MOOD DISORDER  Loss of energy, great fatigue
 Negative self-concept
Pervasive alterations in emotions that are
manifested by depression, mania, or both, and
interfere with the person’s ability to live life
Mood Disorders
Mood Disorders involve a disabling disturbance
in emotion
 Depression is an emotional state marked
by
 Sadness or loss of pleasure
 Feelings of worthlessness and
guilt
 Withdrawal from others
 Reduced sleep, appetite, sexual
desire
 Mania is an emotional state marked by
 Intense elation
 Hyperactivity, talkativeness,
distractibility
Diagnosis of Unipolar Depression
 Unipolar depression diagnosis requires
presence of 5 of the following:
 Sad, depressed daily mood
 Loss of interest in usual activities
 Difficulties in sleeping
 Poor appetite and weight loss
 Recurrent thoughts of suicide or death
Depression Issues
 Depression exists on a continuum
 Major depression is quite common
 Lifetime prevalence rates range
from 5.2% to 17.1%
 Women are twice as likely to
develop depression as are men
 Higher rates in young adults and
among individuals in lower
socioeconomic groups.
 Depression prevalence varies
across cultures
 Prevalence of depression has been
increasing over the last 50 years
Cavs' West arrested in Maryland
UPPER MARLBORO, Md. -- Cleveland
Cavaliers, Delonte West guard was arrested
Thursday after officers pulled him over for
speeding on a motorcycle while carrying two
loaded handguns and a loaded shotgun in a
guitar case. West left the Cavaliers' training
camp to seek treatment for depression and a
"mood disorder" he said he has battled his entire
life. He said he was taking medication and
attending therapy sessions. West said his mood
problems date to his childhood.
West has said his mood swings seem to be most
erratic when his life seems to be in order.
Diagnosis of Bipolar Disorder
 Bipolar disorder involves
 Alternating episodes of mania
and depression
 Increase in activity level (work,
social, sexual)
 Unusual talkativeness, rapid
speech
  Reduced requirements for sleep
 Inflated self-esteem
 Distractability
 Reckless spending
Mood Disorders: Psychological Causes
Chronic Mood Disorder
 Chronic Mood Disorder refers to long-
term changes in mood that are less
severe than that of unipolar or bipolar
depression
 Cyclothymic disorder refers to frequent
periods of depressed mood and
hypomania
 Dysthymic disorder involves chronic
depression
-Recent studies suggest dysthymia may
be more debilitating over the long term
than depression.
Psychological Theories of Depression
 Psychoanalytic theory views grief over
object loss as the basis for depression
 Cognitive views of depression include
Beck’s theory of depression: the
way depressed people think is biased
towards negative interpretations
Learned helplessness: depressed
people are passive because they have
been unable in the past to control
traumatic events
Depression and Positive Emotion
Depressed individuals:
 Display fewer positive expressions
 Report experiencing less pleasant emotion
in response to pleasant stimuli
 Physiologically less responsive to positive,
but not negative, stimuli
 Negative Cognitive Biases
 Beck’s Cognitive Triad
 Negative Schema About
Self,
World,
& Future
Cognitive Biases in Depression
 Arbitrary influence refers to a
conclusion drawn in the absence of
sufficient evidence
 Selective abstraction refers to a
conclusion drawn on one of many
elements in a situation
 Overgeneralization refers to an overall
sweeping conclusion drawn on a basis of
a trivial event
 Magnification of trivial events
Helplessness Views
 Learned helplessness view is that
depression is a response to a history of
failing to control traumatic life events
 The Attribution-Learned helplessness
view is that depressed people make
global, stable and internal attributions
 Hopelessness view is that depressed
persons expect that desired outcomes
will not occur, their actions will have no
effect
 Mood Disorders: Psychological Causes
 Stressful Life Events
 Learned Helplessness
 Attributional Style
 Internal attributions – Negative
outcomes are one’s own fault
 Stable attributions – Believing future
negative outcomes will be one’s fault
 Global attribution – Believing negative
events will disrupt many life activities
 All three domains contribute to a sense
of hopelessness
Mood Disorders: Social & Cultural Dimensions
Marriage and Interpersonal Relationships
 Marital dissatisfaction is strongly related
to depression
