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Mood Disorders
Characterized by a disregulation of emotion
Persons with mood d/os demonstrate a wide
range of emotions, from intense elation or
irritability to severe depression
Characterized by a constellation of sx including:
Impaired cognition
Physiologic disturbances
Lowered self-esteem
Impairment in social and occupational functioning
Etiology of Mood D/os
Neurobiologic Factors
Altered neurotransmission
Neuroendocrine dysregulation
Genetic transmission
Neurobiologic Factors—Altered
Neurotransmission
It is believed that the monoamine NT
systems, especially those of NE and 5-HT,
their metabolites, and their receptors are
somehow altered during episodes of
depression and mania
Proposed that there is an overactivity of
neurotransmission in mania and an
underactivity in depression
Neurobiologic Factors—Altered
Neurotransmission (cont)
Kindling
Neurotransmission is initially altered by stress,
resulting in a first episode of depression
This initial episode creates an electrophysiologic
sensitivity to future stress, requiring less stress to
evoke another depressive or manic episode
Creates long lasting alterations in neuronal
functioning
Neurobiologic Factors—Altered
Neurotransmission (cont)
Negativity Demandingness
Pessimism Feeling of being bored
Low sense of self-worth or empty
Proneness to worry and
Hypochondriasis
anxiety Quietness
Self-denial Incapacity for
Tendency to be serious enjoyment and
and overly responsible relaxation
Dependence on others
love or affection
Epidemiology
Epidemiology
Lifetime prevalence of developing any affective
d/o is 19.3%
Women and men have about an equal lifetime
prevalence of developing bipolar d/o
21.3% of women and 12.7% of men develop
major depression
Average age of onset for bipolar d/o is mid to
late 20s
Average age of onset of depression is mid 30s
Depressive Disorders
Major depression
Dysthymic Disorder
Depressive Disorder NOS
Melancholic depression
Atypical depression
Seasonal Affective Disorder
MDD
Five or more of the following symptoms
have to be present during the same two
week period and represent a change from
previous functioning
At least one of the symptoms is either
(1) depressed mood or
(2) loss of interest or pleasure (anhedonia)
MDD
1. Depressed mood most of the day, nearly
every day, as indicated by either subjective
report or observation made by others
2. Markedly diminished interest or pleasure in
all or almost all activities most of the day, nearly
every day
3. Significant weight loss when not dieting or
weight gain or decrease or increase in appetite
nearly every day ( 5% in one month)
MDD
4. Insomnia or hypersomnia nearly every
day
5. Psychomotor agitation or retardation
nearly everyday (observable by others not
merely subjective feelings of restlessness
or being slowed down)
6. Fatigue or loss of energy nearly every
day
MDD
7. Feelings of worthlessness or excessive or
inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or
indecisiveness, nearly every day
9. Recurrent thoughts of death, recurrent
suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing
suicide
MDD
The symptoms cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
The sx occur as a result of the d/o and not from
the effects of a substance medical condition or
loss of a loved one within the previous 2 months
There cannot be a hx of a manic episode
Types of Depression
Melancholic
Anhedonia, lack of reactivity to usual pleasurable
stimuli, psychomotor retardation, anorexia or weight
loss, EMA, guilt, depression worse in the AM
Atypical
Mood reactivity (mood brightens in response to
positive events), weight gain, hypersonia, increased
appetite and weight gain, leaden paralysis
Seasonal Affective Disorder
Episodes begin in fall or winter and remit in the spring
Pattern has occurred for 2 yrs
Dysthymic Disorder
Chronic low grade depression that does not fit
criteria for MDD
Lasts for at least 2 years
depressed mood most of the day, nearly every day
and at least 2 of the following sx:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Difficulty making decisions
Feelings of hopelessness
MDD superimposed on dysthymia = double
depression
Mnemonic: SIGECAPS
S Sleep
I Interest
G Guilty feelings
E Energy
C Concentration
A Appetite
P Psychomotor agitation or retardation
S Suicidal thoughts
Nursing Management:
Assessment
Psychological
Thought content
Suicidal behavior
Nurse-Patient Relationship
Developmental history
Family psychiatric history
Quality of support system
Role of substance abuse in relationships
Work history
Physical and sexual abuse
Social Nursing Interventions
– Bipolar II
– 1 to 5% first-degree relatives
• Psychosocial factors
– Contribute to the timing of the disorder
Treatment Issues
Complex issues treated by an
interdisciplinary team
Priority issues:
Safety from poor judgement and risk-taking
behaviors
Risk for suicide during depressive disorders