Mood Disorders

 Are characterized by disturbances in feelings, thinking and behavior that tend to occur
on a continuum ranging from severe depression to severe mania.

DEPRESSION
 A state in which an individual feels very sad and despondent and has no energy or sense
of future.
 Disturbances in mood as a reaction to the loss of love object

Types of depression
 Agitated depression: characterized by increased psychomotor activity
 Anxious depression: characterized by prominent patterns of anxiety
 Chronic depression: lasts longer than 2 years; about 10% of those diagnosed with
depression fall into this category
 Endogenous depression: characterized by biological cause, without known external
stressors
 Involutional depression: occurs in the person’s late 40’s and 50’s
 Masked depression: usually revealed during treatment of somatic complaints
 Paranoid depression: characterized by paranoid ideation
 Postpartum depression: can occur after childbirth, in three stages
 Within the first 3 to 4 days after delivery, the patient may begin to feel ‘blue’ and
sad
 About the 3rd week after delivery, other symptoms of depression appear; these
symptoms can last for about one year
 About 3 months after delivery, confusion and disturbances in thought processes
begin to accompany other symptoms.
 Psychotic depression: characterized by hallucinations and delusions
 Reactive depression: associated with external stressors
 Retarded depression: accompanied by decreased psychomotor activities
 Seasonal depression: occurs during a specific season of the year.
 Drug-induced depression: results from patient’s use of prescription, over-the-counter,
or other types of drugs
e.g., statins, proton pump inhibitors, H2 Blockers, stimulants, anticonvulsants,
Parkinson's drugs and many more

Causes of Depression
1. Genetic and biologic predisposition theory
 70% chance for identical twins
 15% chance for siblings, parents or children with the disorder
 7% chance for grandparents, aunts and uncles
 A dominant gene may influence an individual to react more readily to experiences of
loss or grief, thus manifesting the symptoms of depression
2. Biochemical theory
 Biogenic amine hypothesis- decreased amount of chemical compounds
norepinephrine and serotonin at the receptor sites of the brain can cause
depression.
 High level of cortisol
 Abnormally low levels of thyroid hormones may cause chronic depression
3. Psychodynamic theory
 Depressed persons are like mourners who do not make a realistic adjustment to
living without the loved one.
 In childhood, they are bereft of a parent or other loved person, usually by the
absence or withdrawal of affection.
 Any loss or disappointment later in life reactivates a delayed grief accompanied by
self-criticism, guilt, and anger turned inward.
 Because the source of the grief is unconscious (childhood), symptoms are not
resolved, but rather persist later in life.
 4. Behavioral theory: learned helplessness
 It is a formed or learned behavior, people who received little positive reinforcement
for their activity become withdrawn, overwhelmed and passive.
 The perception that things are beyond their control will promote feelings of
helplessness and hopelessness.
5. Cognitive theory
 Depressed people are convinced that they are worthless, that the world is hostile,
that the future offers no hope, and that every accidental misfortune is a judgment
of them.
6. Environmental theory
 Factors like financial hardships, physical illness, perceived or real failure, midlife
crises
 Dramatic changes in one’s life
7. Interpersonal theory
 The person is abandoned by or separated from parent early in infancy causing
incomplete bonding.
 Traumatic separation from a significant other in adulthood can be a precipitating
factor; the person then withdraws from reality and social contacts.

Risk factors for depression

 Prior episodes of depression
 Family history of depressive episodes
 Female gender
 Prior suicide attempts
 Age of onset younger than 40 years
 postpartum period
 illness
 Lack of social support
 Stressful life events
 Current use of alcohol or substance abuse
 Presence of anxiety, eating disorder, obsessive-compulsive disorder, somatization,
personality disorder, grief , adjustment reactions
 5 to 10 - moderate level
 11 plus - high level depression

Clinical symptoms of depression

1. Mild depression
 Is exhibited by affective symptoms of sadness or the ‘blues’- an appropriate
response to stress.
 The person may usually complain of physical discomfort and may be less responsive
to the environment.
 He will recover within shorter period
2. Moderate depression (dysthymia)
 Clinical symptoms are less severe compared to severe depression and do not
include psychotic manifestation
3. Major depressive disorder
 Person with this disorder may already manifests hallucination and delusion and may
appear in a person with no known reason or cause.

