Mood disorders

Categories of Mood disorders

Unipolar
o Major depression
Bipolar
o Mania
o Depression
o Period of normalcy

Unipolar: Major depression

Sad mood or lack of interest in life for 2 or more weeks
Another 4 symptoms must also be present
o Change in appetite (increase or decrease)
o Change in sleep patterns (too much or too little)
o Unable to concentrate and make decisions
o Loss of self-esteem (guilt- how you were raised; how worthy a person
perceives themselves).
Those at risk:
o PMS/PMDD
o Suffering from anxiety and irritability
o PP depression
o Chronic illness (dialysis)

o PTSD
o Grief and loss
Can be observed by others, or the depression is just in ones head

Incidence
Major depression occurs at least twice as often in women
Single and divorced people have the highest rates of depression

Treatments
Psychotherapy (groups, counselor)
Psychopharmacology (Meds)
ECT

Electroconvulsive therapy
The biggest concern is memory loss.
Patient is pre-medicated, much like a pre-op patient
Elders are treated for depression with ECT more frequently than younger
persons.
o Elder persons have increased intolerance of side effects of
antidepressants
o ECT produces a more rapid response

Suicidal Ideation

 Safety is primary concern

Watch for overt cues of suicide (Obvious) active
Covert cues are more subtlepassive
People who suddenly are happier are of great concern; may have made the
suicidal plan are content with their decision.
People whose meds are finally workinghave enough energy to carry out the act

Clients Affect
Compare verbal with non-verbal behaviorsdo they match up?
Asocial: Withdrawal from family and friends
Anhedonic: Lose sense of pleasure
When confronting these clients about their behavior, use I statements
o I really wish youd join the group

Judgment
Feel overwhelmed with normal activities
Difficulty with task completion
Always exhausted

Self Concept
Ruminate: Worry to excess.
Lack energy for normal activities (always tired)

Interventions
Assess safety for client (PRIORITY!)
Perform suicide lethality assessment
Orient client to new surroundings (they need structure)
Offer explanations of unit routine (again, need structure)
Start to promote a therapeutic relationship; schedule short interaction times.

Patient and Family teaching

Stress importance of follow-up carekeep it structured; make appointment for
them.
Stress importance of continuing medications; assess if they can afford them
Make phone number lists of how to get help if they need it.

Bipolar disorder
Condition with cyclic mood changes
Person has manic episodes, periods of profound depression, and times of normal
behavior in-between
Occurs equally in men and women; often seen in highly educated people.

Clinical course of mania

Episode of unusual, grandiose, or agitated mood lasting at least one week with
three or more of the following symptoms:
o Exaggerated self-esteem
o Sleeplessness

o Pressured speech
o Flight of ideas
o Reduced ability to filter out stimuli
o Distractibility
o More activities with increased energy

Drug treatment
Lithium
o Lithium is not metabolized; rather, it is reabsorbed by the proximal tubule
and excreted in the urine.
o Thought to work in the synapse to increase destruction of dopamine and
norepinephrine; decreases sensitivity to postsynaptic receptors (Basicallywhen a person is in a manic phase, they are synapsing super fast. Lithium
helps slow this synapsing down).
o Onset of action is 5-14 days; other drugs must be used during the acute
phases to reduce symptoms of mania or depression.
o Maintenance lithium level is 0.5-1.0 mEq/L.
3 is toxic! Duh.
o Lithium is a salt contained in the human body. It not only competes for salt
receptor sites but also affects calcium, potassium, and magnesium ions as
well as glucose metabolism.
MUST complete an electrolyte blood panel (focus on Chloride).
o Having too much salt in the diet can cause the lithium level to be too low.
o Not having enough dietary salt can cause the lithium levels to be too high.
o Persistent thirst and diluted urine can indicate the need to call the MD;
lithium dosage may need to be reduced.

 Anticonvulsant drugs: mechanism is unclear, but they raise the brains threshold
for dealing with stimulation; this prevents the person from being bombarded with
external and internal stimuli.
o Tegretol
Huge concern about agranulocytosis (a decrease in WBC).
Need serum levels monitored 12 hours after last dose.
o Depakote
Need to monitor serum level, CBC with platelets, liver function
including ammonia level (ammonia is a by-product of liver
metabolism)
o Klonopin
Anticonvulsant and benzodiazepine
Drug dependence can occur
Monitor CBC, liver function
Withdrawal drug slowly to prevent GI issues
Cannot be used alone to manage bipolar; must be used in
conjunction with lithium or another mood stabilizer.

Helpful hints to care for bipolar clients

You cant teach a manic client
Safety is a huge issue because their judgment is poor.
Only spend short periods of time with patient
Must be flexible in taking intake assessment; may need to obtain data in several
short sessions as well as talking to family members.
Ask the client to explain any coded speech

 Assist the client to meet socially accepting behaviors. Kathy, you are too close to
my face. Please stand back two feet.
Feed them finger foods high in calories while in a manic phase; provide nutritional
support!
Use simple sentences when communicating. It is also helpful to ask client to
repeat brief messages to ensure they have heard and incorporated them.
o Please speak more slowly. Im having trouble following you.
Avoid becoming involved in power struggles over who will dominate the
conversation.

Suicide
4 out of 5 who actually commit suicide have made at least one prior attempt
In a majority of cases, there are clear indicators hat the person was very troubled.
Few than 15% of suicide victims leave suicide notes
The suicide risk is greatest in the 90 days following a major depressive episode.
survivor guilt happens when 1 or more family members feel guilty that they are
still living
Separation anxiety may cause they surviving to join the beloved deceased
Make the patient sign a contract for life
Crisis interventionmay need 1:1 care. The client is no more than 2-3 feet away
from a staff member at any time, including going to the bathroom.