chapter 15 mood disorders part i

Chapter 15Chapter 15

Mood Disorders

Part I

IntroductionIntroduction

Depression is the oldest and most frequently described psychiatric illness.

Transient symptoms are normal, healthy responses to everyday disappointments in life.

Introduction (cont.)Introduction (cont.)

Pathological depression occurs when adaptation is ineffective.

EpidemiologyEpidemiology

Affects almost 10 percent of the population, or 19 million Americans, in a given year

Considered to be the “common cold” of psychiatric disorders

Epidemiology (cont.)Epidemiology (cont.)

Gender prevalence Higher in women than in men by about 2 to 1 Incidence of bipolar disorder is roughly equal


Age Depression more common in young

women than in older women; has a tendency to decrease with age

Opposite is true for men Studies of bipolar disorder suggest median

age at onset of bipolar disorder is 18 years in men and 20 years in women


Social class: There is an inverse relationship between social class and report of depressive symptoms; the opposite is true with bipolar disorder.

Seasonality: Affective disorders are more prevalent in the spring and in the fall.


Race: No consistent relationship between race and affective disorder reported

Marital status: Single and divorced people more likely to experience depression than married people

Types of Mood DisordersTypes of Mood Disorders

Depressive disorders Major depressive disorder Dysthymic disorder Premenstrual dysphoric disorder

Bipolar disorder Bipolar I disorder Bipolar II disorder Cyclothymia

Major Depressive DisorderMajor Depressive Disorder

Characterized by depressed mood Loses interest or pleasure in usual activities Social and occupational functioning impaired

for at least 2 weeks No history of manic behavior Cannot be attributed to use of substances or

a general medical condition

Dysthymic DisorderDysthymic Disorder Sad or “down in the dumps” No evidence of psychotic symptoms Essential feature is a chronically depressed

mood for Most of the day More days than not For at least 2 years

Premenstrual Dysphoric DisorderPremenstrual Dysphoric Disorder Essential Features

Depressed mood Anxiety Mood swings Decreased interest in activities

Symptoms occur during the week prior to menses and subside shortly after onset of menstruation

Bipolar DisordersBipolar Disorders

Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy

Delusions or hallucinations may or may not be part of clinical picture

Onset of symptoms may reflect seasonal pattern

Bipolar I DisorderBipolar I Disorder

Individual is experiencing, or has experienced, a full syndrome of manic or mixed symptoms

May also have experienced episodes of depression

Bipolar II DisorderBipolar II Disorder

Recurrent bouts of major depression Episodic occurrences of hypomania Has not experienced an episode that meets the

full criteria for mania or mixed symptomatology

Other Mood DisordersOther Mood Disorders

Due to general medical condition Substance-induced mood disorder

Etiological Implications-Depressive DisordersEtiological Implications-Depressive Disorders

Biological theories Genetics: Hereditary factor may be

involved Biochemical influences: Deficiency of

norepinephrine, serotonin, and dopamine has been implicated

Etiological Implications-Depressive Disorders (cont.)Etiological Implications-Depressive Disorders (cont.)

Biological theories (cont.) Neuroendocrine disturbances

Possible dysfunction within the hypothalamic-pituitary-adrenocortical axis

Possible diminished release of thyroid-stimulating hormone


Physiological influences Medication side effects Neurological disorders Electrolyte disturbances Hormonal disorders Nutritional deficiencies


Physiological conditions (cont.)

Secondary depression related to: Collagen disorders (e.g., SLE) Cardiovascular disease Infections (e.g., hepatitis, pneumonia, syphilis) Metabolic disorders (e.g., diabetes mellitus)


Psychosocial theories

Psychoanalytical theory (Freud) Mourning Melancholia Follows loss of a loved object


Learning theory Learned helplessness: Repeated failure to

control life, leading to defeat and dependence on others, resulting in predisposition to depression

Etiological Implications-Depressive Disorders (cont.) Etiological Implications-Depressive Disorders (cont.)

Object loss theory Experiences loss of significant other during

first 6 months of life Early loss or trauma may predispose client

to episodes of depression in response to losses later in life


Cognitive theory: Beck Primary disturbance in depression is cognitive

rather than affective Three cognitive distortions serve as basis for

depression Negative expectations about

Environment Self Future


Theoretical Integration

Etiology of depression likely due to multiple influences of Genetics Biochemical Psychosocial

Developmental ImplicationsDevelopmental Implications

Childhood Depression Symptoms:

<age 3: feeding problems, tantrums, lack of playfulness and emotional expressiveness Ages 3 to 5: accident proneness, phobias,

excessive self-reproach Ages 6 to 8: physical complaints,

aggressive behavior, clinging behavior Ages 9 to 12: morbid thoughts and

excessive worrying

Developmental Implications (cont.)Developmental Implications (cont.)Childhood Depression (cont.) Precipitated by a loss Focus of therapy: alleviate symptoms and

strengthen coping skills Parental and family therapy

Developmental Implications (cont.)Developmental Implications (cont.)

Adolescence Symptoms include:

Anger, aggressiveness Running away Delinquency Social withdrawal Sexual acting out Substance abuse Restlessness; apathy


Adolescence (cont.) Best clue that differentiates depression from

normal stormy adolescent behavior: A visible manifestation of behavioral change that

lasts for several weeks Most common precipitant to adolescent suicide:

perception of abandonment by parents or close peer relationship


Senescence Bereavement overload High percentage of suicides among elderly Symptoms of depression often confused with

symptoms of dementia Treatment

Antidepressant medication Electroconvulsive therapy Psychosocial therapies

Developmental Implications (cont.)Developmental Implications (cont.)Postpartum Depression May last for a few weeks to several months Associated with hormonal changes, tryptophan

metabolism, or cell alterations Treatments: antidepressants and psychosocial

therapies Symptoms include:

Fatigue Irritability Loss of appetite Sleep disturbances Loss of libido Concern about inability to care for infant

Nursing Process/AssessmentNursing Process/Assessment

Transient depression Symptoms at this level of the continuum

not necessarily dysfunctional Affective: The “blues” Behavioral: Certain amount of crying

AssessmentAssessment

Transient depression (cont.) Cognitive: Some difficulty getting mind off

one’s disappointment Physiological: Feeling tired and listless

Assessment (cont.)Assessment (cont.)

