Mood Disorders

Mr. Ibrahim Rawhi Ayasreh

RN, MSN, CNS

Introduction

Depression is likely the oldest and still one of the most

frequently diagnosed psychiatric illnesses.
An occasional bout with the blues, a feeling of sadness
or downheartedness, is common among healthy people
and considered to be a normal response to everyday
disappointments in life. These episodes are short lived as
the individual adapts to the loss, change, or failure (real or
perceived) that has been experienced.
Pathological depression occurs when adaptation is
ineffective

Terms definition

Mood is a pervasive and sustained emotion that may

have a major influence on a persons perception of
the world. Examples of mood include depression, joy,
elation, anger, and anxiety.

Affect is described as the temporary emotional

reaction associated with an experience.

Terms definition

Depression is an alteration in mood that is expressed by feelings of

sadness, despair, and pessimism. There is a loss of interest in usual
activities, and somatic symptoms may be evident.
melancholia, a severe form of depressive disorder in which
symptoms are exaggerated and interest or pleasure in virtually all
activities is lost.
Mania is an alteration in mood that is expressed by feelings of
elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and
accelerated thinking and speaking. Mania can occur as a biological
(organic) or psychological disorder, or as a response to substance use
or a general medical condition

Epidemiology

Major depression is one of the leading causes of disability

in the United States. It affects almost 10 percent of the
population.

Studies indicate that the incidence of depressive disorder

is higher in women than it is in men by about 2 to 1.

The incidence of bipolar disorder is roughly equal, with a

1.2 to 1 ratio of women to men

Epidemiology

Several studies have shown that the incidence of

depression is higher in young women and has a tendency
to decrease with age. The opposite has been found in men,
with the prevalence of depressive symptoms being lower
in younger men and increasing with age. This occurrence
may be related to gender differences in social roles and
economic and social opportunities and the shifts that occur
with age

Epidemiology

Results of studies have indicated an inverse

relationship between social class and report of
depressive symptoms, which is most likely related
to the accessibility of resources for dealing with
life stressors

Epidemiology

The highest incidence of depressive symptoms has been

indicated in individuals without close interpersonal
relationships and in persons who are divorced or
separated.
When gender and marital status are considered together,
the differences reveal lowest rates of depressive symptoms
among married men, and the highest by married women
and single men.

Etiological Implications
(Genetics)

Twin studies suggest a genetic factor in the illness because

about 50 percent of monozygotic twins are concordant for the
illness (concordant refers to twins who are both affected with
the illness).

The concordance rate in dizygotic twins is 10 to 25 percent.

Most family studies have shown that major depression is 1.5 to

3 times more common among first-degree biological relatives
of people with the disorder than among the general population.

Etiological Implications
(Biochemical Influences)

It has been hypothesized that depressive illness may be

related to a deficiency of the neurotransmitters
norepinephrine, serotonin, and dopamine, at functionally
important receptor sites in the brain.

Etiological Implications
(Physiological Influences)
- Depressed mood may also occur with any of the following
medications, although the list is by no means all-inclusive:
Steroids: Prednisone and cortisone
Hormones: Estrogen and progesterone
Sedatives: Barbiturates and benzodiazepines
Antibacterial and antifungal drugs: Ampicillin, cycloserine,
tetracycline, and sulfonamides
Antineoplastics: Vincristine and zidovudine
Analgesics and anti-inflammatory drugs: Opiates, ibuprofen,
and phenylbutazone
Antiulcer: Cimetidine

Etiological Implications
(Physiological Influences)

Excessive levels of sodium bicarbonate or calcium can

produce symptoms of depression, as can deficits in
magnesium and sodium.
It is postulated that excess estrogen or a high estrogen-toprogesterone ratio during the luteal phase of the menstrual
cycle is responsible for the symptoms associated with
premenstrual syndrome.
Deficiencies in vitamin B1 (thiamine), vitamin B6
(pyridoxine), vitamin B12, niacin, vitamin C, iron, folic acid,
zinc, calcium, and potassium may produce symptoms of
depression.

Postpartum depression

The severity of depression in the postpartum period varies from a

feeling of the blues, to moderate depression, to psychotic depression
or melancholia.
Of women who give birth, approximately 70 percent experience an
emotional letdown following delivery.
Symptoms of the maternity blues include tearfulness, despondency,
anxiety, and subjectively impaired concentration appearing in the
early puerperium. The symptoms usually begin 3 to 4 days after
delivery, generally do not impair functioning, and resolve
spontaneously within a couple of weeks.

Assessment & clinical manifestations

(Transient depression)

Affective: Sadness, dejection, feeling downhearted, having

the blues
Behavioral: Some crying possible
Cognitive: Some difficulty getting mind off of ones
disappointment
Physiological: Feeling tired and listless

Assessment & clinical manifestations

(Mild depression)

Affective: Denial of feelings, anger, anxiety, guilt,

helplessness, hopelessness, sadness, despondency
Behavioral: Tearfulness, regression, restlessness,
agitation, withdrawal
Cognitive: Preoccupation with the loss, self-blame,
ambivalence, blaming others
Physiological: Anorexia or overeating, insomnia or
hypersomnia, headache, backache, chest pain, or other
symptoms associated with the loss of a significant other.

