Mood disorders involve disturbances in mood that are accompanied by related cognitive, physical, and interpersonal difficulties. They include conditions like bipolar disorder and major depressive disorder. Bipolar disorder involves episodes of mania and depression, while major depressive disorder involves recurrent episodes of depression without mania. Mood disorders have biological, genetic, neurological, and psychosocial causes. They are diagnosed based on symptoms and treated with medications, psychotherapy, and electroconvulsive therapy with the goal of managing mood disturbances and related issues. Nursing care focuses on safety, treatment adherence, symptom monitoring, and education.

2. MOOD DISORDERS
The term “Mood disorders” groups
together a number of clinical
conditions whose common and
essential feature is a disturbance of
mood, accompanied by related
cognitive, psychomotor, psycho-
physiological and interpersonal
difficulties.

3. “Mood” refers to an internal emotional
state of an individual. While
“Affect” is the external expression of
internal emotional content.

4. BIPOLAR AFFECTIVE
DISORDER
BPAD
UNIPOLAR
Recurrent
Episodes of
Depression
BIPOLAR
BIPOLAR I
{Mania &
Depression}
BIPOLAR II
{Hypomania &
Depression}
BIPOLAR III
{Depression}

5.  MANIA:
The central features of mania are elevated mood,
increased activity, and self- important ideas.
 HYPOMANIA:
Distinct period of at least a few days of mild elevation of
mood, positive thinking, increased energy & activity level
without manic episode.
 DEPRESSION:
A change of affect is regarded as the central clinical
feature, mood is depressed, loss of interest, guilt &
suicides etc
 DYSTHYMIC DISORDER:
Denote subsume depressive neurosis, neurasthenia and
other mild chronic depression.
 CYCLOTHYMIC DISORDER:
Mood swing between short period of mild depression &
hypomania never reach the severity or duration of major
depression or full mania episode.

6. ICD – 10 CLASSIFICATION
F 30 – 39 Mood Affective Disorder
F30 Manic episode
F31 Bipolar Affective Disorder
F32 Depressive Episode
F33 Recurrent Depressive Disorder
F34 Persistent Mood Disorders
F38 Other Mood Disorders
F39 Unspecified Mood Disorder

7. ETIOLOGY
1) BIOLOGICAL THEORIES
 Catecholamine Hypothesis:
The activity of catecholamine is too high or
low.
 Serotonin Hypothesis:
Deficiency in serotonin activity in both mania &
depression may be seen.
 GABA Hypothesis of Mania:
Deficiency has been postulated to contribute to
the etiology of psychotic states, especially
Mania.

8. 2) NEURO ENDOCRINAL ASPECTS:
 Hypothalamic- Pituitary- Adrenal Axis (HPA
Axis):
Neurons in the Peri-ventricular nucleus
release corticotrophin releasing hormone
(CRH), which stimulates the release of
(ACTH) from the pituitary.
 Melatonin:
It is decreased in depression and increased
in mania.

9. 3) GENETIC STUDIES
Identical twins (monozygotic) have a 54%
risk of one twin developing depression if
the other has had a diagnosed episode,
risk of developing depression in non
identical (dizygotic) twins is about 24% higher
than that of general population but less than
that for monozygotic twins.

10.  PSYCHOSOCIAL THEORIES
1) Life events and environmental stress:
Stressful life events more often precede the
first episodes of mood disorders than the
subsequent episodes.
2) Premorbid personality factors:
There are certain personality characteristics,
such as lack of energy, breakdown under
stress, introversion, insecurity, tendency
to worry, dependency & obsessionality.

11. PSYCHOPATHOLOGY
 Adolph Meyer believed depression to be the
person’s reaction to a disturbing life
experiencing such as the loss of a loved one,
financial set back or unemployment.

12. PSYCHOPATHOLOGY
 According to Beck, depression results from
faulty cognition. He discussed a cognitive triad,
consisting of:
1) Perceiving oneself as defective & inadequate.
2) Perceiving world as demanding & punishing.
3) Expecting failure, defeat and hardship.

13. CLINICAL MANIFESTATION
 Major depression:
1) Depressed Mood
2) Loss of Interest
3) Anxiety
4) Insomnia
5) Suicide
6) Guilt
7) Somatic symptoms
8) Retardation
9) Agitation
10) Diurnal variation of symptoms

14. CLINICAL MANIFESTATION
 Mania:
1) Mood
2) Thought
3) Speech
4) Activity
5) Sleep
6) Appetite
7) Libido
8) Appearance
9) Insight

15. CLINICAL MANIFESTATION
 Dysthymic Disorders:
1) Milder form of depressive symptoms
2) Diurnal variation
3) Feeling of sadness
4) Lack of interest in daily activity
5) Nihilism, Demanding, Complaining
6) Change in appetite
7) Decreased sexual drive

16. DIAGNOSTIC CRITERIA (DSM-IV)
 Manic Episode
1) A distinct period of abnormally & persistently
elevated, expansive or irritable mood lasting at
least 1 week.
2) During the period of mood disturbance, three (or
more) of the following symptoms have persisted:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 More talkative than usual or pressured to keep
talking
 Flight of ideas

17. DIAGNOSTIC CRITERIA (DSM-IV)
 Distractibility
 Increase in goal- directed activity or
psychomotor agitation
 Excessive involvement in pleasurable
activities that have a high potential for
painful consequences.

18. DIAGNOSTIC CRITERIA (DSM-IV)
 Major Depressive Episode
1) Five (or more) of the following symptoms have
been present during the same 2- week period
and represent a change from previous functioning;
 Depressed mood
 Markedly diminished interest or pleasure
 Significant weight loss
 Insomnia or Hypersomnia
 Fatigue or loss of energy
 Feeling of worthlessness
 Recurrent thoughts of death

19. DIAGNOSTIC CRITERIA (DSM-IV)
 Dysthymic Disorder
1) Depressed mood for most of the day
2) While depressed of two (or more) of the
following:
 Poor appetite or overeating
 Insomnia or Hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making
decisions
 Feelings of hopelessness

20. ASSESSMENT:
History taking, Physical Examination and Mental
Status Examination are the same as for patient
with schizophrenia. The special assessment of
patient with mood disorders are as follows:
1) Dexamethasone Suppression Test (DST)
2) Rating Scales:
 Beck Depression Inventory (BDI)
 Zung Rating Scale
 Hamilton Depression Rating Scale (HDRS)

21. TREATMENT MODALITIES OF
PATIENT WITH MOOD DISORDERS:
1) Pharmacologic Treatments
 Tricyclic Antidepressants
 Mono amine oxidase inhibitors
 Selective Serotonin reuptake inhibitors
2) Electroconvulsive Therapy
3) Psychotherapeutic Approach
 Supportive Psychotherapy
 Brief therapy
 Interpersonal therapy
 Cognitive Behavior therapy
 Marital Therapy and Family Therapy

22. NURSING MANAGEMENT OF PATIENT
WITH MOOD DISORDERS:
1) NURSING DIAGNOSIS: Risk for violence
directed to self or others related to
hyperactivity, agitation, hostile behavior and
low self esteem
 NURSING GOAL: Demonstrates decreased
restlessness, hyperactivity and agitation,
doesn’t harm himself or herself or others

23.  INTERVENTION
1) Decrease Environmental stimuli whenever
possible.
2) Provide a consistent, structured environment.
3) Give simple direct explanations for routine
actions, procedures, tests and so forth, do not
argue with the client.
4) Administer chemotherapy (Probably lithium or
antipsychotic medications initially).
5) Encourage supervised physical activity.

24. NURSING CARE PLAN
2) NURSING DIAGNOSIS: Risk for suicide
related to lack of impulse control, self
destructive tendencies, feeling of
worthlessness, hopelessness, guilt, social
isolation.
 NURSING GOAL: Doesn’t harm him self or her
self or others, demonstrates use of alternative
way of dealing with stress and emotional
problems.

25. INTERVENTION
1) Determine the appropriate level of suicide
precautions for the client.
2) The client has one to one contact with as staff
member at all times, even when going to the
bathroom and sleeping.
3) Be alert to the possibility of the client saving up his
or her own medications or obtaining medication or
dangerous objects from other client or from visitors.
4) Be alert to the client behavior especially decreased
communication, conversations about death or the
futility of life.

26. NURSING CARE PLAN
3) NURSING DIAGNOSIS: Defensive coping
evidenced by denial of problems, repeated like
exaggeration of achievements.
 NURSING GOAL: Demonstrate increased
feelings of self worth, demonstrate more
appropriate appearance.

27. INTERVENTION
1) Decrease environment stimuli.
2) Provide consistent structure environment.
3) Give simple direct explanations
4) Ignore or withdraw your attention from
bizarre appearance and behavior and sexual
acting out, as much as possible.
5) Give the client positive feedback whenever
appropriate.

28. NURSING CARE PLAN
4) NURSING DIAGNOSIS: Disturbed thought
processes evidenced by tangentiality of ideas
and speech, hallucination, delusions, loose
association.
 NURSING GOAL: Demonstrates orientation to
person, place and time, demonstrates
decreased hallucinations or delusion,
demonstrates decreased push of speech,
tangentiality and loose associations.

29.  INTERVENTION
1) Reorient the client to person, place and time
as indicated (call the client by name, tell the
client your name, tell the client where he or
she is and the date )
2) Decrease environmental stimuli whenever
possible.
3) Set and maintain limits on behavior that is
destructive or adversely affect others.
4) Show acceptance of the client as a person.
5) Make only promises you can realistically
keep.

30. NURSING CARE PLAN
5) NURSING DIAGNOSIS: Self- Care deficit
related to inadequate food and fluid intake,
lack of ability to make judgment regarding
health and self care needs, inattention to
personal needs, hyperactivity and fatigue.
 NURSING GOAL: Participates in self-care
activities, establish adequate nutrition,
hydration and elimination.

31. INTERVENTION
1) If necessary, assist the client with personal
hygiene, including mouth care, bathing,
dressing and laundering clothes.
2) Encourage the client to meet as many of his
or her own needs as possible.
3) Monitor the client eating pattern and fluid
intake.
4) Monitor the client elimination patterns.
5) Teach the client about the signs of relapse,
such as insomnia, decreased nutrition and
poor personal hygiene.

32. FOLLOW-UP AND HOME CARE
AND REHABILITATION:
1) Educate the family about the impact of untreated
mood disorders on the individual’s life and functional
ability.
2) Tell the client and family to report any worsening
signs of depression or suicidal thoughts.
3) Educate the client and family about mood disorders
as illnesses that are not their “fault”.
4) Teach the client and families about the “lag time”
between starting antidepressants and onset of
therapeutic effect.
5) Tell client about the need to continue medication and
discuss with their prescriber any desire to stop it.