Mood Disorders

As the name implies, mood disorders are defined by pathological extremes of certain moods -
specifically, sadness and elation. While sadness and elation are normal and natural, they may
become pervasive and debilitating, and may even result in death, either in the form of suicide or
as the result of reckless behavior. In any one year, roughly 7% of Americans suffer from mood
disorders.

Mood Disorders defined as:

Pervasive alterations in emotions that are manifested by depression, mania, or both, and
interfere with the person’s ability to live life

Categories:

• Major depression: 2 or more weeks of sad mood, lack of interest in life activities, and
other symptoms

• Bipolar disorder (formerly called “manic-depressive illness”): mood cycles of mania

and/or depression and normalcy and other symptoms

Related Disorders

• Dysthymia: sadness, low energy, but not severe enough to be diagnosed as major
depression disorder

• Cyclothymia: mood swings not severe enough to be diagnosed as bipolar disorder

• Substance-induced mood disorder

• Mood disorder due to a general medical condition

• Seasonal affective disorder (SAD)

• Postpartum or “maternity” blues

• Postpartum depression

• Postpartum psychosis

Major Depressive Disorder

• Twice as common in women and more common in single or divorced people

• Involves 2 or more weeks of sad mood, lack of interest in life activities, and at least four
other symptoms:

– Changes in appetite or weight, sleep, or psychomotor activity

 – Decreased energy

– Feelings of worthlessness or guilt

– Difficulty thinking, concentrating, or making decisions

– Recurrent thoughts of death or suicidal ideation, plans, or attempts

• Untreated, can last 6 to 24 months; recurs in 50% to 60% of people

• Symptoms range from mild to severe

Treatment and Prognosis

-Antidepressants

• SSRIs (Prozac, Zoloft, Paxil, Celexa) prescribed for mild and moderate depression

• TCAs (Elavil, Tofranil, Norpramin, Pamelor, Sinequan) used for moderate and severe
depression

• Atypical antidepressants (Effexor, Wellbutrin, Serzone)

• MAOIs (Marplan, Parnate, Nardil) used infrequently because interaction with tyramine
causes hypertensive crisis

-Electroconvulsive therapy (ECT) is used when medications are ineffective or side effects are
intolerable.

• 6 to 15 treatments scheduled three times a week

• Preparation of a client for ECT is similar to preparation for any outpatient minor
surgical procedure

• The client will have some short-term memory impairment

-Psychotherapy in conjunction with medication is considered most effective treatment; useful

therapies include behavioral, cognitive, interpersonal therapy

Nursing Process: Major Depressive Disorder

Assessment

• History: the client’s perception of the problem, behavioral changes, any previous
episodes of depression, treatment, response to treatment, family history of mood
disorders, suicide, or attempted suicide
 • General appearance and motor behavior: slouched posture, latency of response,
psychomotor retardation or agitation

• Mood and affect: hopeless, helpless, down, anxious, frustrated, anhedonia, apathetic;
affect is sad, depressed, or flat

• Thought processes and content: slowed thinking processes, negative and pessimistic,
ruminate, thoughts of dying or committing suicide

• Sensorium and intellectual processes: oriented, memory impairment, difficulty

concentrating

• Judgment and insight: impaired judgment, insight may be intact or limited

• Self-concept: low self-esteem, guilty, believe that others would be better off without them

• Roles and relationships: difficulty fulfilling roles and responsibilities

• Physiologic considerations: weight loss, sleep disturbances, lose interest in sexual

activities, neglect personal hygiene, constipation, dehydration

• Depression rating scales: Zung Self-Rating Depression Scale, Beck Depression

Inventory, the Hamilton Rating Scale for Depression

Data Analysis

Nursing diagnoses may include:

• Risk for Suicide

• Imbalanced Nutrition: Less Than Body Requirements

• Anxiety

• Ineffective Coping

• Hopelessness

• Ineffective Role Performance

• Self-Care Deficit

• Chronic Low Self-Esteem

• Disturbed Sleep Pattern

• Impaired Social Interaction

Outcomes

The client will:

• Not injure himself or herself

• Independently carry out activities of daily living (showering, changing clothing,

grooming)

• Establish a balance of rest, sleep, and activity

• Establish a balance of adequate nutrition, hydration, and elimination

• Evaluate self-attributes realistically

• Socialize with staff, peers, and family/friends

• Return to occupation or school activities

• Comply with antidepressant regimen

• Verbalize symptoms of a recurrence

Intervention

• Providing for the client’s safety and the safety of others

• Promoting a therapeutic relationship

• Promoting activities of daily living and physical care

• Using therapeutic communication

• Managing medications

• Providing client and family teaching

Evaluation

• Does the client feel safe?

• Is the client free of uncontrollable urges to commit suicide?

• Is the client participating in therapy and medication compliance?

• Can the client identify signs of relapse?

• Will the client agree to seek treatment immediately upon relapse?

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual
shifts in a person’s mood, energy, and ability to function. Different from the normal ups and
downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result
in damaged relationships, poor job or school performance, and even suicide. But there is good
news: bipolar disorder can be treated, and people with this illness can lead full and productive
lives.

• Occurs almost equally among men and women

• It is more common in highly educated people

• The mean age for a first manic episode is the early 20s

• Involves mood swings of depression (same symptoms of major depressive disorder) and
mania. Major symptoms of mania include:

• Inflated self-esteem or grandiosity

• Decreased need for sleep

• Pressured speech

• Flight of ideas

• Distractibility

• Increased involvement in goal-directed activity or psychomotor agitation

• Excessive involvement in pleasure-seeking activities with a high potential for

painful consequences

Treatment and Prognosis

Medication

• Lithium; regular monitoring of serum lithium levels is needed

• Anticonvulsant drugs are used for their mood-stabilizing effects: Tegretol, Depakote,
Lamictal, Topamax, and Neurontin, as is Klonopin (a benzodiazepine)

Psychotherapy

• Useful in mildly depressive or normal portion of the bipolar cycle. It is not useful during
acute manic stages

Nursing Process: Bipolar Disorder

Assessment

• General appearance and motor behavior: psychomotor agitation; flamboyant clothing or

makeup; think, move, and talk fast; pressured speech

• Mood and affect: euphoria, exuberant activity, grandiosity, false sense of well-being,
angry, verbally aggressive, sarcastic, irritable

• Thought processes and content: flight of ideas, circumstantiality, tangentiality, possible

grandiose delusions

• Sensorium and intellectual processes: oriented to person and place but rarely to time,
impaired ability to concentrate, may experience hallucinations

• Judgment and insight: judgment poor, insight limited

• Self-concept: exaggerated self-esteem

• Roles and relationships: rarely can fulfill role responsibilities, invade intimate space and
personal business of others, can become hostile to others, cannot postpone or delay
gratification

• Physiologic and self-care considerations: inattention to hygiene and grooming, hunger or

fatigue

Data Analysis

Nursing diagnoses may include:

• Risk for Other-Directed Violence

• Risk for Injury

• Imbalanced Nutrition: Less Than Body Requirements

• Ineffective Coping

• Noncompliance

• Ineffective Role Performance

• Self-Care Deficit

• Chronic Low Self-Esteem

• Disturbed Sleep Pattern

Outcomes
The client will:

