The most common types of mood disorders are major depression, dysthymia (dysthymic disorder), bipolar disorder, mood disorder due to a general medical condition, and substance-induced mood disorder. There is no clear cause of mood disorders.

1. MOOD DISORDERS
Ms Nyahoda I

2. • Mood is a pervasive and sustained feeling
tone that is experienced internally which
influences a person's behavior and
perception of the world.
• Affect is the external expression of mood.
• Mood can be normal, elevated, or
depressed.
• Healthy persons experience a wide range
of moods and have capacity to control
their moods and affects.

3. • Mood disorders are a group of clinical
conditions characterized by a loss of the
sense of control and a subjective
experience of great distress.
• Patients with elevated mood
demonstrate expansiveness, flight of
ideas, decreased sleep as well as
grandiose ideas.
• Patients with depressed mood
experience a loss of energy and interest,
feelings of guilt, difficulty in concentrating,
loss of appetite, and thoughts of death or
suicide.

4. Categories affective disorders
• The mood disorders are primary
categorised into three (3) namely
• – Mania
• – Depression
• – Bipolar (manic-depressive) mood
disorders manifested by cycles of mania
and depression.

5. • A bipolar disorder is characterized by
mood swings from profound
depression to extreme euphoria
(mania), with intervening periods of
normalcy.
• Delusions or hallucinations may or
may not be a part of the clinical
picture, and onset of symptoms may
reflect a seasonal pattern.

6. • During a manic episode, the mood is
elevated, expansive, or irritable.
• The disturbance is sufficiently severe to
cause marked impairment in occupational
functioning or in usual social activities or
relationships with others.
• It requires hospitalization to prevent harm
to self or others.
• Motor activity is excessive and Psychotic
features may be present.

7. • A somewhat milder degree of this clinical
picture is called hypomania.
• Hypomania is not severe enough to
cause marked impairment in social or
occupational functioning or to require
hospitalization, and it does not include
psychotic features
• A hypomanic episode lasts at least 4 days

8. • When the symptom presentation includes
rapidly alternating moods (sadness,
irritability, euphoria) accompanied by
symptoms associated with both depression
and mania, the individual is given a
diagnosis of bipolar disorder, mixed.
• This disturbance is severe enough to
cause marked impairment in social or
• occupational functioning or to require
hospitalization.
• Psychotic features may be evident.

9. Bipolar I Disorder (Mania)
• Bipolar I disorder is the diagnosis given to
an individual who is experiencing, or has
experienced, a full syndrome of manic or
mixed symptoms.
• lasting for at least 1 week and patient
must be hospitalized.

10. • Definition - Mania is an alteration in
mood that is expressed by feelings of
elation, inflated self-esteem, grandiosity,
hyperactivity, agitation, and accelerated
thinking and speaking.
• Mania is a mental condition with distinct
period during which mood is abnormally
and persistently elevated, expansive, or
irritable lasting about 1 week or more.

11. • CLINICAL FEATURES
At least three of the following symptoms
accompany the manic episode:
1. Elevated, expansive or irritable mood
• The mood change is essential “diagnostic” feature
of a manic episode. Usually manic people feel
wonderful, see the world as an excellent place,
and have limitless enthusiasm for whatever they
are doing or plan to do. This expansiveness is
usually mixed with irritability. They see others as
very slow, doltish spoilsports and can become
hostile, especially if someone tries to interfere
with their behavior. They have a euphoric mood.

12. 2.Inflated self-esteem or grandiosity;
• They often see themselves as extremely
attractive, important and powerful people,
capable of great achievements in fields for
which they may in fact, have no aptitude
whatsoever.
• They may begin to compose symphonies,
design nuclear weapons or calling state house
on how to run the country. Exegerated self
importance.

