Nursing care of patients with Mood

disorders (depression)
Disturbance of Mood
Depression
 :

Depression is a mood disturbance characterized by

pathological sadness,
hopelessness and helplessness.
 Symptoms of depression
Psychological symptoms of depression:
Depressed mood most of the day, nearly every day.
Deep sense or feeling of
Tendency to
feelings.
Feeling empty.
Inability to enjoy anything, hopelessness,
loss of sexual desire, loss of self esteem, inexplicable crying spells.
In sever states: .
 :Inability to perform normal tasks “lack of energy”.

: insomnia or excessive sleeping, difficulty

falling asleep, difficulty staying a sleep, or early morning awakening.
loss of appetite or overeaters, weight
loss or weight gain.

nausea, diarrhea or constipation.

Unexplained headaches or backaches.

Changes in behavior and attitude

– Psychomotor retardation: Reduced mental and

physical activity.

– Neglect of responsibilities and appearance

(Lack of self- care).
Diagnostic criteria of Major Depressive Disorder (MDD)

A- At least symptoms of the fowling have been present during

the same weeks

Ø Depressed mood most of day, nearly every day

Ø Marked diminished interest most of day, nearly every day
Ø Significant weight loss or weight gain
Ø Insomnia/ hypersomnia nearly every day
Ø Psychomotor retardation.
Ø Feeling of worthlessness / guilt nearly every day
Ø Diminished ability to think or concentrate nearly every day.
Ø In severe cases ( ).
B. There has never been a manic episode, a mixed episode, or a
hypomanic episode that was not substance or treatment induced or
due to the direct physiological effects of medical condition.
C. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
D. The symptoms are not due to the direct physiological effects
as substance abuse or a medical condition (e.g., hypothyroidism).
 Etiology of Major Depressive Disorder:
1- Biological factors:
q It has been hypothesized that depressive illness may be related
to dysregulation in the mainly
.
2- Genetic factors:
Family Study: Family data indicate if one parent has mood
disorder, a child will have a risk percent of mood disorder.
If both are affected, the risk will be double.
Twin Studies: The rate of mood disorder in monozygotic 70-
90% compared with the same sex dizygot twins 15-35 %.
3- Cognitive theory:
Cognitive distortions result in negative attitude: (1) negative self view
(things are bad because I'm bad), (2) negative interpretation of experience
(everything has always been bad), (3) negative view of future
(anticipation of failure) (pessimism).
4- Alteration in sleep neurophysiology:
Depression associated with loss of deep sleep & increase nocturnal
arousal and decrease total sleep time
5- Psychosocial Factors: Life events and environmental stress play the
primary role in depression.

6- Personality Factors:
q Humans of whatever personality pattern can become depressed
under appropriate circumstances.
q Persons with certain personality disorder- OCD, histrionic may be
greater risk for depression than persons with antisocial or paranoid
personality disorder.
 Common Types of Depression

• Dysthymia
• Seasonal Affective Disorder (SAD)
 Definition of Dysthymia
Suffering from mild depression every day for
at least two years. The
on a but their
.
 Definition of Seasonal Affective Disorder

This is a that results from in the

. Most cases begin in the or , or
when there is a in .
§ Assessing the is important to any
of , , and client’s to
.

§ The nurse also asks about of ,

, or attempted suicide.

§ Assess of depression (mild, moderate, or severe).

§ Assess and feeling, , ,

symptoms and assess and social
interaction.
 Nursing diagnosis
§ Risk for suicide (Violence against self) RT feeling of hopelessness
AEB depression S&S.

§ Self-care deficit (hygiene, sleeping, grooming, elimination) RT

hopelessness AEB loss of interest in self and inability to feed or
dress self.

RT internal stressors AEB

difficulty falling asleep and sleeping only short periods.

§ Impaired social interaction RT psychomotor retardation AEB

withdrawal and failure to initiate relationship.

§ Self-esteem disturbance RT worthlessness AEB negative self-

evaluations, feelings of inadequacy and feelings of guilt,
verbalization of idea that conveys low self-esteem.
 Nursing intervention
1- Providing safe environment

§ The first priority is to determine if a client with

depression has .

Observe and of as (I wish

I were dead) Observe behavioral clues as
from depression to more to
out a of .

§ Provide and don't be nursed at a

.
 of , from
such as , ,
, , , .

§ Be when client using .

§ Be that the patient dose by dose.

§ Make at ,
especially at , , and at
.
 Increasing patient's self-esteem by:

the patient and with .

§ Focusing on his , ,
and and minimize failure.

§ Give for any .

§ Encourage the patient to and and stay
of the the .

§ Provide in the .

§ Reduce stimulus in the evening to

facilitate by , soft , quite
and warm .
§ Avoid and .
§ Maintain routine/schedule of activities.
 Self-care deficit
• Encourage Bathing and Hygiene.

• Give step-by-step reminders.

• Provide hygienic requirements and support as

necessary with care of nails, and hair, mouth care,
shaving.

• Provide privacy when bathing and dressing as suitable.

• Offer makeup