Mood disorder Slideshare

Mood disorder characterized by disturbance of mood. it includes mania or depressive syndrome. it includes definition, causes, sign and symptoms, treatment and nursing diagnosis etc.

1. BY- PREETI SHARMA MSC. NSG. 1 st YEAR MOOD DISORDER

2. Mood disorders are characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome, which is not due to any other physical or mental disorder. Mood disorder is a mental health problem that primarily affects a person's emotional state. It is a disorder in which a person experiences long periods of extreme happiness, extreme sadness, or both. It is normal for someone's mood to change, depending on the situation. INTRODUCTION:-

3. F30- F39 Mood disorders F30 Manic episode F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F34 Persistent mood disorder F38 Other mood disorder F39 Unspecified mood disorder CLASSIFICATION OF MOOD DISORDERS

4. MANIC EPISODE

5. Mania is an affective disorder with consistent elevated mood with increased physical and mental activity present in an individual at least for few days or a week. When the mood is elevated that person seems to be cheerful optimistic, irritable easily become violent. DEFINITION:

6. Manic types are classified into three stages- CLASSIFICATION:

7. The exert mechanism by which mania occurs is not yet known. Biological Factors Genetic Monozygotic twins Bio chemical Factors Excess Level of norepinephrine and dopamine Social pressures Environmental influence Sociocultural factor ETIOLOGY:

8. CLINICAL FEATURES: Elevated, expansive or irritable mood Psychomotor activity Speech and thought Goal-directed activity Other features

9. The elevated mood can pass through 4 stages: Euphoria (mild elevation of mood) an increased sense of psychological well-being and happiness Hypomania (stage I) Elation (mod elevation of mood) A feeling of confidence and enjoyment, increase in psychomotor activity Mania (stage II) Exaltation (sev elevation of mood) Intense elation with delusion of grandeur Severe mania (stage III) Ecstasy (very sev elevation of mood) Intense sense of rapture or blistfullness Stupurous mania (stage III)

10. History collection Mental status examination Psychological tests such as young mania rating scale Based on sign and symptoms DIAGNOSTIC EVALUATION:

11. TREATMENT: PHARMACOTHERAPY ELECTROCONVULSIVE THERAPY (ECT) PSYCHOSOCIAL TREATMENT

12. Mood stabilizers: Lithium (900-2100mg/day) Carbamazepine (600-1800mg/day) Sodium valproate (600-2600mg/day) Antipsychotics: Olanzapine Chlorpromazine Haloperidole Sedtives /Hypnotics: Benzodiazepines ( lorazepam , clonazepam ) 1. Pharmacotherapy:

13. ECT can also be used for acute manic excitement if not adequately responding to antipsychotics and lithium. 2 . Electroconvulsive therapy (ECT):

14. Family and marital therapy is used to decrease interfamilial and interpersonal difficulties and to reduce or modify stressors. The main purpose is to ensure continuity of treatment and adequate drug compliance. 3. Psychosocial treatment:

15. DEPRESSIVE EDPISODE

16. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. DEFINITION :

17. Mild depressive episode Moderate depressive episode Severe depressive episode CLASSIFICATION

18. BIOLOGICAL THEORIES: Neurochemical like norepinephrine and serotonin level is decreased Genetic factors Changes in the body’s balance of hormones SOCIOLOGICAL THEORIES: Stressful life events e.g. death, marriage, financial loss ETIOLOGY:

19. PSYCHOSOCIAL THEORIES: According to Freud (psychoanalytic theory) due to loss of a loved object. In this model, mania is viewed as a denial of depression. According to behaviour theory of depression connects depressive phenomena to the experience of uncontrollable events. CONT…

20. A typical depressive episode is characterized by following features, which should last for at least 2 weeks. Depressed mood: Sadness of mood Loss of interest Suicidal thoughts CLINICAL FEATURES:

21. Depressive cognitions: Hopelessness Helplessness Worthlessness Unreasonable guilt Self blame   Psychomotor activity: Think, walk and act slowly Answered after a long delay Feeling of uneasiness Psychotic features: Hallucination present Nihilistic delusions , delusion of poverty and delusion of guilt is present CONT…

