MOOD DISORDERS

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Learning Outcomes: After completing this lecture, the student will be able to:
Define mood, depressive disorders and

bipolar disorders.

Identify predisposing factors of major

depressive disorders.
Discuss clinical manifestations of MDD. List types of bipolar disorders. Identify predisposing factors & clinical

manifestations of mania.
Discuss nursing management of mood

disorders. 3/23/12

Definition of mood: Mood is defined as an individuals sustained emotional tone, which significantly influences behavior, personality, and perception.
Mood disorders are classified as:
Depressive disorder Bipolar disorder

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Depressive Disorders: Major depressive disorder is described as a disturbance of mood involving depression or loss of interest or pleasure in the usual activities and pastimes. There is evidence of interference in social and occupational functioning for at least 2 weeks. Bipolar Disorders These disorders are characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy.
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MAJOR DEPRESSIVE DISORDER

Predisposing Factors:
q Physiological

a.

Genetic:
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Numerous

d. Medication Side Effects: A number of drugs can produce a depressive syndrome as a side effect. (anxiolytics, antipsychotics, sedativehypnotics .and antihypertensive) e. Other Physiological Conditions: Depressive symptoms may occur in the presence of electrolyte disturbances, nutritional deficiencies, and with certain physical disorders, such as cardiovascular accident, systemic lupus erythematosus, hepatitis, and diabetes mellitus.

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qPsychosocial:
a. Psychoanalytical: Freud observed that it occurs after the loss of a loved object, either actually by death or emotionally by rejection. b. Cognitive: depressive illness occurs as a result of impaired cognition. Disturbed thought processes foster a negative evaluation of self by the individual. The perceptions are of inadequacy and worthlessness.

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c. Learning Theory: depressive illness is predisposed by the individuals belief that there is a lack of control over his or her life situations. d. Object Loss Theory: depressive illness occurs as a result of having been separated from, a significant other during the first 6 months of life.

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Clinical Manifestations of MDD

Sadness, helplessness, and

hopelessness.
Thoughts are slowed and concentration

is difficult.
Obsessive ideas is common. Psychotic features such as hallucinations

and delusions may be evident.

There is evidence of weakness and

fatigue. 3/23/12

 Some

individuals may be inclined toward excessive eating and drinking, whereas others may experience anorexia and weight loss

Sleep disturbances are common, such

as insomnia.
Verbalizations are limited. Social participation is diminished.

Psychomotor retardation, decrease activities. 3/23/12

increase or

Management:
A. Nurse Interventions
D drugs E expression of feelings P patient involvement in physical activities R reinforce decision making E never reinforce hallucination or delusions S suicide precaution S safe environment
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B. Pharmacotherapy 1. Fluoxetine (Prozac) 2. Imipramine (Tofranil) 3. Phenelzine (Nardil)

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Common Nursing Diagnoses For Depression:

RISK FOR SUICIDE COMPLICATED GRIEVING LOW SELF-ESTEEM IMPAIRED SOCIAL INTERACTION POWERLESSNESS DISTURBED THOUGHT PROCESSES IMBALANCED NUTRITION:LESS THAN BODY

REQUIREMENTS.

INSOMNIA
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Example: RISK FOR SUICIDE Related/Risk Factors (related to)

Depressed mood Feelings of worthlessness Irrational feelings of guilt Numerous failures Hopelessness Hallucinations Delusional thinking

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Goals/Objectives
Client will seek out staff when feeling urge to

harm self.
Client will not harm self.

Interventions:
Create a safe environment for the client. Formulate a short-term verbal or written contract

with the client that he or she will not harm self during specific time period.

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?
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Secure promise from client that he or she will

seek out a staff member or support person if thoughts of suicide emerge. medications.

Maintain special care in administration of Maintain close observation of client. Encourage verbalizations of honest feelings. Encourage client to express angry feelings

within appropriate limits.

Most important, spend time with client. This

provides a feeling of safety and security.

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Outcome Criteria:
Client verbalizes no thoughts of suicide. Client commits no acts of self-harm.

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Bipolar Disorders Bipolar I Disorder:

A full syndrome of manic or

mixed symptoms. The client may also have experienced episodes of depression. Bipolar II Disorder
3/23/12 Recurrent bouts of major

Predisposing Factors Biological

A. Genetics: If one parent has bipolar disorder, the risk that a child will have the disorder is around 28 percent . If both parents have the disorder, the risk is two to three times as great. B. Biochemical: It has also been suggested that manic individuals have increased intracellular sodium and calcium.
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Physiological
A. Neuroanatomical Factors. Enlarged third

ventricles and subcortical white matter in clients with bipolar disorder.

