Depression
Management Program for Elderly Clients With Relapsing
Depression
Kathleen
Falk, BNC, MS, FNP
Family Nurse Practitioner
MSHS Adult Day Health
A pilot project conducted at the Adult Day Health Center
Problem
Nurse case management data
at Adult Day Health Center identified an aggregate with
relapsing clinical depression and related co-morbid decompensation.
These individuals remained symptomatic of major affective
disorders, even though they had access to outpatient psychiatric
services and the social structured environment of the Center.
Data from nursing assessments revealed a high level of non-compliance
with antidepressant medication (58%), long-term dependency
of hypnotic pharmacology, and fragmented psychiatric treatment.
Evidence
A Family Nurse Practitioner/Certified
Psychiatric Nurse administered the following diagnostic
scales: the Geriatric Depression Scale, Yesavage J., Psychopharmacology
Bulletin, 1998; 24: 709-710; and Zung Self Rating Depression
Scale, Copyright @ 1965, 1974, 1991, W. K. Zung, used with
permission of Eli Lilly and Company. All of the clients
in this subgroup (twelve participants) scored positively
for evidence of mild, moderate or marked depression. Data
from admission nursing care plans indicated there was 100%
knowledge deficit regarding antidepressant medication.
Strategy
Development of the Depression
Management Program to promote continuity of psychiatric
care, reduce risk of acute relapsing depression, and fewer
co- morbid decompensations. The project was designed to
maximize opportunities for integration of brain functioning
(stimulate parts of the brain that are not related to depression),
therefore mediating symptoms of anxiety and depression.
Modalities to accomplish this were cognitive/behavioral
therapeutic techniques, group therapy support process, psycho-educational
sessions and, complementary venues of music therapy, oral
histories, culinary workshops, cultural events and the arts.
Practice change
A nurse led group
format was utilized to target clients, who have been vulnerable
to relapsing depression. Nursing interventions were intensified
in regards to current psychiatric care, medication regimen,
responses to medications and the various modalities offered
in the group. Weekly sessions were run by a Family Nurse
Practitioner/ Certified Psychiatric Nurse for six months,
then on going every two weeks. Diagnostic scales are repeated
every six months.
Evaluation
At the six month mark,
all participants (100%) were free of acute relapsing depression,
there were no psychiatric re-hospitalizations or medical
hospitalizations for co-morbid diagnosis. Subjective client
satisfaction survey rating was high, 61% in the excellent
category and 35% in the good category. Compliance with
psychiatric care plan and psychotropic medications improved
to 92%. Scores for intensity of depressive responses decreased
on average 2 points on the Geriatric Depression, and 5
points on the Zung Rating SDS Index, six months after
the program started.
Recommendations
Adult Day Health
Centers are to incorporate the expertise of psychiatric and
advanced practice nursing to health programs for the elderly,
depressed populations. Provide training for nurses at
the Center in Depression Management, Pharmacology and
Therapeutic Group Process. Expand the program to include
a family systems approach to empower clients, reduce dependency
and promote improved family relationships.
Bibliography
Alder LA, Angrist BM. Paroxetine and akathisia. Biol Psychiatry. 1995;27:336-337.
Armstrong SC, Schweitzer SM. Delirium associated with paroxetine and benztropine combination. Am
J Psychiatry. 1997;154:581-582. Letter
Brody, Arthur L.,; Regional Brain Metabolic Changes in Patients with Major Depression. Archives of
General Psychiatry, 2001 58:631-640.
Claghorn JL, Feighner JP. A double-blinded comparison of paroxetine with imipramine in the long-term
treatment of depression. J Clin Psychopharmacol. 1993;13(suppl 2) :23S-27S.
Cozolino Louis, PhD., The Neuroscience of Psychotherapy, Guilford Press: February 2002.
Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing
better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter
study. J Affect Disord. 1990;18:289-299.
Davidson J. Seizures and bupropion: a review. J Clin Psychiatry. 1989; 50: 256-261.
Esposito S, Prange AJ Jr, Golden RN. The thyroid axis and mood disorders: overview and future
prospects. Psychophamarcol Bull. 1997;33:205-217.
Evans D. Antidepressant adverse effects and antidepressants in the medically ill. Am Soc Clin
psychopharm Progress Notes. 1995;6;22-25.
Frank E, Kupfer DJ, Perel JM, et al. Three-year outcomes for maintenance therapies in recurrent
depression. Arch Gen Psychiatry. 1990;47:1093-1099.
Glennon RA, Dukat M. Serotonin receptor subtypes. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology:
The Fourth Generation of Progress. New York, NY: Raven Press; 1994: 425-430.
Presktorn SH. Outpatient Management of Depression: A Guide for the Primary Care Practitioner. 2nd
Edition Professional Communicaitons, Inc., 1999.
Schwartz, Jeffrey, MD, Archives of General Psychiatry, 02/1996.
Siegle, Daniel, MD, The Developing Mind: How Relationships and the Brain Interact to Shape Who We
Are. W.W. Norton and Company;1st edition (June 15, 2002).
Thase ME, Rush AJ. Treatment-resistant depression. In: Bloom FE, Kuper DJ, eds. Psychopharmacology:
The Fourth Generation of Progress. New York, NY: Raven Press; 1994: 1081-1097.
Wheatley DP, van Moffaert M, Timmerman L, Kremer CM. Mirtazapine: efficacy and tolerability in
comparison with fluoxetine in patients with moderate to severe major depressive disorder.
Mirtazapine-Fluoxetine Study Group. J Clin Psychiatry. 1998;59:306-312.
Yesavage, J, Geriatric Depression Scale. Psychopharmacology Bulletin, 1998: 24: 709-710.
Zajecka J, Tracy KA, Mitchell S. Discontinuation symptoms after treatment with serotonin reuptake
inhibitors: a literature review. J Clin Psychiatry 1007;48:291-297.
Zung, WK, Zung Self Rating Depression Scale. Copyright @ 1965, 1974, 1991, used with permission
of Eli Lilly and Company.
Previous
Abstract | 2003 Summer Institute Winner's List | Return to ACE
| Next Abstract
|
