mood disorders

1. Lecture 6
Mood Disorders
Mental Health Nursing-NUR 417
Depressive disorders Bipolar disorder

2. Mood Disorders
Part I
Depressive disorders

3. Outline-Part I-Depressive disorders
 Introduction
 Epidemiology
 Types
 Etiological Implications
 Developmental Implications
 Nursing Process

4. Introduction
Depression or depressive disorders (unipolar depression
) are mental illnesses characterized by a profound and
persistent feeling of sadness or despair
and/or a loss of interest in things that once were
pleasurable. Disturbance in sleep,appetite, and mental
processes are a common accompaniment.

5. Introduction (cont.)
 Depression is the oldest and most frequently
described psychiatric illness.
 Transient symptoms are normal, healthy
responses to everyday disappointments in life.
 Pathological depression occurs when
adaptation is ineffective.

6. Epidemiology
 Gender prevalence
 Higher in women than in men by about 2 to 1
 Age
 Depression more common in young women
than in older women
 Opposite is true for men
 Marital status: Single and divorced people
more likely to experience depression than
married people

7. Epidemiology (cont.)
 Social class: There is an inverse
relationship between social class and
report of depressive symptoms; the
opposite is true with bipolar disorder.
 Seasonality: Affective disorders are
more prevalent in the spring and in the
fall.

8. Types of Depressive disorders
 Major depressive disorder
 Dysthymic disorder
 Premenstrual dysphoric disorder

9. Major Depressive Disorder
 Loses interest or pleasure in usual activities
 Social and occupational functioning impaired
for at least 2 weeks

10. Dysthymic Disorder
 Sad or “down in the dumps”
 No evidence of psychotic symptoms
 Essential feature is a chronically depressed
mood for
 Most of the day
 More days than not
 For at least 2 years

11. Premenstrual Dysphoric Disorder
 Essential Features
 Depressed mood
 Anxiety
 Mood swings
 Decreased interest in activities
 Symptoms occur during the week prior to menses
and subside shortly after onset of menstruation

12. Etiological Implications-Depressive Disorders
 Biological theories
 Genetics: Hereditary factor may be involved
 Biochemical influences:
Deficiency of norepinephrine, serotonin, and
dopamine has been implicated
Possible diminished release of thyroid-
stimulating hormone

13. Etiological Implications-Depressive Disorders (cont.)
 Physiological influences
 Medication side effects
 Neurological disorders
 Electrolyte disturbances
 Hormonal disorders
 Nutritional deficiencies
 Secondary depression related to:
 Cardiovascular disease
 Infections (e.g., hepatitis, pneumonia)
 Metabolic disorders (e.g., diabetes mellitus)

14. Developmental Implications
Adolescence
 Symptoms include:
 Anger, aggressiveness
 Social withdrawal
 Substance abuse
 Restlessness; apathy

15. Developmental Implications (cont.)
Postpartum Depression
 May last for a few weeks to several months
 Usually associated with hormonal changes
 Treatments: antidepressants and psychosocial
therapies
 Symptoms include:
 Fatigue
 Irritability
 Loss of appetite
 Sleep disturbances
 Loss of libido
 Concern about inability to care for infant

16. Nursing Process/Assessment
Transient
depression
Mild depression
Moderate
depression
Severe depression
Symptoms
Not necessarily
dysfunctional
With normal
grieving
associated with
dysthymic disorder
A constant sense of
hopelessness and
despair
Affective
The “blues” Anger, anxiety,
sadness
Helpless, powerless
Feelings of total
despair, worthlessness,
apathy
Behavioral
Certain amount
of crying
Tearful, regression
Slow physical
movement, limited
verbalization
Psychomotor
retardation, curled-up
position, no
interaction with others
Cognitive
Some
difficulty
getting mind
off one’s
disappointment
Self-blame and
blaming of others
Retarded thinking
processes, difficulty
with concentration
Prevalent delusional
thinking, with
delusions of
persecution
Physiological Feeling tired
Anorexia or
overeating, sleep
disturbances,
somatic symptoms
Anorexia or overeating,
sleep disturbances,
somatic symptoms,
feeling best early in
morning and worse as
the day progresses
Anorexia, insomnia,
feels worse early in
morning and
somewhat better as the
day progresses

17. Nursing Diagnosis
 Risk for suicide
 Dysfunctional grieving
 Low self-esteem
 Powerlessness
 Social isolation/Impaired social interaction
 Disturbed thought processes
 Imbalanced nutrition less than body requirements
 Disturbed sleep pattern
 Self-care deficit

18. Planning
 The client
 Is able to identify aspects of self-control
over life situation
 Is able to maintain reality orientation
 Is able to concentrate, reason, and solve
problems

19. Implementation
 Maintaining client safety
 Promoting increase in self-esteem
 Encouraging client self-control and control over
life situation

20. Client/Family Education
 Management of the illness
 Medication management
 Stress management techniques
 Ways to increase self-esteem
 Electroconvulsive therapy
 Support services
 Suicide hotline
 Support groups
 Legal/financial assistance

21. Evaluation
 Evaluation of the effectiveness of
nursing interventions is measured by
fulfillment of the outcome criteria.

