Major Depressive Disorders: Atypical Symptoms (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Now what are some of the more significant features that we're going to see when we look at a person, and we are interacting with a person who may have major depressive disorder? So a person, as I've said before, there are typical and atypical features.

    00:19 So the typical features this sadness, this anhedonia, or losing any kind of enjoyment and things that you used to enjoy, this not being able to get up and get out of bed.

    00:33 But sometimes, we see very critical later stage features.

    00:42 A person might start hallucinating, they might become delusional.

    00:48 What's the difference there? So hallucinations are sensory, hearing, feeling, touching, smelling, tasting, and seeing things that are not there.

    01:00 And what is a delusion? How does that switch over from hallucination? What is the difference there? When you're thinking about delusion, it is a thought.

    01:12 A delusion is a thought that is not true, that you believe 100%.

    01:18 You may believe that you are the king of the world, if you are extremely grandiose.

    01:25 But if you are very, very depressed, you might have delusions that maybe people are telling you that you're worthless, you may have the delusion that everyone is out there to prove how worthless you are.

    01:40 And you don't need to have any kind of evidence for that.

    01:45 That's what makes it a delusion.

    01:47 In the face of evidence a delusion persists.

    01:51 A delusion is in your thoughts.

    01:55 It is something that we have to work with, we have to find medication and therapy to help lift these thoughts.

    02:04 Also, when you think about how a person might feel so guilty, so inadequate.

    02:11 They might think that they deserve to be punished, they might think that they deserve to be, you know, taken outside and hurt.

    02:22 And that increases that likelihood that this person with depression might put themselves with people who are willing to hurt them.

    02:31 And they might feel that they deserve that hurt.

    02:34 And they need protection.

    02:36 Remember, violence is usually not perpetrated by a person with mental illness.

    02:42 They are usually the victims of a violent action.

    02:47 Finally, there are two other words that come up.

    02:51 One is echolalia.

    02:53 And the other is echopraxia.

    02:56 So when you were thinking about this, I want you just to break up that word for a second.

    03:01 Think about echo, what is an echo? If I'm on the top of a mountain, and I shout "Hello", what happens? You hear hello, hello, hello.

    03:11 So that's the repetition.

    03:13 An echo is a repetition.

    03:15 Echolalia is a feature where when you're talking to a person who is significantly depressed, you say, how are you and the person looks right at you and says, how are you? You say, are you doing better? And they look at you and they say, are you doing better? Now, where does this come from, this echolalia? It may come from a poverty of words, it may come from a brain that really can't find any new words.

    03:49 And so they just repeat exactly what is said to them.

    03:54 Echopraxia, on the other hand, is when they imitate what you're doing.

    04:02 So if you are standing there like this, they might stand up like this.

    04:08 It is not one of those typical features.

    04:12 It is atypical feature.

    04:15 We also have to worry about if depression continues.

    04:20 And it becomes really critical.

    04:22 They may have catatonia or non responsiveness.

    04:28 And I have had patients who are totally unresponsive, you almost think they're in a coma.

    04:35 But nothing medically demonstrates that they're in a coma.

    04:39 They are just simply not responsive.

    04:42 And it looks like they are incapable, which they are, it's almost...

    04:49 paralysis, an emotional paralysis.

    04:53 And you may see that they have waxy stiffness where you actually move their hand and it's stays there.

    05:02 And even when you don't move it down, it will stay there as long as they have this kind of catalepsy or catatonia, and it is against gravity, you would think this would get very heavy for them, but they will hold it.

    05:23 Again, these are not your typical symptoms.

    05:26 Your typical symptoms with most people who have major depressive disorder, are going to be this lack of energy, this change in appetite, this amazing sadness, this inability to have any kind of joy in what they're doing.

    05:45 If they're moving forward and they are not getting help.

    05:49 And this depression becomes something that is so weighty in their body that they no longer can get out of bed, they no longer can eat or drink, they are sleeping all the time.

    06:03 It is critical, it is critical that they get help.

    About the Lecture

    The lecture Major Depressive Disorders: Atypical Symptoms (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Mood Disorders: Major Depressive and Bipolar Disorders (Nursing).

    Included Quiz Questions

    1. Catatonia
    2. Echopraxia
    3. Anhedonia
    4. Hypersomnia
    1. “Hallucinations are when someone sees, hears or feels something that is not actually there.”
    2. “I had a client who experienced delusions. They were convinced that the government was trying to kill them.”
    3. “Hallucinations and delusions are typical symptoms of MDD.”
    4. “Delusions are when someone hears or feels something that is not actually there.”
    5. “I had a client who hallucinated once. They thought they were a famous singer.”
    1. The client who repeats back everything the nurse says to them
    2. The client who is talking to an empty chair
    3. The client who is staring off into space and not saying anything
    4. The client who is imitating the nurse’s actions

    Author of lecture Major Depressive Disorders: Atypical Symptoms (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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