2. Content outlines
Definition
Risk factors for mood disorders
Etiology of mood disorder
1-Genetic Theory
2-Biochemical Theory
3-Biologic Theory
4-Psychodynamic Theory
5- Behavioral Theory
6-Cognitive Theory
7- Life Events and Environmental Theory
3. Types of mood disorders:
A) Depressive disorders
1- Transient depression
2- Mild depression (grief reaction)
3- Moderate depression (Dysthysmia)
4- Premenstrual Dysphoric disorder
5- Sever depression (major depression)
B) Bipolar disorder
1- Bipolar disorder mixed
2- Bipolar disorder depressed
3- Cyclothymic disorder
4- Bipolar disorder manic
• Treatment Modalities for mood disorder
• Application of nursing process
4. Introduction
• Mood is an individual’s sustained emotional tone, which significantly
influences behavior, personality and perception.
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.
5. Risk Factors for Mood Disorders
• Prior episodes of depression
• Family history of depressive disorders
• Prior suicide attempts
• Female gender
• Age of onset younger than 40 years
• Postpartum period
• Medical comorbidity associated with a high risk of depression
6. Risk Factors for Mood Disorders
• Lack of social support
• Stressful life events
• Current alcohol or substance abuse or use of medication associated
with a high risk of depression
• Presence of anxiety, eating disorder, obsessive–compulsive disorder,
somatization disorder, personality disorder, grief, adjustment
reactions. Depression may coexist with other psychiatric conditions.
7. Etiology of mood disorders
1-Genetic Theory
• Significant factor of mood disorder is genetics
• The first degree relatives of bipolar and major depressive are more
likely to be affected more than other families.
• Twin studies indicate monozygotic twins are affected more than
dizygotic twins.
8. Etiology of mood disorders
2-Biochemical Theory
• Increased amounts of neurotransmitters as norepinephrine and
serotonin in the brain cause an elevation in mood, whereas
decreased amounts can lead to depression.
9. Neuroendocrine Regulation
• High levels of the hormone cortisol have been observed in persons with
mood disorder .Normally, cortisol levels peak in the early morning, level
off during the day, and reach the lowest point in the evening. Cortisol
peaks earlier in persons with a depressed mood and remains high all day
• Mood is also affected by the thyroid gland. Approximately 5% to 10% of
clients with abnormally low levels of thyroid hormones may suffer from a
chronic mood disorder.
10. 3-Biologic Theory
• It has long been believed that there is a biologic relationship
between various medical conditions (eg, pain or cardiovascular
disease in women) and depression..
a-Neuro-degenerative Diseases
• A variety of neurodegenerative diseases are associated with
depressive manifestations as Alzheimer’s disease, Parkinson’s
disease, stroke.
11. b- Immunotherapy
• Depression is linked biologically to the use of immunotherapeutic
agents in the treatment of certain diseases as Pancreatic tumors
(cytokine therapy) , Cancer as procarbazine inhibit dopamine beta-
hydroxylase, and hepatitis C,as tamoxifen and interferon-alpha
c- Medical Conditions and medication side effects correlated with
depression
12. 4-Psychodynamic Theory
-The psychodynamic theory of depression, based
on the work of Sigmund Freud, view people with a
depressed mood are like mourners who do not
make a realistic adjustment to living without the
loved person. Because the source and object of
the grief are unconscious (from childhood),
symptoms are not resolved but, rather, persist and
return later in life.
-Manic episodes are viewed as a defense reaction
against underlying depression due to the client’s
inability to tolerate a developmental tragedy, such
as the loss of a parent
13. 5- Behavioral Theory: Learned Helplessness
Learned helplessness exists in humans who receive little positive
reinforcement for their activity, become withdrawn, overwhelmed, and
passive, → lead to numerous failures (either real or perceived → learned
helplessness and hopelessness
14. 6-Cognitive Theory
Cognitive distortions that result in negative defeated attitudes.
• Negative expectations of the environment .
• Negative expectations of the self.
• Negative expectations of the future.
These 3 cognitive distortions arise out of a defect in cognitive
development and the individual feels inadequate, worthless and rejected
by others and low self esteem.
15. 7- Life Events and Environmental Theory
-Stressful life events such as the loss of a parent or spouse, financial
hardship, illness, perceived or real failure, and midlife crises are all
examples of factors contributing to the development of a mood
disorder.
