‫بسم اهلل الرحمن الرحيم‬

‫تمريض نفسيه‬

‫‪Presentation about:‬‬

‫‪Depression‬‬
‫تحت إشراف ‪/‬‬ ‫عمل الطالب ‪/‬‬

‫د‪ /‬فوزيه عبدالحليم‬ ‫عبداهلل خالد محمد ق ايد الحياسي‬

‫د‪ /‬كمال بادي‬

‫د‪ /‬وجدان العبدي‬

‫‪1‬‬
  Definition:
- Depression is mental state of excessive sadness characterized by
persistently low mood, loss pleasure and interest.
- Depression in male is 8-12 percent and in female 20-26 percent.
- Depression occurs twice frequently in women as in men.

 Types:
1- Major depression.
2- Dysthymia : (history 2 years, 2 signs of depression, continuous, & not
absence more than 2 months).

 Differences between major depression & Dysthymia:

Major depression
Caused by factors with in
individuals.
Premorbid personality: cyclothymic
dysthymic.
Late insomnia.
More sad in the morning.
Feel better when alone.
Psychotic feature as Psychomotor
retardation, suicidal tendencies,
delusion etc. are common.
Releases are comes.
ETC & antidepressants are used for
management.
Insight is absent.
Dysthymia
Caused by stressful event.
Premorbid personality: anxious or
obsessive.
Early insomnia.
More sad in the evening.
Feel better when in group.
Usually Psychomotor retardation
and
No other psychotic.
Relapses are uncommon.
Psychotherapy & antidepressants are
Used for management.
Insight is present.

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  Clinical features:
- Five or more of following symptoms have been present during the
same 2 weeks.
- Period and represent change from previous functioning at least one
of the symptoms.
 Is either (1) depressive mood
-Depressed mood: sadness, loss pleasure and interest.
-Depressive cognition: hopelessness, helplessness, worthlessness,
unreasonable Guilt and self-blame.
-Suicidal thought.
-Psychomotor retardation: restlessness, retarded patient thinks, walk and
acts, Felling uneasiness.
-Psychotic features: delusions and hallucinations.
-Somatic symptoms of depression: decrease or increase in appetite and
weight, Insomnia or hypersomnia, Psychomotor retardation, lack reactivity.

 Medical treatment:
(1)- Pharmacotherapy:
- TCA or MARI: Imipramine 75 - 300 mg / day.
Amitriptyline 75 - 300 mg / day.
Clomipramin 75 – 300 mg / day.
Mianserin 30 - 120 mg / day.
- SSRI: Fluoxetine 10 – 80 mg / day.
Sertraline 50 – 200 mg / day.
- MAOI: Trazodone 150 - 600 mg / day.
Isocarboxazid 10 – 30 – 120 mg / day.
- Dopaminergic antidepressants: fluvoxamine 50 - 300 mg / day.
- Typical antidepressants: Amineptine 100 - 400 mg / day.

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(2)- Psychosocial treatment
- Cognitive therapy.
- Supportive therapy.
- Group therapy.
- Family therapy.
- Behavior therapy.

(3)- ECT
 Indication:
- Unresponsive or contraindications use antidepressants.
- The pt. Immediate risk for suicide too great to wait for response to
antidepressants.
- Urgent need for rapid recovery.

 Contraindications:
- Increase ICP.
- Space-occupying lesions in the brain.
- Recent history of MI.
- Larger aneurysms.

 Good prognostic:
- Acute onset.
- Severe depression.
- Good response.
- Well-adjusted premorbid personality.
- Typical clinical features.

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  Bad prognostic factors:
- Double depression.
- Chronic ongoing stress.
- Poor drug compliance.
- Co-morbid physical disease.
- Marked hypochondrial features.

 Nursing management:
- Create safe environment for pt.
- Ask pt. directly "have your thought about harming yourself in any way?"
- Close observation.
- Encourage the pt. to express his feelings.
- Provide simple activity and easily achieved activity
- Allow the pt. to take decisions regarding own care.
- Observe for non-verbal communication.
- Introduce the pt. to another pt. who is quite and possibility convalescing
from depression.
- Provides comfortable measures (back rub, warm milk, tipid bath).
- Don't allow pt. to sleep for long time during day.
- Give pt. sedative as prescribed.
- Closely monitor pt.'s food & fluid intake.
- Record pt.'s weight regularly.
- Encourage more fluid, rough age & green leafy vegetables.
- Ensure that his take bath regularly.
- When the pt. has taken care of himself, express realistic appreciation.
 Resources:
- A guide for mental health & psychiatric nursing.
- Previous research.
- Psychiatric nursing.