurology: Depression

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Definition

Depression is a common mental health disorder characterized by persistent sadness, loss of interest or pleasure in activities, and a range of physical and emotional symptoms. It is more than just feeling low or sad; depression significantly affects an individual's ability to function in daily life.

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Causes

Depression is a multifactorial condition with causes that include:

1. Biological Factors

• Imbalance of neurotransmitters like serotonin, norepinephrine, and dopamine.
• Genetic predisposition (family history of depression).
• Hormonal changes (e.g., thyroid dysfunction, postpartum).

2. Psychological Factors

• Negative thought patterns.
• Low self-esteem or chronic stress.
• History of trauma or abuse.

3. Social Factors

• Loneliness or social isolation.
• Financial problems, unemployment, or strained relationships.
• Major life changes or losses.

4. Medical Conditions

• Chronic illnesses like diabetes, cancer, or neurological disorders.
• Side effects of medications.

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Signs and Symptoms

• Persistent sadness or hopelessness.
• Loss of interest in previously enjoyed activities.
• Fatigue or low energy levels.
• Difficulty concentrating, making decisions, or remembering details.
• Sleep disturbances (insomnia or hypersomnia).
• Changes in appetite or weight (increased or decreased).
• Feelings of worthlessness or excessive guilt.
• Thoughts of self-harm or suicide.

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Investigations

To diagnose depression, a combination of clinical evaluation and laboratory tests may be used:

1. Clinical Evaluation

• Detailed patient history (family, medical, psychological).
• Use of standardized scales, such as:
  • Patient Health Questionnaire (PHQ-9).
  • Hamilton Depression Rating Scale (HDRS).

2. Laboratory Tests

• Thyroid function tests (to rule out hypothyroidism).
• Vitamin D and B12 levels.
• Complete blood count (to rule out anemia).

3. Imaging (if necessary)

• MRI or CT scan (to exclude neurological causes, such as tumors or stroke).

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Medical Treatment

1. Pharmacotherapy

• Antidepressants:
  • Selective Serotonin Reuptake Inhibitors (SSRIs) – e.g., Fluoxetine, Sertraline.
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) – e.g., Duloxetine, Venlafaxine.
  • Tricyclic Antidepressants (TCAs) – e.g., Amitriptyline.
  • Atypical Antidepressants – e.g., Bupropion, Mirtazapine.
• Augmentation Therapies: Antipsychotics or mood stabilizers if required.

2. Psychotherapy

• Cognitive Behavioral Therapy (CBT).
• Interpersonal Therapy (IPT).
• Mindfulness-based therapies.

3. Other Interventions

• Electroconvulsive Therapy (ECT) for severe or treatment-resistant depression.
• Transcranial Magnetic Stimulation (TMS).

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Nursing Interventions

1. Assessment:

   • Assess the patient's mood, thought patterns, and behavior.
   • Monitor for suicidal ideation or self-harm.

2. Building Trust:

   • Establish a therapeutic relationship with active listening and empathy.

3. Environment Modification:

   • Provide a calm, supportive, and safe environment.

4. Encourage Routine:

   • Help the patient establish daily routines, including self-care and physical activity.

5. Education:

   • Educate the patient and family about the illness, treatment options, and coping strategies.

6. Medication Management:

   • Administer prescribed medications and monitor for side effects.
   • Ensure compliance with the treatment regimen.

7. Promote Social Interaction:

   • Encourage participation in social or group therapy sessions.

8. Monitor Nutritional and Physical Health:

   • Address appetite changes and ensure adequate nutrition.

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Nursing Care Plan for Depression

Nursing Diagnosis	Goals	Nursing Interventions	Evaluation
Risk for self-harm	Prevent harm to the patient.	- Monitor for suicidal ideation. - Remove potentially harmful objects. - Stay with the patient during acute episodes of distress.	Patient remains safe with no self-harm incidents.
Ineffective coping	Improve coping mechanisms.	- Encourage expression of feelings. - Teach stress management techniques. - Refer to support groups or counseling sessions.	Patient demonstrates improved coping strategies.
Imbalanced nutrition	Restore adequate nutritional intake.	- Monitor weight and dietary intake. - Provide nutrient-rich meals. - Involve a dietitian if needed.	Patient maintains a healthy weight and dietary intake.
Disturbed sleep pattern	Establish a healthy sleep routine.	- Promote a relaxing bedtime routine. - Limit caffeine and screen time before bed. - Administer prescribed sleep aids if necessary.	Patient reports improved sleep quality and duration.
Low self-esteem	Enhance self-esteem and confidence.	- Provide positive reinforcement for small achievements. - Encourage participation in activities that boost confidence. - Avoid criticism or judgmental statements.	Patient shows improvement in self-esteem and participates in activities confidently.