B. Medication Side Effects. The most common of these are the steroids frequently used to treat chronic illnesses such as multiple Sclerosis and systemic lupus erythematosus.

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Clinical manifestations of mania

q The affect of a manic individual is one of elation

and euphoria. However, the affect may change quickly to hostility.

q Alterations

in thought processes and communication patterns are manifested by the following: shift from one topic to another.

Flight of Ideas. There is a continuous, rapid Delusions of Grandeur. The individual

believes he is important, powerful, with feelings of greatness and magnificence.

Delusions of Persecution. The individual
3/23/12 believes someone or something desires to harm

q Motor activity is constant. q Dress is often inappropriate: bright colors;

clothing inappropriate for age ; excessive makeup and jewelry.

q Anorexia, despite excessive activity level. q Pt is unwilling to stop moving in order to eat. q Sleep patterns are disturbed. Insomnia. q Individual spends large amounts of money,

which is not available, on numerous items, which are not needed.

q Projection is a major defense mechanism q There is an inability to concentrate. q hallucinations.
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Hypomanic Episode
q Is almost similar to mania but with

less severe level of impairment.

q Not severe enough to cause major

problems in school, work, or home.

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Management:
A. Nursing intervention: M - Maintain a safe environment. Monitor sleeping pattern. A - Always limit group activities. N - Never reinforce altered perceptions and delusions. I - Institute motor programs (running, walking) 3/23/12 A - Avoid stimulants. Provide finger

B. Pharmacotherapy

Antianxiety drugs. Antipsychotics for psychotic episodes during the manic phase of Bipolar I. C. Electro-convulsive therapy
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Common Nursing Diagnoses and Interventions for Mania:

RISK FOR INJURY IMBALANCED NUTRITION: LESS THAN BODY

REQUIREMENTS
DISTURBED THOUGHT PROCESSES DISTURBED SENSORY PERCEPTION IMPAIRED SOCIAL INTERACTION INSOMNIA

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Example: Risk for injury: Related/Risk Factors (related to):

Extreme hyperactivity Destructive behaviors Hitting head (hand, arm, foot, etc.) against wall

when angry

Increased agitation and lack of control over

purposeless, and potentially injurious, movements

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Goals/Objectives:
Client will experience no physical injury.

Interventions:
Reduce environmental stimuli. Assign

private room, if possible, with soft lighting, low noise level, and simple room decor.
Assign to quiet unit. Limit group activities. Help client try to

establish one or two close relationships.

Remove hazardous objects and 3/23/12

Stay with the client to offer support and provide

a feeling of security as agitation grows.

Provide structured schedule of activities that

includes established rest periods throughout the day. purposeless hyperactivity (Examples: brisk walks, housekeeping, dance therapy, aerobics.) by physician. Antipsychotic drugs.

Provide physical activities as a substitution for

Administer tranquilizing medication, as ordered

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Outcome Criteria
Client is no longer exhibiting signs of physical

agitation.
Client exhibits no evidence of physical injury.

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Somatoform Disorders
Complains of physical symptoms or illness for which no organic or physiologic cause can be identified. The symptoms are severe enough to interfere with patients ability to do social or occupational activities.

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Types of somatoform disorders

qSomatization Disorder:

These individuals verbalize recurrent, frequent, and multiple somatic complaints for several years without physiologic cause.

Onset of the disorder is usually in

adolescence or early adulthood and is more common in women than in men. 3/23/12

Common symptoms:
Nausea and vomiting Dizziness Shortness of breath Dysmenorrhea Chest pain

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qPain Disorder: severe and prolonged pain that

causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This diagnosis is made when

psychological factors have been judged to have a major role in the 3/23/12 onset.

qHypochondriasis: It is an unrealistic preoccupation

with the fear of having a serious illness. This fear arises out of an unrealistic interpretation of physical signs and symptoms.
qConversion Disorder: Conversion disorder is a loss of or

change in body function resulting from a psychological conflict

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 The most common conversion symptoms are

those that suggest neurological disease such as paralysis, seizures, coordination disturbance, blindness and anosmia.

qBody Dysmorphic Disorder

Exaggerated belief that the body is deformed or

defective in some specific way. The most common complaints involve imagined or slight flaws of the face or head, such as thinning hair, acne, wrinkles, scars, vascular markings, facial swelling or asymmetry, or excessive facial hair
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Psychological intervention
Individual psychotherapy Must have single identified physician as care

taker

Patient should be seen during regularly

schedule brief monthly visit

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 THANK YOU

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