Which Assessment Finding Is Associated With Depression

Race Ethnicity And Subcultural Issues

Of ever-increasing importance, although still underrepresented in the literature, is the identification of issues when assessing depression in cancer patients that may be specific to different racial, ethnic, or subcultural groups. A limited review of the literature on the assessment of depression over the past 10 years revealed that the racial breakdown of the sample was only provided in approximately 25% of the studies. In additional studies, results were reported as not differing by racial status without providing the racial composition of the sample . In those studies that did provide a racial distribution, Caucasians made up between 50% and 99% of the sample, with the majority of studies being > 85% Caucasian. The exceptions were studies with pediatric cancer patients by Varni et al. and Frank et al. , who reported that 50% and 59% of their samples, respectively, were Caucasian.

Screening Accuracy Of A 14

• Roles Data curation, Formal analysis, Methodology, Visualization, Writing original draft

  Affiliation Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany

• Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Writing original draft

  Affiliation Institute of Psychology, University of Kassel, Kassel, Germany

• Roles Conceptualization, Methodology, Supervision, Writing original draft

  Affiliation Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany

Practical Treatment Approaches Based On Available Evidence

Dr Culpepper summed up his discussion by stating that after evaluating the available evidence, depression can be seen as a disorder that involves a complex set of changes, many of which impact cognition, and these, in turn, may affect symptom severity and functional impairment. Insights into available treatment modalities have demonstrated their effects on the neural basis of cognition. On the basis of these insights, the treatment of cognitive impairment in depression should focus on effectively alleviating mood symptoms. For many patients, this will lead to improvement in cognition. For patients with significant cognitive impairment at baseline, treatment with an agent that has demonstrated efficacy, and particularly those that have direct efficacy, in cognition may be warranted, or augmentation with an adjunctive pharmacologic agent such as a psychostimulant or cognitive enhancer may be considered, or a psychological intervention may be added.

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Cognitive Impairment In Patients With Depression: Awareness Assessment And Management

This Academic Highlights section of The Journal of Clinical Psychiatry presents the highlights of the planning teleconference series Cognitive Impairment in Patients With Depression: Awareness, Assessment, and Management, which was held in May and June 2017. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc. and Lundbeck.

The teleconference was chaired by Larry Culpepper, MD, MPH, from the Department of Family Medicine, Boston University, Massachusetts. The faculty were Raymond W. Lam, MD, FRCPC, from the Department of Mood and Anxiety Disorders, The University of British Columbia, Vancouver, Canada, and Roger S. McIntyre, MD, FRCPC, from the Mood Disorders Psychopharmacology Unit, University of Toronto, Ontario, Canada.

The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

J Clin Psychiatry 2017 78:1383-1394

https://doi.org/10.4088/JCP.tk16043ah5c

Limitations Of Our Review

As with any review, publication bias is possible. Publishers and authors tend to favour the publication of significant findings over non-significant ones. We were only able to review papers in English, French and Finnish, potentially missing some studies. Nevertheless, we only found English studies to fit our criteria. We included only studies from Western countries results may therefore have limited generalisability to other geographical areas, particularly low-income countries and/or other cultural contexts. Future research focusing on other cultures and countries is recommended. We restricted our search to samples from the general population. The association between social support and protection from depression may differ in vulnerable subgroups.

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Depression Patient Psychological Assessment

• History taking was done through Clinical interview
• BDI was administered
• Dysfunctional thought record was given
• Mental state examination was done

2nd Session

• Link between B-C of ABC model
• Socialization with CBT model

• Mastery and pleasure was added in activity schedule

5th Session

• Previous activities was reviewed and given feedback
• Sleep hygiene principle was taught the patient
• Vicious cycle of anger was explained to patient

6th Session

• Taking it all away technique was done

12th session

• Taking it all away technique was done

13th session

• BDI was administered for post assessment
• Subjective rating of patients problems
• Therapy blue print was given to the patient

Case Summary

Bio Data

It is not tolerable for optimism

History of Present Illness

In 2012, patient adopted her brothers daughter. Her in-laws objected that on that but her husband supported the patient. He gave love and care to their daughter and also fulfilled her all needs. By adopting a child, patients attention was shifted from her husband towards her daughter. It brought a healthy change in their life. Her depressed mood, irritability and anger outburst were reduced. They paid more attention and care towards their child, she was satisfied with her husband as he gave attention, care and fulfilled her all demands and desires.

BACKGROUND INFORMATION

Family History

Personal History

Educational History

Sexual History

Children

Occupation History

Premorbid Personality

What Are The Different Types Of Depression

You might have heard a number of terms used to describe depression. In this section, we explain what some of these terms mean.

What is clinical depression?

Clinical depression is a common term, but it is not a formal diagnosis. People sometimes say clinical diagnosis to just mean they have been diagnosed by a doctor.

What is a depressive episode?

Your doctor might say that you are going through a ‘depressive episode’. This is the formal name that doctors give depression when they make a diagnosis. They may say that you are going through a ‘mild’, ‘moderate’ or ‘severe’ episode.

