I am Bsc nursing student but social teaching is my hobby and this slide is very helpful for Bsc nursing students and mood disorder patient.

1. NURSING MANAGMENET OF
PATIENT WITH MOOD
DISORDER [Affective
BY-AYUSH KUMAR
(Bsc. Nursing)
disorders] 1

3. Definition
mood disorders are characterized by a
disturbance of mood, accompanied by a full or
partial manic or depressive syndrome, which is
not due to any physical or mental disorder.3

5. Classification of mood disorders
F30-39: Mood (Affective) disorder
F30:Manic episode
F31:Bipolar affective disorder
F32:Recurrent depressive disorder
F33:Persistent mood disorder
F38:Other mood disorder
F39: Unspecified mood disorder.

6. Manic episode
Definition:-
Mania refers to a syndrome
in which the central features are over
activity, mood changes and self important
ideas.

7. Classification of mania(ICD10)
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.

8. Incidence:-
*The lifetime risk of manic episode is about 0.8-
1%
*This disorder occurs in episodes lasting usually
3-4 month.
*The male and female incidence is 3:2
*It occurs in 3-4 patients per 1000
population.

9. Etiology:-
*Genetics:-Genetics plays a strong role in predisposition of MDP. It
is found that identical twins have higher chances of MDP. Siblings and
close relation have a higher incidence of MDP than a general.
*Neuro physiological factors:-Researchers have found that
imbalances in neurotransmitters may cause mania and depression.
*psychological and interpersonal factors
Predisposing family and personality factors:-Mood swings
in the parents will lead to maladaptive learning in children.

10. Severe stress:-patients who have experienced severe stress in their
life time may be predisposed to MDP.
Socio cultural factors:-It will differ according to society and
cultures.
Clinical feature:-
classical tried symptoms of mania are:-
*elevated, expansive or irritable mood.
*Increase pressure of speech.
*increased motor activity.

11. Other symptom include
*flight of ideas. *delusion of grandeur.
*decreased need for sleep(<3hrs)
*decreased food intake.
*decreased attention and concentration

12. *Hypomania
It is a mild form of
mania in which the patient shows moderate
elevation, flightness and overactivity. Energy
is moderate increased and appetite may be
uncontrollable.

13. Diagnosis:-
*psychological tests
* Based on sign and symptom
* Based on ICD10 criteria.
Treatment:-
*pharmacotherapy
*Lithium-(900-1200mg/day)
*carbamazepine(600-1800mg/
day)
*sodium valproate(600-2600mg/
day)
*other drugs like clonazepam,
calcium channel blockers etc.

14. Electro-convulsive therapy
ECT can be used
if the patient is
not responding
to drugs.

15. Psychotherapies
*individual therapy
*Family therapy
*milieu therapy

16. Nursing diagnosis:-
●High risk for injury related to extreme hyperactivity evidence
by lack of over purposeless injurious movements.
*Goals:-
ꟷPatient will not injure self.
*Interventions:-
ꟷKeep environmental stimuli to a minimum.
ꟷRemove dangerous object and substance near from the
patient.
ꟷAssist the patient to engage in activities such as writing,
drawing and other physical exercise.
ꟷAdminister medication prescribed by physician.

17. ●High risk for violence related to manic excitement delusional
thinking and hallucinations:-
*Goals:-
ꟷpatient will not harm self or other.
*Interventions:-
ꟷprovide unchallenging environment.
ꟷObserve patientʼs behavior atleast every 15 minutes.
ꟷEncourage verbal expression of feeling.
ꟷApply restraints, if necessary.

18. ●Atleast nutrition less than body requirement related to refusal
or inability to sit still long enough to eat evidenced by weight
loss amenorrhea.
*Goals:-
ꟷpatient will not exhibit sign and symptoms of malnutrition.
*Interventions:-
ꟷprovide high protein, high caloric food.
ꟷFind out patientʼs likes and dislike and provide favorite foods.
ꟷprovide 6-8 glasses of fluids per day.
ꟷWeight the patient regularly.
ꟷSupplement diet with vitamins and minerals.

