Mood Disorders

Mood Disorders
• Depression is the oldest and most frequently
described psychiatric illness.
• Transient symptoms are normal, healthy
responses to everyday disappointments in life.
• Pathological depression occurs when
adaptation is ineffective.
 Types of Mood Disorders
• Depressive Disorders

• Bipolar Disorders

• Others
 Depressive Disorders
• Major Depressive Disorder
• Dysthymic Disorder
• Premenstrual Dysphoric Disorder
• Bipolar Disorders
Other Mood Disorders
• Mood disorder due to a general medical condition

• Substance-induced mood disorder

 Bipolar Disorders

• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
 Depression: Predisposing Factors
• Biological theories
– Genetics:
– Biochemical influences:
Neuroendocrine theories
Physiological influences
– Psychoanalytical theory
• Mourning
• Melancholia
Learning theory
Object loss
Cognitive theory
 Depression: Developmental
Implications
Childhood Depression
• Symptoms:
Adolescence
• Symptoms include:
• Senescence
Treatment
• Postpartum Depression Treatment
 Assessment

• Transient depression
• Mild depression
• Moderate depression
• Severe depression
Nursing Diagnosis
Outcome
Planning/Implementation
Client/Family Education
Evaluation
Treatment Modalities
 Antidepressants
Newer-generation antidepressants
– Selective serotonin reuptake inhibitors (SSRIs)
– Second- and third-generation antidepressants
• Tricyclic antidepressants
• Monoamine oxidase inhibitors (MAOIs)
 Contraindications/precautions
• Contraindications/precautions
– Contraindicated in known hypersensitivity (SSRIs,
MAOIs, tricyclics); acute phase of recovery from
myocardial infarction; angle-closure glaucoma
(tricyclics); and concomitant with MAOIs (SSRIs
and tricyclics).
– Caution with elderly or debilitated clients; clients
with hepatic, cardiac, or renal insufficiency;
psychotic clients; clients with benign prostatic
hypertrophy; and those with history of seizures
(tricyclics, MAOIs).
 Antidepressants- SSRI
• Generic • Brand
Fluoxetine Prozac
Paroxetine Paxil
Sertraline Zoloft
Citalopram Celexa
Escitalopram Lexapro
Fluvoxamine Luvox
 Serotonin Syndrome
• Delirium Agitation
• Tachycardia Sweating
• Hyperreflexia Muscle spasms
• Shivering Coarse tremors
More severe cases
• Hyperthermia Seizures
• Renal failure Rhabdomyolysis
• Dysrhythmias DIC
 Antidepressants
• Generic • Brand
Bupropion Wellbutrin
Mirtzapine Remeron
Venlafaxine Effexor
Duloxetine Cymbalta
Amitriptyline Elavil
Imipramine Tofranil
Phenelzine Nardil
Selegiline Emsam
 Monoamine Oxidase Inhibitor
• Nardil
• Parnate
• Marplan
• Selegiline*
*Available in a patch form called EMSAM

Hypertensive Crisis and Tyramine

 Bipolar Disorder (Mania)
Assessment
Stage I—Hypomania
Stage II—Acute mania
Stage III—Delirious mania
 Bipolar Disorder (Mania)
Childhood and Adolescence
• Lifetime prevalence of pediatric and
adolescent bipolar disorders is estimated at
about 1 percent
• Diagnosis is difficult
• Guidelines for diagnosis and treatment have
been developed by the Child and Adolescent
Bipolar Foundation (CABF)
Nursing Diagnosis
Outcomes
Planning/Implementation
Client/Family Education
Evaluation
Psychopharmacology/Mood Stabilzers

• Generic • Brand
Lithum Eskalith, Lithobid
Valproic acid Depakote, Depakene
Carbamazepine Tegretol, Equetro
Oxcarbazepine Trileptal
Lamotrigine Lamictal
Topiramate Topamax
 Planning/Implementation
• Blood levels are needed • Monitor for side effects of
for Lithium (0.4- lithium
1.2mEg/ml) – Drowsiness, dizziness,
headache
– Dry mouth; thirst; GI upset;
Depakote (4-12 mEg/ml) nausea/vomiting
– Fine hand tremors
– Hypotension; arrhythmias,
Tegretol (4-12 meg/ml) pulse irregularities
– Polyuria; dehydration
– Weight gain
--Potential for toxicity
Symbyax is a combination of
Prozac an antidepressant
and Zyprexa an atypical
major tranquilizer.
Monitor for side effects of anticonvulsants
– Nausea and vomiting
– Drowsiness; dizziness
– Blood dyscrasias
– Prolonged bleeding time (with valproic acid)
– Risk of severe rash (with lamotrigine)
– Decreased efficacy with oral contraceptives (with
topiramate
Planning/Implementation (cont.)
• Educate client and family about the
medication

Outcome Criteria/Evaluation