MOOD

DIOSORDER
MOOD DISORDERS

Mood disorders are characterized by a

disturbance of mood, accompanied by a full
or partial manic or depressive syndrome,
which is not due to any other physical or
mental disorder.
 CLASSIFICATION OF MOOD DISORDERS

F30- F39MOOD (AFFECTIVE) DISORDERS

• F30 Manic episode

• F31 bipolar affective disorder
• F32 Depressive episode
• F33 Recurrent depressive disorder
• F34 Persistent mood disorder
• F38Other mood disorders
• F39 Unspecified mood disorder
 MANIC EPISODE

Mania refers to a syndrome in which the central

features are over-activity, mood change (which
may be towards elation or irritability) and self-
important ideas. This disorder occurs in episodes
lasting usually 3-4 months, followed by complete
recovery.
MANIA

• Manic Episode is defined by a distinct

period during which there is an abnormally
and persistently elevated, expansive, or
irritable mood. This period of abnormal
mood must last at least 1 week (or less if
hospitalization is required).
CLASSIFICATION OF MANIA(ICD10)

• F30 Manic episode

• F30.0 Hypomania
• F30.1 Mania without psychotic symptoms

• F30.2 Mania with psychotic symptoms

• F30.8 Other manic episodes

• F30.9 Manic episode unspecified
ETIOLOGY

BIOLOGICAL FACTORS
• Genetic factors
• Biochemical factors
PHYSIOLOGICAL FACTORS
• Brain studies
• Side effects of medications
• Neurological disorders
ETIOLOGY
cont.….

PSYCHOSOCIAL FACTORS
• Psychoanalytical theory
• Family dynamics theory
• Transactional theory
BIOLOGICAL FACTORS-

It includes

1.Genetic factors:
a) Twin studies: - Evidence has suggested
incidences of manic disorders among twins.
Identical twins have four to five times more
incidence compared to fraternal twins.
b) Family studies:- Evidence have
suggested that the incidences of manic
disorders are seven to ten times more
incidences if any of the family member is
suffering from manic disorders compared to
general population.
2.Biochemical factors
a) Biogenic Amines:- Evidence has
suggested increased level of nor-
epinephrine and dopamine nuero-amines
b)Electrolyte imbalance : Evidence has
suggested increased level intracellular
sodium calcium among bipolar mood
disorders
2.PHYSIOLOGICAL FACTORS

A)Brain lesions: - Brain lesion are

associated with Bipolar mood disorders.

Lesion in right fronto-temporal or left parieto-

occipital is associated with mania where as
lesion in left fronto-temporal or right parieto-
occipital area is associated with depression.
 B. Side effects of medications:

Certain medications used to treat somatic

disorders been associated increase incidences
manic episodes. These are follows
• Amphetamines
• Antidepressants
• Corticosteroids
• Bromocriptine
• Levodopa
• Methylphenidate
• Cocaine other stimulates
 Neurological disorders:-

Certain neurological disorders are known to

potential for mania. Some of these are follows:
• Brain tumours
• Head Injuries
• Multiple sclerosis
• Temporal epilepsy
• AIDS
• Encephalitis
Psychodynamic theory

1. Psycho-analytic theories: - mania is

considered as a denial of or defense against
the depression

2. Faulty family
• Transactional theory: - According to this
theory exact etiology of bipolar mood
disorders remain unknown but is
perceived that it is result of an interaction
between biological, psychosocial, past
experiences, existing condition, individual
perception of an illness and environmental
factors.
 Clinical Features

An acute manic episode is characterized by the following features

which should last for at least one week

Elevated, Expansive or Irritable Mood

Elevated mood in mania has four stages depending on the

severity of manic episodes

• Expansive mood is unceasing and unselective enthusiasm for

interacting with people and surrounding environment.

Sometimes irritable
 1: Four stages of elevated mood

Euphoria (Stage I): Increased sense of psychological

well-being and happiness not in keeping with ongoing
events
Elation(Stage II): Moderate elevation of mood with
increased psychomotor activity
Exaltation (Stage III): Intense elevation of mood with
delusions of grandeur
Ecstasy (Stage IV): Severe elevation of mood, intense
sense of rapture or blissful ness seen in delirious or
stuporous mania
• psychomotor activity
• speech and thought
• other fatures
psychomotor activity
speech and thought

• flight of ideas
• pressure of speech
• clang association
• delusion of gradeur
• delusions of presecution
• disractabilty
DIAGNOSIS

• Young mania rating scale

• ICD 10 Diagnostic criteria
• based on signs and symptoms
Treatment modalities

• lithium 900-2100 mg/day

• carbamazepine 600-1800mg/day

• sodium valproate 600-1800mg/day

• other drugs clonazepam,calcium chanal
blockers
Electroconvulsive therapy

Acute manic excitement

psychosocial treatment

family and marital therapy

 Hypomania F 30.0

 Hypomania is a lesser degree of mania in which abnormalities of

mood and behaviour are too persistent

 No hallucinations or delusions.

 Persistent mild elevation of mood (for at least several days on end),

 Increased energy and activity, and usually marked feelings of well-

being and both physical and mental efficiency.

 Increased sociability, talkativeness, over familiarity, increased

sexual energy
Hypomania 30.0

• Decreased need for sleep are often

present but not to the extent.
• Concentration and attention may be
impaired,
 Mania without psychotic symptoms
F 30.1

• Mood is elevated ,uncontrollable excitement.

• Elation is accompanied by increased energy, resulting in

overactivity, pressure of speech, and a decreased need for

sleep.

• Normal social inhibitions are lost, attention cannot be

sustained, and there is often marked distractability.

• Self-esteem is inflated, and grandiose or over-optimistic ideas

are freely expressed.

Mania without psychotic symptoms
F 30.1

• The individual may embark on extravagant and impractical

schemes, spend money recklessly, or become aggressive,

• In some manic episodes the mood is irritable and

suspicious rather than elated.

• The first attack occurs most commonly between the ages

of 15 and 30 years, but may occur at any age from late

childhood to the seventh or eighth decade

Mania with psychotic symptoms

• The clinical picture is that of a more severe form of

mania as described in F30.1.

• Inflated self-esteem and grandiose ideas may

develop into delusions, and irritability and

suspiciousness into delusions of persecution.

• grandiose or religious delusions of identity or role

may be prominent
• Severe and sustained physical activity and

excitement may result in aggression or

violence, and neglect of eating, drinking, and

personal hygiene may result in dangerous

states of dehydration and self-neglect.

Nursing management

Nursing assessment
seveity of the disorder
mood and affect
thinking and perceptual ability
sleep patten
changes in energy leveleating pattens
weight changes
speech
1.NURSING MANGEMENT

Risk for injury related to extreme

hyperactivity/ destructive behavior/ anger
directed at the environment,/increased
agitation and lack of control over
purposeless and potentially injurious
movements
 Intervention

• Reduce environmental stimuli, assign private room, if possible

with soft lighting, low noise level, and simple room décor
• Assign to quiet unit, if possible. Milieu unit may be too distracting.
• Limit group activities. Help client try to establish one or two close
relationships.
• Remove hazardous objects and substances from client's
environment (including smoking materials).
• Stay with the client to offer support and provide a feeling of
security as agitation grows and hyperactivity increases.
 Intervention conti…

• Provide structured schedule of activities that includes

established rest periods throughout the day.

• Administer tranquilizing medication, as ordered by physician.

Antipsychotic drugs, such as chlorpromazine (Thorazine),

haloperidol (Haldol), or olanzapine (Zyprexa) are commonly

prescribed for rapid relief of agitation and hyperactivity.

Observe for effectiveness and evidence of adverse side

effects.
2.Nursing diagnosis

Risk for self-directed or other-directed

violence related manic excitement
dysfunctional grieving, biochemical
alteration,
• Maintain low level of stimuli in client's environment

(low lighting, few people, simple decor, low noise level

• Observe client's behavior frequently (every 15

minutes).

• Remove all dangerous objects from client's

environment.
• Try to redirect the violent behavior with physical outlets for the

client's hostility (e.g., punching bag

• Staff should maintain and convey a calm attitude to the client.

• Have sufficient staff available to indicate a show of strength to

client if necessary.

• Administer tranquilizing medications as ordered by physician.

Monitor medication for effectiveness and for adverse side effects.

If the client is not calmed by "talking down" or by medication, use

mechanical restraints as necessary. Be sure to have sufficient staff

available to assist.

If the client has refused medication, administer after restraints have been

applied.

Observe the client in restraints every 15 minutes (or according to

institutional policy).

Ensure that circulation to extremities is not compromised (check

temperature, color, pulses).

 .Disturbed thought process

• Convey your acceptance

• Do not argue or deny the belief.

• Use a firm yet calm, relaxed approach.

• Set and maintain limits on behavior that is destructive or adversely

affects others.
• Decrease environmental stimuli whenever possible.
• Respond to cues of increased restlessness or agitation by removing
stimuli and perhaps isolating the patient, to single or private
• Provide a consistent structured environment.
Reinforce and focus on reality. Talk about real

events and real people..

Give positive reinforcement

Teach client to intervene, using thought-

stopping techniques, when irrational thoughts

prevail.
 IMBALANCED NUTRITION:LESS THAN BODY REQUIREMENTS

• Provide high-protein, high caloric, nutritious finger foods and drinks

that can be consumed 'on the run‘

• Find out patient's likes and dislikes and provide favorite foods

• Provide 6-8 glasses of fluids per day

• Have juice and snacks on unit at all times

• Maintain accurate record of intake, output and calorie count. Weigh

the patient regularly

• Supplement diet with vitamins and minerals

• Walk or sit with patient while he eats

Guidelines for the self protection when
handling an aggressive patient
• Never see a potentially violent person
alone
• Keep a comfortable distance away from
the patient (arm length)
• Be prepared to move, violent patient can
strike out suddenly
• Maintain a clear exit route for both the staff
and patient
• Be sure that the patient has no weapons in
his possession before approaching him
• If patient is having a weapon, ask him
• to keep it on a table or floor rather than
fighting with him to take it away
• Keep something like a pillow, mattress or
blanket wrapped around arm between you
and the weapon
• Distract the patient momentarily to remove
the weapon (throwing water in the patient's
face, yelling, etc.)
• Give prescribed antipsychotic medications
Thank you