mood disorde

8/2/2019 mood disorde

1/38

Click to edit Master subtitle style

3/23/12

MOOD DISORDERS


2/38

3/23/12

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.


3/38

3/23/12

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


4/38

3/23/12

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.


5/38

3/23/12

MAJOR DEPRESSIVE

DISORDER

PredisposingFactors:

qPhysiological

a. Genetic: Numerous


6/38

3/23/12

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.


7/38

3/23/12

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.


8/38

3/23/12

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.


9/38

3/23/12

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.


10/38

3/23/12

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.


11/38

3/23/12

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


12/38

3/23/12

B. Pharmacotherapy

1. Fluoxetine (Prozac)

2. Imipramine (Tofranil)

3. Phenelzine (Nardil)


13/38


14/38

3/23/12

Example: RISK FOR SUICIDE

Related/Risk Factors (related to)

Depressed mood

Feelings of worthlessness

Irrational feelings of guilt

Numerous failures

Hopelessness

HallucinationsDelusional thinking


15/38

3/23/12

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?


16/38

3/23/12

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.


17/38


18/38

3/23/12

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


19/38

3/23/12

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.


20/38

3/23/12

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.


21/38

3/23/12

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


22/38

3/23/12

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.


23/38

3/23/12

Hypomanic Episode

qIs almost similar to mania but withless severe level of impairment.

qNot severe enough to cause majorproblems in school, work, or home.


24/38

3/23/12

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


25/38


26/38

3/23/12

Common Nursing Diagnoses andInterventions for Mania:

RISK FOR INJURYIMBALANCED NUTRITION: LESS THAN BODY

REQUIREMENTS

DISTURBED THOUGHT PROCESSESDISTURBED SENSORY PERCEPTION

IMPAIRED SOCIAL INTERACTION

INSOMNIA


27/38

3/23/12

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


28/38

3/23/12

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


29/38

3/23/12

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.


30/38

3/23/12

Outcome Criteria

Client is no longer exhibiting signs of physical

agitation.Client exhibits no evidence of physical injury.


31/38

3/23/12

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.


32/38

3/23/12

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.


33/38

3/23/12

Common symptoms:

Nausea and vomiting Dizziness

Shortness of breath Dysmenorrhea

Chest pain


34/38

3/23/12

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.


35/38

3/23/12

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


36/38

3/23/12

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


37/38


38/38

3/23/12

THANK YOU

mood disorde

Documents