Mood Disorders

Defnition
aka afective disorders, are pervasive alterations in a person emotions,
manifested by depression or mania. Mood disorders interfere w/ personals
life.
The person is plagued by drastic & long term sadness, agitation, or elation,
accompanied by selfdoubt, guilt, & anger, that alters his/her life activities,
especially those that involves selfesteem, occupation, & relationships.
Theoretical !n"uences
#iologic Theory$
%enetic$
a. &
st
degree relatives will have '( risk of having it in the
general population.
b. twins will have )*+ risk
,euro chemical theories$
in"uences of neurotransmitters -chemical messengers. focus on
decrease serotonin & norepinephrine as the ma/or biogenic
amines implicated in mood disorders.
serotonin has many roles in behavior, mood, activity,
aggressiveness & irritability, cognition and pain

Neuro endocrine infuences
0ormonal "uctuations are being studied in relation to depression.
those with thyroid, adrenal, parathyroid, and pituitary problems
1ostpartum hormone alterations have created serious depressions.
1remenstrual syndrome involves symptoms of depression along w/ the
physical symptoms of 0'2 retention & breast swelling.
Hypothalamic-Pituitary-Adrenocortical Axis.
3ortisol levels are increased in many depressed people.
1sychodynamic theories
Freud $ hypothesi4ed that depressions stemmed from the rage over
abandonment of the infant by the mother through death, emotional
detachment, or other absence.
Introjection is an unconscious defense mechanism in w/c a person
internali4es the viewpoints & values of the loved ob/ect, integrating them into
his/her own identity & belief system.
Ego overpowered by punitive superego. This results in rigidity, w/ rule
oriented goals that are unrealistic & unattainable, setting the stage for
failure.
Grief is the normal response to losses of personal relationships, status,
health, wealth, occupation, goals, selfesteem, cognitive ability, & other
signifcant ob/ects.
%rief that occurs before the loss is anticipatory grieving, the mourning
that starts, for instance,
on receiving the diagnosis of 3a & subse5uent loss of health. The ob/ect
lost can be real or
perceived.
3ognitive Theories
Aaron Becks theory depressed people have comprehensive negative
thoughts that lead to depression.
They view themselves, their world, & their future in a distorted failure mode,
repeatedly interpreting e6periences as di7cult & burdensome & themselves
as inconse5uential & incompetent.
8ocial/9nvironmental Theories
3ircumstances i.e. :ambivalent, abusive, re/ecting or highly dependent family
relationships; can < the risk for mood disorders.
- =oss of relationships or an important life role may precede depression. -e6.
=oss of /ob.
- 1hysical or se6ual abuse can be a factor in depression.
- 8ocial isolation & severely limited fnances are implicated in the depression of
senior citi4ens.
2ther considerations$
#ehaviors masking depression, making the disorder di7cult to identify &
diagnose in certain age groups.
Depressed chidren often appear cranky. They may have school
phobia, hyperactivity, learning disorders, failing grades, & antisocial
behaviors.
Depressed adoescents may engage in substance abuse, /oin
gangs, engage in risky behavior, be underachievers, or drop out of
school.
Depressed aduts! can be signaled by substance abuse, eating
disorder, compulsive behaviors i.e. workaholic ,gambler &
hypochondriacs.
Edery depression ! people who are cranky & argumentative may
actually be depressed.
Types of Mood Disorder$
&. Ma/or Depressive Disorder /MDD
at least ' weeks depression > * 8!%93?18
8leep -increased/decreased.
!interest -decreased. :anhedonia;
%uilt/ low selfesteem
9nergy -decreased.
3oncentration -decreased.
?ppetite -increased/decreased.
1sychomotor ?ctivities -increased/decreased.
8 uicidal !deation
impairs social & occupational functioning
8pecifers/variants of MDD$
?. atypica depressionoccurs in younger generation characteri4ed by
increased appetite, weight gain, hypersomnia
#. "eanchoic depressioncharacteri4ed by anhedonia, common in elderly
misdiagnosed as dementia
3. postpartu" depressionoccurs during the frst @A days post partum due to
rapid fall in hormonal levels
D. psychotic depression presence of delusions/ hallucination in con/unction
with mood disturbances
9. seasona afective disorder is precipitated by decrease exposure to sunlight
-normally during the winter.B symptoms include reduced energy, decreased
activities, increased sleep, & increased appetite, esp for carbohydrates, resulting
in weight gain.
!ncidence
Ma/or depression is #$ as co""on in %o"en & has a &.) C @6 greater
incidence in &stdegree relatives than in the general population.
The incidence of depression decreases w/ age in women & increases %&
age in "en.
Single & divorced people have the highest incidence of depression.

2nset of illness
?n untreated episode of depression can last D '* mos. before remitting.
)ADA+ of people who have one episode of depression will have another.
?fter a second episode of depression, there is a EA+ chance of recurrence.
Depressive symptoms can vary from mild to severe. The degree of depression
is comparable to the personFs sense of helplessness & hopelessness.
Treatment
'( )*+,-.)-A/0A,.1.G+
2 "ajor categories of antidepressants
'( tricycic antidepressants 34,As5
#( "onoa"ine o6idase inhi7itors 30A.Is5
2( seective serotonin reuptake inhi7itors 3**/Is5
8( atypica antidepressants
#( E,4
2( )sychotherapy
2ther therapies
&. !nterpersonal therapy
'. #ehavioral therapy
@. 1sychoanalytic therapy
*. 3ognitive therapy
). Gamily therapy
'. MildModerate Mood Disorders
&.Dysthymia/Dysthymic Disorder -depression > @ 8!%93?18.
chronically depressed mood with a duration of at least ' yr
does not aHect social and occupational functioning
'.0ypothymia elated mood that last for at least * daysB less intense form of
mania and does
not aHect social/occupational functioning
@. 3yclothymia/3yclothymic disorder
o numerous episode of hypomania & dysthymia that lasts for at least '
years and does not aHect social/occupational functioning
*. Depressive Disorder not otherwise specifed
@. #ipolar Disorders
The diagnosis re5uires episode of unusual & increasingly heightened,
grandiose or agitated mood
?t least ' %k duration of 2 of the f9
- Glight of ideas
- Ieduce ability to flter out e6traneous stimuli
- Distractibility
- !ncreased number of /udgment w/ severe conse5uences i.e. spending sprees,
having se6 w/ strangers or making impulsive investments
8ubtypes$
?. Manic/8ingle 9pisode
period of elated or irritable mood for at least one week
very talkative, grandiose, decreased need for sleep, "ight of ideas, e6cessive
involvement in
activities that have high potential for problems e.g. se6ual
promiscuity
needs to be hospitali4ed, homicidal /suicidalB impairment in social/
occupational functioning
symptoms not due to a substance
#. Mi6ed 9pisodes
b.&.#ipolar ! one or more manic episodes usually accompanied by a ma/or
depressive episode
b.'.#ipolar !!one or more ma/or depressive episodes accompanied by at
least one hypomanic
episode
Treatment & 1rognosis
lifetime regimen of bipolar medications, often called antimanic medications,
& adherence to the treatment regimen.
=ithium & 2ther mood stabili4ers
!f a client in the acute stage of mania or depression e6hibits psychosis
-disordered thinking, as seen in delusions, hallucinations, & illusions., an
antipsychotic agent is administered in addition to the bipolar medication.
3ommon ,ursing 1roblems
Iisk for violence
Iisk for in/ury
?ltered nutrition less than body re5uirements
!neHective !ndividual coping
,oncompliance
1owerlessness
?ltered Iole 1erformance
8elfcare defcit
8elfesteem disturbance
8leep pattern disturbance
!neHective management of therapeutic regimen
Desired outcome$
3lient will beB
safe & e6hibit in/ury free behaviors to self & others
%et enough sleep
gain selfawareness about potentially dangerous situations -8e6ually
promiscuous behaviors,
risky fnancial & occupational ventures, dangerous acts..
participate in treatment
take ade5uate food & "uids
evaluate personal 5ualities realistically
interact courteously & appropriate w/ others
handle con"ict politely
eliminate se6ual provocativeness from verbal & nonverbal behaviors.