Mood Disorders.pdf

Mood disorders, also known as affective disorders, are a category of mental health conditions characterized by significant changes in mood that affect a person's daily functioning, emotions, and overall quality of life. There are several types of mood disorders, with the most common being depression and bipolar disorder. this ppt contains mood disorders which is useful for the students of Basic B.Sc. Nursing.

1. PRESENTED BY:
VIROLA TEJAL D.
ASSISTANT PROFESSOR
M.Sc. NURSING (MHN)
INS&GHPSN

2. MOOD DISORDERS

3. MOOD
Mood is a pervasive and sustained emotion that may have
a major influence on a person’s perception of the world.
AFFECT
Affect is described As the emotional reaction
associated with an experience.

5. “Mood is internal emotional
state of an individual.”

7. INTRODUCTION
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
medical or mental disorder.
The prevalence rate of mood disorder is
1.5 percent, and it uniform throughout
the world.

9. Ifthemoodisexcessivelyhappywithoutany
causewecallitasMANIA.
Ifthemoodissadwithoutanycauseorit
remainssadforalongtimewecallitas
DEPRESSION.
Ifthemoodischangingandpatientgetsboth
attacksofmaniaordepressionatdifferent
timesthenwecallitasBIPOLARDISORDER.

10. CLASSIFICATION OF MOOD DISORDERS:
❖ACCORDING TO ICD10-
F30-F39 MOOD (AFFECTIVE) DISORDERS
F30-Manic episode
F31-Bipolar affective disorder
F32-Depressive episode
F33-Recurrent depressive episode
F34-Persistent mood (affective) disorder
F38-Other mood (affective) disorder
F39-Unspecified mood disorder

11. Manic episode

12. “It is a psychiatric medical condition in
which client manifests a clinical
syndrome characterized by extremely
elevated mood, energy, hyperactivity,
unusual thought process with flight of
ideas and acceleration in speaking
process.”
-KP Neeraja.
MANIA

13. “Mania refers to a syndrome in
which central features are over
activity, mood change (which
may be towards elation or
irritability) and self important
ideas.”
-R Sreevani.
MANIA

14. INCIDENCE
0.8-1 % adults
will have
mania during
their life time.
Onset is most
common in late
adolescence or
early
adulthood.
Incidence is
more in
1. Unmarried,
separated and
divorces case.
2. Monozygotic
twins
3. Male female
ratio is 1:1

15. The life time risk of manic episode
is about 0.8-1%.
This disorder occurs in episodes
lasting usually 3-4 months,
followed by complete recovery.

16. CLASSIFICATION
F30 Manic Episode
F30.0 Hypomania
F30.1 Mania without Psychotic Symptoms
F30.2 Mania with Psychotic Symptoms
F30.8 Other Manic Episodes
F30.9 Manic Episode, Unspecified

17. ETIOLOGY
NEUROTRAN
SMITTERS
AND
STRUCTURAL
HYPOTHESES
GENETIC
CONSIDERATI
ON
PSYCHODYNA
MIC
THEORIES
ENDOCRINAL
DISORDERS

18. NEUROTRANSMITTERS AND
STRUCTURAL HYPOTHESES
•Lesions are more common in
this population in area of the
brain such as right hemisphere
or bilateral subcortical &
periventricular grey matter
•Brain trauma
Excessive Level Of
NorepinephrineAnd Dopamine,
an imbalance between
cholinergic & noradrenergic
systems or a deficiency in
serotonin

19. GENETIC CONSIDERATION
MONOZYGOTIC
TWINS OR IDENTICAL
TWINS with BPD:
40-70% chances.
FIRST DEGREE
RELATIVE:
5-10% chances.

20. PSYCHODYNAMIC
THEORIES
Denial of
depression
Faulty family
dynamics

21. ENDOCRINAL DISORDERS
Hyperthyroidism
Addison’s disease

22. PSYCHOPATHOLOGY OFMANIA
Manic state shows lack of inhibition, apparent
quickness of psychological reaction, distractibility
& flight of ideas
Elation of mood is accompanied by a feeling of
general well being (lack of insight)
a/c Abraham: manic episode may reflect an
inability to tolerate a developmental tragedy
a/c Klein: defensive reaction to depression
INTERACTION BETWEEN GENETIC, BIOLOGICAL &
PSYCHODYNAMIC DETERMINANTS

24. CLINICAL FEATURES
❑EUPHORIA (STAGE-I)
Increased sense of psychological well being and
happiness not in keeping with ongoing events.
❑ELATION (STAGE-II)
Moderate elevation mood with increased
psychomotor activity.
❑EXALTATION (STAGE-III)
Intense elevation of mood with delusion of grandeur.
❑ECSTASY (STAGE-IV)
Severe elevation of mood, intense sense of
rapture or blissfulness seen in delirious or stupors
mania.
❖ELEVATED, EXPANSIVE OR IRRITABLE MOOD