Mild depression Symptoms with normal grieving are

identified by clinicians as associated with normal grieving

Affective: Anger, anxiety, sadness Behavioral: Tearful, regression


Mild depression (cont.) Cognitive: Preoccupied with loss; self-

blame and blaming of others Physiological: Anorexia or overeating,

sleep disturbances, somatic symptoms


Moderate depression Symptoms associated with dysthymic disorder Affective: Helpless, powerless Behavioral: Slow physical movement,

slumped posture, limited verbalization


Moderate depression (cont.) Cognitive: Retarded thinking processes,

difficulty with concentration Physiological: Anorexia or overeating,

sleep disturbances, somatic symptoms, feeling best early in morning and worse as the day progresses


Severe depression Includes symptoms of major depressive

disorder and bipolar depression Affective: Feelings of total despair,

worthlessness, flat affect, apathy, anhedonia

Behavioral: Psychomotor retardation, curled-up position, no interaction with others


Severe depression (cont.) Cognitive: Prevalent delusional thinking,

with delusions of persecution and somatic delusions; unable to concentrate; confusion

Physiological: A general slow-down of the entire body, anorexia, insomnia, feels worse early in morning and somewhat better as the day progresses

Diagnosis/Outcome IdentificationDiagnosis/Outcome Identification

Risk for suicide related to: Depressed mood Feelings of worthlessness Anger turned inward on the self Misinterpretations of reality

Nursing DiagnosisNursing Diagnosis

Dysfunctional grieving related to: Real or perceived loss Bereavement overload, evidenced by

denial of loss Inappropriate expression of anger Idealization of or obsession with

lost object

Nursing Diagnosis (cont.)Nursing Diagnosis (cont.) Low self-esteem related to:

Learned helplessness Feelings of abandonment by significant

others Impaired cognition fostering negative view

of self

Nursing Diagnosis (cont.)Nursing Diagnosis (cont.)

Powerlessness related to: Dysfunctional grieving process Lifestyle of helplessness, evidenced by

feelings of lack of control over life situation


Spiritual distress related to: Dysfunctional grieving over loss of valued

object evidenced by anger toward God Questioning meaning of own existence Inability to participate in usual religious

practices


Social isolation/Impaired social interaction related to: Developmental regression Egocentric behaviors Fear of rejection or failure of the interaction


Disturbed thought processes related to: Withdrawal into self Underdeveloped ego Punitive superego Impaired cognition fostering negative

perception of self or environment

Other Nursing DiagnosesOther Nursing Diagnoses

Imbalanced nutrition less than body requirements

Disturbed sleep pattern Self-care deficit

Criteria for Measuring OutcomesCriteria for Measuring Outcomes

The client Has experienced no physical harm to self Discusses the loss with staff and family

members No longer idealizes or obsesses about the

lost object

OutcomesOutcomes

The client (cont.) Sets realistic goals for self Is no longer afraid to attempt new activities Is able to identify aspects of self-control

over life situation

Outcomes (cont.)Outcomes (cont.)

The client (cont.) Expresses personal satisfaction with and

support from spiritual practices Interacts willingly and appropriately with

others Is able to maintain reality orientation Is able to concentrate, reason,

and solve problems

Planning/ImplementationPlanning/Implementation

Nursing Interventions are aimed at: Maintaining client safety Assisting client through grief process Promoting increase in self-esteem Encouraging client self-control and control

over life situation Helping client to reach out for spiritual

support of choice

Client/Family Education Client/Family Education

Nature of the illness Stages of grief and symptoms associated

with each stage What is depression? Why do people get depressed? What are the symptoms of depression?

Client/Family Education (cont.) Client/Family Education (cont.)

Management of the illness Medication management Assertive techniques Stress management techniques Ways to increase self-esteem Electroconvulsive therapy

Client/Family Education (cont.) Client/Family Education (cont.)

Support services Suicide hotline Support groups Legal/financial assistance

Nursing Process/EvaluationNursing Process/Evaluation

Evaluation of the effectiveness of nursing interventions is measured by fulfillment of the outcome criteria.

Evaluation Evaluation

Has self-harm to the client been avoided?

Have suicidal ideations subsided? Does the client know where to seek

assistance outside the hospital when suicidal thoughts occur?

Evaluation (cont.) Evaluation (cont.)

Has the client discussed the recent loss with the staff and family members?

Is he or she able to verbalize feelings and behaviors associated with each stage of the grieving process and recognize own position in the process?

Evaluation (cont.)Evaluation (cont.)

Has obsession with and idealization of the lost object subsided?

Is anger toward the lost object expressed appropriately ?

Does client set realistic goals for self?

Evaluation (cont.)Evaluation (cont.)

Is he or she able to verbalize positive aspects about self, past accomplishments, and future prospects?

Can the client identify areas of life situation over which he or she has control?

chapter 15 mood disorders part i

Documents

bipolar disorders

onset of bipolar disorder

incidence of bipolar

disorder cyclothymia

age depression

affective disorders

profound depression

secondary depression