Assessment & clinical manifestations

(Moderate depression)

Affective: Feelings of sadness, dejection, helplessness,

powerlessness, hopelessness; gloomy and pessimistic outlook;
low self-esteem; difficulty experiencing pleasure in activities.
Behavioral: Slowed physical movements (i.e., psychomotor
retardation); slumped posture; slowed speech; limited
verbalizations, possibly consisting of ruminations about failures
or regrets in life; social isolation with a focus on the self;
increased use of substances possible; self-destructive behavior
possible; decreased interest in personal hygiene and grooming

Assessment & clinical manifestations

(Moderate depression)

Cognitive: Retarded thinking processes; difficulty

concentrating and directing attention; obsessive and repetitive
thoughts, generally portraying pessimism and negativism;
verbalizations and behavior reflecting suicidal ideation.
Physiological: Anorexia or overeating; insomnia or
hypersomnia; sleep disturbances; amenorrhea; decreased libido;
headaches; backaches; chest pain; abdominal pain; low energy
level; fatigue and listlessness; feeling best early in the morning
and continually worse as the day progresses. This may be
related to the diurnal variation in the level of neurotransmitters
that affect mood and level of activity.

Assessment & clinical manifestations

(Severe depression)

Affective: Feelings of total despair, hopelessness, and

worthlessness; flat (unchanging) affect, appearing devoid of
emotional tone; prevalent feelings of nothingness and emptiness;
apathy; loneliness; sadness; inability to feel pleasure
Behavioral: Psychomotor retardation so severe that physical
movement may literally come to a standstill, or psychomotor
behavior manifested by rapid, agitated, purposeless movements;
slumped posture; sitting in a curled-up position; walking slowly
and rigidly; virtually nonexistent communication (when
verbalizations do occur, they may reflect delusional thinking); no
personal hygiene and grooming; social isolation is common, with
virtually no inclination toward interaction with others

Assessment & clinical manifestations

(Severe depression)

Cognitive: Prevalent delusional thinking, with delusions of

persecution and somatic delusions being most common;
confusion, indecisiveness, and an inability to concentrate;
hallucinations reflecting misinterpretations of the environment;
excessive self-deprecation, self-blame, and thoughts of suicide
Physiological: A general slowdown of the entire body,
reflected in sluggish digestion, constipation, and urinary
retention; amenorrhea; impotence; diminished libido; anorexia;
weight loss; difficulty falling asleep and awakening very early
in the morning; feeling worse early in the morning and
somewhat better as the day progresses

Etiological Implications
(Mania)

Early studies have associated symptoms of depression with a

functional deficiency of norepinephrine and dopamine and
mania with a functional excess of these amines.
Some studies have suggested possible alterations in normal
electrolyte transfer across cell membranes in bipolar disorder
resulting in elevated levels of intracellular calcium.
Magnetic resonance imaging studies have revealed enlarged
third ventricles and subcortical white matter and periventricular
hyperintensity in clients with bipolar disorder

Background Assessment Data

Symptoms of manic states can be described

according to three stages: hypomania,
acute mania, and delirious mania.
Symptoms of mood, cognition and
perception, and activity and behavior are
presented for each stage.

Background Assessment Data

(Hypomania)
Mood
- The mood of a hypomanic person is cheerful and expansive. However,
there is an underlying irritability that surfaces rapidly when the persons
wishes and desires go unfulfilled. The nature of the hypomanic person is
very volatile and fluctuating.
Cognition and Perception
- Perceptions of the self are exaltedideas of great worth and ability.
Thinking is flighty, with a rapid flow of ideas. Perception of the
environment is heightened, but the individual is so easily distracted by
irrelevant stimuli that goal-directed activities are difficult.
Activity and Behavior
- Hypomanic individuals exhibit increased motor activity

Background Assessment Data

(Acute Mania)
Mood
- Acute mania is characterized by euphoria and elation. The person
appears to be on a continuous high.
Cognition and Perception
- Cognition and perception become fragmented and often psychotic in
acute mania. Rapid thinking proceeds to racing and disjointed
thinking (flight of ideas).
Activity and Behavior
- Psychomotor activity is excessive. Sexual interest is increased. There
is poor impulse control, and the individual who is normally discreet
may become socially and sexually uninhibited.

Background Assessment Data

(Delirious Mania)
Mood:
- The mood of the delirious person is very labile. He or she may exhibit
feelings of despair, quickly converting to unrestrained merriment and
ecstasy or becoming irritable or totally indifferent to the environment.
Panic anxiety may be evident.
Cognition and Perception:
- Cognition and perception are characterized by a clouding of
consciousness, with accompanying confusion, disorientation, and
sometimes stupor.
Activity and Behavior
- Psychomotor activity is frenzied and characterized by agitated,
purposeless movements.