2. Definition
Mood can be defined as a pervasive and sustained emotion or feeling tone
that influences a person’s behavior and colors his or her perception of
being in the world.
3. EPIDEMIOLOGY
Incidence and Prevalence
Mood disorders are common. major depressive disorder has the highest lifetime
prevalence (almost 17 percent) of any psychiatric disorder.
Sex
Bipolar I disorder has an equal prevalence among men and women. Manic
episodes are more common in men, and depressive episodes are more common in
women.
Sociocultural
Depressive disorders are more common among single and divorced compared
to married persons. No correlation with socioeconomic status. No difference
between races or religious groups.
5. Depressive disorders
DSM-5- Diagnostic criteria for major depression
A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning, at least one of
the symptoms is either 1 or 2:
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g. Feels sad or empty) or observation made by others.
2.Markedly diminished interest or pleasure in all, or almost all, activities most of
the day, nearly everyday
6. 3. Significant weight loss when not dieting or weight gain (more than 5% in a month),
or decreased or increased in appetite nearly every day.
4.Insomnia or hypersomnia nearly every day.
5.Psychomotor agitation or retardation nearly every day.
6.Fatigue or loss of energy nearly every day.
7.Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
8.Diminished ability to think or concentrate, or indecisiveness nearly every day.
9.Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or
suicidal attempt or a specific plan to committing suicide.
7. TREATMENT
Hospitalization
Indication of hospitalization:
Risk of suicide or homicide
A patient’s grossly reduced ability to get food and
shelter
The need for diagnostic procedures.
A history of rapidly progressing symptoms
The rupture of a patient’s usual support systems
8. Pharmacotherapy
There are many types of antidepressants include:
Selective Serotonin reuptake inhibitors( SSRI)
Tricyclic Antidepressants (TCA)
11. RISK FOR SUICIDE
Interventions:
1. Ask client directly: “Have you thought about harming yourself in any way? If so, what do
you plan to do? Do you have the means to carry out this plan?”
2. Create a safe environment for the client. Remove all potentially harmful objects from
client’s access (sharp objects, straps, belts, ties, glass items). Supervise closely during meals
and medication administration. Perform room searches as deemed necessary
3. Formulate a short-term verbal or written contract with the client that he or she will not
harm self during specific time period. When that contract expires, make another, and so
forth.
4. Secure promise from client that he or she will seek out a staff member or support person if
thoughts of suicide emerge.
5. Maintain close observation of client. Depending on level of suicide precaution, provide
one-to-one contact, constant visual observation, or every-15-minute checks..
12. 7. Make rounds at frequent, irregular intervals (especially at night, toward early morning, at change
of shift, or other predictably busy times for staff
8. Encourage verbalizations of honest feelings. Through exploration and discussion, help client to
identify symbols of hope in his or her life.
9. Encourage client to express angry feelings within appropriate limits. Provide safe method of
hostility release. Help client to identify true source of anger and to work on adaptive coping skills for
use outside the treatment setting.
10. Identify community resources that client may use as support system and from whom he or she may
request help if feeling suicidal.
11. Orient client to reality, as required. Point out sensory misperceptions or misinterpretations of the
environment.
Take care not to belittle client’s fears or indicate disapproval of verbal expressions.
12. Most important, spend time with client.
13. • Provide rest periods after activities.
• Encourage the client to get up and dress and to stay out of bed
during the day.
• Provide relaxation measure in the evening
• (e.g. back rub, lukewarm bath, or warm milk).
• Reduce environmental and physical Stimulants in the
evening. Provide decaffeinated coffee, soft light, soft music,
and quiet activities.
• Spend more time with the client before bedtime.
14. Accepting of patient and spend time with even though pessimism and
negativism
Focus on strengths and accomplishments and minimize failures.
Ask patient to describe positive thoughts and write them down.
Encourage increasing decision making as possible, ask for
participation in planning for own care.
Support any evidence of motivation or initiative and praise efforts
and progress.
15.
16. There are two types of bipolar affective disorders:
Bipolar I : manic episodes alternating with
depressive episodes
Bipolar II : depressive episodes alternating with
hypomanic episodes
17. Bipolar I disorders
Mania (manic episode):
DSM –5-Diagnostic criteria for manic episode
A. Adistinct period of abnormally and persistently
elevated, expansive, or irritable mood, lasting at least
1 week (or any duration if hospitalization is necessary
18. 1.Inflated self-esteem or grandiosity
2.Decreased need for sleep(e.g. feels rested after only 3hours
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)
19. 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 investment
20. Bipolar II disorders
Hypomanic episode
Hypomania is an episode of manic symptoms that does
not meet the criteria for manic episode.
21. Treatment
Hospitalization
Indication of hospitalization:
1. Risk of suicide or homicide
2. A patient’s grossly reduced ability to
get food and shelter
3. The need for diagnostic procedures.
4.A history of rapidly progressing
symptoms.
5.The rupture of a patient’s usual support
systems
22. Pharmacotherapy
The pharmacological treatment of bipolar disorders is
divided into both acute and maintenance phases.
Treatment of bipolar disorders include:
Lithium carbonate
23. Anti- convulsants mood stabilizers (
Valproate,Carbamezapine,Lamotrigine)
Atypical anti psychotics
(Olanzapine,Quetiapine,Risperidons,Ziprasidone, and
Aripiprazole).
Typical anti-psychotic:Haloperidol
24. Psychosocial Therapy
a. Cognitive Therapy
b. Interpersonal Therapy.
c. Behavior Therapy
d.Psychoanalytically Oriented Therapy.
e. Family Therapy.
25. DYSTHYMIC DISORDER
The most typical features of dysthymia, also known as
persistent depressive disorder, is the presence of a
depressed mood that lasts most of the day and is
present almost continuously
Dysthymia is distinguished from major depressive
disorder by the fact that patients complain that they
have always been depressed. Thus, most cases are of
early onset, beginning in childhood or adolescence
and certainly occurring by the time patients reach
their 20s.
26. Psychotherapy
Cognitive Therapy.
Behavior Therapy.
Insight-Oriented (Psychoanalytic) Psychotherapy
Interpersonal Therapy
Family and Group Therapies.
27. CYCLOTHYMIC DISORDER
Cyclothymic disorder is symptomatically a mild form of
bipolar II disorder, characterized by episodes of hypomania
and mild depression .
The disorder is differentiated from bipolar II disorder,
which is characterized by the presence of major (not
minor) depressive and hypomanic episodes.
28. Treatment
Biological Therapy.
The mood stabilizers and antimanic drugs are the first
line of treatment for patients with cyclothymic
disorder.
29. Psychosocial Therapy
Psychotherapy for patients with cyclothymic disorder
is best directed toward increasing patients’ awareness
of their condition and helping them develop coping
mechanisms for their mood swings