19. depression is a common mental
disorder that presents with
depressed mood,
loss of interest or
pleasure, feeling
of guilt or low energy
and poor concentration.
definition
Depressive episode

20. Classification of depression (ICD10)
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
F32.8: Other depressive episode - atypical depression
F32.9: Depressive episode, unspecified
F33: Recurrent depressive disorder

21. Incidence:-
*The lifetime risk of depression in males is 8-
12% and female 20-26%.
*depression occurs twice as frequently in
woman as in men.
*The age of onset is 18years in men and
20years in women.

22. Etiology:-
*genetic factor
*neurochemical factor
*severe stress
*sociocultural factors
*negative cognition

23. Clinical features:-
In depression, classical tried symptoms are:-
*depressed mood
*retarded thinking
*psychomotor retardation.
Other symptom are:-
*hopeless and worthlessness
*suicidal thought
*difficulties in thinking and concentration
*Somatic/melancholic features like decreased in weight,
early morning awakening and lack of interest.

24. Diagnosis:-
*psychological test –beck depression inventory.
Hamilton rating scale for depression to assess
severity and prognosis.
*Dexamethasone suppression test showing failure
to suppress cortisol secretion in depressed patients.
*Toxicology screening suggesting drug induced
depression.
*Based on ICD10 criteria.

25. Treatment:-
*psychopharmacology
Antidepressant drug like citalopram, fluoxetine, amitriptyline
Imipramine, doxepin, isocarboxazid etc are used.
*electroconvulsive therapy
severe depression with suicidal risk is the most important
indication for ECT.

26. *psychotherapies
ꟷ cognitive therapy
ꟷsupportive therapy
ꟷgroup therapy
ꟷFamily therapy
ꟷBehavioral therapy

27. Nursing diagnosis
●High risk of self directed violence related to depressed mood
feeling of worthlessness and anger directed inward on the self.
*Goals:-
ꟷPatient will not harm self.
*Intervention:-
ꟷCreate a self environment for the patient.
ꟷformulate a written or verbal contract that the patient will not
harm self.
ꟷPlace the patient near the nursing station.
ꟷDo not allow the patient to put the on his bathroom.
ꟷEncourage the patient to express his feelings.

28. ●Altered communication process related to depressed
cognition evidence by being unable to interact with others,
withdrawn expressing fear of failure.
*Goals:-
ꟷpatient with communicate with staff or other patient in the
unit.
*Interventions:-
ꟷObserve for non verbal communication.
ꟷAsk question in such a way that the patient will have to
answer in more than one ward.
ꟷAs the patient improves take him to other patients and
includes as a part of the group.

29. ●Self care deficit related to depressed mood feeling on
worthlessness evidenced by poor personal hygiene and
grooming.
*Goals:-
ꟷpatient will maintain adequate personal hygiene.
*Interventions:-
ꟷEnsure that he takes his bath regularly.
ꟷDo not ask the patientʼs permission for a wash or bath.
Instead lead the patient to the action with positive suggestions.
ꟷWhen the patient has taken care of himself, express realistic
appreciation.

30. Bipolar mood disorder
*This is characterized by
recurrent episode of
mania and depression in
the same patient at
different times.
*It is also known as bipolar
affective disorder or manic
depression disorder
Definition:-

31. Classification:-
F31.0: Bipolar affective disorder, current episode hypomania.
F31.1: Bipolar affective disorder, current episode mania
without psychotic symptoms.
F31.2: Bipolar affective disorder, current episode mania with
psychotic symptoms.
F31.3: Bipolar affective disorder, current episode mild or
moderate depression.
F32.4: Bipolar affective disorder, current episode severe
depression without psychotic symptoms.
F31.5: Bipolar affective disorder, current episode severe
depression with psychotic symptoms.

