Chapter 21 Mood Disorders Copyright 2012 Wolters Kluwer

Mood disorders are highly prevalent yet underdiagnosed and undertreated conditions that have a significant

Learning Objectives • Briefly describe the historical perspective of mood disorders • Explain the

Learning Objectives (cont. ) • Compare and contrast the clinical symptoms of dysthymic disorder,

Mood Disorder Statistics • Approximately 20. 9 million adults (or 9. 5% of the

Etiology of Mood Disorders • Genetic theory • Biochemical theory – Neuroendocrine regulation •

Clinical Symptoms and Diagnostic Characteristics of Depressive Disorders • Major depressive disorder • Dysthymic

Clinical Symptoms and Diagnostic Characteristics of Bipolar Disorders (BPD) • Bipolar I disorder A

Clinical Symptoms and Diagnostic Characteristics of Other Mood Disorders • Mood disorder due to

The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning interventions

Assessment • Screening tools and assessment scales • General description or appearance • Communication

Nursing Diagnoses • Activity intolerance • Imbalanced nutrition: less than body requirements • Fatigue

Outcome Identification • Outcome identification for the client with major depression focuses on the

Planning Interventions • Any plan for clients with depression or BPD should strive to

Implementation • Assistance in meeting basic needs • Medication management • Pain management •

Evaluation • Clients who respond to treatment are able to do the following: –

Key Terms • Affective disorders • Endogenous depression • Anaclitic depression • Euphoria •

Reflection Reflect on the chapter-opening quote by Culpepper, 2006. • What impact on quality

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Mood disorders are highly prevalent yet underdiagnosed and undertreated conditions that have a significant impact on quality of life in terms of suffering and functional impairment, disability, health risks, and lifespan. Approximately half of all cases of mood disorder are missed in primary-care practice, and fewer than one quarter of clients who are diagnosed receive adequate care. Culpepper, 2006 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Learning Objectives • Briefly describe the historical perspective of mood disorders • Explain the following theories of mood disorders: genetic theory, biochemical theory, biological theory, psychodynamic theory, behavioral theory, cognitive theory, and life events and environmental theory • Recognize the primary risk factors for developing mood disorders • Differentiate among the clinical symptoms of major depressive disorder, bipolar I disorder, and bipolar II disorder • Articulate the rationale for the use of the diagnosis mood disorder due to a general medical condition Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Learning Objectives (cont. ) • Compare and contrast the clinical symptoms of dysthymic disorder, cyclothymic disorder, premenstrual dysphoric disorder, and mood disorder with postpartum onset • Articulate the rationale for each of the following modes of treatment for mood disorders: medication management, somatic therapy, interactive therapy, and complementary and alternative therapy • Formulate an education guide for clients with a mood disorder • Construct a sample plan of care for an individual exhibiting clinical symptoms of major depressive disorder Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mood Disorder Statistics • Approximately 20. 9 million adults (or 9. 5% of the U. S. population) experience depressive disorders. • It affects approximately 14. 8 million adults (or about 6. 7% of the U. S. population). • Nearly twice as many women (6. 5 %) as men (3. 3 %) suffer from a major depressive disorder. • Statistics also reveal that more than 5. 7 million adults (or about 2. 6 % of the U. S. population) are diagnosed with bipolar disorder. • Men and women are equally likely to develop bipolar disorder. • By the year 2020, mood disorders are estimated to be the second most important cause of disability worldwide. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Etiology of Mood Disorders • Genetic theory • Biochemical theory – Neuroendocrine regulation • Biological theory – Neurodegenerative diseases – Immunotherapy – Medical conditions – Pain • Psychodynamic theory • Behavioral theory: learned helplessness • Cognitive theory • Life events and environmental theory Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Symptoms and Diagnostic Characteristics of Depressive Disorders • Major depressive disorder • Dysthymic disorder • Depressive disorder not otherwise specified (NOS) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Symptoms and Diagnostic Characteristics of Bipolar Disorders (BPD) • Bipolar I disorder A client with mania • Bipolar II disorder • Cyclothymic disorder Note the exaggerated dress and hand movements Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Symptoms and Diagnostic Characteristics of Other Mood Disorders • Mood disorder due to a general medical condition • Premenstrual dysphoric disorder (PDD) • Mood disorder with postpartum onset Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning interventions • Implementation • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment • Screening tools and assessment scales • General description or appearance • Communication • Mood, affect, and feelings • Behavior • Risk factors • Transcultural considerations Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Diagnoses • Activity intolerance • Imbalanced nutrition: less than body requirements • Fatigue • Hopelessness • Impaired verbal communication • Ineffective coping • Situational low self-esteem • Disturbed sleep pattern • Social isolation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Outcome Identification • Outcome identification for the client with major depression focuses on the following: – Safety and security – Physical health – Acceptance – Belonging – Positive self-concept – Empowerment • In addition to those for the client with depression, outcomes for the manic client will focus on the following: – Channeling energy and accurately perceiving reality Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Planning Interventions • Any plan for clients with depression or BPD should strive to attain and maintain these personal attitudes: – Acceptance – Honesty – Empathy – Patience Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Implementation • Assistance in meeting basic needs • Medication management • Pain management • Somatic therapies • Interactive therapies • Complementary and alternative therapies • Client education Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Evaluation • Clients who respond to treatment are able to do the following: – Demonstrate the resolution of clinical symptoms – Demonstrate minimal residual symptoms Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms • Affective disorders • Endogenous depression • Anaclitic depression • Euphoria • Anergia • Hypomania • Anhedonia • Mania • Apathy • Poverty of speech content • Asthenia • Psychomotor agitation • Bipolar disorders • Psychomotor retardation • Depressive disorders • Rapid-cycling • Dysthymia • Residual symptoms • Elation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Reflection Reflect on the chapter-opening quote by Culpepper, 2006. • What impact on quality of life is experienced by a client diagnosed with a mood disorder? Please explain. ? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins