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MOOD DISORDERS

Mood disorders (also called as Affective disorders) are a set of psychiatric


diseases, also called affective disorders. The main types of affective disorders
are depression, bipolar disorder, and anxiety disorder. Symptoms vary by
individual, but they typically affect mood. They can range from mild to severe.
Individuals with mood disorders suffer significant distress or impairment in
social, occupational, educational or other important areas of functioning.
PATHOPHYSIOLOGY
Neurobiological Theory

Psychoanalytical
Cognitive-Behavioral
Theory
Theory
With high familial and
Disturbance in
Depression associated
genetic patterns
interpersonal relations
with significant loss of
in early childhood
important sources of
Dysregulation of
positive reinforcements
Arouse from withdrawal of
norepinephrine and
or high rate of aversive
serotonin (biogenic mine
maternal love and
experience
hypothesis)
support during oral
(reinforcement theory)
phase and later
Low levels od tryptophan
Learned helplessness
experiences of loss
(precursor of serotonin)
Predisposed by
Cognitive triad: negative
ambivalence in love
view of the self; of the
relationships
world; and of the future
Types of Mood Disorders
The three main types of affective disorders are: depression, bipolar disorder,
and anxiety disorder. Each includes subtypes and variations in severity.
Depression
Depression, or major depressive disorder, is characterized by feelings of
extreme sadness and hopelessness. It is more than simply feeling down for a day or
two. If you have depression, you may experience episodes that last for several days
or even weeks. A milder form of depression is called dysthymia.
2 Basic Theories of Depression
A. RESULT OF LOSS (REAL OR SYMBOLIC)
B. HOSTILITY TURNED TOWARD HIMSELF
MAIN CONCERN BY THE NURSE in DEPRESSED CLIENTS: SAFETY
Types of Depression:
1. INVOLUTIONAL: severe type with loss of weight, somatic complaints, severe guilt
feelings (ECT, ANTI-DEPRESSANTS, and HYDRATION)
2. REACTIVE DEPRESSION: less severe, secondary to uncontrolled or unresolved
loss, with poor sleep and appetite, withdrawal (PSYCHOTHERAPY, ANTIDEPRESSANTS, HYDRATION AND NUTRITION)
3. MAJOR DEPRESSION: severe type, lasting for 2 weeks
4. DYSTHYMIC: less severe but lasts up to 2 years
5. NON SPECIFIC: less severe, lasting for 2 days to 2 weeks.
PRECIPITATING FACTORS
1.
2.
3.
4.
5.

Loss of love ones


Major life events
Role strain
Decreased coping resources
Physiological changes

Bipolar Disorder
Bipolar disorder means having periods of depression, and periods of mania.
Mania is when you feel extremely positive and active. This may sound good, but
mania is the feeling of irritable, aggressive, impulsive, and even delusional. There
are different types of bipolar, classified by the severity of depression and mania, as
well as by how often mood swings occur.
Anxiety Disorders
There are several different types of anxiety disorders. All are characterized by
feelings of nervousness, anxiety, and even fear. They are:

social anxiety: anxiety caused by social situations


post-traumatic stress disorder: anxiety, fear, and flashbacks caused by a
traumatic event
generalized anxiety disorder: anxiousness and fear in general, with no
particular cause
panic disorder: anxiety that causes panic attacks
obsessive-compulsive disorder: obsessive thoughts that cause anxiety
and compulsive actions

Symptoms of Mood Disorders


Depression:
prolonged sadness
irritability or anxiety
lethargy and lack of energy
lack of interest in normal activities
major changes in eating and sleeping habits
difficulty concentrating
feelings of guilt
aches and pains that have no physical explanation
suicidal thoughts
Bipolar Disorder:
unusual and chronic mood swings
during depression, symptoms similar to those for major depressive disorder
during mania, less sleep and feelings of exaggerated self-confidence,
irritability, aggression, self-importance, impulsiveness, recklessness, or in
severe cases delusions or hallucinations
Anxiety Disorders:
constant worry
obsessive thoughts
restlessness
trouble concentrating
trembling
irritability
difficulty sleeping
sweating
shortness of breath and rapid heart rate
nausea
Diagnosis of Mood Disorders
There are no medical tests to diagnose mood disorders. To make a diagnosis,
a psychiatrist or other trained mental health professional can give a psychiatric
evaluation.
Psychotherapies of Mood Disorders
Cognitive-Behavioral Therapy

A FORM OF PSYCHOTHERAPY THAT EMPHASIZES THE IMPORTANT ROLE OF


THINKING, FEELING, AND BEHAVING
A GENERAL TERM FOR CLASSIFICATION OF THERAPIES WITH SIMILARITIES IN
APPROACH:
BEHAVIORAL THERAPY
COGNITIVE THERAPY
BEHAVIORAL THERAPY

