PSYCHIATRIC NURSING (Lecture Series) MOOD DISORDERS Lecture No. 4

1
PSYCHIATRIC NURSING(Lecture Series)MOOD
DISORDERSLecture No. 4

• ARNEL MARIA SALGADO y BAÑAGA
• School of Nursing Faculty of Medical Sciences
• University College Sedaya International

2
I. Overview / Classification

• Mood
• A prolonged emotional state that affects a
  persons life and personality
• Change of mood is normal and expected life
  occurrence
• Mood can easily be influenced by experience like
  watching a movie.
• Affect
• Individuals PRESENT feeling and mood
• Cue is always presented by an individual for
  their mood
• They demonstrate mood, thoughts and feelings as
  behavior

3

• C. When there are no changes in mood or the
  change is too pronounced or interferes with daily
  living, working, attention in school, or regular
  involvement in social activities, the individual
  has a mood disorder
• D. The Mood Disorders are characterized by
  changes in mood that range from depression to
  elation.
• The DSM-IV describes MD as a person experiencing
  a loss of interest in life and a depressed mood
  that moves from mild to severe and lasts at least
  2 weeks.
• Dysthymic Disorder
• A MD classified as chronic
• Depressed mood fluctuates with Normal Mood
• The sx in DD are less severe than in major
  Depression

4
MOOD RANGE
DEPRESSED MANIC
Severe Moderate Mild
Normal
Hypomanic Euphoric
BIPOLAR
Cyclothymic Disorder
Unipolar Disorder (Major Depression)
Dysthymic Disorder
5

• 3. Bipolar Disorder (manic-depressive disorder)
• Moods alternating between depression and elation
• The categories of BD are the following
• Bipolar I there is occurrence of one or more
  manic episodes and one or more depressive
  episodes
• Bipolar II less severe and has one or more
  hypomanic episodes and one or more depressive
  episodes
• Mixed (rapidly alternating moods)
• 4. Cyclothymic Disorder
• a. Also a mood disorder
• b. Client demonstrates a range of mood changes
  between moderate
• depression and hypomania
• c. The disorder last for at least 2 years
• d. There is usually no sign of normal range in
  clients with cyclothymic
• disorder

6

• 5. SAD (Seasonal Affective Disorder)
• Client exhibits a depressed mood that occurs in
  season
• Summer usually is when the client has a normal
  behavior
• There is a direct correlation with light and the
  production of melatonin in clients with SAD
• 6. Schizoaffective Disorder
• a. A combination of the signs of schizophrenia
  and those of mood
• disorders.
• b. Symptoms
• 1. Delusions
• 2. Hallucinations
• 3. Diusorganized speech
• 4. Disorganized behavior

7

• 5. Negative symptoms (anergia lack of
  activity anhedonia-
• loss of pleasure social abehavior attention
  deficits
• avolition blunted affect)
• 6. Other symptoms include communication
  difficulties,
• difficulty with abstractions, passive social
  withdrawal, poor grooming and hygiene, poor
  rapport, poverty of speech)
• 7. Major depressive symptoms or manic symptoms
  or mixed
• symptoms
• 7. Co-occuring Disorders
• a. Person who suffer from mood disorders may
  also suffer from a
• physical and psychological co-morbid
  disorder.
• b. Physical disorders can include pain,
  physical illness, stroke,
• dementia, diabetes, coronary artery disease,
  cancer, chronic
• fatigue syndrome and fibromyalgia

8

• c. Psychiatric Disorders can include alcohol
  and drug disorders, anxiety
• disorders, eating disorders, obssessive
  compulsive disorders,
• somatization disorders and personality
  disorders.
• 8. Suicide And Mood Disorders
• a. 15 of the population who experience major
  depressive
• disorders die by SUICIDE.
• b. Those who die are aged 55 and above
• c. Individuals with severe depressive disorder
  are admitted
• to nursing homes and majority of them are more
  
• like to commit suicide on their year of
  admission.
• 9. Most of the individuals with Mood Disorders go
  undiagnosed or misdiagnosed because their
  symptoms are seen as part of medical disorder and
  not explored as mood disorder or psychological
  Disorder

