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MOOD Disorders
MOOD Disorders
• Two Categories:
a. Major Depressive Disorder
b. Bipolar Disorder (Manic-Depressive Illness)
1. MAJOR DEPRESSIVE DISORDER
• Characterized by at least two weeks of a depressed mood
or loss of interest in pleasure and activities.
• MIXED EPISODE
- Diagnosed when the person experiences both mania and
depression nearly everyday for at least 1 week.
- A person with mixed episodes experiences both mood "poles"--
mania and depression--simultaneously or in rapid sequence.
• Postpartum Depression
- Meets all the criteria for a major depressive episode,
with onset within 4 weeks of delivery.
• Postpartum Psychosis
- A psychotic episode developing within 3 weeks of
delivery and beginning with fatigue, sadness,
emotional lability, poor memory, and confusion and
progressing to delusions, hallucinations, poor insight
and judgment, and loss of contact with reality.
- Considered a medical emergency that requires
immediate treatment.
Etiology
BIOLOGIC THEORIES
• Major Depressive Disorder
- 3 times more common among first-degree
biological relatives.
- Twin studies reveal a higher rate of
concordance in monozygotic twins than
dizygotic twins.
• Bipolar Disorder
- The risk increases 4% to 24% in first-degree
relatives of people with bipolar disorder.
- Twin studies of monozygotic twins indicate a
65% concordance rate.
Etiology
NEUROCHEMICAL THEORIES
• Biogenic Amine Theory
- Depressive Disorder: ↓ NE and serotonin
- Bipolar Disorder: ↑ NE and serotonin
• Kindling Theory
- External environmental stressors activate internal
physiologic stress responses, which trigger the first
episode of a mood disorder, the first episode then
creates electrophysiologic sensitivity to future episodes
so that less stress is required to evoke another episode.
Etiology
NEUROENDOCRINE INFLUENCES
Depression
• Increased cortisol secretion in 40% of clients.
• Increased thyroid-stimulating hormone in 5% to 10% of clients.
Major Depressive Disorder
Symptoms:
a. Depressed mood
b. Anhedonism
c. Unintentional wight change of 5% or more in a month.
d. Change in sleep pattern
e. Agitation or psychomotor retardation
f. Tiredness
g. Worthlessness or guilt inappropriate to the situation
h. Difficulty thinking, focusing or making decisions.
i. Hopelessness, helplessness, and/or suicidal ideation.
Major Depressive Disorder
• Psychotherapy
• Anticonvulsant Drugs
- Exact mechanism is unknown but may raise the brain’s
threshold for dealing with stimulation.
- Given to clients who have problems in lithium therapy
(SEs, drug interactions, renal disease)
- Carbamazepine, Valproic Acid, Clonazepam
Bipolar Disorder
Treatment
Psychotherapy
Data Analysis
• Risk for other-directed violence
• Risk for injury
• Imbalanced Nutrition: Less than body requirements
• Ineffective coping
• Noncompliance
• Ineffective role performance
• Self-Care deficit
• Chronic low self-esteem
• Disturbed sleep pattern
Application of the Nursing Process
Bipolar Disorder
Outcome Identification
• Managing Medications
- Monitor serum lithium levels.
- Clients should drink adequate water and continue with the
usual amount of dietary table salt. (table)
- Too much salt and water = Lithium blood level is too low
- Too little salt and water = Lithium toxicity
- Monitor fluid balance by measuring I and O
- Monitor thyroid function tests and renal status.
• Managing Medications
-Monitor serum lithium levels.
Suicide
Assessment:
• Suicidal clues:
- Giving away personal, special, and prized
possessions
- Cancelling social engagements
- Making out or changing a will
Suicide
Suicidal clues:
Interventions