-Certain populations of people including the poor, single persons, or
working mothers with young children seem to be more susceptible
than others to stressful events and the development of mood
disorders
17. A) Depressivedisorder
1- Transient depression:-
It's life's every day disappointment. Symptoms are: sadness,
crying, difficulty getting mind off of one's disappointment, tired
and restless
2- Mild depression (grief reaction)
Its subjective feelings and affect that are precipitated by a loss as
1) Divorce, separation, death or abortion
2) Health (as body function or part)
3) Security (occupational, financial or social)
4) Self confidence
5) A dream
The grief response is considered to be pathological prolonged if
there has been no resumption of normal activity of daily living
within 4-8 weeks of a loss
18. Signs and symptomsof grief(Assessment)
• Anxiety, depression
• Preoccupation with lost object
• Insomnia, anorexia
• social withdrawal
Factor which influence the grief response:
1) The importance of lost object
2) The degree of dependency on the relationship with the lost object
3) The degree of ambivalence felt toward the lost object
4) The number and nature of other meaningful relationships
5) The number and nature of previous grief experiences
6) The age of a lost person
7) Health of the mourners at the time of the loss
8) The degree of preparation for the loss
19. 3- Moderate depression (Dysthymia) → it’s
depressive neurosis with mild mood disturbance no
evidence of psychotic symptoms
• Less severe, but more chronic
• Chronic “low grade” depression
• Depressed mood, plus 2 additional following
symptoms
• poor appetite or overeating
• insomnia or hypersomnia
• low energy or fatigue
• low self-esteem
• poor concentration or difficulty making decisions
• feelings of hopelessness
20. 4- Premenstrual Dysphoric disorder
It's include markedly depressed mood, marked anxiety,
mood swings and decreased interest in activities during
the week prior to menses and subsiding shortly after the
onset menstruation.
5- Major depression (Engagement in high risk
behavior )
Is a disorder characterized by depressive syndrome that
is present for at least 2 weeks. Not caused by general
medical condition, substance induced, bereavement and
is not mixed with manic symptoms
21. Diagnosticcriteriaof majordepression
A- Five or more of the following symptoms have been present during the
same 2 week period at least one of the symptoms is either depressed mood
or loss of interest
• Depressed mood most of the days nearly every day.
• Markedly diminished interest or pleasure in all or almost all activities most
of the day nearly every day.
• Significant weight loss when not dieting or weight gain
• Insomnia or hypersomnia nearly every day.
22. Diagnosticcriteriaof majordepression
• Psychomotor agitation or retardation nearly every day.
• Fatigue or loss of energy every day.
• Feeling of worthlessness or, inappropriate guilt.
• Diminished ability to think or concentrate or indecisiveness nearly every
day.
• Recurrent thought of death, recurrent suicidal ideation without a specific
plan or committing suicide
23. B-There has never been a manic episode, a mixed episode or a hypo manic episode
C-The symptoms cause clinically significant distress or impairment in social,
occupational or other important areas of functioning.
D-The symptoms are not due to the direct physiological effects of a substance or a
general medical condition (e.g hypothyroidism).
E- The symptoms are not better accounted for by bereavement (i.e after the loss of a
loved one, the symptoms persist for longer than 2 months) or are characterized by
marked functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms or psychomotor retardation.
24. B – Bipolar Disorders
Is a mood disturbance in which the symptoms of mania have
occurred at least one time. Depression may or may not occur as a
separate episode in bipolar disorder.
25. Hypomania
• Less extreme form of mania
• Euphoric, feel wonderful, “on top of the world”
• No psychotic features
• Overly involvement in projects of an interpersonal, political,
religious, or occupational nature.
• Labile mood (euphoria to irritability)
25
26. Hypomania continued
• Increased sexual behaviors (flirting, making sexual overtures,
multiple sexual relationships)
• Dress flashy or seductive manner
• Wear heavy make up
• Pressured speech
• Racing thoughts or flight of ideas
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27. Types of bipolar disorders
1- Bipolar disorder mixed
2- Bipolar disorder manic or bipolar I disorder
3- Bipolar disorder depressed or bipolar II disorder
4- Cyclothymic disorder
28. 1-Bipolar disorder mixed → this diagnosis applies to a fuel symptomatic
picture of both manic and major depressive episodes, intermixed on rapidly
alternating every few days. Psychotic features may or may not be present.
2- Bipolar disorder depressed or bipolar II disorder
The client with BP II has a presence or history of one or more major
depressive episodes, alternating with at least one hypomanic episode.
29. 3- Cyclothymic Disorder
• Chronic, fluctuating mood disturbance involving
numerous periods of hypomanic symptoms and
numerous periods of depressive symptoms
• Begins in adolescence or early adulthood.
• Free of severe symptoms that qualify for the
diagnosis of manic disorder or major depressive
disorder.
• Moody, unpredictable
29
30. 4- Bipolar disorder manic or bipolar I disorder
It is characterized by one or more manic episodes with or without a
history of a depressive episode .
During a manic episode, the individual exhibits abnormal, persistently
elevated, or irritable mood that lasts for at least 1 week. Impairment in
various areas of functioning, psychotic symptoms and the possibility of
self-harm exist and require hospitalization to prevent harm for self or
other.
31. Diagnosticcriteriaformanicepisode
A- A distinct period of abnormally and persistently elevated,
expansive or irritable mood lasting at least 1 week on any
duration if hospitalization is necessary. Common mood Happiness
and elation
B- During the period of mood disturbance three or (more) of the
following symptoms
• Inflated self-esteem or grandiosity.
• Decreased need for sleep (e.g. feels rested after only. 3 hours
of sleep)
• More talkative than usual or pressure to keep talking.
• Flight of idea or subjective experience that thought is racing.
• Distractibility.
• in goal directed activity (either socially, at work or school or
sexually) psychomotor agitation.
• Excessive involvement in pleasurable activities that have a high
potential for painful consequences
32. • The mood disturbance is sufficiently severe to cause marked
impairment in occupational functioning or in usual social
activities or relationship with others or to necessitate
hospitalization to prevent harm to self or others on their
psychotic features.
• The symptoms are not due to the direct physiological effects of a
substance (e.g a drug abuse, medication or other treatment or a
general medical condition (e.g hyperthyroidism)
33. TreatmentModalitiesfor mood disorder
I-Individual psychotherapy
2- Group therapy not indicated for acutely suicidal patients
3- Family therapy is indicated when the disorder is disturbing family stability,
when the disorder is related to family events.
4- Cognitive behavioral therapy this approach includes identifying and challenging
the accuracy of the client's negative cognitions, reinforcing more accurate
perceptions, and encouraging behaviors that are designed to counteract the
depressive symptoms
5-Phototherapy—or the exposure to bright artificial light—can markedly reverse
the symptoms of seasonal affective disorder (SAD), which occurs in the fall and
winter
34. 6 E.C.T. Electroconvulsive therapy (ECT) has been
used for clients who experience treatment-resistant
or severe depression.
7- Psychopharmacology:
- Depressive disorder may require an antidepressant
(eg, [Zoloft]) in combination with psychotropic agents
to treat clinical symptoms of psychosis (eg,
risperidone [Risperdal]).- It may be necessary to
administer an antidepressant that is also effective in
the treatment of underlying anxiety (eg, fluoxetine
[Prozac]) or insomnia (eg, mirtazapine [Remeron]).
35. -A client with BPD may require
• a mood stabilizer : eg, lithium [Eskalith]) as well as
• a neuroleptic : eg, olanzapine[Zyprexa]) or
• anticonvulsant : eg, valproic acid [Depakene] to
stabilize aggressive or disruptive behavior secondary
to manic behavior or psychotic symptoms
36. Application of nursing process
Nursing Assessment
• The client's history for precipitating stressors and significant data; include
the following information:
• Genetic-biologic vulnerability (family history)
• Stressful life events and recent losses
• Results of standardized assessment tools for depression (Beck Depression
Inventory, Hamilton Rating Scale of Depression, Geriatric Depression Scale,
Self-Rating Depression Scale)
• Review Past episodes of mood disorder or suicidal behaviors
• Medication history
• Drug and alcohol use
• Education and employment history.
37. • Assess for the following suicidal risk factors and the lethality of the client's
suicidal behavior.
• The client's intent (to relieve stress, as a solution to difficult problems)
• The suicidal plan, including whether the client has an organized plan and the means
to carry out the plan
• The client's mental state (presence of thought disorder, level of anxiety, severity of
mood disorder)
• Support systems available
• Current stressors affecting the client, including other illnesses (both psychiatric and
medical), recent losses, and history of substance abuse.
• Assess the family support system and the client or family's knowledge of
specific mood disorder symptoms, medications and treatment
recommendations, signs of relapse, and self-care measures.
38. Quick assessment of suicide risk factors
• Sex (men more than women)
• Age (adolescent or older than age 50)
• Previous attempt (increases risk)
• Alcohol or substance abuse
• Presence of thought disorder
• Lack of support system
• Unmarried, divorced, or widowed
• Presence of physical illness (especially chronic)
• Organized plan
39. NURSING MANAGEMENT OFMANIA
Nursing Diagnosis
• Risk for injury
• Risk for violence (Other-directed or Self-
directed)
• Risk for suicide
• Ineffective health maintenance related to
hyperactivity
• Disturbed sleep pattern
• Disturbed thought process
40. NURSING INTERVENTIONS
• Reduce environmental stimuli
• Limit patient’s participation in group activities
• Create a safe environment
• Provide physical exercise as a substitute for increased
motor activity
• Avoid arguments or confrontations with the patient
• Restrict caffeine intake
• Limit the selection of clothing available
• Keep the patient oriented to reality
• Assist patient in focusing on a single task
41. NURSING MANAGEMENT OF DEPRESSION
Nursing Diagnosis
• Risk for suicide
• Dysfunctional Grieving
• Powerlessness
• Low Self-esteem
• Altered Communication
• Altered sleep
• Altered nutrition
• Self care deficit
42. Nursing Diagnosis
• Risk for injury
• Risk for violence (Other-directed or Self-directed)
• Ineffective health maintenance related to hyperactivity
• Disturbed thought process
42
44. NURSING INTERVENTION
• Inquire about suicidal thoughts, plans, means
• Make environment safe
• Verbal or written Contract
• Close observation
• Develop Trust
• Explore feelings of anger
• Teach normal behaviors associated with grief
• Focus on strengths
• Encourage group activities
• Assist with behaviors require change
• Encourage participation in goal setting
• Ensure that goals are realistic
• Sit with client without talking with him
