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3/23/12
MOOD DISORDERS
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Learning Outcomes:
After completing this lecture, the student
will be able to: Define mood, depressive disorders and
bipolar disorders.
Identify predisposing factors of majordepressive disorders.
Discuss clinical manifestations of MDD.
List types of bipolar disorders.
Identify predisposing factors & clinicalmanifestations of mania.
Discuss nursing management of mood
disorders.
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Definition of mood:
Mood is defined as an individuals sustainedemotional tone, which significantly
influences behavior, personality, andperception.
Mood disorders are classified as:
Depressive disorderBipolar disorder
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Depressive Disorders:
Major depressive disorder is described as a
disturbance of mood involving depression or lossof interest or pleasure in the usual activities andpastimes. There is evidence of interference insocial and occupational functioning for at least 2
weeks.
Bipolar Disorders
These disorders are characterized by moodswings from profound depression to extremeeuphoria (mania), with intervening periods ofnormalcy.
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MAJOR DEPRESSIVE
DISORDER
PredisposingFactors:
qPhysiological
a. Genetic: Numerous
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d. Medication Side Effects: A number of drugscan produce a depressive syndrome as a side
effect. (anxiolytics, antipsychotics, sedative-hypnotics .and antihypertensive)
e. Other Physiological Conditions: Depressivesymptoms may occur in the presence of electrolytedisturbances, nutritional deficiencies, and withcertain physical disorders, such as cardiovascular
accident, systemic lupus erythematosus, hepatitis,and diabetes mellitus.
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qPsychosocial:
a. Psychoanalytical:Freud observed that it
occurs after the loss of a loved object, eitheractually by death or emotionally by rejection.
b. Cognitive: depressive illness occurs as aresult of impaired cognition. Disturbed thoughtprocesses foster a negative evaluation of self bythe individual. The perceptions are of inadequacy
and worthlessness.
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c. Learning Theory: depressive illness ispredisposed by the individuals belief that there is a
lack of control over his or her life situations.
d. Object Loss Theory: depressive illness occursas a result of having been separated from, asignificant other during the first 6 months of life.
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Clinical Manifestations of MDD
Sadness, helplessness, andhopelessness.
Thoughts are slowed and concentrationis difficult.
Obsessive ideas is common.
Psychotic features such as hallucinationsand delusions may be evident.
There is evidence of weakness and
fatigue.
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Some individuals may be inclinedtoward excessive eating and drinking,
whereas others may experienceanorexia and weight
loss
Sleep disturbances are common, suchas insomnia.
Verbalizations are limited.
Social participation is diminished.
Psychomotor retardation, increase or
decrease activities.
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Management:
A. Nurse Interventions
D drugs
E expression of feelings
P patient involvement in physical activities
R reinforce decision making
E never reinforce hallucination or delusions
S suicide precaution
S safe environment
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B. Pharmacotherapy
1. Fluoxetine (Prozac)
2. Imipramine (Tofranil)
3. Phenelzine (Nardil)
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Example: RISK FOR SUICIDE
Related/Risk Factors (related to)
Depressed mood
Feelings of worthlessness
Irrational feelings of guilt
Numerous failures
Hopelessness
HallucinationsDelusional thinking
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Goals/Objectives
Client will seek out staff when feeling urge toharm self.
Client will not harm self.
Interventions:
Create a safe environment for the client.Formulate a short-term verbal or written contract
with the client that he or she will not harm selfduring specific time period.
Ask client directly: Have you thought aboutharming yourself in any way? If so, what do youplan to do? Do you have the means to carry outthis plan?
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Secure promise from client that he or she willseek out a staff member or support person ifthoughts of suicide emerge.
Maintain special care in administration ofmedications.
Maintain close observation of client.
Encourage verbalizations of honest feelings.
Encourage client to express angry feelingswithin appropriate limits.
Most important, spend time with client. Thisprovides a feeling of safety and security.
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Bipolar Disorders
Bipolar I Disorder:A full syndrome of manic ormixed symptoms. The clientmay also have experiencedepisodes of depression.
Bipolar II Disorder
Recurrent bouts of major
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Predisposing Factors
BiologicalA. Genetics: If one parent has bipolar disorder,
the risk that a child will have the disorder
is around 28 percent . If both parents have the
disorder, the risk is two to three times as great.
B. Biochemical: It has also been suggested thatmanic individuals have increased intracellularsodium and calcium.
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Physiological
A. Neuroanatomical Factors. Enlarged thirdventricles and subcortical white matter inclients with bipolar disorder.
B. Medication Side Effects. The most common
of these are the steroids frequently used to
treat chronic illnesses such as multiple
Sclerosis and systemic lupus erythematosus.
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Clinical manifestations of mania
qThe affect of a manic individual is one of elation
and euphoria. However, the affect may changequickly to hostility.
q Alterations in thought processes andcommunication patterns are manifested by the
following:
Flight of Ideas. There is a continuous, rapidshift from one topic to another.
Delusions of Grandeur. The individualbelieves he is important, powerful, with feelingsof greatness and magnificence.
Delusions of Persecution. The individual
believes someone or something desires to harm
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q Motor activity is constant.
q Dress is often inappropriate: bright colors;
clothing inappropriate for age ; excessivemakeup and jewelry.
q Anorexia, despite excessive activity level.
q Pt is unwilling to stop moving in order to eat.q Sleep patterns are disturbed. Insomnia.
q Individual spends large amounts of money,which is not available, on numerous items, whichare not needed.
q Projection is a major defense mechanism
qThere is an inability to concentrate.
q hallucinations.
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Hypomanic Episode
qIs almost similar to mania but withless severe level of impairment.
qNot severe enough to cause majorproblems in school, work, or home.
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Management:
A. Nursing intervention:
M - Maintain a safe environment.
Monitor sleeping pattern.A - Always limit group activities.
N - Never reinforce altered
perceptions and delusions.
I - Institute motor programs (running,walking)
A - Avoid stimulants. Provide finger
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Common Nursing Diagnoses andInterventions for Mania:
RISK FOR INJURYIMBALANCED NUTRITION: LESS THAN BODY
REQUIREMENTS
DISTURBED THOUGHT PROCESSESDISTURBED SENSORY PERCEPTION
IMPAIRED SOCIAL INTERACTION
INSOMNIA
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Example: Risk for injury:
Related/Risk Factors (related to):
Extreme hyperactivity
Destructive behaviors
Hitting head (hand, arm, foot, etc.) against wallwhen angry
Increased agitation and lack of control overpurposeless, and potentially injurious,
movements
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Goals/Objectives:
Client will experience no physical injury.
Interventions:
Reduce environmental stimuli. Assignprivate room, if possible, with softlighting, low noise level, and simpleroom decor.
Assign to quiet unit.
Limit group activities. Help client try toestablish one or two close relationships.
Remove hazardous objects and
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Stay with the client to offer support and providea feeling of security as agitation grows.
Provide structured schedule of activities thatincludes established rest periods throughout theday.
Provide physical activities as a substitution for
purposeless hyperactivity (Examples: briskwalks, housekeeping, dance therapy, aerobics.)
Administer tranquilizing medication, as orderedby physician. Antipsychotic drugs.
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Outcome Criteria
Client is no longer exhibiting signs of physical
agitation.Client exhibits no evidence of physical injury.
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Somatoform Disorders
Complains of physical symptoms orillness for which no organic orphysiologic cause can be identified.The symptoms are severe enough
to interfere with patients ability todo social or occupational activities.
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Types of somatoform disorders
qSomatization Disorder:
These individuals verbalizerecurrent, frequent, and multiplesomatic complaints for severalyears without physiologic cause.
Onset of the disorder is usually inadolescence or early adulthood and ismore
common in women than in men.
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Common symptoms:
Nausea and vomiting Dizziness
Shortness of breath Dysmenorrhea
Chest pain
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qPain Disorder:
severe and prolonged pain thatcauses clinically significant distressor impairment in social,occupational, or other importantareas of functioning.
This diagnosis is made whenpsychological factors have been
judged to have a major role in the
onset.
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qHypochondriasis:
It is an unrealistic preoccupation
with the fear of having a seriousillness. This fear arises out of anunrealistic interpretation of physical
signs and symptoms.
qConversion Disorder:
Conversion disorder is a loss of orchange in body function resultingfrom a psychological conflict
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The most common conversion symptoms arethose that suggest neurological disease such asparalysis, seizures, coordination disturbance,
blindness and anosmia.
qBody Dysmorphic Disorder
Exaggerated belief that the body is deformed ordefective in some specific way. The most commoncomplaints involve imagined or slight flaws of the
face or head, such as thinning hair, acne,wrinkles, scars, vascular markings, facial swellingor asymmetry, or excessive facial hair
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THANK YOU