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MOOD DISORDERS
• Associated with severe and painful sadness or abnormal elevated mood.
• Changes a person’s behavior, cognition, motivation, and emotions;
• Most common psychiatric diagnosis:
– 5% of people have mood disorder;
– 25% of people with depression have a family member with mood disorder;
– 50% of people with bipolar disorder have a family member with mood disorder;

• Two Diagnostic Categories:

1. Major Depressive Disorder (MDD)

• A person experiences one or more episodes of depression with no manic or
hypomanic manifestations;
• Twice as many women than men;
• Onset is usually early to mid 20’s;

2. Bipolar Disorders
• A person experiences major depression with one or more manic or hypomanic
episodes;
• Female and male ratio is the same;
• Onset is usually mid to late 20’s (late adolescence to early adulthood)
• High prevalence among professionals and well-educated persons;

MAJOR DEPRESSION
• Is one of the most prevalent mental health problem within the US;
• Depressive symptoms are experienced by 9-20% of adult persons, and half of these
persons will develop clinical depression within a year;
• About 80% will eventually have recurrent episodes;
• In elderly, 6 – 12% have depression (MELANCHOLIC DEPRESSION)
• Children of parents who suffered from depression are at risk to develop the disorder;
• The onset of childhood depression predisposes a child to develop recurrent adult
depression;

• Events that will predispose children and adolescent to depression:

• Loss of parents
• Death of very important persons
• Death of a beloved pet
• Move to another neighborhood or town
• Academic problems or failures
• Physical illness or injury

• THEORIES OF DEPRESSION:
a. Biochemical Theory
• Decreased norepinephrine and serotonin.
• Alterations in the functions of the hypothalamic-pituitary-adrenal system may
cause depression;
• Alterations in the circadian rhythm (wake-sleep cycle) will cause problem with
sleep patterns, arousal, activity, and hormonal secretions;

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b. Psychodynamic or Psychoanalytical Theory

 Depression occurs as a result of a person’s ego loss in relationship to early life
occurrences;
 Anger inappropriately directed TO SELF often triggered by the loss of a loved
one or object.
 Unresolved grieving in the early stage of child-parent relationship;

c. Cognitive Theory
 Depression results when a person perceives all stressful situations as being
negative;
 Reacts to all situations as if they are stressful and relate himself or others in a
negative light;
 Arise from negative experiences during childhood such as loss of loved ones,
leaving home, or divorce;

d. Interpersonal Theory
 Person’s difficulties, coping with individuals, life events, and life changes can
be stressful and may lead to depression;
 Role dispute, social isolation, prolonged grief reaction, and role transition are
major interpersonal themes;

e. Behavioral Theory
 Depression develops when one feels helpless and unworthy

f. Sociological Theory
 Stated that depression is caused by abnormal medical, social learning, and
stress and response mechanism by an individual;

DSM-IV Criteria for Major Depression:

1. DEPRESSED MOOD
2. ANHEDONIA
3. Sleep disturbances
4. Possible weight loss or weight gain.
5. Fatigue or energy loss.
6. Reduced recognition and concentration;
7. Psychomotor agitation – increase or decrease activities;
8. Feelings of worthlessness or guilt;
9. Recurrent death or suicidal thoughts;

 Symptoms must persists for a minimum of 2 weeks.

 A person must have at least 5/9, one of which is a depressed mood or anhedonia.

Types of Depression:
1. Atypical Depression
• Mood disturbance that occurs in younger populations;
• May involve other mental conditions such as schizophrenia;
• Char by increased appetite, weight gain, hypersomnia, leaden paralysis, and
extreme sensitivity to interpersonal rejection;

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2. Melancholic or Endogenous Depression

• Occurring most often in older persons (at least 40 years old)
• Char by anhedonia and an inability to be cheered up;

3. Postpartum Depression
• Symptoms of depression occurs in the first 30 days postpartum but may last for
one year;

4. Psychotic Depression
 Manifests with signs of depression accompanied by delusions and hallucinations;

5. Seasonal Affective Disorder (SAD)

 Depression occurring in relation to seasonal change most often beginning in fall or
winter and remitting in spring;

6. Chronic Depression
 About 10% of depressed patients will fall under this category;
 Depression last longer than two years;

7. Paranoid Depression
 Patient have depressed symptoms with paranoid ideation;

8. Drug-induced Depression
 Depression developed due to use of prescription, OTC, or other types of drugs;

9. Retarded Depression
 Depression manifested by decreased psychomotor activities;

10. Dysthymic Disorder

• Depressed mood with 3 other signs of depression.
• Duration is at least 2 years.