32. Type:-
Bipolar I disorder involves of severe mood episode from mania
to depression.
Bipolar II disorder is a milder from of mood elevation,
involving milder episodes of hypomania that alternate with
periods of severe depression.
Cyclothymic disorder describes brief period of hypomanic
symptoms that are not as extensive or as long-lasting as seen
in full depressive episode.
Mixed features refers to the occurrence of simultaneous
symptoms of opposite mood polarities during manic,
hypomanic or depressive episodes.
Rapid cycling is a term that describes having four or more
episode within a 12 month period. Episode must last for some
minimum number of days in order to be considered distinct
episodes.

34. Incidence:
*About 2 in 1000 people develop this condition.
*Onset usually occurs between ages 20-30 years.
*Symptom sometimes appear in late children or early
adolescence
*An average manic episode lasts for 3-4 month.
*An average depressive episode lasts for 49 months.

35. Etiology:-
*Exact cause is unknown.
*genetic, biochemical and psychological factors may play a
role.
*stressfull events, antidepressant use.
*sleep deprivation.

36. Clinical features:-
*manic phase
-expansive, Grandiose or hyperirritable mood
-Increased psychomotor activity.
-Rapid speech with frequent topic changes.
-Decreased need for sleep and food.
-Impulsivity.
-Impaired judgement.
*Depressive phase
-low self esteem.
-Feeling of hopelessness, apathy.
-Psychomotor retardation.
-Anhedonia.
-suicidal ideation.

37. Treatment *psychopharmacology
-Antimanic drug:-lithium, sodium volprate,
carbamazepine
-Antidepressant drug:-Citalopram, fluoxetine,
amitriptyline, imipramine
-Antipsychotic drug:-(If necessary)

38. *Electroconvulsive therapy(ECT)
It is useful to those
who do not
respond to other
treatment.

39. Persistent mood disorder
Type
*cyclothymia
*dysthymia
Definition:-
cyclothymic disorder is characterized by short
periods of mild depression alternating with short period of
hypomania.
*cyclothymia:-

40. Etiology:-
*Genetic factor
*family history of bipolar disorder, major
depression, substance abuse or suicide.
Clinical features:-
*hypomanic phase *Depressive phase
-Insomnia -Insomnia & hypersomnia
-Hyperactivity -feeling of inadequacy
-Aggressiveness -decreased productivity
-Grandiosity -social withdrawal
-Increase productivity. -Loss of libido
-Lethargy
-suicidal ideation.

41. Treatment:-
*psychopharmacology
-Antimanic agent-lithium, carbamazepine, valporic
acid,
-Antidepressant-Imipramine, amitriptyline,
fluoxetine
*psychotherapies
Individual therapy family therapy

42. Nursing intervention:-
ꟷExplore way to help patient cope with frequent
mood changes.
ꟷEncourage vocational opportunities that allow
flexible hours.
ꟷEncourage patients with artistic ability to pursure
their talents as a creative outlet.

43. Dysthmia
Definition:-
It refers to mild depression that lasts atleast 2
years in adult or 1 year in children.
*Etiology:
ꟷBased normal serotonin level.
ꟷ Increased chances when multiple stressors and personality
problems are combined with inadequate coping skill.
*Clinical features
●Psychological symptoms
ꟷpersistent sad, anxious or empty mood.
ꟷExcessive crying.
ꟷIncreased feeling of guilt, helplessness or hopelessness.

44. ●Physiological symptoms
ꟷWeight or appetite changes
ꟷSleep difficulties
ꟷReduced energy level
*Diagnosis:-
ꟷcareful psychiatric examination and medical history.
ꟷBased on ICD 10 criteria.

45. Treatment
●Psychopharmacology
ꟷAntidepressant- Amitryptyline, Imipramine Doxepin
Citalopram Fluoxetine etc are used.
●psychotherapy
ꟷShort term psychotherapy
ꟷBehavioral therapy
ꟷGroup therapy

46. *Nursing intervention
ꟷprovide supportive measures such as
reassurance, warmth, availability and acceptance.
ꟷTeach patient about the illness.
ꟷEncourage positive health habits.

47. THANK
YOUǃ