• Not injure self or others

• Establish a balance of rest, sleep, and activity

• Establish adequate nutrition, hydration, and elimination

• Participate in self-care activities

• Evaluate personal qualities realistically

• Engage in socially appropriate, reality-based interaction

• Verbalize knowledge of his or her illness and treatment

Intervention

• Providing for safety of client and others

• Meeting physiologic needs

• Providing therapeutic communication

• Promoting appropriate behaviors

• Managing medications

• Providing client and family teaching

Evaluation

• Safety issues

• Comparison of mood and affect between start of treatment and present

• Adherence to treatment regimen of medication and psychotherapy

• Changes in client’s perception of quality of life

• Achievement of specific goals of treatment including new coping methods

The following table summarizes the nursing care for mood disorders
 MOOD DISORDERS
DEPRESSION
TYPES/
SUBTYP MAJOR DEPRESSIVE
ES DISORDER
(MDD)
• A single, recurrent, or
chronic episode (s) of
CONCEP depression resulting in a
T significant change in
the client’s normal
functioning (social,
occupational, self-care)
accompanied by at least
5 specific symptoms.
• These symptoms must
happen almost every
day, last most of the
day, and occur
continuously for a
minimum of 2 years.
• Depressed Mood
• Insomnia/Hypersomnia
• Decreased ability to
concentrate
• Anergia (Lack of
Energy)
• Significant weight loss
or gain (of more than
5% of body weight in 1
month)
• Indecissiveness
FEATUR
ES • Increase or Decrease in
motor activity
• ****Suicidal
Ideations ****
• Anhedonia (Inability
to feel pleasure in life)
Specifiers (Features):
• PSYCHOTIC
FEATURES
(Hallucinations,
Delusions etc)
• POSTPARTUM
ONSET (Begins within
4 weeks of childbirth,
known as Postpartum
Depression)
• SEASONAL
FEATURES
(SEASONAL
AFFECTIVE
DISORDER –SAD-)
(Generally occurring in
fall or winter, and
(AFFECTIVE DISORDERS)
BIPOLAR DISORDER
• Bipolar disorders are mood disorders with recurrent episodes of
DYSTHYMIC depressionand mania. Phases vary depending on the type of
DISORDER bipolar disorder.
(DD) OR • Bipolar disorders usually emerge in late adolescence/early
DYSTHYMIA adulthood, but can be diagnosed in the school-age as well.
• A milder form of TYPES OF BIPOLAR DISORDERS:
depression that BIPOLAR I: At least 1 episode of Mania alternating w/ Major
usually has an Depression.
early onset, such BIPOLAR II: Hypomanic episodes alternating w/ Major
as childhood or Depressive ones.
adolescence CYCLOTHYMIA: At least 2 years of alternating episodes of
(Chronic Hypomanic Episodes alternating w/ Minor Depressive episodes
Depressed (dysthymia)
Mood) IT BEHAVIORS shown with Bipolar Disorders include:
LASTS: MANIA: Abnormally elevated mood, also described as expansive or
• More than 1 year irritable. HYPOMANIA: A less severe episode of mania that lasts at
(for Children and least 4 days accompanied by 3 or 4 symptoms of mania.
Adolescents) MIXED EPISODE: A manic episode and an episode of major
• More than 2 years depression experienced by the client simultaneously. Marked
(For Adults) impairment in functioning and may require admission to prevent
• Contains at least 3 self-harm or others-directed violence.
symptoms of RAPID CYCLING: Four or more episodes of acute mania within 1
depression, and year
may, later in life,
become Major ***BIPOLAR DISORDER IS ASSOCIATED WITH THE
Depressive HIGHEST RATE OF SUICIDE OF ANY PSYCHIATRIC
Disorder DISORDERS.
• Depressed Mood
• Insomnia/Hyperso MANIA HYPOMANIA
mnia
• Decreased ability 1. Severe enough to cause a 1. Associated with an
to concentrate marked impairment in unequivocal change in
• Anergia occupational activities, usual functioning that is
• Decreased Self social activities, or uncharacteristic of the person
Esteem relationships. when not symptomatic
• Feelings of
Hopelessness and OR 2. The disturbance in mood and
Despair the change in functioning
2. Necessitates hospitalization are observed by others
• Decreased/Increas
ed Appetite to prevent harm to self or
others, or there are
Specifiers (Features) psychotic features 3. Absence of marked
impairment in social or
3. Symptoms are not due to occupational functioning.
• Early Onset
(before 21 y/o) direct physiological effects
of substance (drug abuse, 4. Hospitalization not indicated
• Late Onset (21
medication, alcohol) other
years or older)
medical condition
• Atypical Features
(hyperthyroidism) 5. Symptoms are not due to
(Appetite
direct physiological effects
changes, weight
of substance (drug abuse,
gain,
medication, alcohol) other
Hypersomnia,
medical condition
extreme
(hyperthyroidism)
sensitivity to
perceived
interpersonal
rejection)