Copyright 2011 Wolters Kluwer Health Lippincott Williams Wilkins

Chapter 10 Mood Disorders Copyright © 2011 Wolters Kluwer Health | Lippincott Williams &

Mood Disorder Defined • A condition in which a person experiences a prolonged alteration

Relevant Terms • Mood: prolonged emotion that colors a person’s entire psychological thinking •

Mood Disorders • Depressive disorders • Dysthymic disorder – Recurrent state of depression over

Major Depressive Disorder • Persistent, prolonged mood of sadness extending beyond two weeks duration

Precipitating Factors • Chronic pain • Loss of job • Lack of support system

Depression Signs and Symptoms • Hopelessness, guilt, and self-blame • Somatic complaints (h/a, body

Depression: Incidence and Etiology • At least 25% of population will experience in lifetime

Dysthymic Disorder Signs and Symptoms • Chronic depression • Often ineffective at coping with

Dysthymia Incidence and Etiology • Occurs 2 -3 times more frequently in women than

Bipolar Disorders (Manic Depression) • Brain dysfunction that causes abnormal and erratic shifts in

Bipolar I and II • Bipolar I—severe manic episodes • Bipolar II—hypomanic episodes •

Signs and Symptoms of Hypomania/Mania • Extreme euphoria • Inflated self-esteem or grandiosity •

Mania http: //www. youtube. com/watch? v=p 9 hb. XPVa. Ouk http: //www. youtube. com/watch?

Bipolar Disorder: Incidence and Etiology • Genetic factor – familial pattern of illness •

Cyclothymic Disorder • Milder form of bipolar disorder characterized by mood disturbances, which involve

Cyclothymic Disorder Signs and Symptoms • Recurrent episodes of hypomania or dysthymia • States

Suicide • Women attempt more often than men • Men are more successful than

Risk Factors for Suicide • Depressive and bipolar disorders/other mood disorders • Family history

Suicide Warning Signs • Difficulty eating and sleeping • Increased substance abuse • Social

Levels of Risk • Suicidal ideation – Indicates a desire toward self-harm • Suicidal

If You Think Someone Might be Suicidal • Do not leave the person alone

Treatment of Mood Disorders • Pharmacologic • Psychotherapeutic – Antidepressants and Mood-Stabilizing Agents •

ECT • Electrical current through the brain • Chanes the neurotransmitter system that leads

Nursing Process Applied • Assessment – Mood and affect – Thinking and perceptual ability

Nursing Process Applied (Cont. ) • Nursing diagnoses – Page 146 • Expected outcomes

Nursing Process Applied (Cont. ) • Interventions – Individual for each client – Implemented

Interventions for a Suicidal Client • Assess the client for risk factors • Determine

Nursing Process Applied (Cont. ) • Evaluation – Improvement in thought processes, behavior, overall

Question • Tell whether the following statement is true or false. Individuals with bipolar

Answer • True • Rationale: Those with bipolar disorder have moods that range from

Question • A marked decrease in energy level is also called A. Anergia B.

Answer • A. Anergia • Rationale: Anergia is a noticeable decrease in energy level,

Question • Tell whether the following statement is true or false. Psychotic symptoms are

Answer • False • Rationale: A person with cyclothymia does not have psychotic symptoms.

Question • Which phrase is used to label the first level of suicide risk?

Answer • C. Suicidal ideation • Rationale: Suicidal ideation is the first level of

Case Application • 10. 1 “Sad and Lonely” • 10. 2 “Out of Control”

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Relevant Terms • Mood: prolonged emotion that colors a person’s entire psychological thinking • Affect: facial expression displayed in association with mood • Euphoria: excessive feeling of happiness • Mania: frenzied, unstable mood • Hypomania: lesser mild-to-moderate form of mania Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mood Disorders • Depressive disorders • Dysthymic disorder – Recurrent state of depression over a period of at least two years • Bipolar disorder—manic depression • Cyclothymic disorder – Milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Major Depressive Disorder • Persistent, prolonged mood of sadness extending beyond two weeks duration – No episodes of mania or hypomania (unipolar) – Depressed mood – Decreased neurotransmitter action in brain • Usually responds to antidepressant medication – May have precipitating event – May be seasonal Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Precipitating Factors • Chronic pain • Loss of job • Lack of support system • Financial difficulties • Conflict with a friend or loved one • Recovery from the impact of a difficult situation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Depression Signs and Symptoms • Hopelessness, guilt, and self-blame • Somatic complaints (h/a, body pains, GI disturbances) • Anxiety and melancholy • Decreased sex drive • Anergia/anhedonia – Marked decrease in energy level, dependent on others for basic needs – Lack of pleasure in things an individual previously enjoyed • Apathy • Lack of eye contact • Recurrent thoughts of death or suicide Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Box 10. 1 Page 141