 This link is particularly strong in males
Gender Imbalances
 Occur across all mood disorders, except
bipolar disorders
 Gender imbalance likely due to
socialization (i.e., perceived
uncontrollability and more rumination in
women)
Social Support
 Extent of social support is related to
depression
 Presence of social support delays onset
of depression
 High expressed emotion and/or family
conflict predicts relapse
 Substantial social support predicts
recovery from depression but not from
mania
Interpersonal Theory of Depression
Interpersonal relations are altered in depression
 Depressed people have limited social
support networks
 Depressed people elicit rejection from
others
 Depressed people are low in social skills
across a wide variety of situations
 Depressed people seek reassurance from
others, but this reassurance is temporary
Biological Theories of Mood Disorder
 Genetic factors for bipolar disorder are
supported by adoption, family and twin
studies
The role of genetic factors in
unipolar depression is not as strong
as bipolar disorder
 Neurochemistry studies link
norepinephrine (NE) to
mania/depression and serotonin (5-HT)
to depression
Mood Disorders: Biological Causes
Sleep and Circadian Rhythms
 Sleep Disturbances are Common
 REM Sleep and Depression
 Diminished Deep Sleep
 Disruption of Circadian Rhythms
Neurochemistry of Mood Disorders
 Tricyclic drugs and MAO inhibitors relieve
depression and increase levels of NE and 5-
HT by blockade of reuptake
 Measurement of NE/5-HT metabolites in
urine and blood does not assess brain
activity
 CSF levels of 5-HIAA (5-HT metabolite)
are related to depression
 Relief of depression takes 2 weeks or
longer, but NE and 5-HT levels may have to
previous state

Integrative Model of Mood Disorders
 Shared Biological Vulnerability
- Overactive neurobiological
response to stress
 Exposure to Stress
- Activates hormones that affect
neurotransmitter systems
- Turns on certain genes
- Affects circadian rhythms
- Activates dormant psychological
vulnerabilities (i.e., negative
thinking)
- Contributes to sense of
uncontrollability
- Fosters a sense of helplessness and
hopelessness
 Social and Interpersonal
Relationships/Support are Moderators
Psychological Treatment of Mood Disorders
 Cognitive Therapy
- Addresses cognitive errors in
thinking
- Also includes behavioral
components (“activation”)
 Behavioral Activation
- Involves helping depressed persons
make increased contact with
reinforcing events
 Interpersonal Psychotherapy
- Focuses on problematic
interpersonal relationships
- Outcomes with Psychological
Treatments Are Comparable to
Medications
Biological Therapies for Mood Disorders
 Electroconvulsive therapy (ECT)
involves the induction of brain seizures
by the application of electrical current to
the skull
- ECT is an effective therapy for
severe depression, but its
mechanism of action is unknown
 Drug therapy involves ingestion of
tricyclic drugs, MAO inhibitor drugs and
selective serotonin reuptake inhibitor
(SSRI) drugs, or mood stabilizers (e.g.,
Lithium, Tegretol, Depakote, Topamax)
for bipolar disorder
Nursing Interventions (KAPLAN Reviewer)
• Institute measures to deal with
hyperactivity/agitation
– Simplify the environment and
decrease environmental stimuli
• Assign to a single room away
from activity
• Keep noise level low
• Soft lighting
– Limit people
• Anticipate situations that will
provoke or overstimulate
client (competitive situations)
– Distract and redirect energy
• Choose activities for brief
attention span
• Choose physical activities
using large movements until
acute mania subsides, e.g.,
dancing
 Provide external control
- Assign one staff person to provide
controls\
- Do not encourage client when telling
jokes or performing, e.g., avoid laughing
- Accompany client to room when
hyperactivity is escalating
- Guard vigilantly against suicide as
elation subsides and mood evens out
Nursing Interventions (KAPLAN Reviewer)
• Institute measures to deal with
manipulativeness
– Set limits, e.g., limit phone calls
when excessive
• Set firm consistent times for
visits-client often late and
unaware of time
 • Refuse unreasonable
demands, e.g., asks for a date
with a nurse
• Explain restrictions on
behavior and reasons so that
client does not feel rejected
– Communicate using a firm,
unambivalent consistent approach
• Use staff consistency in
enforcing rules
• Remain nonjudgmental, e.g.,
when the client disrobes say,
“I cannot allow you to
undress here.”