22. History collection Mental status examination Psychological tests such as Hamilton rating scale for assess severity of depression Dexamethasone suppression test showing failure to suppress cortisol secretions in depressive patient DIAGNOSTIC EVALUATION:

23. TREATMENT: PSYCHO PHARMACOLOGY PHYSICAL THERAPIES PSYCHOSOCIAL TREATMENT

24. Selective serotonin reuptake inhibitors (SSRI S ) like Citalopram , fluoxetine Tricyclic antidepressants (TCA s ) like Amitriptyline , Imipramine , Doxepin Monoamine oxidase inhibitors (MAOI S ) Isocarboxazid , phenelzine 1. Psychopharmacology:

25. ECT Therapy : Severe depression with suicidal risk is the important indication for ECT Light therapy: Sometimes called phototherapy involves exposing the patient to an artificial light source during winter months to relieve seasonal depression. 2 . Physical therapies:

26. Psychotherapy- It is based on psychoanalytic interventions emphasizes helping patients gain insight into the cause of their depression. Cognitive therapy- It aims at correcting the depressive negative cognitions like hopelessness, helplessness and replace them with new cognitive and behavioural responses. 3 . Psychosocial treatment:

27. Group therapy- It is useful for mild case of depression. In group therapy negative feelings such as anxiety, anger, guilt and emotional growth is improved through expression of their feelings. Family therapy- It is used to decrease intrafamilial and interpersonal difficulties and to reduce or modify stressors which may help in faster and more complete recovery. Behavioral therapy- It includes social skills training, problem solving techniques, self control therapy and decision making techniques. CONT…

28. BIPOLAR DISORDER

29. This is characterized by recurrent episodes of mania and depression in the same patient at different times. Typically, the patient experiences extreme highs (mania) alternating with extreme lows (depression). DEFINITION

30. Precise cause unknown Genetic, biochemical and psychological factors Stressful events Hypothyroidism ETIOLOGY:

31. CLINICAL FEATURES:

32. Based on sign and symptoms History taking DIAGNOSTIC EVALUATION:

33. Lithium Valporic acid Carbamazepine Antidepressants Antipsychotic TREATMENT:

34. Nursing assessment: Severity of disorder. Knowing the causes. Resources available. Judging the effect of patient’s behaviour on other people. Mental status examination (MSE). NURSING MANAGEMENT OF MOOD DISORDER

35. Risk for violence related to manic excitement as evidence by aggression towards his mother. Self-care deficit related to cognitive deficit as evidenced by dirty clothes and appearance. Altered sleep and rest related to depressed mood and depressive cognitions evidenced by difficulty in falling asleep, early morning awakening. Nursing diagnosis:

36. Mood disorders in children and adolescents: an epidemiologic perspective Author Ronald C Kessler Shelli Avenevoli , Kathleen Ries Merikangas RESEARCH ARTICLES

37. Epidemiologic studies  show that  major depression  is comparatively rare among children, but common among adolescents, with up to a 25% lifetime prevalence by the end of adolescence. Mania is much less common, with no more than 2% lifetime prevalence by the end of adolescence . . Developmental studies that include assessments of both hormonal changes and social changes through the pubertal transition are needed to investigate joint biological and environmental influences on the emergence of the gender difference in depression in puberty. This controversy is made more complex by methodological uncertainties regarding inconsistent symptom reports obtained from parents, teachers, and children and by the pervasive existence of co morbidity. Abstract

38. Retrospective reports about age of onset in adult studies suggest that at least 50% of youngsters with major depression and 90% of those with mania continue to have adult recurrences. These recurrences are mediated by adverse role transitions, such as truncated educational attainment and teenage child bearing, that typically occur before the time of initial treatment. Aggressive outreach and early treatment aimed at preventing the occurrence of adverse role effects might help decrease the persistence of child and adolescent mood disorders . Continue..

39. Continue… Long-term follow-up studies are needed to resolve current uncertainties regarding  nosology , methodology, and long-term treatment effects. Innovative epidemiologic research designs aimed at more quickly providing provisional information is also needed to advance understanding of long-term developmental processes.

40. Mood disorders is a group of psychiatric illnesses where a disturbance in mood is considered the main underlying feature. Disturbances in mood can take the form of either elevated mood, as it occurs in mania or hypomania , or reduced (depressed) mood as it occurs in major depressive episodes. CONCLUSION: