MOOD DISORDER Environmental Theory

 Financial hardship, physical

Mood-Pervasive and sustained emotions that illness, perceived or real
influences how a person perceives the world. failure, midlife crises
 Poor, single persons, working
Affect-Indicates a person’s current emotional state. mothers with young children
 Divorce, relocation, loss or
TYPES OF MOOD change of employment,
1. Euthymic mood retirement
2. Elated mood
3. Dysphoric mood TYPES:
4. Irritable mood I. UNIPOLAR
- with history of depression
Mood Disorder-pervasive alterations in emotions without any history of elation
that are manifested by mania, depression or both.
1. MAJOR DEPRESSIVE
Etiology DISORDER
1. Genetic/Hereditary Theory
2. Biochemical Theory 2. DYSTHYMIC DISORDER
3. Object Loss Theory
4. Personality Organization Theory 3. Depressive Disorder Not Otherwise Specified
5. Aggression turned inward Theory (DDNOS)
6. Learned Helplessness Theory
7. Cognitive Theory II. BIPOLAR
8. Environmental Theory - with history of elation with or
without depression
Genetic/hereditary
Twin – 70% 1. MANIC EPISODE or MANIA
Parents – 15%
Sibling – 15% 2. HYPOMANIC EPISODE or
2 ° relative – 7% HYPOMANIA

Biochemical Theory 3. BIPOLAR I

 Norepinephrine and Serotonin
*Deficit serotonin in Depression 4. BIPOLAR II
*Norepineprine increase - mania
*Norepinephrine decrease - depression 5. CYCLOTHYMIC DISORDER or
CYCLOTHYMIA
Object Loss Theory
Loss of parent before DEPRESSION/UNIPOLAR DISORDER
age 11 increases risk  persistent sad or depressed mood, loss of
interest on things that were pleasurable and
Personality Organization Theory disturbance in sleep, appetite, energy and
 Obsessive-Compulsive concentration.
 Dependent personality
 Hyterical personality RISK FACTORS FOR DEPRESSION
1. Prior episodes of depression.
Aggression turned inward Theory 2. Family history of depressive disorder
Over-developed superego leads to depression 3. Prior suicide attempts.
4. Gender: female
Learned Helplessness Theory 5. Age: younger than 40 years
 one has no control 6. Postpartum period
over his environment 7. Chronic general medical condition
8. Lack of social support
 helplessness and 9. Stressful life events.
hopelessness 10. Substance abuse or dependency
11. Other psychiatric conditions.
Cognitive Theory
(-) view of self
(-) view of future
(-) interpretation of
Experience
 9 CLINICAL SIGNS
D-ecrease ability to concentrate
E-ating disturbance
P-hysical signs (agitation or retardation)
R-eccurent thought of death
E-xcessive feeling of unworthiness
S-leep disturbance (insomnia/hypersomnia)
S-adness/dysphoria
E-nergy diminished
D-iminished pleasure (anhedonia)
MAJOR DEPRESSIVE EPISODE
 At least 2weeks period of maladaptive
functioning that is a clear change from
previous levels of functioning.
 The mood disturbance causes marked
distress and / or significant impairment in
social or occupational functioning.
 There is no evidence of a physical or
substance etiology for the patient’s
symptoms or of the presence of another
major mental disorder that accounts for the
patient’s depressive symptoms.
2. Dysthymic Disorder

Exhibit 2 or more of six clinical symptoms
with depression.
 Clinical symptoms usually persist for 2
years or more and may be continual or may
occur intermittently with normal mood
swings for a few days or weeks.
 Clinical symptoms interfere with
functioning and are not due to a medical
condition or the physiologic effects of a
substance.
 Not as severe and do not include symptoms
such as delusions, hallucinations, impaired
communication, or incoherence.
3. Depressive Disorder Not Otherwise Specified
Disorders with depressive features that do not meet
the criteria for major depressive disorder, dysthymic
disorder and other related disorder.
BIPOLAR DISORDER
 Also called manic-depressive disorder
 both poles of mood

At least 1 or 2 of the following symptoms must be TYPES

present during that 2-week period: 1. Manic episode or Mania
1. Depressed mood 2. Hypomanic episode or
2. Inability to experience pleasure or markedly Hypomania
diminished interest in pleasurable activities 3. Bipolar I
3. Appetite disturbance with weight change 4. Bipolar II
4. Sleep disturbance 5. Cyclothymic Disorder or
5. Psychomotor disturbance Cyclothymia
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or Manic/Mania Episode
inappropriate guilt
8. Diminished ability to concentrate or A. A distinct period of abnormal and persistent
indecisiveness elevated, expansive, or irritable mood that
9. Recurrent thoughts of death or suicidal ideations lasts at least 1 week (or less if
hospitalization is required).
Categories of MDD according to specifiers B. At least 3 of the following
(population, time frame, and/or symptoms) symptoms must occur during
1. Atypical depression the episode (or 4 if the patient
2. Melancholic depression is only irritable).
3. Postpartum depression 1. Inflated self-esteem or grandiosity
4. Psychotic depression 2. Decreased need for sleep
5. Seasonal affective disorder (SAD) 3. Very talkative
4. Flight of ideas
Characteristics of Major Depressive Episode 5. Distractibility
• Mood depressed; Memory problems 6. Psychomotor agitation
• Anxious; Apathetic; Appetite changes 7. Excessive involvement in pleasurable
• “Just no fun” activities that have a high potential for
• Occupational impairment personal problems.
• Restlessness C. Mood disturbance severe
• Doubts self; Difficulty making decisions enough to cause problems
• Empty feeling socially, interpersonally, or at
• Persistent sadness; Psychomotor retardation work, or the person has to be
• Report vague pains hospitalized to prevent harm
• Energy gone to self or others.
• Suicidal thoughts and impulses
• Sleep disturbances D. The symptoms are not due to
• Irritability; Inability to concentrate the direct physiological
• Oppressive guilt effects of a substance or a
• “Nothing can help” (Hopelessness) general medical condition.
Characteristics of Manic  Reduction of environmental stimuli
Episodes  Dealing with patients who are escalating
Endless energy  Reinforcement of appropriate hygiene &
Decreased need for sleep dress
Omnipotent feelings  Nutrition and Sleep issues
Substance abuse
Increased sexual interest Bipolar patients who are too busy to eat:
Poor judgment; Provocative behavior 1. Provide finger foods
Euphoric mood 2. Provide high-protein, high-calorie
snacks
Can’t sit still 3. Weigh regularly
Irritable, impulsive, intrusive behavior
“Nothing is wrong” Bipolar patients who cannot sleep:
Active; Aggressive
Mood swings 1. Provide a quiet place to sleep
2. Structure and plan activities
Hypomanic/Hypomania 3. Do not allow caffeinated drinks before
Meets most of the criteria for manic Bedtime
episode, with 2 major exceptions:
Psychopharmacology
1. The symptoms must last at least 4 days
2. The person must manifest an unequivocal change  Antimanic: Lithium (900-1200mg/day)
in functioning that is observable by others.  Mood Stabilizers: Anticonvulsants
Carbamazepine (Tegretol)
Bipolar I Valproic acid (Depakote)
The patient must have a history of a manic episode Gabapentin (Neurontin)
Six categories: Lamotrigine (Lamictal)
1. Bipolar I disorder, single episode Topiramate (Topamax)
2. Bipolar I disorder, most recent episode manic
3. Bipolar I disorder, most recent episode
hypomanic
4. Bipolar I disorder, most recent episode
mixed
5. Bipolar I disorder, most recent episode
depressed
6. Bipolar I disorder, most recent episode
unspecified

Bipolar II
The patient has experienced major depression and a
hypomanic episode but not a manic episode

Cyclothymic/Cyclothymia
1. For a period of 2 years, the
patient has had numerous periods
of hypomanic symptoms and
numerous periods of a depressed
mood.
2. The patient is never symptom-free
for more than 2 months at a time.
3. The patient has never experienced major
depression.

PSYCHOTHERAPEUTIC MANAGEMENT
1. Therapeutic Nurse-Patient Relationship
2. Milieu Management
3. Psychopharmacology

Therapeutic nurse-patient relationship

 Matter of fact tone
 Clear, concise directions and comments
 Limit setting
 Reinforcement of reality
 Respond to legitimate complaints
 Redirect patients into more healthy activity
 Safety
 Consistency among staff