13. 3. Decreased need for sleep;
• May sleep only for 2 to 3 hours a night and yet
have twice as much energy as those around
them.
4. Talkativeness
• Manic people tend to be talk loudly, rapidly
and constantly (pressured speech)
(unrelenting, rapid, often loud talking without
pauses);
• Their speech is often full of irrelevant details
and jokes that they alone find funny

14. 5. Flight of ideas (often racing and unconnected
thoughts);
• Manic individuals often have racing thoughts
hence they speak so rapidly to keep up with the
flow of their ideas. Manic speech also tends to
shift abruptly from one topic to the next
6. Distractibility;
• They are easily distracted. While doing or
discussing one thing, they notice something else
in the environment and abruptly turn their
attention to that instead. They also show deficits
on tasks that require sustained attention

15. 7. Hyperactivity
• The expansive mood is usually accompanied by
restlessness and increased goal-directed activity-
physical, social, occupational and often sexual
8. Reckless behaviour
• The euphoria and grandiose self-image of manic
people often lead them into impulsive actions:
buying sprees, reckless driving, and careless
business investments, calling friends in the
middle of the night, or spending the family
savings on new porches. Excessive involvement in
pleasure- seeking activities with a high potential
for painful consequences

16. • Outside the hospital, manic patients often
show:
• Drinking alcohol excessively, perhaps in an
attempt to self-medicate.
• Excessive use of the telephone, making long-
distance calls during the early morning hours
"Disinherited".
• Pathological gambling.
• Wearing clothing and jewellery of bright
colours in unusual or outlandish
combinations. Flamboyant dressing.

17. • Inattention to small details (e.g., forgetting to
hang up the telephone).
• Acting impulsively and with a sense of
conviction and purpose.
• Often preoccupation by religious, political,
financial, sexual, or persecutory ideas that can
evolve into complex delusional systems

18. Diagnostic Criteria for Manic
Episode
• A distinct period of abnormally and
persistently elevated, expansive, or
irritable mood, lasting 1 week (or any
duration if hospitalization is necessary).
• B. During the period of mood disturbance,
three (or more) of the following symptoms
have persisted and have been present to a
significant degree:

19. • 1. Inflated self-esteem or grandiosity
• 2. Decreased need for sleep (e.g., feels
rested after only 3 hours of sleep)
• 3. More talkative than usual or pressure to
keep talking
• 4. Flight of ideas or subjective experience
that thoughts are racing
• 5. Distractibility (i.e., attention too easily
drawn to unimportant or irrelevant
external stimuli)

20. • 6. Increase in goal-directed activity (either
socially, at work or school, or sexually) or
psychomotor agitation
• 7. Excessive involvement in pleasurable
activities that have a high potential for
painful consequences (e.g., engaging in
unrestrained buying sprees, sexual
indiscretions, or foolish business
investments)

21. • C. The mood disturbance is sufficiently
severe to cause marked impairment in
occupational functioning or in usual social
activities.
• D. The symptoms are not due to the direct
physiological effects of a substance (e.g., a
drug of abuse, a medication, or other
treatment) or a general medical condition
(e.g., hyperthyroidism).

22. Bipolar II Disorder
(Depression)
• The bipolar II disorder diagnostic category
is characterized by recurrent bouts of
major depression with episodic occurrence
of hypomania.
• The client has never experienced an
episode that meets the full criteria for
mania or mixed symptomatology.

23. • An occasional bout with the “blues,” a
feeling of sadness or downheartedness, is
common among healthy people and
considered to be a normal response to
everyday disappointments in life.
• These episodes are short-lived as the
individual adapts to the loss, change, or
failure (real or perceived) that has been
experienced.
• Pathological depression occurs when
adaptation response to adverse life events
is ineffective

24. • Depression is An alteration in mood that
is expressed by feelings of sadness,
despair and pessimism.
• It is also characterised by loss of interest
in usual activities and somatic symptoms
may be evident. Changes in appetite and
sleep patterns are common.

25. DSM-V Criteria for Major
Depressive Episode
• Five (or more) of the following symptoms
have been present during a 2-week period
and represent a change from previous
functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are
clearly due to a general medical condition.

26. –1. depressed mood nearly every day, as
indicated by either subjective report
(e.g., feels sad or empty) or observation
made by others (e.g., appears tearful).
–2. markedly diminished interest or
pleasure in almost all activities.
–3. significant weight loss when not
dieting or weight gain (e.g., a change of
more than 5% of body weight in a
month), or decrease or increase in
appetite nearly every day.

