20-Nov-19

Learning Outcome
MOOD At the end of the session, the students will be
able to:
DISORDERS • Define manic
• Define depression
• Define bipolar mood disorder
• List clinical manifestations of major depressive
disorder
• List clinical manifestations of manic episode
• Explain treatment for mood disorder

.
MOOD
DISORDERS

DEPRESSION MANIA

BIPOLAR DISORDER (BAD)

or
MANIC DEPRESSIVE PSYCHOSIS (MDP)

Definition
Two Types of Mood Disorders
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• UNIPOLAR - One polar • BIPOLAR – Two polar • MANIA - mood disorder characterized by an
moods fluctuating between
mood → episodes of
depression and mania elevated, expensive or irritable mood.
depression

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Definition
• DEPRESSION – the state where an individual
experiences a profound sadness, has become
psychotic; almost completely lost touch with
reality
Definition
• BIPOLAR DISORDER - mood disorder
characterized by cyclic experiences with both
mania and depression

EPIDEMIOLOGY
EPIDEMIOLOGY

 Unipolar Disorder (Depression)  Bipolar disorder

 Prevalence  Prevalence – 1 %
• Male : 5-12 %  Age onset – 20 yrs
• Female : 10-25 %  Prognosis poorer than Unipolar disorder
 Age of onset – 25 yrs
 Suicidal risk – 15 %

UNIPOLAR MOOD DISORDER

UNIPOLAR
MOOD DISORDER ● Major depressive episode
● Major depressive disorder
● Dysthymic disorder (chronic disorder)

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Major Depressive Disorder (cont’d.)
UNIPOLAR DEPRESSION: CAUSES
■ Stress may be a trigger for depression
● People with depression experience a greater
number of stressful life events during the month
just prior to the onset of their symptoms
● Some clinicians distinguish reactive (exogenous)
depression from depression which seems to be a
response to internal factors (endogenous)
UNIPOLAR DEPRESSION: CAUSES
■ Genetic factors
● Family pedigree, twin and adoption studies
suggest that some people inherited a biological
predisposition
• Relatives of those with depression have higher rates
of depression compared with members of the general
population
• Twin studies demonstrate a strong genetic
component
- Rates for identical (MZ) twins – 46%
- Rates for fraternal (DZ) twins – 20%
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Major Depressive Disorder (cont’d.)
UNIPOLAR DEPRESSION
• Endogenous (within the body)
• Neurotransmitters
• Hormonal/endocrine (thyroid, postpartum)
• Genetic
• Exogenous (neurotic—mind/emotional)
• Learned helplessness
• Unresolved grief/Object loss
• Irrational thinking
• Anger turned inward
UNIPOLAR DEPRESSION: CAUSES
■ Biochemical factors
● Low level of Serotonin and norepinephrin
• Serotonin acts both as a chemical messenger that
transmits nerve signals (neurotransmitter) between
nerve cells
• Changes in the serotonin levels in the brain can alter
the mood.
– Endocrine hormone – elevated level of cortisol
• Released by adrenal glands during times of stress
• Persons who secrete an excessive amount of the stress
hormone cortisol in the presence of stressful situations
may have a higher risk of developing depression
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UNIPOLAR DEPRESSION: CAUSES UNIPOLAR DEPRESSION: CAUSES

■ Cognitive views
■ Psychodynamic views – Negative thinking
– Link between depression and grief • Individual repeatedly interpret their
• When a loved one dies, the mourner regresses to the experience, themselves and their futures in
oral stage (total dependency on others)
– For most people, grief is temporary
negative ways, negative conclusions on little
– If grief is severe and long-lasting - depression result evidence - leading to depression
– Strength - research
• supports the theory that early losses set the stage for
later depression
• suggests that people whose childhood needs were
improperly met are more likely to become depressed
after suffering a loss

Unipolar Depression: Treatment

■ Biological
– Electroconvulsive therapy (ECT)
Bipolar
– Antidepressant drugs Disorder
• MAOI –Monoamine Oxidase Inhibitors
• Tricyclics antidepressant
• SSRI (Selective Serotinin Reuptake Inhibitors) - ↑
serotonin

■ Psychotherapy
■ Cognitive therapy

Bipolar Disorder Bipolar Disorder

■ Bipolar ■ Bipolar I – mania

■ Two polar moods fluctuating

between periods of depression ■ Bipolar II – hypomania and depression
and mania
• Depressive and manic
episodes last for weeks
to several months
• Often have normal
mood occurring
between episodes

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Bipolar Disorder
■ Rapid cycling Bipolar disorders
• When 2 or more episodes of both depression
and mania occur within 1 year
• Sometimes rapid cyclers switch mood
dramatically from week to week or even day to
day
BIPOLAR I
• Symptoms: (cont.)
B. During the period of mood disturbance and increased energy or
activity, three (or more) of the following symptoms (four if the
mood is only irritable) are present to a significant degree and
represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e. g . , feels rested after only 3
hours of sleep) .
3. More talkative than usual or pressu re to keep talking.
4. Flight of ideas or subjective experience that thoughts are
racing.
5. Distractibility ( i . e . , attention too easily d rawn to
unimportant or irrelevant external stimuli), as reported or
observed.
6. Increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation ( i . e . ,
purposeless non-goal-di rected activity) .
7. Excessive involvement in activities that have a high potential
for painful consequences (e. g . , engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business
investments) .
BIPOLAR I
■ Average age on onset 18 years, but can begin
in childhood
■ Tends to be chronic
■ Suicide common : 17%
■ 52% suffer recurrent episodes
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BIPOLAR I
■ Manic episode
A. A distinct period of abnormally and
persistently elevated, expansive, or irritable
mood and abnormally and persistently
increased goal-directed activity or energy,
lasting at least 1 week and present most of
the day, nearly every day (or any duration if
hospitalization is necessary) .
C. The mood disturbance is sufficiently severe to cause marked
impairment in social or occupational functioning or to
necessitate hospitalization to prevent harm to self or others,
or there are psychotic featu res.
D. The episode is not attributable to the physiological effects of a
substance (e. g . , a drug of abuse, a medication, other
treatment) or to another medical condition.
Note: A full manic episode that emerges during antidepressant
treatment (e.g . , medication, electroconvulsive therapy) but
persists at a fully syndromal level beyond the physiological effect
of that treatment is sufficient evidence for a manic episode and,
therefore, a bipolar I diagnosis.
Note: Criteria A-D constitute a manic episode. At least one lifetime
manic episode is required for the diagnosis of bipolar I disorder.
BIPOLAR I: Interventions
■ Safety is related to physical and thought
– Decrease anxiety
• Decrease/minimize over stimulation
• Avoid threats and challenges
• Non-competitive activities
– Prevent exhaustion
• Encourage rest
• “food on the run” if necessary
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BIPOLAR II HYPOMANIA
■ Alternations between major depressive episodes and
A. A distinct period of abnormally and persistently elevated , expansive, or irritable mood and
abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and
hypomanic episodes present most of the day, nearly every day.

■ Average age of onset 22 years, but can begin in childhood

B. During the period of mood disturbance and increased energy and activity, three (or more) of
■ 10-13% progress to Bipolar I disorder the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable
■ Suicide common : 24% change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
■ Tends to be chronic 2. Decreased need for sleep (e. g . , feels rested after only 3 hours 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), as reported or observed .
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation .
7. Excessive involvement in activities that have a high potential for painful consequences (e. g ,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business
investments).

C. The episode is associated with an unequivocal change

in functioning that is uncharacteristic of the individual
when not symptomatic.

D. The disturbance in mood and the change in

functioning are observable by others.

E. The episode is not severe enough to cause marked

impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic
features, the episode is, by definition , manic.

F. The episode is not attributable to the physiological

effects of a substance (e.g. , a drug of abuse, a
medication, other treatment) .

TREATMENT OF MOOD DISORDER

■ Psychosocial Intervention
■ Psychotherapy
■ Psychoeducation
■ Cognitive Behavior Therapy (CBT)
■ Milieu Therapy

■ Pharmacotherapy
■ Depression – Antidepressant
■ Manic – Antimanic @ Mood Stabilizer,
antipsychotic,
Benzodiazepine - Diazepam
■ Electroconvulsive therapy (ECT)

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NURSING PROCESS
IN
DEPRESSIVE
DISORDERS
PLANNING and IMPLEMENTATION
Facilitate adequate nutrition (e.g. provide smaller
or larger portions, consider food preferences, stay
with the patient during meals)
Assist the patient in developing a daily schedule
that balance activity and rest
Promote sleep with daily exercise and activities
and bedtime relaxation interventions (e.g. quite
time, back rubs, music)
Assist with hygiene and grooming as needed
Evaluation – the patient
Exhibits improved coping skill
Maintains adequate nutritional status
Demonstrates improved self-care ability
Reports and displays improved self-concept and
increase self-esteem
Exhibits improved sleep patterns
Maintains social interaction to the extent
possible
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NURSING DIAGNOSIS
Ineffective individual coping
Altered nutrition: less than or more requirements
Self-care deficit: hygiene, grooming, self-esteem
Disturbance in self-concept: self-esteem
Sleep pattern disturbance
Impaired social interaction
Have brief, therapeutic interactions with the
patient
Don’t force conversation, but encourage
participation in social interaction and activity
Assist the patient to identify feelings and reduce
negative cognitions
Institute suicide precaution as necessary
Facilitate successful problem solving and
reinforcement by structuring simple, manageable
tasks
Administer antidepressant medication, as ordered
NURSING PROCESS
IN
MANIA
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NURSING DIAGNOSIS FOR MANIC PATIENT
 Constipation
 Ineffective individual coping
 High risk for injury
 Altered nutrition: less than body requirements
 Self-care deficit: hygiene, grooming, feeding
 Sleep pattern disturbance
 Altered thought process
PLANNING and IMPLEMENTATION
Promote bowel regularity through adequate
dietary roughage, adequate fluid intake and
establishment of a regular schedule for
defecation
Take a matter-of-fact and consistent
approach in describing acceptable behavior
and realistic limits
Provide the patient with simple tasks that
focus attention and yield successful
completion
EVALUATION, The patient
 maintains good bowel elimination patterns
 exhibits improved coping skills
 remains injury-free
 maintains adequate nutritional status
 demonstrates improved self-care ability
 exhibits improved sleep patterns
 demonstrates improved cognition
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PLANNING and IMPLEMENTATION
Promote adequate nutrition (e.g. offer the
patient high-calorie foods that can be
eaten “food on the run”, stay with the
patient during meals)
Reduce stimulation throughout the day,
especially before bed-time
Promote rest perids, enhance relaxation
(e.g. reduce noise, promote queit time)
Assist with self-care as necessary
PLANNING and IMPLEMENTATION
Assist the patient to think through
consequences of behavior and to control
his behavior
Provide a safe environment and patient
monitoring to reduce the risk of accidents
and injury
Administer lithium, as ordered
SUMMARY
• Definition manic
• Definition depression
• Definition bipolar mood disorder
• Clinical manifestations of major depressive
disorder
• Clinical manifestations of manic episode
• Treatment for mood disorder
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