IT SEEKS TO INCREASE FREQUENCY OF CLIENTS POSITIVELY REINFORCING


INTERACTIONS WITH ENVIRONMENT AND DECREASE (-) NEGATIVE
INTERACTIONS
FOCUS:
MODIFY BEHAVIOR INCLUDING EMOTION & VERBALIZATION
VARIOUS BEHAVIOR ARE SUBJECTED TO REWARD AND PUNISHMENT
CERTAIN BEHAVIORS CAN BE CHANGED IF ENVIRONMENT IS CHANGED

COGNITIVE THERAPY

HELPING THE INDIVIDUAL CHALLENGE AND INVALIDATE DISTORTED


THOUGHTS THRU SERIES OF MENTAL EXERCISE AND ULTIMATELY REPLACE
THEM WITH APPROPRIATE REALISTIC THOUGHTS

Medications
ANTI-DEPRESSANTS / mood elevator ( for Depression)
INDICATIONS: Treatment of endogenous depression
1. MAO ( Monoamine Oxidase Inhibitors) (PaNaMa )
A. PARNATE ( Tranylcypromine)
B. NARDIL ( Phenelzine)
C. MARPLAN ( Isocarboxazid )
( Avoid Thyramine Rich foods)
* Aged Cheeze
* Liver
* Beer
* Sausage
* Chocolates
REMEMBER: HYPERTENSIVE CRISIS s/s--RESULTS FROM TAKING TYRAMINE
CONTAINING FOOD WHEN UNDER MAO INHIBITORS:
1. HEADACHE
2. CHEST PAIN
3. PALPITATION
4. DIAPHORESIS
2. TRI-CYCLICS (Tofel)
A. TOFRANIL
B. FLUOXETINE ( Prozac)
C. ELAVIL
Action: Block the reuptake of norepinephrine & serotonin
Adverse Effects:
a. Anti-cholinergic Effects- dry mouth/ constipation
b. Cardiovascular Effects Arrhythmias / Palpitation
General considerations:
1. Antidepressants effect may not occur until up to 3 weeks after the initial
dose !
2. Drugs must be discontinued gradually

3. Common side effects:


a. Constipation
b. Dry mouth
c. Blurred vision
d. Sedation
e. Restlessness & Irritability
Electroconvulsive therapy
-Administration of electric shock (70-150 volts through electrodes in the temple for .
2-8 seconds) producing 30-60 seconds of GRAND-MAL SEIZURE
-Seizure of more than 180 seconds is unfavorable and terminated with diazepam or
benzodiazepine
-Used (controversially) to treat major depressive episodes (especially those with
suicidal ideations), acute mania, delirium, catatonic and schizophrenia
Side effects: Temporary memory loss and confusion (most common)
Pre-treatment care:
Signed informed consent
NPO 6-8 hours prior
Remove dentures, eye glasses, and contact lens
Empty bladder
Baseline V/S
Pre-meds: Atrophine Sulfate (to decrease secretion), Methohexital (shortacting barbiturate), Succynylcholine (muscle relaxant)
Post-treatment care:
Place patient to side (prevent aspiration)
Oxygenation
Maintain quiet environment
Provide orientation to time, place, and person as there is temporary memory
loss.
Nursing Diagnoses and Interventions
Mood disturbance
Educate about depression and treatment
Observe and document
Administer Anti-depressant, as ordered
Dysfunctional grieving
Encourage verbalization of thoughts and feelings
Foster communication between family
Risk for self-directed violence
Maintain safe environment
Assess risk for suicide
Encourage ventilation of feelings
Self-esteem disturbance
Engage in simple tasks (that he/she can succeed)
Praise accomplishments
Assist in identification of strength

BIPOLAR!
Is characterized by
feelings of extreme
sadness and
hopelessness

Individuals with mood disorders


suffer significant distress or impairment in
social, occupational, educational or other
important areas of functioning.

MOOD DISORDERS

Neurobiological Theory
Psychoanalytical Theory
Cognitive-Behavioral Theory

Having periods of
depression, and
periods of mania
(feeling of happy)

DEPRESSION!

S/SX: Unusual and chronic mood


swings. In Mania, less sleep and
feelings of exaggerated selfconfidence, irritability,

ANXIETY!
S/SX:
prolonged
sadness
Irritability or
anxiety
Lethargy and
lack of energy
Lack of
interest in
normal
Diagnosis: There are no
medical tests to diagnose
mood disorders.
Psychiatrist can give a
psychiatric evaluation.

Jazzmin Angel R.
Comaling
4B1-BSN

Having periods of
depression, and
periods of mania
(feeling of happy)
S/SX:
constant
worry,
obsessive
thoughts,
restlessne
ss, trouble
concentrat
ing,
trembling,
irritability
Psychotherapies: CognitiveBehavioral Therapy, ANTIDEPRESSANTS, Electroconvulsive
therapy

Nsg. Dx. And Interventions:


Mood disturbance - Administer Anti-depressant, as ordered
Dysfunctional grieving - Encourage verbalization of thoughts
and feelings
Risk for self-directed violence - Maintain safe environment
Self-esteem disturbance - Engage in simple tasks (that he/she

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