27. –4. insomnia or hypersomnia nearly
every day
–5. psychomotor retardation
–6. fatigue or loss of energy
–7. feelings of worthlessness or excessive
or inappropriate guilt
–8. diminished ability to think or
concentrate, or indecisiveness, nearly
every day (either by subjective account
or as observed by others)

28. • 9. recurrent thoughts of death, recurrent
suicidal ideation without a specific plan, or
a suicide attempt or a specific plan for
committing suicide
• The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
• The symptoms are not due to the direct
physiological effects of a substance (e.g.,
a drug of abuse, a medication) or a
general medical condition (e.g.,
hypothyroidism).

29. Cyclothymic Disorder
• The essential feature of cyclothymic
disorder is a chronic mood disturbance
of at least a 2-year duration involving
numerous episodes of hypomania and
depressed mood of insufficient severity or
duration to meet the criteria for either
bipolar I or II disorder.
• The individual is never without hypomanic
or depressive symptoms for more than 2
months.

30. ETIOLOGY OF MOOD DISORDERS
• The exact cause of bipolar disorder has
yet to be determined. (Idiopathic)
• However scientists have implicated the
following factors to play a role
Biochemical Influences
• norepinephrine has been identified as a
key component in the mobilization of the
body to deal with stressful situations.

31. • Neurons that contain serotonin are
critically involved in the regulation of
many psychobiological functions, such as
mood, anxiety, arousal, vigilance,
irritability, thinking, cognition, appetite,
aggression, and circadian rhythm
• Decreased supply of these biogenic
amines inhibits the transmission of
impulses from one neuronal fiber to
another, causing a failure of the cells to
fire or become charged

32. Neuroendocrine Disturbances
• In clients who are depressed, the normal
system of hormonal inhibition fails,
resulting in a hypersecretion of cortisol
resulting to meningial inflammation and
enlarged ventricles
• Hormones: estrogen and progesterone
imbalance

33. Medication Side Effects.
• A number of drugs, either alone or in
combination with other medications, can
produce a depressive syndrome.
• Most common among these drugs are
those that have a direct effect on the
central nervous system. E.g
antipsychotics,and sedative-hypnotics,
anaesthetic drugs

34. • Brain tumors, particularly in the temporal
lobe, often cause symptoms of depression.
• Both the symptoms of mood disorders and
biological research findings support the
hypothesis that mood disorders involve
pathology of the brain
Electrolyte Disturbances.
• Excessive levels of sodium bicarbonate or
calcium can produce symptoms of
depression, as can deficits in magnesium and
sodium.

35. Genetic Factors
• Numerous family and twin studies have
long documented the heritability of mood
disorders.
• Concordance rate for monozygotic twins is
70 to 90 percent, whereas that for
dizygotic twins is only 16 to 35 percent

36. Psychological factors
• Life Events and Environmental Stress- A
long-standing clinical observation is that
stressful life events more often precede
first, rather than subsequent, episodes of
mood disorders
• children raised by rejecting or unloving
parents were prone to feelings of
insecurity and loneliness, making them
susceptible to depression.

37. • Medical conditions such as meningitis,
cerebral malaria and other chronic illness
such as HIV/AIDS and syphilis
• Use of substances such as alcohol, marijuana,
cocaine, heroin etc

38. Medications Used in the Treatment
of Depression
Major categories of antidepressants include
• Tri-cyclic antidepressants (TCA)
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors
(SSRIs)
• Atypical antidepressants.
• levels of neurotransmitters especially
norepinephrine and serotonin, are
decreased in depression

39. Tricyclic Antidepressants (TCAs)
• Amitriptyline 50–300mg
• Imipramine (Tofranil) 30–300mg
• Nortriptyline 30–100
Side Effects
• Dry mouth, drowsiness, blurred vision,
urinary
• retention, constipation, Tachycardia,,
nausea and vomiting, photosensitivity,
exacerbation of mania,

