MOOD DISORDERS

Maybellaine V. Solmerano RN BSN

MOOD DISORDERS
“Disorders characterized by a disturbance in a
person’s mood or affect.”

MOOD is defined as a person’s state of

mind that is exhibited through feelings and
emotions.

MOOD is a signal of pleasant or unpleasant

feeling, of sadness… or joy.
TWO MAIN CATEGORIES
•Mood disorder can occur in any age
group
 Exposure to early childhood
trauma or caregivers
Modeling from adults
with psychopathology
Unmet psychological
needs

Early "learned
"Biological
helplessness
kindling"
in face of
severe trauma
Low epinephrine
Low levels of
Marital Marital (depression)
serotonin
High dopamine Elevated
Suicide/murder
dissatisfaction discord Circadian
(Mania) cortisol
rhythm
(-)Learned
cognitive
helplessness
style
DEPRESSIVE DISORDERS
MAJOR DEPRESSIVE
DISORDER
MAJOR DEPRESSIVE
DISORDER
• Also known as clinical depression, unipolar
depression, or major depression.
• A recurrent emotional state characterized by
feelings of persistent sadness, hopelessness
and loss of interest in life.
• Symptoms persist over a minimum two-week
period.
Incidence: “YOU ARE NOT
ALONE.”
– Affects nearly 10% of the population.
– Occurs at any age.
– Affects all ethnic, racial and socioeconomic
groups.
– More than twice as many women (6.7M) as men
(3.2M) suffer from major depression each year.
– ¾ of those who experience a first episode will
have at least one other episode in their lives.
– Left untreated, depression can lead to suicide.
Diagnostic Criteria
A person must have at least 5 of the 9 criteria,
one of which must be a persistent depressed
mood, or anhedonia.
1. Extreme sadness
2. Inability to experience pleasures in life
3. Appetite disturbance with weight change
4. Sleep disturbance
5. Increase or decrease in psychomotor activity
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Diminished ability to concentrate
9. Recurrent thoughts of death or suicide ideations.
 Dysthymic Disorder
 a chronic form of
depression
 has an early onset and
unrelenting,
“smoldering” course
 has subsyndromal
nature
 seldom remits
spontaneously as
compared to major
depression
 Dysthymic Disorder
– Also known as dysthymia, minor depression,
neurotic depression, and depressive neurosis.
– A chronic state of mild depression that last for at
least 2 years.
– Literally means “ill humor.”
– Less disabling than major depression.
Diagnostic Criteria:
A person must have a depressed mood for at
least 2 years (1 year for children), occurring
on almost daily basis and with at least 2 of
the following symptoms:

1. Appetite disturbance
2. Sleep disturbance
3. Fatigue or low energy
4. Poor concentration
5. Shyness
Incidence: “I AM HERE WITH
YOU.”

– 3-5% of the general population suffers

from dysthymia.
– More prevalent in women than men.
– More common among the poor and
unmarried.
 DEPRESSIVE DISORDER NOT
OTHERWISE SPECIFIED
 Used to identify disorders with depressive
features that do not meet the criteria for
MDD, DD, adjustment disorder with
depressed mood or adjustment with mixed
anxiety and depressed mood.
ASSESSMENT OF DEPRESSION
1. History of onset of symptoms
2. Presence of substance, alcohol and medication
use.
3. Physical exam to rule out presence of medical
conditions.
4. Patient resources and social support systems.
5. Interpersonal and coping abilities.
6. Level of stressors.
7. Presence of suicidal ideations.
NURSING PROBLEMS
1. Risk for Suicide
2. Alteration in Nutrition: Less than Body
Requirements
3. Anxiety
4. Ineffective Individual Coping
5. Hopelessness
6. Ineffective Role-Performance
7. Self-care Deficit
8. Sleep-pattern Disturbance
9. Impaired Social Interaction
MANAGEMENT OF DEPRESSION

Providing for safety

Meeting physiologic needs

1. Sleep patterns
2. Eating patterns
3. Physical care
4. Activities of daily living
Establishing Therapeutic Nurse-Patient
Relationship
a) Accept patients as they are and focus on their
strengths.
b) Reinforce decision making by patients.

c) Never reinforce hallucinations and delusions.

d) Respond to anger therapeutically.

e) Spend time with withdrawn patients.

f) Make decisions for patient that they are not ready to
make for themselves.
g) Involve patients in activities in which they can
experience success.
Approach: “KIND FIRMNESS”
Managing Medications
Objectives of
psychopharmacology:
1. Reduce and ultimately
remove all signs and
symptoms of depression.
2. Restore occupational and
psychological function to that
of the asymptomatic state.
3. Reduce the likelihood of
relapse and occurrence.

*Work with clients to manage

medications and side effects.*
Cyclic Antidepressants
Action:
Increase the availability of
specific neurotransmitters at
receptor sites by blocking
their reuptake.
Others:
-produce sedation
-increase psychomotor
activity
improve appetite
SSRI MAOI
Action: Action:
Inhibits serotonin uptake in Blocks monoamine oxidase,
neurons. an enzyme involved in the
metabolic decomposition
and inactivation of
neurotransmitters.

Absorption:
-given p.o.
SAME
-absorbed well from the GI SAME
tract
-metabolized in liver

LAG TIME:
2-4 weeks 10 days to 4 weeks
Cyclic Antidepressants SSRI MAOI
Side Effects: Side Effects: Side effects:
1. Dry mouth 1. Nausea 1. CNS hyperstimulation
2. mydriasis 2. diarrhea or loose causing agitation,
3. diminished lacrimation stools restlessness,
insomnia and
4. blurred vision 3. weight loss
euphoria
5. eye pain 4. Headache
2. hypotension
6. urinary hesitation 5. Dizziness
3. drymouth
7. constipation 6. Nervousness
4. blurred vision
8. anhidrosis 7. tremors
5. urinary hesitancy
9. tachycardias 8. decreased libido
6. constipation
10. orthostatic
hypotension
11. sedation
12. delirium or mania
 Cyclic Antidepressants SSRI MAOI
Drug Interaction: Drug Interactions: Drug Interactions:
1. Cimetidine 1. MAOIs 1. TCAs
2. MAOIs 2. Lithium 2. CNS depressants
3. Clonidine 3. Antipsychotics 3. Anesthetics
4. Warfarin 4. TCAs 4. Antihypertensives
5. Barbiturates 5. Anticonvulsants 5. Sympathomimetics
6. Procainamide 6. SSRIs
7. Anticholinergics
8. Alcohol
9. Anticonvulsants
Special Considerations Special Considerations Special Considerations
Caution: Caution: Caution:
1. Pregnancy (Category B) 1. SAME 1. SAME
— should be avoided during 2. Use in the elderly 2. Use in the elderly
the 1st trimester
 safe for use in the  effective in older
2. Use in the elderly elderly, however, patients because MAO
— to be given in lower doses dosage should be activity increases with
(start slow, go slow)
reduced. age
— side effects are more
pronounced in this group.
 potential for weight loss  precautions for
must be monitored. orthostatic hypotension
3. Use cautiously in patients
with glaucoma. 3. C/I in stroke patients,
elective surgery patients
Electroconvulsive Therapy

- Commonly referred to as EST (electroshock

therapy).
- A procedure wherein an electric current is
passed through the brain, causing a seizure
which is though to reset the pattern of brain
cell activity into a more normal state.
- Introduced in 1938 by Ugo Cerletti and
Luciano Bini.
- A treatment of last resort.

Providing Family and Client Teaching

FIRST PERSON DESCRIPTION OF MAJOR
DEPRESSION
 It takes the greatest effort to get out of bed in the morning.
 I am tired all day, yet when night comes, sleep evades me.
 I stare at the ceiling, wondering what has happened to my life
and what will become of me.
 Nothing is getting done at work.
 I have projects to complete, but I can’t think.
 I try to focus on my work and I get lost.
 My wife does not understand.
 She keeps telling me to “snap out of it.”
 I’m irritable all the time and yell at the kids, and then I feel
terrible later.
 Nothing is fun anymore.
 I am bored, but I feel like doing nothing.
 There are times when I’m alone, that I think life is hopeless and
meaningless, and I can’t go on much longer.
SUICIDE
– an act or an instance of killing oneself
intentionally.
Incidence:
 Common in people with mood disorders.
 Men commit suicide 3x the rate of women.
 Women are 4x more likely to attempt suicide.
 Most occur in April, Monday mornings, and when
depression lifts.
*Antidepressant treatments can give clients with
depression the energy to act on suicidal ideation.*
Predisposing Factors to Suicide:
1. psychiatric disorder.
2. chronic medical illnesses
3. environmental factors ( isolation, recent
loss)
4. lack of social support
5. unemployment
6. critical life events
7. family history of depression and suicide
Warning Signs:
1. Talking about wanting to die.

2. Feeling hopeless and helpless.

3. Feeling like a burden to family and

friends.
4. Putting affairs in order. ( giving away
possessions)
5. Writing a suicide note.

6. Putting oneself in harm’s way.

Goals in Treating Suicidal Patients:
1. Keep them safe.

2. Help them develop new coping skills.

Interventions:
1. Provide safe environment.
– remove items they can use to commit
suicide.
– Constant staff supervision.
– 24-hour responsible watcher.
2. Use of authoritative role.

3. Initiate a no-suicide contract.

4. Create a list of support system.

BIPOLAR DISORDERS
ETIOLOGY OF BIPOLAR
DISORDERS
1. Biological Theories
a) Neurotransmitter levels excess.
(norepinephrine, serotonin and dopamine)
b) Genetics

2. Psychodynamic Theories
a) Family dynamics- caused by psychological
conflicts.
b) Use of mania as defense.
 BIPOLAR DISORDERS
1. Bipolar Disorder
 A disorder that causes unusual shift in a
person’s mood, energy and ability to function.
 Also known as ‘manic-depressive disorder’ and
‘mood swing’.
 Individuals experience the extremes of mood
polarity.

*ONE MAY FEEL VERY EUPHORIC OR VERY

DEPRESSED*
Subtypes
1. Bipolar I- classic and most severe form
- Manic or mixed episodes alternating with
major depressive episodes

2. Bipolar II
- Hypomania alternating with major
depressive episodes
Incidence:
 1% of the population age 18 and older in any
given year has bipolar disorder.
 Develops late in adolescents or early
adulthood.
 A long term illness that must be carefully
managed throughout a person’s life.
 Equally common among men and women.
(only with different order of expression)
Related Bipolar Disorder

Cyclothymic Disorder (Cyclothymia)

A mild or sub clinical form of bipolar
disorder characterized by mood swings
from mania to depression.
 Mood swing occur frequently in people
with cyclothymia; may occur every few
days or weeks- even few hours.
A person with cyclothymia experiences
symptoms of hypomania but never a full
blown manic episode.
 Hypomania is defined as mild to moderate
mania

A person with cyclothymia is depressed but

not severe enough to be classified as a major
depression.
Diagnostic Criteria:
Symptoms of hypomania (at least four) and mild
depression must be present alternately for at
least 2 years. (1 year for children and
adolescents)

Remissions of not more than 2 months at a time

during the 2 year (or 1 year) cyclothymic
period.
Nursing Diagnosis
1. Risk for other directed violence
2. Risk for injury
3. Nutritional imbalance
4. Ineffective coping
5. Self-care deficit
6. Chronic low self esteem
7. Sleep pattern disturbance
Management for Bipolar Disorders

1. Providing safety
2. Establishing Therapeutic Relationship
a) Provide emotional support.
b) Give clear, concise directions and comments.
c) Limit setting
d) Reinforce reality.
e) Promote appropriate behavior.
Approach: “MATTER OF FACT”
3. Milieu Management
a) Decrease environmental stimuli.
b) Deal with manic patients in calm and
confident manner. Use of antipsychotic
drug to prevent physical
aggressiveness.
4. Meeting Physiologic Needs
a) Maintain nutrition.
b) Maximize opportunity for sleep.
c) Promote physical care.

Lithium Carbonate
-drug of choice for manic
phase of bipolar disorder.
Action: Inhibits release of
neurotransmitters.
Absorption: Absorbed in
GI tract.
-----Given p.o. in tablets,
capsules and concentrates.
Not metabolized, but
excreted in the kidneys.
Therapeutic serum level:
0.6-1.2 mEq/L
Side effects:
-nausea, dry mouth, thirst,
polyuria, drowsiness, mild
hand tremor, weight gain,
metallic taste,
sleeplessness, edema
MANAGING MEDICATIONS
Carbamazepine
- may be given alone or in
combination with lithium.
Action: Inhibits abnormal
brain activities. (kindling)
Absorption: Absorbed in
The GI tract.
Given p.o.
Therapeutic serum levels:
4-12 ug/ml.
Side effects:
-nausea, anorexia, vomiting
agranulocytosis.
*Complete blood count
should be performed
weekly when the drug is
initiated.*
Valproic Acid
- can be used initially
without attempting lithium.
Action: Inhibits abnormal
brain activities.
Absorption: Absorbed in
The GI tract.
Therapeutic serum levels:
50-100 ug/ml.
Side effects:
-transient hair loss, weight
gain, tremors, GI upset and
dose-related
thrombocytopenia.
Lag time: 7 to 10 days
Special Consideration/
Contraindications:
- Pregnancy category - D
-Use cautiously in elderly,
patients with renal disease
and dietary salt restrictions
Lithium Toxicity:
Mild-moderate (1.5-2.5)
Mod. – severe (2-2.5)
Severe (above 3 mEq/L)
Symptoms:
Mild
-diarrhea, vomiting
-drowsiness, muscle
weakness
Moderate
-ataxia, giddiness
-tinnitus, blurred vision
-large output of diluted
urine
Severe
-involvement of multiple
organs leading to coma
and death
There is no antidote for
Lithium poisoning.
Management of
Toxicity:
-Discontinue drug.
-Gastric lavage.
-Parenteral normal saline
and sodium.
For severe poisoning,
Forced diuresis
or hemodialysis is
needed.
The end!
Thanks!