Diagnostic criteria for depressive disorders

Major depressive disorder

 Persons with this disorder do not experience momentary shifts from one unpleasant
mood to another.
 The clinical symptoms interfere with social, occupational, or other important areas of
functioning.
 Symptoms are not due to physiologic effect of a substance or due to a general medical
condition
Clinical symptoms of major depressive episodes
5 or more of the following symptoms have been present during the same 2-week period and
represent a change from previous functioning.
At least one of the symptoms is either depressed mood or loss of interest or pleasure.
 Depressed mood occurring most of the day, nearly everyday
 Markedly diminished interest or pleasure in all, or almost all activities most of the day
 Significant weight loss when not dieting or weight gain, or decrease or increase in
appetite nearly everyday
 Insomnia or hypersomnia nearly everyday
 Psychomotor retardation or agitation nearly everyday
 Fatigue or loss of energy nearly everyday
 Feelings of worthlessness or excessive or inappropriate guilt
 Diminished ability to think or concentrate, or indecisiveness
 Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a
suicide attempt

2. Dysthymic disorder
 Symptoms of dysthymia are similar to those of the major depressive disorder or severe
depression but are less severe.
 There is no delusion, hallucination, impaired communication or incoherence.
 Clinical symptoms usually last for 2 years or more and may be continual or may occur
intermittently with normal mood swings for a few days or weeks.
 Persons who develop dysthymic disorder are usually overly sensitive, often have intense
guilt feelings, and may experience chronic anxiety.
At least 2 or more of the ff. symptoms are present:
 Loss of appetite or overeating
 Insomnia or hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness

Diagnostic criteria for Bipolar Disorders

1. Bipolar I disorder
 Is a recurrent disorder in which the individual may experience one or more manic
episodes or mixed episodes.
 During the manic episodes, the individual exhibits an abnormal, persistently
elevated, expansive, or irritable mood that lasts for at least one week.
 Impairment in various areas of functioning, psychotic symptoms, and the possibility
of self-harm exist.
Clinical symptoms of manic episode
At least 3 or more of the following symptoms are present:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 More talkative than usual or pressure to keep talking
 Flight of ideas of subjective experience that thoughts are racing
 distractibility
 Increase in goal-oriented activity or psychomotor agitation
 Excessive involvement in pleasurable activities that have a high potential for
painful consequences

2. Bipolar II
 Is characterized by recurrent major depressive episodes with hypomania ( a mood
between euphoria and excessive elation) episodes
 Common in women
 Diagnostic criteria require that the client have a presence or history of one or more
major depressive episodes, alternating with manic episode
 3. Cyclothymic disorder
 This diagnosis is used when an individual displays numerous periods of hypomanic
symptoms and depressive symptoms that do not meet the criteria for a major
depressive episodes.
 Such symptoms occur for at least 2 years, during which they do not subside for
more than 2 months.

Medications correlated with depression

 Analgesics, non-steroidal anti-inflammatory drugs: narcotics, ibuprofen, indomethacin
 Antimicrobials: sulfonamides and isoniazid
 Anti-neoplastic agents: asparaginase and tamoxifen
 Antiparkinsonian agents: levodopa and amantadine
 Cardiac medications and anti-hypertensives: digoxin, propranolol, methyldopa,
clonidine, and hydralazine
 Central nervous system agents: alcohol, benzodiazepines, haloperidol, barbiturates, and
fluphenazine
 Histamine blockers; cimetidine and ranitidine
 Steroids: corticosteroids and estrogens

Medical illnesses
 Central nervous system: Parkinson’s disease, strokes, tumors, hematoma, neurosyphilis,
and normal pressure hydrocephalus
 Nutritional deficiencies: folate or B12, pernicious anemia, and iron deficiency
 Cardiovascular disturbances: congestive heart failure, and acute and sub-acute bacterial
endocarditis.
 Metabolic and endocrine disorders: diabetes, hypothyroidism or hyperthyroidism,
hypoglycemia or hyperglycemia, parathyroid disorders, adrenal diseases, and hepatic or
renal disease
 Fluid and electrolyte disturbances: hypercalcemia, hypokalemia
 Infections: meningitis, viral pneumonia, hepatitis and urinary tract infections.

Planning and implementation for depressive disorders

 Facilitate adequate nutrition e.g. provide smaller or larger portions, consider food
preferences, stay with the patient during meals.
 Assist the patient in developing a daily schedule that balances activity and rest.
 Promote sleep with daily exercise and activities and bedtime relaxation interventions.
 Assist with hygiene and grooming as needed
 Have brief, therapeutic interactions with the patient
 Don’t force conversation, but encourage participation in social interaction and activity.
 Assist the patient to identify feelings and reduce negative cognition.
 Institute suicide precaution as necessary.
 Facilitate successful problem solving and reinforcement by structuring simple,
manageable tasks.
 Administer anti-depressant medications as ordered.

Planning and implementation for bipolar disorders

 Promote adequate nutrition e.g. offer the patient high-calorie foods that can be eaten
‘on the run’; stay with the patient during meals.
 Reduce stimulation throughout the day, especially during bedtime.
 Promote rest periods; enhance relaxation e.g. reduce noise, promote quiet time
 Assist with self-care as necessary
 Promote bowel regularity through adequate dietary roughage, adequate fluid intake,
and establish a regular schedule for defecation.
 Provide the patient with simple tasks that focus attention and yield successful
completion.
 Assist the patient to think through consequences of behavior and to control his
behavior.
 Provide a safe environment and patient monitoring to reduce the risk of accidents and
injury.
 Administer lithium as ordered.