What is recurrent depressive disorder?

If you have had repeated episodes of depression, your doctor might say that you have recurrent depressive disorder. They may say that your current episode is ‘mild’, ‘moderate’ or ‘severe’.

What is reactive depression?

If your doctor thinks that your episode of depression was caused by particular stressful events in your life, they may say that it is reactive. For example, divorce, job or money worries. This is sometimes separated from an adjustment disorder, where you may struggle with some symptoms of depression because of adapting to a major change in your life. Such as separation from people, retirement or migrating to a new area.

What is a severe depressive episode with psychotic symptoms?

You can find more information about Psychosis by clicking here.

What is dysthymia?

What is cyclothymia?

What is postnatal depression?

What is manic depression?

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Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

• Try to be active and exercise.
• Set realistic goals for yourself.
• Try to spend time with other people and confide in a trusted friend or relative.
• Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately.
• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Continue to educate yourself about depression.

Join A Research Study: Enrolling Nationally From Around The Country

Depression also known as major depressive disorder or clinical depression is a common but serious mood disorder that can interfere with how people feel, think, and handle daily activities, such as sleeping, eating, or working. Although sadness can be a symptom of depression, it does not characterize the disorder. Symptoms of depression include sad or anxious mood, feelings of hopelessness or guilt, loss of interest in previous hobbies or activities, decreased energy, difficulty concentrating or sleeping, changes in appetite or weight, and persistent physical symptoms. People with depression experience symptoms nearly every day for at least two weeks. Learn more about depression.

Join A Study

For opportunities to participate in NIMH research on the NIH campus, visit the clinical research website. Travel and lodging assistance may be available.

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Detecting And Screening For Depression In Older Adults

Adelle Gertheimer, age 77, is a is a former teacher who lives alone in downtown Philadelphia. She has osteoarthritis and diabetes mellitus type 2.

When she arrives at the primary-care clinic, she states she hasnt been taking her prescribed medications because she got mixed up about the dosages and forgot some of the numerous daily tablets she takes. Laboratory tests show her diabetes and arthritis are well controlled. After noting the patients disheveled appearance, inattentiveness, sad affect, and lethargy, the nurse administers the Geriatric Depression Scale. Ms. Gertheimer scores a 9, indicating moderate depression. She denies thoughts of wanting to harm herself or others.

Nonetheless, for many older adults, depression is real and can have deadly consequences. About 5% of adults older than age 55 suffer depression and other mood disorders over the course of a given year. In 2004, persons older than age 65 accounted for 16% of successful suicides in the United States. Alcohol or prescription drug abuse commonly is involved in these suicides.

As the elderly population increases, depression statistics will undoubtedly rise, and nursing practice increasingly will entail identifying and caring for the depressed elderly.

Short Form Health Survey

As part of the Medical Outcomes Study , a multi-year, multi-site study that investigated variations in patient outcomes, the RAND Corporation developed the 36-item Short Form Health Survey as a set of easily administered quality-of-life measures. These measures rely on patient self-reports and are widely used for routine monitoring and assessment of care outcomes in the adult population. The survey can be completed in 10 minutes or less.

Ware, J.E., & Sherbourne, C.D. . The MOS 36-item short-form health survey : I. Conceptual framework and item selection. Medical Care, 30, 473-483.

McHorney, C.A., Ware Jr, J.E., Lu, J.R., & Sherbourne, C.D. . The MOS 36-item Short-Form Health Survey : III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40-66. Retrieved from

More Information

• 36-Item Short Form Survey Instrument

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Information For Family Carers And Friends

You can get support if you are a carer, friend or family member of someone living with depression.

Being a carer might mean you can claim certain benefits that might help you and the person you care for. For more information, please see the Mental Health and Money Advice services website:www.mentalhealthandmoneyadvice.org/en/welfare-benefits/what-benefits-are-available-for-mental-health-carers/

You could also get in touch with carer support groups or sibling support groups. You can search for local groups in your area online or ask your GP.

You can ask your local authority for a carers assessment if you need more practical support to help care for someone.

As a carer you should be involved in decisions about care planning. There are rules about information sharing and confidentiality which may make it difficult for you to get all the information you need in some circumstances.

You can find out more information about:

• Carers assessments by clicking here.
• Confidentiality and information sharing by clicking here.

How can I support the person that I care for?

You might find it easier to support someone with depression if you understand their symptoms, treatment and self-management skills. You can use this to support them to get help and stay well.

Below are some initial suggestions for providing practical day to day support to someone with depression.

You can find out more information about:

You can find more information about:

Website: www.web.ntw.nhs.uk/selfhelp/

Tips For Coping With Depression

• Get dressed every day.
• Practice stress management and relaxation techniques.
• Get out and walk daily.
• Follow your prescribed exercise regimen.
• Ask your health care provider about a cardiac rehabilitation program.
• Resume hobbies and social activities you enjoy.
• During your recovery from surgery or a recent hospitalization, visits with friends should be limited to 15 minutes at first. Then, increase the amount of time spent with visitors, depending on how you feel.
• Get a good nights sleep.
• Eat well-balanced, nutritious meals and follow your prescribed dietary guidelines.
• Ask your health care provider about support groups that may help you cope. Support groups are available for patients who have had heart surgery and their families.
• Dont use harmful habits to cope, such as smoking, using drugs, drinking excessively or overeating. These harmful habits increase your risk for heart disease and stroke.

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Developmental Issues Pertinent To Assessing Depression

The majority of the studies in the preceding discussion assessed depression in adult cancer patients, although the age ranges varied widely and often included individuals who could be classified as elderly or old age. A separate body of literature focuses on depression in children with cancer. Both children and the elderly, however, have issues that need to be considered when assessing depression in the cancer patient.

Assessment And Diagnostic Findings

A number of tests should be conducted to diagnose depression.

• Beck Depression Inventory is a psychological test used to determine symptom onset, severity, duration, and progression.
• Dexamethasonesuppression test showing failure to suppress cortisol secretion in depressed patients .
• Toxicology screening suggesting drug-induced depression.
• Diagnosis is confirmed if DSM-V-TR criteria is met.

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What Treatment Should I Be Offered

The National Institute of Health and Care Excellence writes guidance on what treatment doctors should offer you. But your doctor does not have to give you these treatments. And the treatments may not be available in your area.

Different treatments may be available in your area. Your doctor might think these suit your symptoms more than the recommended treatments.

NICE recommend that depression is treated in different steps depending on how severe the condition is for you. The steps are as follows.

Step 1: Everyone who may have depression

Your doctor should offer you:

• an assessment of your symptoms,
• support, such as regular appointments in person or by telephone,
• information on how to deal with your symptoms,
• monitoring of your symptoms and follow-up, and
• referral for further assessment and treatment if needed.

Step 2: Mild to moderate depression

Your doctor may offer you:

• low-intensity interventions, such as self-help guided by the doctor or computerised cognitive behavioural therapy ,
• physical activity programmes,
• group cognitive behavioural therapy ,
• medication if you have a history of moderate or severe depression, or you have had symptoms for a long time, and
• referral for further assessment and treatment if needed.

Step 3: Moderate to severe depression, or mild to moderate depression when other treatments havent worked

Your doctor may suggest:

Step 4: Severe and complex depression or if your life is at risk Your doctor may suggest:

• medication,

What Causes Depression

There is no single cause of depression. Different things may cause depression for different people. This section looks at some of the things that might cause depression, or depressive symptoms.

Can depression be inherited?

There is not a clear pattern to suggest that depression can be inherited. Some studies suggest that your genetics can play a part in developing depression. For example, 1 study found that particular genes may play a key role in developing recurrent depression.

Some researchers have suggested that people who have a parent or sibling with depression, have a 2 to 3 times more chance of developing depression. However, just because a relative lives with depression, it does not mean you will too.

Can my background or current situation cause depression?

Researchers have looked at whether having parents or other family members with depression can increase your chances of developing the condition. For example, a study has looked into the effects having a mother with postpartum depression can have on children as they grow up.

Research has also suggested that stressful events, such as problems at home or work, a relationship ending or financial issues may also make it more likely you will get depression.

Can my hormones or the chemicals in my body cause depression?

Changes in your hormones and chemicals in your body may cause depressive symptoms.

How can lifestyle factors affect depression?

Can drugs and alcohol affect my mental health?

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Take Care Of Yourself

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesnt respond to medication. Your healthcare professional may recommend other treatment options if your symptoms dont improve.

These options include electroconvulsive therapy or repetitive transcranial magnetic stimulation to treat depression and improve your mood.

Practice Quiz: Major Depression

Quiz time about the topic! For more practice questions, visit our NCLEX practice questions page.

1. Which patient would the nurse expect to prepare for ECT?

A. A female patient with dysthymic disorderB. An elderly male with major depressive disorder and a history of strokeC. A middle-age, female patient with major depression and an immediate risk of suicide.D. A female patient with depression and hypomania due to cyclothymic disorder

2. How long should a depressive episode last for it to be considered for diagnosis?

A. 7 daysB. more than 10 daysC. 2 weeks

D. Stroke

1. Answer: C. A middle-age, female patient with major depression and an immediate risk of suicide.

ECT may be used to treat major depression as well as certain psychotic disorders, particularly in situations of severe depression when psychotherapy and medications have been ineffective, when ECT poses a lower risk than other treatments do, or when the patient is at an immediate risk for suicide.

2. Answer: C. 2 weeks.

Major depression is a syndrome of a persistently sad mood lasting 2 weeks or longer.

3. Answer: A. MAOIs.

This is the reason why this drug class is rarely used.

4. Answer: C. Scrabble.

Noncompetitive activities should be promoted for these patients.

5. Answer: B. Suicide.

It occurs in 15% of untreated cases.

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