• Explain restrictions on
behavior and reasons so
client does not feel rejected
– Avoid long, complicated discussions
 Use short sentences with specific
straightforward responses
 Avoid giving advice when
solicited, e.g., “I notice you want
me to take responsibility for your
life.”
• Meet physical needs
– Meet nutritional needs
• Encourage fluids; offer water
every hour because client
will not take time to drink
• Give high-calorie foods and
drinks to be carried while
moving, e.g., cupcakes,
sandwiches
• Serve meals on tray in
client's room when too
stimulated
– Encourage rest
• Sedate PRN
• Encourage short naps
– Supervise bathing routines when
client plays with water or is too
distracted to clean self
• Help decrease denial and increase client's
awareness of feelings
– Encourage expression of real
feelings through reflecting
– Help client acknowledge the need
for help when denying it, e.g., “You
say don't need love, but most people
need love. It's okay to feel that.”
– Function as a role model for client
by communicating feelings openly
– Help client recognize demanding
behavior, e.g., “You seem to want
others to notice you.”
– Encourage client to recognize needs
of others
– Have client verbalize needs directly,
e.g., wishes for attention
ANTIMANIC MEDICATIONS
• LITHIUM
– SE: dizziness, headache, impaired
vision, fine hand tremors, reversible
leukocytosis
– Nrsg. Considerations:
• Blood levels must be
monitored frequently
– 2-3 times weekly
initially and monthly
when on
maintenance; blood
should be drawn in
AM prior to dose
• GI symptoms can be reduced
if taken w/ meals
• Therapeutic effects precede
by lag of 1-2 wks.
• Signs of intoxication:
vomiting, diarrhea,
drowsiness, muscular
weakness, ataxia
• Normal bld. Level: 1-1.5
mEq/L
• Should have fluid intake of
2.5-3 L/day and adequate salt
intake
Excessive sodium intake (e.g. a dramatic dietary
change) lowers Lithium concentrations.
Conversely, too little sodium (e.g. Fad diets) can
lead to potentially toxic concentrations of Lithium.
Decreases in body fluid (e.g. excessive perspiration)
can lead to dehydration and
Lithium concentration.
Suicide
• Suicide is the intentional ending of one’s
own life
– Suicide is often related to
depression, to drug use and to
borderline personality disorder
– Suicide is the 9th leading cause of
death in the US
– There are gender differences in the
methods of suicide (men choose
guns, women choose drugs)
Deadlier Side of Mood
Disorders: Suicide
 In the United States
 300,000 Kill Themselves
 9th Leading Cause of Death
 Increasing in Adolescents & Elderly
 Males > Females in Killing Themselves
 Females > Males in Attempts
Ten Commonalities of Suicide
 The common purpose of suicide is to seek a
solution
 The common goal of suicide is the cessation
of consciousness
 The common stimulus in suicide is
intolerable psychological pain
 The common stressor in suicide is frustrated
psychological needs
 The common emotion in suicide is
hopelessness-helplessness
 The common cognitive state in suicide is
ambivalence
 The common perceptual state in suicide is
constriction
 The common action in suicide is regression
 The common interpersonal act in suicide is
communication of intention
 The common consistency in suicide is with
lifelong coping patterns
Suicide Myths
• People who talk about suicide won’t do it
• Suicide has no warning
• Only people of a certain class commit
suicide
• All who commit suicide are depressed
• Suicide is a lonely event
• Suicidal people clearly want to die
• Thinking about suicide is rare
The Nature of Suicide: Risk Factors
• Suicide in the Family Increases Risk
• Low Serotonin Levels Increase Risk
• A Psychological Disorder Increases Risk
• Alcohol Use and Abuse
• Past Suicidal Behavior Increases Subsequent
Risk
• Experience of a Shameful/Humiliating
Stressor Increases Risk
• Hopelessness is a strong predictor of suicide
(Beck et al.)
• Publicity About Suicide and Media
Coverage Increase Risk
Preventing Suicide
• Reduce the intense psychological pain and
suffering
• “Lift the blinders” (expand the constricted
view by helping the person see other options
other than the extremes of continued
suffering or nothingness)
• Encourage the person to pull back even a
little from the self-destructive act.