Depression: Incidence and Etiology • At least 25% of population will experience in lifetime • Predisposition runs in families • Women at a greater risk • Average of onset is mid-20 s • 15% in major depression will attempt suicide • Possible functional deficit of serotonin in the brain – Leads to a chemical imbalance Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dysthymic Disorder Signs and Symptoms • Chronic depression • Often ineffective at coping with loss • Pessimistic attitude • Negativism • Low self-esteem • Poor concentration, decision making Box 10. 2 Page 142 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dysthymia Incidence and Etiology • Occurs 2 -3 times more frequently in women than in men • More likely to occur in first-degree biologic relatives with depressive disorders • Usually an early onset beginning anytime from childhood through early adulthood • May eventually develop bipolar disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bipolar Disorders (Manic Depression) • Brain dysfunction that causes abnormal and erratic shifts in mood, energy, and functional ability • Moods range from high manic episodes to low depressive periods • Severity of symptoms from mild to severe Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bipolar I and II • Bipolar I—severe manic episodes • Bipolar II—hypomanic episodes • Rapid cycling— 4+ mood shifts within one year Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs and Symptoms of Hypomania/Mania • Extreme euphoria • Inflated self-esteem or grandiosity • Excessive energy • Extreme irritability, moodiness • Reckless and impulsive behaviors Box 10. 3 Page 143 • Sexual indiscretions • Poor hygiene, bizarre dress • Auditory and visual hallucinations • Grandiosity – unrealistic or exaggerated sense of selfworth, importance, wealth, or ability • Clang Associations – rhyming phrases Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mania http: //www. youtube. com/watch? v=p 9 hb. XPVa. Ouk http: //www. youtube. com/watch? v=LLVEQgkbw 9 Y Person has a continued mental flood of overly confident self-expectations that lead to frenzied psychomotor activity. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bipolar Disorder: Incidence and Etiology • Genetic factor – familial pattern of illness • Environmental factors • Possible link with substance abuse, stressful life events • Women at a greater risk • If occur in adolescents – may lead to school failure, behavioral problems, and substance use Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cyclothymic Disorder • Milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression – Not longer than two months – No psychotic symptoms – Functioning is not severely impaired – Short periods of normalcy – Equal occurrence in men and women – Begins in adolescence or early adulthood Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cyclothymic Disorder Signs and Symptoms • Recurrent episodes of hypomania or dysthymia • States not as severe as in bipolar disorders • Short periods of normalcy • No psychotic symptoms • Functioning not severely impaired Box 10. 4 Page 144 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suicide • Women attempt more often than men • Men are more successful than women • Need for relief from agonizing emotional pain • Eleventh leading cause of death in the United States • All ages, races, socioeconomic status • Often preventable Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Factors for Suicide • Depressive and bipolar disorders/other mood disorders • Family history • Stressful life events • Substance abuse • Childhood abuse • Chronic illness • Decreased levels of serotonin have been found in those with depression and other mood disorders and in the brains of those who have died by suicide • Loss of a love object, health • Escape from the realities of life Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suicide Warning Signs • Difficulty eating and sleeping • Increased substance abuse • Social withdrawal • Preoccupation with death and dying, talks about suicide • Giving away possessions • Previous suicide attempt • Recent major loss • Unnecessary risk taking • Lack of attention to personal hygiene Box 10. 5 • Talks about suicide Page 144 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Levels of Risk • Suicidal ideation – Indicates a desire toward self-harm • Suicidal threat – Statement of intent and behavioral changes • Suicidal gesture – Act of suicide an imminent threat • Suicide attempt – Involves definite risk Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

If You Think Someone Might be Suicidal • Do not leave the person alone • Try to get the person immediate medical help • Call 911 • Eliminate access to firearms or other potential suicide tools • Remove any unsupervised access to prescription or overthe-counter drugs • Listen and find support for the person Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Treatment of Mood Disorders • Pharmacologic • Psychotherapeutic – Antidepressants and Mood-Stabilizing Agents • Psychosocial – Interpersonal and Cognitive Behavior Therapy • Electroconvulsive therapy Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

ECT • Electrical current through the brain • Chanes the neurotransmitter system that leads to the expected mood elevation • Unilateral ECT can lead to short-term memory deficits • Bilateral ECT can lead to long-term memory deficits Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied • Assessment – Mood and affect – Thinking and perceptual ability – Somatic complaints – Sleep disturbances – Changes in energy level – Character of speech patterns Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process Applied (Cont. ) • Interventions – Individual for each client – Implemented according to the priority of need – Page 147 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interventions for a Suicidal Client • Assess the client for risk factors • Determine the content of suicidal thoughts or ideations • Assess the lethality of method if the client has a plan • Suicide precautions • Active listening • Sense of caring Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Tell whether the following statement is true or false. Individuals with bipolar disorder experience symptoms of both mania and depression. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • A. Anergia • Rationale: Anergia is a noticeable decrease in energy level, which may make a person depend on others for basic needs. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which phrase is used to label the first level of suicide risk? A. Suicide attempt B. Suicidal threat C. Suicidal ideation D. Suicidal gesture Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • C. Suicidal ideation • Rationale: Suicidal ideation is the first level of risk for suicide; it is a verbalized thought or idea that indicates a desire to do self-harm. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins