The document discusses mood disorders, primarily focusing on mania, its classification, symptoms, psychopathology, and diagnostic criteria according to DSM guidelines. It outlines treatment modalities such as pharmacotherapy and psychosocial interventions, as well as the associated nursing diagnoses. References are provided from various psychiatric nursing texts.

1. MOOD DISORDER
MS. PUSPASANA YUMNAM
M.Sc in Psychiatric Nursing

2. MOOD DISORDER
• Mood defined as a temporary state of mind or feeling.
• Mood disorder are characterized by a disturbance of
mood , accompanied by a full or partial manic or
depressive syndrome which is not due to physical or
mental disorder

3. Classification of mood disorder
• F30-F39: Mood (affective ) disorders
• F30 : Manic episode
• F31: Bipolar affective disorder
• F32: Depressive episode
• F33: Recurrent depressive disorder
• F34: Persistent mood disorder
• F38: Other mood disorder
• F39: Unspecified Mood disorder

4. Manic episode
• Mania refers to a syndrome in which the central features
are over-activity , mood change and self important ideas,
episodes usually last for 3-4 months.

5. Classification of mania
• F30: Manic episode
• F30.0 : Hypomania
• F30.1: Mania without psychotic symptoms
• F30.2 :Mania with psychotic symptoms
• F30.8 : Other manic episode
• F30.9 : Manic episode unspecified

6. Etiology
• Neurotransmitter and structural hypothesis :
excessive levels of norepinephrine and dopamine ,
imbalance between cholinergic and noradrenergic system
or a deficiency in serotonin.
• Genetic consideration :
 1ST degree relative : 5-10%
Identical twin : 40-70%
• Psychodynamic theories : faulty family dynamics during
early life, manic episodes as a defense against or denial
of depression.

7. Psychopathology

8. Stages of elevated mood
• EUPHORIA ( Stage I) : Increased sense of psychological
well being and happiness not keeping with ongoing
events
• ELATION ( Stage II) : moderate elevation of mood with
increased psychomotor activity
• EXALTATION ( Stage III) : Intense elevation of mood with
delusions of grandeur
• ECSTASY (Stage IV ) : Severe elevation of mood ,
intense sense of rapture or blissfulness seen in delirious
or stuporous mania

9. STAGES OF MANIA
• Stage I : Hypomania (cheerful and expansive)
• Stage II : Acute mania ( euphoria , elation and continuous
high )
• Stage III : Delirious mania ( labile )

10. Clinical features
• Elevated , expansive or irritable mood
• Increased psychomotor activity
• Flight of ideas
• Pressure of speech
• Clang association
• Delusion of grandeur
• Delusion of persecution
• Distractibility
• Increased sociablities
• Disinhibition
• Hypersexual and promiscuous behavior

11. • Poor judgment
• High risk activities ( eg; reckless driving , foolish business
investment )
• Dressed up in flamboyant and gaudy clothes
• Decreased need for sleep
• Decreased need for sleep (less than 3 hours)
• Decreased food intake
• Decreased attention and concentration
• Absent insight .

12. DSM DIAGNOSTIC CRITERIA
• A distinct period of abnormally and persistently elevated ,
expansive or irritable mood ; persistently increased goal
directed activity , lasting for atleast 1 week and present
most of the day.
• Three or more following symptoms are present :
Inflated self esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking
Flight of ideas, distractibility
Excessive involvement in activities that have a high
potential for painful consequences

13. • The mood disturbance is sufficiently severe to cause mark
impairment in social or occupational functioning or to
necessitate hospitalization to prevent harm to self or
others or there are psychotic features
• The episode is not attributed to the physiological effects
of a substance or to another medical condition

14. Treatment modalities
• Pharmacotherapy
 Lithium :900-2100 mg/day
Carbamazepine : 600-1800mg /day
Sodium valproate : 600-2600mg/day
Lamotrigine : 25-200mg/ day
Other drugs : Clonazepam , calcium channel blockers

15. ELECTROCONVULSIVE THERAPY

16. PSYCHOSOCIAL TREATMENT
• Family and marital therapy.
• The main purpose is to ensure continuity of treatment and
adequate drug compliance.

17. Nursing diagnosis
• High risk for injury related to extreme hyperactivity and
impulsive behavior , evidenced by lack of control over
purposeless and potentially injurious movements.
• High risk for violence , self directed or directed to others
related to manic excitement , delusional thinking and
hallucination
• Imbalanced nutrition less than body requirements related
to refusal or inability to sit still long enough to eat as
evidenced by weightloss.

18. Bibliography
• R Sreevani , A Guide to Mental Health & Psychiatric
Nursing , Jaypee Publication , 4th Edition
• Mary C Townsend , Psychiatric Mental Health Nursing ,
Concepts of Care in Evidence- Based Practice , Jaypee
Publication , 8th Edition
• Diagnostic and Statistical Manual of Mental Disorders,
American Psychiatric Publishing , 5th Edition