Nursing care of patients with depressive disorders

Uobičajeni, normalni afekti (tuga, bol i radost) dio su našega svakodnevnoga života i trebaju se razlikovati od patoloških stanja ili poremećaja raspoloženja. Afektivni poremećaji ili poremećaji raspoloženja su najzastupljenija skupina duševnih poremećaja. Njihovo osnovno obilježje je patološki promijenjeno raspoloženje. Značajno oštećuju sve aspekte ličnosti i ccjelokupno psihosocijalno funkcioniranje oboljelog. Depresija će do 2020.godine zauzeti drugo mjesto u svijetu po oboljevanju i smrtnosti (Svjetska zdravstvena organizacija), a do 2030.god. bit će vodeći uzrok zdravstvenog opterećenja u bogatijim zemljama. Etiologija poremećaja raspoloženja je multifaktorijalna i rezultat je interakcije genetske predispozicije, biološke osnove te ranog životnog (traumatskog) iskustva i utjecaja sredine. Tipične teškoće i upadljiva obilježja depresije su žalost, utučenost, neraspoloženje, slabost, bezvoljnost, pomanjkane poticaja, sumnje u sebe, osjećaj bezvrijednosti, beznađe, besmislenost, a uz njih se često pojavljuju i tjeskoba i nemir, nedostatak energije, poremećaji apetita, gubitak tjelesne težine, smanjeni libido, poremećaji spavanja, bolovi, teškoće s koncentracijom i samoubilačke misli. Dijagnoza poremećaja raspoloženja postavlja se na osnovu anamnestičkih podataka, kliničke slike i tijeka bolesti. U liječenju poremećaja raspoloženja najbolje rezultate daje kombinacija farmakološke i psihološke terapije. Cilj je liječenja: umanjiti ili ukloniti simptome, uspostaviti radno i opće funkcioniranje, te smanjiti mogućnosti relapsa ili recidiva bolesti. Medicinska sestra je najčešće prvi stručnjak koji kontaktira s bolesnicima. Intenzivno sudjeluje u cjelokupnom životnom ritmu bolesnika. U najbližem je kontaktu s bolesnikom i njegovom obitelji pa može prva uočavati promjene i stručnom timu iznositi svoja zapažanja, vrlo značajna za daljnji postupak. Stoga je osobito velika i važna njezina mogućnost terapijskoga djelovanja. Ona je nužan i nezamjenjiv član tima u psihijatrijskoj njezi. O patnji depresivnih bolesnika svjedoči izreka: „Ako postoji pakao na zemlji, onda je on u duši depresivnih osoba“.Usual, normal emotions such as sadness, pain and joy are all part of our everyday lives and we should differentiate between them and pathological conditions or mood disorders. Affective disorders or mood disorders represent the most common group of mental disorders. Their fundamental characteristic is pathological mood change. They significantly deplete all aspects of a patient’s personality along with the overall psychological and social functioning. By the year 2020 depression will have become the second most common disease in the world with respect to morbidity and mortality (World Health Organization), and by the year 2030 the leading cause of disease burdens in affluent countries. The etiology of mood disorders is multifactorial and is the result of interaction between genetic predisposition, biological basis and an early life (traumatic) experience along with the impact of the surrounding circumstances. The typical difficulties and the most conspicuous features of depression are sadness, dejection, moodiness, weakness, listlessness, lack of incentive, self-doubt, feelings of worthlessness, hopelessness, futility. Along with them, often appear anxiety and restlessness, lack of energy, appetite disturbance, loss of body weight, decreased libido, sleep disorders, aches, poor concentration and suicidal thoughts. Mood disorders are diagnosed based on patient’s medical history, the clinical picture and the progress of the disease. In the treatment of mood disorders the best results are achieved by the combination of pharmacological and psychological therapy. The aim of the treatment is: diminish or eliminate symptoms, increase physical abilities and the general functioning of a patient, and reduce the possibilities of a relapse or recurrence of the disease. The nurse is often the first expert who contacts with patients. She participates intensively in the overall rhythm of a patient’s life. She is the closest person that patients and their families are in contact with so she is the first who is able to observe the changes and present her observations to the professional team, which are very important before proceeding. Therefore, the nurse’s therapeutic action is extremely important. She is a necessary and indispensable member of the team in a psychiatric care unit. The proof of the suffering of depressive patients can be found in this saying: "If there is a hell on Earth, then it is in the soul of a depressed person.