25. Expansive mood is unceasing and
unselective enthusiasm for interacting
with people and surrounding
environment.
Sometimes irritable mood may be
predominant, especially when the
person is stopped from doing what he
wants.
There may be rapid, short lasting shifts
from euphoria to depression or anger

26. PSYCHOMOTOR
ACTIVITY
Increased psychomotor
activity
Restlessness
Over activeness

27. SPEECH AND THOUGHT
FLIGHT OF IDEAS
PRESSURE OF SPEECH
CLANG ASSOCIATION
DELUSIONS OF GRANDEUR
DELUSIONS OF PERSECUTION
DISTRACTIBILITY

28. Increased sociabilities
Impulsive behavior
Disinhibition
Hypersexual & promiscuous
Poor judgment
High risk activities
OTHERFEATURES

29. Dressed up in gaudy and flamboyant
clothes although in severe mania there
may be poor self care.
Decreased need for sleep (<3 hrs)
Decreased food intake due to over
activity
Decreased attention and concentration
Absent insight
OTHERFEATURES

30. Psychological tests such as Young
Mania Rating Scale
ICD 10 Diagnostic Criteria
Based on sign and symptoms
DIAGNOSIS

31. TREATMENT
•Drugs
•ECT
•Physical Restraint
SOMATIC
•Cognitive therapy
•Behaviour therapy
•Interpersonal
Psychotherapy
•Group Psychotherapy
•Family & Marital Therapy
Non
Pharmaco-
logical

32. NURSING
MANAGEMENT

33. High risk for injury related to extreme
hyperactivity and impulsive behavior, evidenced
by lack of control over purposeless and
potentially injurious movements.
NURSING MANAGEMENT

34. High risk for violence self directed or
directed at others related to manic
excitement as evidenced by delusional
thinking and hallucination
NURSING MANAGEMENT

35. Altered nutrition less than body requirements
related to refusal or inability to sit still long
enough to eat evidenced by weight loss and
poor skin turgor.
NURSING MANAGEMENT

36. Impaired communication related to egocentric
and narcistic behavior evidenced by inability to
develop satisfying relationship and manipulation
of others foe own desires.
NURSING MANAGEMENT

37. Hypomania is a lesser degree of
mania.
In this abnormalities in mood and
behaviour are too persistent &
marked to be include under
cyclothymia ( F34.0) but are not
accompanied by hallucination &
delusions.
HYPOMANIA(F30.0)

38. Mild elevation of mood ( For at least several
days.)
Increased energy & activity
Marked feelings of well-being both physical &
mental efficiency.
Increased sociability, talkativeness & over
familiarity.
Increased sexual energy
Decreased need of sleep
SYMPTOMS OF HYPOMANIA

39. Irritability, conceit & boorish behavior
may take the place of the more usual
euphoric sociability.
Concentration and attention may be
impaired, thus diminishing the ability to
settle down to work or to relaxation and
leisure.
SYMPTOMS OF HYPOMANIA

40. In fact, the ability to function becomes
better in hypomania, and there is a
marked increase in productivity and
creativity; many artists and writers have
contributed significantly during such
periods.
SYMPTOMS OF HYPOMANIA

45. DEPRESSION

47. Depression is a widespread
mental health problem affecting many
people. The life time risk of depression in
males is 8-12% and in female 20-26%. It
occurs twice in female than male.
❖ONSET:- The age for disorder is 18 years
in men and 20 years in women.
INTRODUCTION:-

48. HISTORY
Hippocrates: melancholia
Clinical Depression
Freud: linked the development of
depression to guilt & conflict
1950s & ‘60s,: two types
Endogenous
Neurotic

50. It is a state of low mood and
aversion to activity that can affect a
person’s thought, behaviour, feelings and
sense of well-being.
DEFINITION:-

51. DEFINITION OF DEPRESSION
According to ICD-10 (F32) in a typical
depressive disorder of all three varieties, mild
(F32.0), moderate (F32.1) & severe (F32.2 &
F32.3 ), the individual usually suffers from a
depressed mood, loss of interest and
enjoyment, energy reduced leading to
fatiguability & diminished activity.

