MOOD DISORDERS

CATEGORIES
MAJOR DEPRESSION BIPOLAR DISORDER
DISORDER
: 2 or more weeks of sad mood, lack (formerly called manic-depressive
of interest in life activities, and other illness):
symptoms
mood cycles of mania and/or
depression and normalcy
 RELATED DISORDERS
• Dysthymic disorder: sadness, low energy, but not severe enough to
be diagnosed as major depression disorder
• Cyclothymic disorder: mood swings not severe enough to be
diagnosed as bipolar disorder
• Seasonal affective disorder (SAD)
• Depressive personality disorder
• Postpartum or ‘maternity’ blues
• Postpartum depression
• Postpartum psychosis
ETIOLOGY
 MAJOR DEPRESSIVE DISORDER
• Twice as common in women and more common in single or
divorced people
• Involves 2 or more weeks of sad mood, lack of interest in
life activities, and at least four other symptoms, such as
anhedonia, changes in weight, sleep, energy, concentration,
decision-making, self-esteem, goal-setting
• Untreated, can last 6 to 24 months; recurs in 60% of people
• Symptoms range from mild to moderate to severe.
Treatment and Prognosis
• Antidepressants
• SSRIs include Prozac, Zoloft,
Paxil, Celexa. Prescribed for
mild and moderate depression.
• Tricyclic antidepressants (TCAs)
include Elavil, Tofranil,
Norpramin, Pamelor, Sinequan;
used for moderate and severe
depression.
• Atypical antidepressants include
Effexor, Wellbutrin, Serzone.
• MAOIs include Marplan, Parnate, Nardil;
used infrequently because interaction
with tyramine causes hypertensive crisis.
• Electroconvulsive therapy (ECT) is used
when medications are ineffective or side
effects are intolerable. After anesthesia
and muscle relaxants, a shock is
administered via electrodes to produce
seizure activity in the brain. Treatments
are administered in a series (for instance,
three times a week for 6 weeks).
• Psychotherapy in conjunction with
medication is considered most effective
treatment. Useful therapies include
behavioral, cognitive, interpersonal,
family therapy.
Assessment
• Must include determination of
suicidal ideas and lethality and
client’s perception of the problem
Depression and rating scales may be used.
Psychomotor retardation or agitation,
feelings of helplessness, anxiety,
sadness, guilt, frustration, negativism
and pessimism, lack of pleasure, social
withdrawal, reduced concentration &
decision-making, fatigue & exhaustion,
low self-esteem and rumination about
past bad deeds or failures, loss of
ability to function in life roles, sleep
disturbances, overeating or
undereating, lack of attention to
hygiene and grooming
 Outcomes
Data Analysis The client will:
Nursing diagnoses • Not injure self or others
may include:
• Carry out activities of daily
• Risk for Suicide
living independently
• Imbalanced
• Establish a balance of rest,
Nutrition
sleep, and activity
• Anxiety
• Establish a balance of
• Ineffective Coping
adequate nutrition,
• Hopelessness
hydration, and elimination
• Evaluate self-attributes
realistically
Intervention
• Providing for the client’s safety
and the safety of others
• Promoting a therapeutic
relationship
• Promoting activities of daily
living and physical care
• Using therapeutic
communication
• Managing medications
• Providing client and family
teaching
 BIPOLAR DISORDER

• Involves mood swings of depression (same symptoms of major

depressive disorder) and mania.
• Major symptoms of mania include grandiose mood, agitation,
exaggerated self-esteem, sleeplessness, pressured speech, flight of
ideas, easily distractible, intrusive behavior, with lack of personal
boundaries, high-risk activities with potentially severe consequences,
poor judgment.
Treatment and Prognosis
Treatment may involve medication with lithium; regular
monitoring of serum lithium levels is needed.
Anticonvulsant drugs are used for their mood-stabilizing effects:
Tegretol, Depakote, Lamictal, Topamax, Trileptal, Neurontin; and
Klonopin (a benzodiazepine)
 APPLICATION OF THE NURSING PROCESS:
BIPOLAR DISORDER
Assessment Assessment
• General appearance and motor behavior: Assessing a client * Roles and relationships: may be charming
in the manic phase may be difficult and based more on and playful, then sarcastic and angry;
observations of the client rather than client’s responses to cannot take “no” for an answer
structured questions. Client jumps from one subject to *Physiologic and self-care considerations:
another, cannot sit still, may wear flamboyant clothing or inattention to hygiene and grooming, hunger
makeup. or fatigue
• Mood and affect: psychomotor agitation, racing thoughts,
pressured speech, ignores directions or requests from
others, unusual speech patterns
• Thought processes and content: starts many grandiose
projects but finishes none; careless spending sprees
• Sensorium and intellectual processes: loud voice; may be
hypersexual
• Judgment and insight: poor
• Self-concept: false, grandiose sense of well-being that
covers low self-esteem
Data Analysis
Nursing diagnoses may include:
• Risk for Other-Directed Violence
• Risk for Injury
• Imbalanced Nutrition
• Ineffective Coping
• Noncompliance
Outcomes
The client will:
• Not injure self or others
• Establish a balance of rest, sleep,
and activity
• Establish adequate nutrition,
hydration, and elimination
• Participate in self-care activities
• Evaluate personal qualities realis
Intervention
• Providing for safety of
client and others
• Meeting physiologic needs
• Providing therapeutic
communication
• Promoting appropriate
behaviors
• Managing medications
 SUICIDE
• Families need support when a Outcomes
member has committed suicide or
is making attempts to do so. They The client will:
may feel guilty, angry, and ashamed
and are at increased risk for suicide • Be safe from harm self or others
themselves.
• Assessment • Engage in a therapeutic relationship
• Populations at risk • Establish a no-suicide contract
• Warnings of suicidal intent
• Create a list of positive attributes
• Risky behaviors
• Lethality assessment • Generate, test, and evaluate realistic
plans to address underlying issues
 Intervention
• Using an authoritative role
• Providing a safe environment
• Initiating a no-suicide contract
• Creating a support system list
• Supervision
 SELF-AWARENESS ISSUES

• Nurses and other staff members need to deal with

their own feelings about suicide.
• Depressed or manic clients can be frustrating and
require a lot of energy to care for.
• Keeping a written journal may help deal with
feelings; talking to colleagues is often helpful.