9
II. Etiology

• Biological causative Theories of Depressive
  Disorders
• Alteration in neurological functioning
• Correlation between CNSs neurotransmitter and
  depressive disorders (1990s)
• The following bionetic amines are identified as
  relevant to depressions are dopamine serotonin
  norepinephrine
• Also indicated are the dysregulations of
  acethyulcholine and the gamma-amninobutyric acid
  (GABA)
• Changes in these neurotransmitters can affect the
  MOOD.
• 2. Genetic Predisposition

10

• Endocrine or Hormonal Change
• Strongly affect an individuals mood and emotions
• Thyrone secretion affects also the mood
• Strong correlation between hypothalmic
  pituitary-adrenal (HPA) and MOOD.
• 4. Circadian Rhythms
• a. Changes in circadian rhythm affect the mood

11

• B. Psychological Theories
• 1. These are derived from the psychoanalytic,
  cognitive,
• interpersonal and behavioral perspectives
• 2. Psychoanalytic Perspective
• Freud believed depression occurs because of an
  ego or object loss in early life.
• He also believed the loss had a profound effect
  on the development of mental difficulties in
  later life
• Freud explained depression as anger turned
  inward.
• The loss of a person or object was usually the
  trigger of the depression
• Psychoanalysis helps (to gain insight of
  thoughts, feelings and actions)
• Insight can help anybody to regain the mental
  health state.

12

• 3. Cognitive Perspective
• Cognitive theorists believe that depression is
  the outcome when the individual perceives all
  stressful situations as negative
• The person sees situations in a negative light
  because of early life experiences of loss of
  significant people in his life and spends most of
  life believing that life is negative.
• Cognitive therapy aims to help individuals to
  learn how to perceive the worlds in a positive
  light and teach them how to relearn thinking and
  decision making based on positive rather than
  negative processing.
• The process of relearning is slow but has an
  outcome that helps the individual change his
  moment-to-moment thinking from a negative frame
  or reference to positive outlook.
• In essence, the client expels negative
  perceptions and distortions and replaces them
  with positive experiences and tools

13

• 4. Behavioral Perspective
• Emphasis Individual develops depression when
  feelings of helplessness, unworthiness and
  powerlessness are the norm during the
  developmental years
• 5. Sociological Perspective
• Emphasis Variations of the learned theory
  include stress theory and
• antipsychiatric theory
• Stress theorists believe that the individual
  becomes depressed because of an inability to
  incorporate life experiences, perceptions, social
  support, biopsychosocial powerlessness and
  occurrences of stress into life
• In contrast, antipsychiatric theorist believe
  that depression is not an abnormal state but
  rather a reaction to oppression and socioeconomic
  inequality

14
III. ASSESSMENT

• Intake Assessment
• The assessment Documentation
• Focused on Psychological Assessment Tools
• Psychometric Assessment Tools
• Beck Depression Inventory
• Geriatric Depression Scale
• Zung Self-Rating Depression Scale (SDS)

15
IV. Nursing Diagnosis / Analysis

• High risk for Violence, self-directed related to
  depressed mood, feeling of worthlessness,
  hopelessness and suicide ideation or plan.
• High risk for violence, directed at others
  related to poor impulse control and labile
  affect.
• Ineffective individual coping related to lack of
  energy, inability to concentrate or make
  decisions.
• Nutrition, altered, less /more than body
  requirements related to inappropriate nutritional
  intake to meet metabolic needs lack of interest
  in eating/food or choosing nutritional foods
  aversion to eating dysfunctional eating pattern
• Sleep pattern disturbance related to biochemical
  alterations (decrease serotonin) or psychological
  stress, lack of recognition of fatigue/need to
  sleep, hyperactivity
• Spiritual distress related to a sense of purpose
  or joy in life lack of connectedness to others
  misperceived shame and guilt.

16
V. Planning and Implementation

• Specific Treatment Modalities
• ECT
• Antidepressant Medications
• Mood Stabilizers Medications
• Group and Individual Therapies
• Cognitive, behavioral, interpersonal,
  psychodynamic, family and group therapy
• Phototherapy
• Nursing Modalities

17
PHOTOTHERAPY
18
VI. Evaluation / Outcomes

• Outcome criteria for clients suffering from mood
  disorders include long and short term behaviors
  and responses that indicate improved functioning.
• These are based on nursing diagnosis and are
  achieved through the implementation of specific
  nursing interventions.
• Outcome criteria provide the nurse with
  direction for evaluating the clients response to
  treatment and nursing care.
• Short-and-long term goals