53. OTHERRISKGROUPS
Socially isolated
Physical illness
Recently given birth
Family history of depression
Past history of depression
Drug and alcohol misuse
Ongoing relationship problems
Multiple adverse events
Other mental health problems

54. CLASSIFICATION OF DEPRESSION
(ACCORDING TO ICD10)
F32 Depressive episode
F32.0 Mild Depressive episode
F32.1 Moderate Depressive episode
F32.2 Severe depressive episode Without
psychotic symptoms.
F32.3 Severe depressive episode With psychotic
symptoms.
F32.8 Other depressive episode –Atypical
depression
F32.9 Depressive episode, unspecified
F33 Recurrent depressive disorder

55. ETIOLOGY
Biological Theories:
A.Neurochemical

56. ETIOLOGY
Genetic

57. ETIOLOGY
Endocrine
CircardianRhythm

58. ETIOLOGY
Changes in brain anatomy

59. ETIOLOGY
Psychosocial Theories:
Psychoanalytic
Behavioural
Cognitive
Sociological

60. ETIOLOGY
Transactional model of stress and
adaptation:
Predisposing factors + past experiences +
existing conditions
Weak ego strength maladaptive
coping mechanism
CLINICAL
DEPRESSION

61. PSYCHOPATHOLOGY
Sadness deepens to a morbid
depression
Difficulty in concentration leads to
retardation of all thought and action
Patients may show complete failure of
all insight, deny that they are ill and
hold steadfastly to their ideas of guilt
and punishment

62. ❖DEPRESSED MOOD:-
Sadness of mood or loss of interest and loss of
pleasureinalmostallactivitiespresent
throughouttheday.
SIGN AND SYMPTOMS:-

63. ❖ Depressive Cognitions:
Hopelessness, helplessness, worthlessness,
unreasonable guilt and self-blame over
trivial matters in the past.

64. Suicidalthoughts-thoughtthatlifeisnolongerworth
livingandthatdeathhadcomeasawelcomerelease.
Thesegloomypreoccupationsmayprogresstothoughtsof
planforsuicide.

65. Psychomotor activity:
Psychomotor retardation is frequent. The
retarded patient thinks walks and acts slowly.

66. PSYCHOTIC FEATURES :
Delusion & Hallucination

67. SOMATIC SYMPTOMS
Significant Decrease in appetite or weight.
Early morning awakening, at least 2 or
more hours before the usual time of
waking up
Diurnal variation, with depression being
worst in the morning
Pervasive Lack of interest and lack of
reactivity to pleasurable stimuli.
Psychomotor agitation or retardation

68. Difficulties in thinking and concentration
Subjective poor memory
Menstrual or sexual disturbances
Vague physical symptoms such as fatigue,
constipation etc.
OTHER FEATURES:-

69. Apathy
Sadness
Sleep disturbance
Hopelessness
Helplessness
Worthlessness
Guilt
Anger
Fatigue
Thoughts of death
Decreased libido
Dependency
Spontaneous
crying
passiveness
Common
symptoms
Other
symptoms

70. DIAGNOSIS
Beck depression inventory
Hamilton rating scale
Dexamethasonesuppression test
Toxicology screening suggesting drug-
induced depression
Based on ICD 10 criteria

72. TREATMENT MODALITIES:-
DEPRESSION
PHYSICAL
THERAPY
PSYCHOSOCIAL
THERAPY
PHARMACO-
THERAPY

73. ANTIDEPRESSANT DRUGS: -
1. Selective serotonin reuptake inhibitors (SSRIs):-
Citalopram, Fluoxetine, Sertaline
2. Tricyclic Antidepressants (TCAs):-
Amitriptyline, Clomipramine, Imipramine,
Doxepine.
3. Monoamino oxidase inhibitors (MAOIs):-
Isocarboxazid ( Morplan), phenelzine ( Nardil)
4. Other newer antidepressant drugs:
Bupropion and Maprotiline.
PHARMACOTHERAPY :-

74. (1) Electroconvulsive therapy (ECT):-
Severe depression with suicidal risk is the most
important indication for ECT.
(2) Light therapy:-
Sometimes called phototherapy involves
exposing the client to an artificial light source
during winter months to relieve seasonal
depression. The light source must be very bright,
full spectrum light.
PHYSICAL THERAPY:-

75. (3) Repetitive TranscranialMagnetic
Stimulation and Vagus Nerve Stimulation:-
Transcranialmagnetic stimulation (TMS)
is one of the newer technologies that is being
used to treat depression.
It directly affect brain function by stimulating
the nerves that are direct extensions of the
brain

76. PSYCHOSOCIAL THERAPY:-
INDIVIDUAL PSYCHOTHERAPY
COGNITIVE THERAPY
SUPPORTIVE THERAPY
GROUP THERAPY
FAMILY THERAPY
BEHAVIORAL THERAPY

77. 1. High risk of self – directed violence related to
depressed mood, feelings of worthlessness and anger
directed inward on self.
2. Dysfunctional grieving related to real or perceived
loss, bereavement, evidenced by denial of loss,
inappropriate expression of anger, inability to carry
out activities of daily living.
NURSING DIAGNOSIS:-

78. 3. Powerlessness related to dysfunctional grieving
process, life-style of helplessness, evidenced by
feelings of lack control over life situations, over
dependence on others to fulfill needs.
4. Self- esteem disturbance related to learned
helplessness, impaired cognition, negative view of
self, evidenced by expression of worthlessness,
sensitivity to criticism.

