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Depressive Disorders | 마이메르시 MyMerci
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Depressive Disorders

NCLEX Review Guide: Depressive Disorders

Understanding Depressive Disorders

Major Depressive Disorder (MDD)

  • Major Depressive Disorder is characterized by persistent sadness, loss of interest in activities, and significant impairment in daily functioning for at least 2 weeks. The disorder affects approximately 8.5% of adults annually and requires comprehensive assessment and intervention.
  • Diagnostic criteria include at least 5 symptoms during a 2-week period: depressed mood, anhedonia, significant weight changes, sleep disturbances, psychomotor agitation/retardation, fatigue, feelings of worthlessness, concentration difficulties, and suicidal ideation.

Memory Aid: SIG E CAPS

Sleep disturbances, Interest loss, Guilt/worthlessness, Energy loss, Concentration problems, Appetite changes, Psychomotor changes, Suicidal ideation

Key Points

  • Depression is a medical condition, not a character flaw or weakness
  • Suicide risk assessment is priority in all depressed patients
  • Therapeutic relationship is foundation of all interventions

Types of Depressive Disorders

Disorder Type Duration Key Features
Major Depressive Disorder ≥2 weeks Severe symptoms, significant impairment
Persistent Depressive Disorder ≥2 years Chronic, less severe than MDD
Seasonal Affective Disorder Seasonal pattern Related to light exposure changes

Nursing Assessment & Interventions

Priority Nursing Assessments

  1. Suicide Risk Assessment - Always assess using direct questions: "Are you having thoughts of hurting yourself?"
  2. Mental Status Examination - Assess mood, affect, thought processes, and cognitive function
  3. Physical Assessment - Monitor for signs of self-neglect, weight changes, and medication side effects
  4. Functional Assessment - Evaluate ability to perform activities of daily living and maintain relationships

Clinical Scenario

A 45-year-old patient states, "I feel hopeless and wonder if my family would be better off without me." This requires immediate suicide risk assessment and safety precautions. Ask directly about suicidal ideation, plan, and means.

Therapeutic Interventions

  • Establish therapeutic rapport through active listening, empathy, and non-judgmental communication. Use open-ended questions and reflect the patient's feelings to demonstrate understanding.
  • Implement safety measures for suicidal patients including 1:1 observation, removal of harmful objects, and environmental modifications to prevent self-harm attempts.
  • Encourage gradual increase in activities and social interaction while respecting the patient's energy limitations and avoiding overwhelming expectations.

Key Points

  • Never leave a suicidal patient alone
  • Avoid false reassurance like "everything will be fine"
  • Document all suicide risk assessments thoroughly

Pharmacological Management

Antidepressant Medications

Drug Class Examples Key Nursing Considerations
SSRIs Fluoxetine, Sertraline Monitor for serotonin syndrome, GI effects
SNRIs Venlafaxine, Duloxetine Monitor BP, discontinuation syndrome
Tricyclics Amitriptyline, Nortriptyline Cardiotoxic, anticholinergic effects

Black Box Warning

Antidepressants may increase suicidal thoughts in patients under 25 years old, especially during the first few weeks of treatment.

Memory Aid: SSRI Side Effects

Sexual dysfunction, Serotonin syndrome, Restlessness, Insomnia

Common Pitfalls & Study Tips

Frequently Confused Concepts

Concept Correct Understanding Common Mistake
Grief vs Depression Grief is normal response to loss; depression is persistent mood disorder Assuming all sadness is depression
Therapeutic Communication Use reflection, open-ended questions Giving advice or false reassurance

Quick Check Questions

  • ☐ Can you identify 5 symptoms of major depression?
  • ☐ Do you know the suicide risk assessment questions?
  • ☐ Can you name 3 SSRI side effects?
  • ☐ Do you understand the black box warning for antidepressants?

Study Tips for Success

  • Practice therapeutic communication techniques daily - focus on reflection and active listening rather than giving advice.
  • Memorize suicide risk factors and protective factors, as these are frequently tested concepts on the NCLEX examination.
  • Understand medication classifications and their specific side effects, particularly the differences between SSRI, SNRI, and tricyclic antidepressants.

NCLEX Success Tip

When answering depression-related questions, always consider safety first, then therapeutic relationship, then specific interventions.

Remember: You're preparing to be an advocate for mental health patients. Your compassionate care can make the difference between despair and hope. Keep studying - you've got this! 💪

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