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![3. Neuroendocrine
(Hypothalamic-
Pituitary-Adrenal
[HPA] axis)
• regulates the
body’s response
to stress
• Elevated levels of
cortisol
• Low levels of
thyroid hormones](https://image.slidesharecdn.com/mood-disorders-250722130715-3945b702/75/MOOD-DISORDERS-PSYCHIATRIC-MENTAL-HEALTH-NURSING-15-2048.jpg)
MOOD DISORDERS- PSYCHIATRIC MENTAL HEALTH NURSING
- 1. Life is amixture of sunshine & rain Laughter & teardrops, pleasure & pain Low tides & high tides, mountains & plains, Triumphs, defeats & losses & gains Helen S. Rice
- 2.
- 3. • Also called affective disorders •Pervasive alterations in emotions that are manifested by depression, mania or both
- 4. Two Main Categories:(DSM-IV-TR) 1. Depressive disorders 2. Bipolar Disorders
- 5. Statistics: (NIMH &NARSAD) • 18.8 million adults experience depressive disorders • Major depression is the leading cause of disability worldwide • Nearly twice as many women as men suffer major depressive disorder • More than 2.3 million adults are diagnosed with bipolar disorder
- 6. • By year2020, mood disorders are estimated to be the second most important cause of disability worldwide
- 7. • Occur inany age groups ⮚Infants: - Anaclitic depression (withdrawal, nonresponsiven ess, depression, vulnerability to physical illness) when separated from the mother
- 8. ⮚School-aged children: - Mood disorder withanxiety - exhibiting behaviors such as hyperactivity, school phobia or excessive clinging to parents
- 9. ⮚Adolescents: - may exhibitpoor academic performance - substance abuse - display antisocial behavior - Promiscuity - truancy or running-away behavior - attempt suicide
- 10. Risk Factors forMood Disorders • Prior episodes of depression • Family history of depressive disorders • Prior suicide attempts • Female gender • Age of onset younger than 40 years • Post-partum period
- 11. • Medical comorbidityassociated with high risk of depression • Lack of social support • Stressful life events • Current alcohol or substance abuse or use of medication associated with a high risk of depression
- 12. Etiology of MoodDisorder Biologic Theories of Depression 1. Genetic Theory • a dominant gene may influence or predispose a person to react more readily to experience of loss or grief, thus manifesting symptoms of mood disorder.
- 13. 2. Biochemical Theory •Serotonin and Norepinephrine – regulate mood and to control drives such as - Hunger - sex - thirst
- 14. • increased amounts at the receptor sitesin the brain cause an elevation in mood
- 15. 3. Neuroendocrine (Hypothalamic- Pituitary-Adrenal [HPA] axis) •regulates the body’s response to stress • Elevated levels of cortisol • Low levels of thyroid hormones
- 16. 4.Circadian Rhythm functions • responsible for thedaily regulation of wake-sleep cycles, arousal and activity pattern and hormonal secretions
- 17. • Changes causedby medications, nutritional deficiencies, physical or psychological illness, hormonal fluctuations associated with woman’s reproductive system or aging • Increased duration & intensity of REM during sleep in people suffering from depression
- 18. Psychodynamic Theory 1. Freud • self- depreciationof people with depression is attributed to anger turned inward related to either a real or perceived loss
- 19. 2. Bibring, Grete •one’s ego aspired to be ideal and that to be loved and worthy, one must achieve these high standards
- 20. 3. Jacobson • situationin which the ego is powerless, helpless child victimized by superego
- 21. 4. Meyer • depressionis a reaction to a distressing life experience such as an event with psychic causality 5. Horney • feelings of insecurity and loneliness makes them susceptible to depression and helplessness
- 22. 6. Beck • depressionresults from specific cognitive distortion early experiences shaped distorted ways of thinking about one’s self, the world and the future
- 23. Behavioral Theory: Learned Helplessness •People who receive little positive reinforcement for their activity become withdrawn, overwhelmed and passive • leads to a perception that things are beyond their control • promote feelings of hopelessness and helplessness
- 24. Cognitive Theory • believedthat thoughts are maintained by reinforcement • cognitive distortions or self- defeating thoughts become part of a destructive cycle in which the individual exhibits apathy, sadness and social withdrawal
- 25. Life Events andEnvironmental Theory • based on the interacting contributions from life events and the environment 1. Loss of a parent (before age of 11) or spouse 2. Financial hardships 3. Illness 4. Perceived or real failure
- 26. 5. Midlife crisis 6.Poor, single persons or working mothers with young children 7. Relocation 8. Loss or change of employment 9. Retirement 10. Experiences of abuse and neglect
- 27. DEPRESSIVE DISORDERS Depression • unhappinessthat is pathologically intense • common cold of psychological disorders • it is a warning that something is wrong
- 28. Categories of Depression MildDepression • exhibited by affective symptoms of sadness or “the blues” • an appropriate response to stress • less responsive to the environment and complain of physical discomfort • recovers within a short period
- 29. Moderate Depression • (dysthymia)less severe and do not include psychotic features • usually complain that they have always been depressed and verbalize • feelings of guilt, inadequacy, and irritability • exhibit lack of interest and lack of productivity
- 30. Major Depressive Disorders •referred to as endogenous depression • exhibit psychotic symptom such as delusions and hallucinations
- 31. MAJOR DEPRESSIVE DISORDERS •Also known as endogenous depression • Characterized by one or more major depressive episodes lasts at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activities and exhibits 5 or more of the nine clinical symptoms
- 32. Clinical Symptoms • Depressedmood • Significant loss of interest or pleasure (anhedonia) • Marked changes in weight or significant increase or decrease in appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation
- 33. • Fatigue orloss of energy • Feelings of worthlessness or excessive or inappropriate guilt • Reduced ability to concentrate or think, or indecisiveness • Recurrent thoughts of death, suicidal ideation, suicide attempt, or plan for committing suicide
- 34. Diagnostic Characteristics 1. Evidenceof at least 5 clinical symptoms in conjunction with depressed mood or loss of interest or pleasure 2. Symptoms occurring most of the day and nearly every day during the same 2-week period representing an actual change in person’s previous level of functioning
- 35. 3. Significant distressor marked impairment in person’s functioning, such as in social or occupational areas 4. Symptoms not related to a medical condition or use of a substance
- 36. Several Variants: 1. Atypicaldepression • occurs in younger population and is more common in women compared with men • Expressed by: ✔Increased appetite or weight gain ✔Hypersomnia - sleeping 10 hrs/day or at least 2 hours more than usual
- 37. ✔Leaden paralysis - feelingheavy, leaden, or weighted down in the arms or legs ✔Extreme sensitivity to interpersonal rejection ✔Mood reactivity - mood brightens considerably with positive events
- 38. 2. Melancholic depression •occurring most often in older adults that might be misdiagnosed as dementia • characterized by anhedonia and an inability to be cheered up; mood does not improve even temporarily
- 39. • at leastthree of the following: ✔ depression worse in the morning ✔early morning awakening ✔psychomotor retardation or agitation ✔significant anorexia or weight loss ✔excessive or inappropriate guilt
- 40. 3. Catatonic features •marked by significant psychomotor alterations including: ⮚Mobility ⮚Excessive motor activity ⮚Mutism ⮚Echolalia ⮚Inappropriate posturing
- 41. 4. Postpartum depression •occurs during the first 30 days postpartum • includes feeling anxious, irritable or tearful but also having periods of normalcy
- 42. 5. Psychotic depression– • has delusions or hallucinations in conjunction with the mood disturbance 6. Seasonal affective disorder (SAD) • depression occurring in conjunction with a seasonal change most often beginning in fall or winter and remitting in spring
- 43. • May have: ✔increasedsleep ✔appetite and carbohydrate craving ✔weight gain ✔irritability ✔interpersonal conflict ✔heaviness in the extremities
- 44. DYSTHYMIC DISORDER • Typicallyexhibits symptoms that are similar to major depressive disorder or severe depression but not as severe and does not include symptoms such as: ⮚delusions and hallucinations ⮚impaired communication or incoherence
- 45. • Clinical symptomspersists for 2 years or more and may occur continuously or intermittently with normal mood swings for a few days or weeks
- 46. Clinical Symptoms • Depressedmood for most of the day, for more days than not • Presence of two or more of the following: ✔Poor appetite or overeating ✔Insomnia or hypersomnia ✔Low energy or fatigue ✔Low self-esteem
- 47. ✔Poor concentration ordifficulty making decision ✔Feelings of hopelessness • Clinical symptoms interfere with functioning and are not caused by a medical condition or the physiologic effects of a substance
- 48. BIPOLAR DISORDER • Formerly knownas manic- depressive illness
- 49. • Involves extrememood swings from episodes of mania to episodes of depression
- 50. Various descriptive terms used to describethe labile affect or mood changes: • Euphoria ⮚an exaggerated feeling of physical and emotional well- being
- 51. • Elation ⮚state ofextreme happiness, delight or excitability
- 52. • Rapid-cycling ⮚a statecharacterized by the occurrence of four or more episodes of mania and depression have occurred in 1 year
- 53. Hypomania • a psychopathologicalstate and abnormality of mood falling somewhere between normal euphoria and mania • characterized by unrealistic optimism, pressure of speech and activity, and a decreased need for sleep
- 54. • the personexperiencing a hypomanic episode meets most of the criteria for manic episode, with two major exceptions: ⮚the symptoms must be present “only” 4 days ⮚the person must manifest an unequivocal change in functioning that is observable by others
- 55. • is notsevere enough to result in significant impairment or to require hospitalization
- 56. Mania • a state characterized byexcessive elation, inflated self- esteem and grandiosity
- 57. • usually begin suddenly, escalate rapidlyand last from a few days to several months • onset is usually in the early 20s
- 58. DSM-IV-TR Criteria forManic Episode • Distinct period of abnormal and persistent elevated, expansive, or irritable mood that lasts at least 1 week (or less if hospitalization is required)
- 59. • At leastthree of the following symptoms must occur during the episode (or four if the patient is only irritable) ✔Inflated self-esteem or grandiosity ✔Decreased need for sleep ✔Very talkative ✔Flight of ideas or subjective feeling that thoughts are racing
- 60. ✔Distractibility ✔Increase in goal-directedactivity (social, occupational, educational, or sexual) or psychomotor agitation ✔Excessive involvement in pleasurable activities that have a high potential for personal problems (e.g. sexual promiscuity, spending sprees, bad business investments)
- 61. • Mood disturbancesevere enough to cause problems socially, interpersonally, or at work, or the person has to be hospitalized to prevent harm to self or others • Not due to a substance
- 62. Categories: Bipolar I Disorder •characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode
- 64. Bipolar II Disorder •characterized by recurrent major depressive episodes with hypomanic episodes occurring with a particular severity, frequency and duration
- 66. Cyclothymic Disorder • fora period of 2 years, the patient has had numerous periods of hypomanic symptoms and numerous periods of a depressed mood. • the patient is never symptom-free for more than 2 months at a time • has never experienced major depression