mania , depression . bipolar disorder

1. MOOD DISORDER

2. MOOD DISORDER
Mood disorder are
characterized by a
disturbance of mood,
accompanied by a full or
partial manic or depressive
syndrome, which is not
due to any other physical

3. CLASSIFICATION OF MOOD
DISORDER
 F30-F39 :- MOOD (AFFECTIVE)
DISORDER
F30 :-MANIC EPISODE
F31 :-BIPOLAR AFFECTIVE
DISORDER
F32 :- DEPRESSIVE EPISODE
F33 :- RECURRENT DEPRESSIVE
DISORDER
F34 :-PERSISTENT MOOD
DISORDER
F38 :- OTHER MOOD DISORDER

4. MANIC EPISODE
Mania refers to a syndrome in
which the central features are
over activity, mood changes
(which may be towards elation or
irritability )and self important
ideas.
The lifetime risk of manic episode
is about 0.8-1%. This disorder
occurs in episodes lasting usually

5. CLASSIFICATION OF
MANIA
 F30 :- MANIC EPISODE
 F30.0 :- HYPOMANIA
 F30.1 :- MANIA WITHOUT
PSYCHOTIC SYMPTOMS
 F 30.2 :- MANIA WITH
PSYCHOTIC SYMPTOMS
 F 30.8 :- OTHER MANIC
EPISODES
 F 30.9 :- MANIC EPISODES

6. ETIOLOGY
oNEUROTRANSMITTER AND
STRUCTURAL HYPOTHESES :-
Manic episode are related to
excessive levels of norepinephrine
and dopamine, an imbalance
between cholinergic and
noradrenergic system. Or a
deficiency of serotonin
oGENETIC CONSIDERATIONS :-
Monozygotic (identical) twins have
a higher rate of incidence than

7.  PSYCHODYNAMIC THEORIES :-
Developmental theorists have
hypothesized that faulty family
dynamics during early life are
responsible for manic
behaviors in later life.

8. Psychopathology of Mania
Manic state shows lack of
inhibition , apparent quickness
of psychological reaction,
distracability and flight of ideas .
Elation of mood is accompanied
by a feeling of general wellbeing
which in the manic state is
manifested as lack of insight.

9. Clinical features
1. ELEVATED , EXPANSIVE,OR
IRRITABLE MOOD
 ELEVATED MOOD IN MANIA HAS FOUR
STAGES:-
EUPHORIA (stage 1) :- Increase sense of
psychological well being and happiness not
in keeping with ongoing events.
ELATION(stage 2) :- Moderate elevation of
mood with increased psychomotor activity.
EXALTATION(stage3) :- Intense elevation
of mood with delusions of grandeur.
ECSTASY(stage4) :- Severe elevation of
mood , intense sense of rapture,

10. 2.PSYCHOMOTOR ACTIVITY
There is an increase
psychomotor activity ranging
from over activeness and
restlessness to manic
excitement. The person involves
in ceaseless activity.

11. SPEECH AND THOUGHT
I. FLIGHT OF IDEAS :- Thoughts racing
in mind , rapid shifts from one topic
to another.
II. PRESSURE OF SPEECH :- Speech
is forceful, strong and difficult to
interrupt.ueses playful language
with rhyming, joking, speaks loudly.
III. CLANG ASSOCIATION :- These are
ideas that are related only by similar
or rhyming sounds rather than
actual meaning.

12. Other features
 INCREASE SOCIABILITIES
 IMPULSIVE BEHAVIOR
 DISINHIBITION
 POOR JUDGMENT
 POOR SELF CARE
 DECREASED NEED FOR SLEEP
 DECREASED FOOD INTAKE DUE TO
OVER ACTIVITY
 DECREASED ATTENTION AND
CONCENTRATION

13. HYPOMANIA
The ability to function
becomes much better and
marked increase in
productivity and creativity

14. SYMPTOMS OF HYPOMANIA
Hypomania is a lesser degree of
mania . There is a persistent
mild elevation of mood and
increase sense of psychological
wellbeing and happiness not in
keeping with ongoing events.
Concentration and attention
may be impaired,

15. DIAGNOSIS
PSYCHOLOGICAL TEST
SUCH AS YOUNG MANIA
RATING SCALE
ICD 10 DIAGNOSTIC
CRITERIA
BASED ON SIGNS AND
SYMPTOMS

16. TREATMENT MODALITIES
PHARMACOTHERAPY:
LITHIUM :- 900-2100 MG/DAY
CARBAMAZEPINE :- 600-1800
mg/day
SODIUM VALPROATE :- 600-
2600mg/day
ELECTROCONVULSIVE
THERAPY
PSYCHOSOCIAL TREATMENT