22. Mood Disorders
Part II
Bipolar disorders

23. Outline-Part II- Bipolar disorders
 Introduction
 Etiological Implications
 Types
 Nursing Process

24. Introduction
 Bipolar disorder
 also known as manic depression
 Characterized by mood swings from profound
depression to extreme euphoria (mania), with
intervening periods of normalcy
 Delusions or hallucinations may or may not be
part of clinical picture

25. Bipolar Disorder (Mania)
Etiological implications
 Biological theories: Strong hereditary
implications
 Biochemical influences: Possible excess of
norepinephrine, serotonin, and/or dopamine

26. Bipolar Disorder (Mania) (cont.)
Physiological influences
 Alterations in electrolyte transfer
 Brain lesions
 Medication side effects
 Steroids
 Amphetamines
 Antidepressants

27. Types of Bipolar disorder
 Bipolar I disorder
 Bipolar II disorder
 Cyclothymia

28. Bipolar I Disorder
 Individual is experiencing, or has experienced, a
full syndrome of manic or mixed symptoms
 May also have experienced episodes of
depression

29. Bipolar II Disorder
 Recurrent bouts of major depression
 Episodic occurrences of hypomania
 Has not experienced an episode that meets the
full criteria for mania or mixed symptomatology

30. Symptoms
may be
categorized
by degree
of severity
Stage I—Hypomania Stage II—Acute mania Stage III—Delirious mania
Symptoms
Symptoms not
sufficiently severe to
cause marked
impairment in social or
occupational functioning
or to require
hospitalization
Intensification of hypomanic
symptoms; requires
hospitalization
A grave form of the disorder,
characterized by severe clouding
of consciousness and representing
an intensification of the
symptoms associated with acute
mania
Mood Cheerful Euphoria labile, from ecstasy to despair
Cognition Self-exultation
Fragmented, disjointed
thinking; flight of ideas;
hallucinations and delusions
Confusion, disorientation,
hallucinations, delusions
Activity
and
behavior
Increased motor activity
Excessive psychomotor
behavior; inexhaustible
energy; goes without sleep;
bizarre dress
Frenzied psychomotor activity;
agitated, purposeless movements;
exhaustion and death can occur
without intervention
Nursing Process/Assessment

31. Nursing Diagnosis
 Risk for Injury related to:
 Extreme hyperactivity
 Disturbed thought processes related to:
 Biochemical alterations in the brain
 Disturbed sleep pattern related to:
 Excessive hyperactivity and agitation

32. Nursing Diagnosis (cont.)
 Imbalanced Nutrition less than body
requirements related to:
 Refusal or inability to sit still long enough to eat
 Disturbed sensory perception related to:
 Biochemical alterations in the brain and to
possible sleep deprivation
 Impaired Social Interaction

33. Planning
 The client
 Exhibits no evidence of physical injury
 Has not harmed self or others
 Eats a well-balanced diet to prevent weight loss
and maintain nutritional status
 Interacts appropriately with others

34. Implementation
 Maintaining safety of client and others
 Restoring client nutritional status
 Encouraging appropriate client interaction with
others
 Assisting client to define and test reality
 Meeting client’s self-care needs

35. Client/Family Education
 Management of illness
 Medication management
 Support services
 Crisis hotline
 Support groups
 Individual psychotherapy
 Legal/financial assistance

36. Evaluation
 Evaluation of the effectiveness of the
nursing interventions is measured by
fulfillment of the outcome criteria.

37. Treatment Modalities for Mood Disorders
 Psychological treatment
 Individual psychotherapy
 Group therapy
 Family therapy
 Cognitive therapy
 Organic Treatments

38. Treatment Modalities for Mood Disorders (cont.)
 Psychopharmacology
 For Depression
* Maprotiline * Mirtazapine
* Amoxapine * Serzone
* Trazodone * Effexor
• Bupropion
 For mania:
 Lithium carbonate
 Anticonvulsants
 Verapamil
 Olanzapine

39. Treatment Modalities for Mood Disorders (cont.)
 Electroconvulsive Therapy
 For depression and mania
 Mechanism of action: increase levels of biogenic
amines (norepinephrine, serotonin, and dopamine)
 Side effects: temporary memory loss and confusion
 Risks: mortality; permanent memory loss; brain damage
 Medications: pretreatment medication; muscle relaxant;
short-acting anesthetic

40. Nursing Process: Suicide Assessment
 Epidemiological factors
 Marital status: Suicide rate for single people twice that
of married people
 Single, divorced, and widowed people have rates four to
five times greater than those who are married
 Gender: Women attempt suicide more often; more men
succeed
 Age: Suicide highest in persons older than 50 years;
adolescents also at high risk

41. Nursing Process: Suicide Assessment (cont.)
 Epidemiological factors (cont.)
 Socioeconomic status: People in the highest and
lowest social classes have higher suicide rates than
those in the middle classes.
 Professionals: Professional healthcare personnel
and business executives are at the highest risk.
 Religion

42. Nursing Process: Suicide Assessment (cont.)
 Presenting symptoms/Medical-
psychiatric diagnosis
 Mood disorders (major depression and bipolar
disorders) are the most common disorders that
precede suicide.
 Other disorders include
 Anxiety disorders
 Schizophrenia

43. Nursing Process: Suicide Assessment (cont.)
 Suicidal ideas or acts
 Assess: plan, previous attempts
 Verbal clues:
 Direct statements: “I want to die.”
 Indirect statements: “I don’t have
anything to live for anymore.”

44. Intervention with the Outpatient Suicidal Client
 Do not leave the person alone.
 Schedule daily appointments.
 Establish trusting relationship.
 Antidepressant medication.
 Take any hint of suicide seriously.
 Report threats of suicide immediately.