The document discusses mood disorders such as depression. It defines depressive disorders as syndromes involving depressed mood, pessimistic thinking, lack of enjoyment and reduced energy. It classifies depressive disorders and lists their prevalence, risk factors, signs and symptoms, diagnosis, treatment options including pharmacotherapy and psychotherapy, and nursing management considerations.

1. DEPRESSION

2. MOOD DISORDERS :
Mood/affective Disorders
are characterised by a
disturbance of mood,
accompanied by a full or
partial manic or depressive
syndrome, which is not due
to any other physical and
mental disorder.

3. CLASSIFICATION
• F 30 : MANIC EPISODE
• F 31: BIPOLAR AFFECTIVE DISORDER
• F32 : DEPRESSIVE EPISODE
• F33 : RECURRENT DEPRESSIVE
DISORDER
• F34: PERSISTENT MOOD DISORDER
• F38 : OTHER MOOD DISORDERS
• F39 : UNSPECIFIED MOOD DISORDERS

4. DEFINITION
Oxford textbook of psychiatry (1997)
defines depressive disorders as
syndromes of depressed mood,
pessimistic thinking , lack of enjoyment,
reduced energy and slowness.

5. ICD-10 CLASSIFICATION
• F30-39- mood ( affective disorder)
• F 32 -Depressive episode
• F 32.0 -Mild depressive episode
• F 32.1 - Moderate depressive episode
• F 32.2 - Severe depressive episode without psychotic
symptoms
• F 32.3 - Severe depressive episode with psychotic
symptoms
• F 32.8 - Other depressive episode – atypical depression
• F 32.9 - Depressive episode , unspecified
• F 33 - Recurrent depressive disorder.

6. EPIDEMIOLOGY
lifetime prevalence of about 15%
perhaps as high as 25% for women.
• Sex: more in women.
• Age: The mean age of onset is about
40 years, 50% of all the patients have
an onset between 20-50 years of age.
• Marital status
• Socioeconomic and cultural
considerations: rural areas than in
urban.

7. ETIOLOGY
• Biological Theories
– Genetics:
• twin studies,
• family studies and
• Adoption studies.

8. ETIOLOGY
• Biochemical influences (
NE,SERO.,DOP,A.CH)
• Neuroendocrine disturbances
– Hyperactivity of adrenal gland
– Decreased level of thyroid hormone

9. ETIOLOGY
• Physiological influences
– Medication side effects: steroids,
hormones, sedatives, antineoplastics,
antibacterials
– Neurological disorders:
– Nutritional deficiencies:

10. ETIOLOGY
• PSYCHOSOCIAL THEORIES
– Psychoanalytic theory: loss of loved
object.
– Behavioral theory: conditioned by
repeated losses in past.
– Cognitive theory: depression is due to
negative cognitions
– Sociological theory: Stressful life
events

11. CLINICAL FEATURES
• DEPRESSED MOOD: Sadness of mood,
loss of interest and loss of pleasure in
almost all activities.
– Pervasive and persistent pattern of
sadness.

12. CLINICAL FEATURES
• DEPRESSIVE COGNITIONS
– Hopelessness: no hope in future due to
pessimism.
– Helplessness: no help is possible
– Worthlessness: feeling of inadequacy and
inferiority.
– Unreasonable guilt
– Self blame

13. CLINICAL FEATURES
• SUICIDAL THOUGHTS:
• PSYCHOMOTOR ACTIVITY:
– Psychomotor retardation
– Thinks, walks and acts slowly
– Monotonous
– Delay in answering questions

14. CLINICAL FEATURES
• PSYCHOTIC FEATURES
– Delusions and hallucinations

15. CLINICAL FEATURES
• Somatic symptoms
– Significant decrease in appetite or weight
– Early morning awakening
– Pervasive lack of interest and lack of reactivity to
pleasurable stimuli
– Posture is stooped
– Reddened eyes from crying
– Persons look 10 years older than their
chronological age.
– Constipation and anorexia
– dry mouth, headache, sleep disturbance, fatigue
and lowered libido

16. MAJOR DEPRESSIVE DISORDERS
• SINGLE EPISODE OR RECURRENT
• MILD/MODERATE/ SEVERE
• WITH PSYCHOTIC FEATURES
• WITH CATATONIC FEATURES
• WITH MELANCHOLIC FEATURES
• CHRONIC
• WITH SEASONAL PATTERN
• WITH POSTPARTUM ONSET
• DYSTHYMIC DISORDER
• PREMENSTRUAL DYSPHORIC DISORDER

17. DIAGNOSIS
• ICD 10 diagnostic criteria
• Psychological tests- Beck depression
inventory, Hamilton rating scale
• Dexamethazone suppression test
• Based on signs and symptoms

18. TREATMENT
• Pharmacotherapy

19. PHARMACOTHERAPY
• antidepressants

20. PHYSICAL THERAPIES
• ELECTROCONVULSIVE THERAPY:
severe depression with suicidal risk .
• LIGHT THERAPY: seasonal depression
• REPETITIVE TRANS CRANIAL
MAGNETIC STIMULATION.

21. PSYCHOSOCIAL THERAPIES
• Cognitive therapy
• Psychoanalytic therapy
• Supportive psychotherapy
• Group therapy
• Family therapy
• Behavioral therapy

22. NURSING MANAGEMENT

23. ASSESSMENT

24. NURSING DIAGNOSIS
• High risk for self directed violence
related to depressed mood, feelings of
worthlessness and anger turned inward
on the self
• Dysfunctional grieving related to real or
perceived loss as evidenced by denial of
loss, inappropriate expression of anger.

25. • Powerlessness related to dysfunctional
grieving process as evidenced by feeling of
lack of control over life situations.
• Self esteem disturbance related to learned
helplessness , negative view of self as
evidenced by expression of worthlessness
and sensitivity to criticism
• Altered sleep and rest related to depressed
mood as evidenced by difficulty in falling
asleep and early morning awakening.

26. THANK YOU