17. NURSING MANAGEMENT FOR
MANIA
 NURSING ASSESSMENT :-
• OBJECTIVE SIGNS :-
DISTURBANCE OF SPEECH
RAPID SPEECH
LOUD, PRESSURED SPEECH
EASILY DISTRACTED
OVER ACTIVITY
WEIGHT LOSS

18. SUBJECTIVE SIGNS :-
FEELINGS OF JOY
RAPID MOOD SWINGS
SLEEP DISTURBANCES
DELUSION AND
HALLUCINATION

19. NURSING DIAGNOSIS
 HIGH RISK FOR INJURY RELATED TO
EXTREME HYPERACTIVITY AND
IMPULSIVE BEHAVIOR, AS
EVIDENCED BY LACK OF CONTROL
OVER PURPOSELESS AND
POTENTIALLY INJURIOUS
MOVEMENT.
 IMPAIRED SOCIAL INTERACTION
RELATED TO EGOCENTRIC AND
NARCISSISTIC BEHAVIOR AS
EVIDENCED BY INABILITY TO

20. DEPRESSIVE
EPISODE

21.  Depression is a widespread mental
health problem affecting many people
. The lifetime risk of depression in
males in 8-12 % and in females it is
20-26 % . Depression occurs twice as
frequently in women as in men.
DEFINITION OF DEPRESSION
:-
A mental health disorder
characterized by persistently

22. CLASSIFICATION OF
DEPRESSION
 F32 :- DEPRESSIVE EPISODE
 F32.0:- MILD DEPRESSIVE EPISODE
 F32.1 :-MODERATE DEPRESSIVE
EPISODE
 F32.2 :- SEVERE DEPRESSIVE
EPISODE WITHOUT PSYCHOTIC
SYMPTOMS
 F32.3 :- SEVERE DEPRESSIVE
EPISODE WITH PSYCHOTIC
SYMPTOMS

23. F 32.9:- DEPRESSIVE
EPISODE AND,UNSPECIFIED
F33 :- RECURRENT
DEPRESSIVE DISORDER.

24. ETIOLOGY
BIOLOGICAL
THEORIES
PSYCHOSOCIAL
THEORIES

25. BIOLOGICAL THEORIES
1. NEUROCHEMICAL :- Research
findings suggest that depression
results when levels of
norepinephrine and serotonin
decrease and dysregulation of
acetylcholine and GABA occurs
2. GENETIC THEORIES :- Studies of
identical twins show that when one
twin is diagnosed with major
depression the other twin has a

26. 3.ENDOCRINE THEORIES
Normally the hypothalamic
pituitary adrenal axis is a
system that mediates the stress
response. However in some
depressed people this system
malfunctions and creates
cortisol, thyroid and hormonal
abnormalities.

27. 4. CIRCADIAN RHYTHM
THEORIES :-Circadian rhythm are
responsible for the daily regulation
of wake-sleep cycles, activity
patterns and hormonal secretions.
5. CHANGES IN BRAIN ANATOMY
:- Loss of neurons in the frontal
lobes , cerebellum and basal
ganglia has been identified in
depression.

28. PSYCHOSOCIAL THEORIES
1. PSYCHOANALYTIC THEORY :-
According to Freud (1957)
depression results due to loss of
a loved object , and fixation in
the oral sadistic phase of
development. In this model ,
mania is viewed as a denial of
depression.

29. 2.BEHAVIORAL THEORY :- This
theory of depression
connects depressive
phenomena to the
experience of uncontrolled
events Depression is
conditioned by repeated
losses in the past.

30. 3) COGNITIVE THEORY
 According to this theory ,
depression is due to negative
cognitions which includes :-
 NEGATIVE EXPEC TATION OF
THE ENVIRONMENT
 NEGATIVE EXPECTATION OF
THE SELF
 NEGATIVE EXPECTATION OF
THE FUTURE.

31. 4)SOCIOLOGICAL THEORY
Stressful life events,
example :- death,
marriage, financial loss
before the onset of the
disease .

32. CLINICAL FEATURES
 A typical depressive episode is
characterized by the following
features :-
 DEPRESSED MOOD :- sadness of
mood or loss of interest and loss of
pleasure in almost all activities
(pervasive sadness)
present throughout the day
(persistent sadness)

33. DEPRESSIVE COGNITIONS :-
Hopelessness and helplessness
worthlessness (a feeling of
inadequacy and
inferiority)unreasonable guilt and
self blame over trivial matters in
the past.
SUICIDAL THOUGHTS :- Ideas of
hopelessness are often

34.  PSYCHOMOTOR ACTIVITY :- The
psychomotor retardation is
frequent. The retarded patients
thinks , walks and acts slowly
.slowing of thought is reflected the
patient speech.
 PSYCHOTIC FEATURES :- Some
patients have delusion and
hallucinations.

35. SOMATIC SYMPTOMS
 DECREASE IN APPETITE
 EARLY MORNING AWAKENING
ATLEAST 2 OR MORE HOURS
BEFORE THE USUAL TIME OF
WAKING UP
 PERVASIVE LAKE OF INTEREST
AND LACK OF REACTIVITY TO
PLEASURABLE STIMULI
 PSYCHOMOTOR AGITATION

36. DIAGNOSIS
 PSYCHOLOGICAL TESTS –BECK
DEPRESSION INVENTORY .
HAMILTON RATING SCALE FOR
DEPRESSION TO ASSESS
SEVERITY.
 TOXICOLOGY SCREENING
SUGGESTING DRUG INDUCED
DEPRESSION.

37. MANAGEMENT
 PSYCHOPHARMACOLOGY :-
Major categories of antidepressants
are :-
1)Selective serotonin reuptake
inhibitors
2)Tricyclic antidepressants
3) Monoamine oxidase inhibitors

38. PHYSICAL THERAPIES
 ELECTROCONVULSIVE
THERAPY
 LIGHT THERAPY
 REPETITIVE TRANSCRANIAL
MAGNETIC STIMULATION

39. PSYCHOSOCIAL TREATMENT
 PSYCHOTHERAPY
 COGNITIVE THERAPY
 SUPPORTIVE PSYCHOTHERAPY
 GROUP THERAPY
 FAMILY THERAPY
 BEHAVIORAL THERAPY

40. NURSING MANAGEMENT
NURSING ASSESSMENT
SHOULD FOCUS ON
JUDGING THE SEVERITY OF
THE DISORDER INCLUDING
THE RISK OF SUICIDE.
OBJECTIVE SIGNS:-
ALTERATIONS OF ACTIVITY
POOR PERSONAL HYGIENE

41. SUBJECTIVE SYMPTOMS
ANHEDONIA
WORTHLESSNESS
,HOPELESSNESS,
HELPLESSNESS SUICIDAL
IDEAS,IMPAIRMENT OF
COGNITION,SOMATIC
SYMPTOMS,DELUSION,
HALLUCINATION

42. NURSING DIAGNOSIS
 HIGH RISK OF SELF DIRECTED
VIOLENCE RELATED TO
DEPRESSED MOOD,FEELINGS
OF WORTHLESSNESS.
 POWER LESSNESS RELATED TO
DYSFUNCTIONAL GRIEVING
PROCESS, LIFESTYLE OF
HELPLESSNESS, AS EVIDENCED
BY FEELINGS OF LACK OF

43. BIPOLAR MOOD DISORDER
 This is characterized by recurrent
episodes of mania and depression
in the same patients at different
times. Typically the patient
experiences extreme highs (mania
or hypomania ) alternating with
extreme lows
(depression),interspersed between
the high and low are periods of

44. ETIOLOGY
 PRECISE CAUSE UNKNOWN
 GENETIC, BIOCHEMICAL,AND
PSYCHOLOGICAL FACTORS MAY PLAY A
ROLE
 MAY BE TRIGGERED BY STRESSFUL
EVENTS, ANTI DEPRESSANT USE
 SLEEP DEPRIVATION AND HYPOTHYROIDISM

45. SIGNS AND SYMPTOMS OF
BIPOLAR

46. CLASSIFICATION
 F31.0 :- BIPOLAR AFFECTIVE
DISORDER,CURRENT EPISODE
HYPOMANIA
 F31.1 :- BIPOLAR AFFECTIVE
DISORDER, CURRENT EPISODE
HYPOMANIA
 F31.2 :- BIPOLAR AFFECTIVE
DISORDER, CURRENT EPISODE
MANIA WITH PSYCHOTIC
SYMPTOMS

47.  F31.3 :- BIPOLAR AFFECTIVE
DISORDER, CURRENT EPISODE
MILD OR MODERATE
DEPRESSION
 F31.4 :- BIPOLAR AFFECTIVE
DISORDER ,CURRENT EPISODE
SEVERE DEPRESSION WITHOUT
PSYCHOTIC SYMPTOMS

48.  F31.5 :- BIPOLAR AFFECTIVE
DISORDER,CURRENT EPISODE
SEVERE DEPRESSION WITH
PSYCHOTIC SYMPTOMS.

49. DIAGNOSIS
BASED ON SIGNS AND
SYMPTOMS
ICD 10 CRITERIA

50. TREATMENT
 LITHIUM
 VALPORIC ACID
 CARBAMAZEPINE
 ANTI DEPRESSANTS
 ANTIPSYCHOTICS (

51. RECURRENT DEPRESSIVE
DISORDER
This disorder is characterized
by recurrent depressive
episodes. The current episode
is specified as mild , moderate ,
and severe, without psychotic
symptoms, severe with
psychotic symptoms.