Diagnostic Examinations related to Depression:

1. Dexamethasone Suppression Test (DST)
• A positive result occurs when serum and urinary cortisol do not fall or not
suppressed;

2. Growth Hormone determination

• Some depressed children may have decreased secretion of GH during the day and
increased secretion while asleep;

3. Polysomnographic Patterns
• In depressed adults, the REM phase is shortened which result in frequent night
and early morning awakening;

4. Thyrotropin-releasing Hormone Test

• In depressed persons, thyroid hormone secretions are decreased;

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Management:
A. Nurse Interventions
 Assess px for signs of suicide.
 Create a safe and structured environment.
 Accept the patient who they are, where they are, and focus on their strengths;
 Reinforce decision making by patients;
 Never reinforce hallucinations or delusions;
 Respond to anger therapeutically;
 Spend time with withdrawn patients;
 Make decisions for patients that are not yet ready to make decisions;
 Involve px in activities in which they can experience success and increase in self-
esteem;
 Monitor px for cheeking or hoarding of drugs;
 Assess px for adverse drug reactions;
 Assess for signs of toxicity;

B. Psychotherapy
C. Behavioral therapy
D. Cognitive therapy
E. Electroconvulsive therapy
F. Pharmacotherapy
1. SSRI – Fluoxetine
2. TCA – Imipramine
3. MAOI – Phenelzine

BIPOLAR DISORDERS
• Also known as manic-depressive disorder;
• Characterized by episodes of mania and depression with periods of normal mood and
activity in between;
• Bipolar disorders are those in which individuals experience the extremes of mood polarity
like he/she may feel very euphoric or very depressed;
• Bipolar disorders appear equally common among men and women;
• In men, the first episode is usually of manic manifestations;
• In women, it is depressive symptoms that come first before the manic signs;

THEORIES OF MANIA:
1. Psychodynamic Theory
• Faulty family relationship and communication during early life are responsible for
manic behaviors in later life;
• Manic behaviors are defense against or massive denial of depression;

2. Biological Theory
• Related to excessive levels of neurotransmitters such as norepinephrine,
serotonin, and dopamine.
• High consideration is also given to genetic considerations (twins and with family
history)

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Clinical Manifestations of Mania:

1. ELEVATED MOOD
2. Loud and rapid speech
3. Flight of ideas
4. Anger
5. Distractibility
6. Grandiosity or inflated self-esteem
7. Increase irritability
8. Hyperactivity
9. Anorexia
10. Insomnia
11. Pleasurable activity involvement
12. Hypersexuality
13. Resistance to treatment
14. Depression and delusion
15. Labile mood and lack of illness awareness

Types of Bipolar Disorders:

• Bipolar I

• Bipolar II

• Cyclothymic Disorder

Management:
A. Nursing Management
o Create a safe environment.
o Reduce environmental stimuli.
o Limit the patient’s participation in group activities.
o Provide clear and concise comments and directions.
o Provide physical exercise as a substitute for increased motor activity.
o Reinforce reality especially if the px have altered perception.
o Provide positive feedback for socially acceptable behaviors.
o Monitor sleeping and eating patterns.
 High-protein, high-caloric “finger foods”
 Avoid stimulants like caffeine or cola.

o Assist the px to focus on a single task.

o Encourage rest periods.

B. Pharmacotherapy
– Antimanic Drugs
• Lithium carbonate
• Carbamazepine
• Valproic acid

– Anxiolytics

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– Antipsychotics

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