40. Selective Serotonin Reuptake
Inhibitors (SSRIs)
• They act by selectively inhibiting the
central nervous system (CNS)
neuronal uptake of serotonin (5-HT).
• Fluoxetine (Prozac; Serafem) 20 – 80 mg
• Paroxetine (Paxil) 10-50 mg/p o
Side Effects
• Headache, insomnia, nausea, diarrhea,
constipation, sexual dysfunction, agitation,
dry mouth

41. Monoamine Oxidase Inhibitors
(MAOIs)
• Isocarboxazid (Marplan) 20 – 60mg
• Phenelzine (Nardil) 30 – 60 mg
Side Effects
• Dizziness, headache, constipation, nausea,
dry mouth, tachycardia, palpitations,
hypomania

42. • TREATMENT OF MANIC PATIENTS

43. The treatment of manic patients in an
inpatient ward can be complicated
by:
• Their testing of the limits of ward rules.
• Their tendency to shift responsibility for their
acts onto others.
• Their exploitation of the weaknesses of
others.
• Their propensity to create conflicts among
staff members.

44. Medications Used in the Treatment
of Bipolar Mania
Antimanic Agent
• Lithium carbonate (Eskalith),
• Acute mania:80 – 100mg
• Maintenance: 20–60
• The therapeutic level of lithium carbonate is
1.0 to 1.5 m Eq /L for acute mania and 0.6 to
1.2 m Eq /L for maintenance therapy
Side Effects
• Drowsiness, dizziness, headache, dry mouth,
thirst, GI upset, nausea and vomiting, fine
hand tremors, hypotension, arrhythmias,
polyuria, weight gain.

45. • Lithium levels should be monitored weekly until
the therapeutic level is reached, and then
monthly during maintenance therapy.
• Because lithium toxicity is a life-threatening
condition, monitoring of lithium levels is critical.
• The initial signs of lithium toxicity include ataxia,
blurred vision, severe diarrhea, persistent
nausea and vomiting, and tinnitus.
• Symptoms intensify as toxicity increases and
include excessive output of dilute urine,
psychomotor retardation, mental confusion,
tremors and muscular irritability, seizures,
impaired consciousness, oliguria or anuria,
arrhythmias, coma, and eventually death.

46. mood stabilisers
• Carbamazepine (Tegretol) 200–1200mg
• Valproic acid (sodium valproate) 500–
1500mg
• Gabapentin (Neurontin) 900–1800mg
• Lamotrigine (Lamictal) 100–200mg
• These drugs stabilize the moods of the patient.
Side Effects
• Nausea and vomiting, somnolence, dizziness,
headache, prolonged bleeding time, risk of
severe rash

47. Antipsychotics
• Chlorpromazine (Thorazine) 75–200mg
• Olanzapine (Zyprexa) 5–20mg
• Quetiapine (Seroquel) 400–800mg
• Risperidone (Risperdal) 1–6mg
• They treat psychotic features
Side Effects
• Drowsiness, dizziness, dry mouth,
constipation, increased appetite, weight gain,
hyperglycemia, headache

48. • Benzodiazepines :( diazepam, lorazepam,
Librium etc)
These drugs calm down the patients

49. Electroconvulsive Therapy for Depression
and Mania
• Electroconvulsive therapy (ECT) is the
induction of a generalized seizure through
the application of electrical current to the
brain.
• ECT is effective with clients who are
acutely suicidal and in the treatment of
severe depression

50. • Episodes of acute mania are occasionally
treated with ECT, particularly when the
client does not tolerate or fails to respond
to lithium or other drug treatment

51. REFERENCES
• Diagnostic And Statistical Manual of Mental
Health, Text Review DSM-V (2016). 4th
edition, American psychiatric
association.washington DC. ISBN: 0-89042-
024-6
• Sadock et al (2007). Kaplan and Sadock
Synopsis Of Psychiatry; Behavioural
Sciences/Clinical Psychiatry. 10th Edition,
Lippincott Williams & Wilkins. china
• Videbek s. (2011) Psychiatric mental health
nursing.5th edition, Wolter Kluver health,
Lippincott Williams&Wilkins. China. Isbn:978-
1-60547-861-6