52. PERSISTENT MOOD
DISORDER
CLASSIFICATION
F34.0 :- CYCLOTHYMIA
F34.1 :- DYSTHYMIA
F 34.8 :- OTHER PERSISTENT
MOOD DISORDER
F 34.9 :-PERSISTENT MOOD
DISORDER UNSPECIFIED.

53. CYCLOTHYMIA
 Cyclothymic disorder is
characterized by short periods of
mild depression alternating with
short periods of hypomania,
between the depressive and manic
episodes, brief periods of normal
mood occur.

54.  ETIOLOGY :- Genetic factors (most
likely cause )- family history of
bipolar disorder, major depressive
,substance abuse, or suicide in
many patients.

55. CLINICAL FEATURES
 HYPOMANIC PHASE :-
 INSOMNIA
HYPERACTIVITY AND PHYSICAL
RESTLESSNESS
IRRITABILITY
GRANDIOSITY
INCREASED PRODUCTIVITY

56. DEPRESSIVE PHASE :-
INSOMNIA
FEELINGS OF INADEQUACY
DECREASED PRODUCTIVITY
SOCIAL WITHDRAWAL
LETHARGY

57. DIAGNOSIS
 BASED ON ICD 10 CRITERIA
 RULE OUT PHYSICAL AND
PSYCHIATRIC DISORDER THAT
CAN MIMIC CYCLOTHYMIC
DISORDER FOR EXAMPLE :-
ENDOCRINE DISORDER,
UREMIA, VITAMIN DEFICIENCY,
MOOD DISORDER .

58. TREATMENT MODALITIES
LITHIUM
CARBAMAZEPINE
VALPORIC ACID
VERAPAMIL
INDIVIDUAL PSYCHOTHERAPY
AND COUPLE OR FAMILY
THERAPY.

59. NURSING
INTERVENTIONS
 EXPLORE WAYS TO HELP
PATIENT COPE WITH FREQUENT
MOOD CHANGES
 ENCOURAGE VOCATIONAL
OPPORTUNITIES THAT ALLOW
FLEXIBLE HOURS
 ENCOURAGE PATIENT WITH
ARTISTIC ABILITY TO PURSUE
THEIR TALENTS AS A CREATIVE

60. DYSTHYMIA
Dysthymic disorder or
dysthymia refers to mild
depression that lasts at least 2
years in adults or 1 years in
children. It is twice as common
in women as in men and more
prevalent among the poor and
unmarried.

61. ETIOLOGY
 BELOW NORMAL SEROTONIN
LEVELS
 INCREASED VULNERABILITY
WHEN MULTIPLE STRESSORS
AND PERSONALITY PROBLEMS
ARE COMBINED WITH
INADEQUATE COPING SKILLS.

62. CLINICAL FEATURES
 PSYCHOLOGICAL SYMPTOMS :-
o PERSISTENT SAD , ANXIOUS, OR
EMPTY MOOD
o EXCESSIVE CRYING
o INCREASE FEELINGS OF
GUILT,HELPLESSNESS,OR
HOPELESSNESS.

63.  PHYSIOLOGICAL SYMPTOMS
WEIGHT OR APPETITE
CHANGES
SLEEP DIFFICULTIES
REDUCED ENERGY LEVEL

64. DIAGNOSIS
CAREFUL PSYCHIATRIC
EXAMINATION AND MEDICAL
HISTORY
BASED ON ICD 10 CRITERIA

65. TREATMENT
 SHORT TERM PSYCHOTHERAPY
 BEHAVIORAL THERAPY
 GROUP THERAPY
 ANTI DEPRESSANTS

66. NURSING INTERVENTION
 PROVIDE SUPPORTIVE
MEASURES SUCH AS
REASSURANCE,WARMTH,
AVAILABILITY, AND
ACCEPTANCE.
 TEACH PATIENT ABOUT THE
ILLNESS
 ENCOURAGE POSITIVE HEALTH
HABITS.