79. F31 : BIPOLAR AFFECTIVE DISORDER
Is a cycling mood disorder characterized
by extreme shift in mood, energy, and
functioning.
bipolar disorder mood disorder in which
the patient swings between emotional
extremes, experiencing both manic and
depressive episodes

80. Manic episodes: are characterised by
highs in mood, very high self esteem,
increased activity and energy, and
poor functioning.
Depressive episodes: are
characterized by low in mood, often
with reduced energy and motivation.

81. CONTI……
Manic episodes usually begins abruptly &
last for between 2 weeks & 4-5 months.
Depressions tends to last longer ( median
length about 6 months), though rarely for
more than a year, except in the elderly.
The first episode may occur at any age
from childhood to old age.

83. CLASSIFICATION OF BPMD
F31.0 Bipolar affective disorder, current episode
hypomanic
F31.1 Bipolar affective disorder, current episode
manic without psychotic symptoms
F31.2 Bipolar affective disorder, current episode
manic with psychotic symptoms
F31.3 Bipolar affective disorder, current episode
mild or moderate depression
F31.4 Bipolar affective disorder, current episode
severe depression without psychotic symptoms

84. F31.5 Bipolar affective disorder, current
episode severe depression with psychotic
symptoms
F31.6 Bipolar affective disorder, current
episode mixed:
F31.7 Bipolar affective disorder, currently
in remission
F31.8 Other bipolar affective disorder
F31.9 Bipolar affective disorder,
Unspecified

85. BIPOLARMOODDISORDER( DSM-IV)
It is further classified in bipolar I &
bipolar II.
BIPOLAR I: Episodes of severe mania &
severe depression.
BIPOLAR II: Episodes of hypomania &
severe depression.

86. F33 RECURRENTDEPRESSIVEDISORDER
The disorder is characterized by repeated
episodes of depression as specified in
depressive episode (mild (F32.0),
moderate (F32.1), or severe (F32.2 and
F32.3)), without any history of
independent episodes of mood elevation
and over activity that fulfill the criteria of
mania (F30.1 and F30.2).

87. F34 PERSISTENTMOOD[AFFECTIVE]
DISORDERS
These are persistent and usually
fluctuating disorders of mood in which
individual episodes are rarely if ever
sufficiently severe to warrant being
described as hypomanic or even mild
depressive episodes.

88. CLASSIFICATION
F34.0 Cyclothymia
F34.1 Dysthymia
F34.8 Other persistent mood
disorder
F34.9 persistent mood
disorder, unspecified

90. F34.0 CYCLOTHYMIA
Cyclothymic disorder is characterized
by short periods of mild depression
alternating with short periods of
hypomania; between the depressive &
manic episodes, brief periods of normal
mood occur.
Both depressive & hypomanic phases
are shorter & less severe than those in
bipolar I or II disorder.

91. ETIOLOGYFORCYCLOTHYMIA
Genetic factors-
family history
Major depression
Substance abuse
Suicide in many
patient

92. CLINICALFEATURES
Insomnia
Hyperactivity & physical
restlessness
Irritability Or
aggressiveness
Grandiosity Or inflated
self-esteem
Increased productivity,
creativity
Insomnia or hypersomnia
Feeling of inadequacy
Decreased productivity
Social withdrawal
Loss of libido
Lethargy
Suicidal Ideation
Lack of interest in
activities
Hypomanic Phase Depressive phase

93. DIAGNOSIS
Based on ICD 10 criteria
Rule out physical and psychiatric
disorders that can mimic cyclothymic
disorder

94. TREATMENTMODALITIES
Lithium
Carbamazepine
Valporic acid
Various antidepressant
Individual psychotherapy
Couple or family therapy.

95. NURSINGINTERVENTION
Explore ways to help patient cope with
frequent mood changes
Encourage vocational opportunities that
allow flexible hours.
Encourage patients with artistic ability
to persue their talents as creative
outlets.

96. F 34.1 DYSTHYMIA
It refers to mild depression that lasts at
least 2 years in adults or 1 year in
children.
It is twice as common in women as in
men.
More prevalent among the poor &
unmarried.

97. ETIOLOGY
Decrease serotonin level
Increased vulnerability when multiple
stressors & personality problems are
combined with inadequate coping skills.

98. CLINICALFEATURESOFDYSTHYMIA
Sad & anxious mood
Excessive crying
Increased feeling of
guilt
Helplessness &
hopelessness or
worthlessness
Weight or appetite
changes
Sleep difficulties
Reduced energy
level
Psychological symptomsPhysical symptoms

99. NURSINGINTERVENTION
Provide supportive measures such as :
Reassurance
Warmth
Acceptance
oTeach patient about illness
oEncourage positive health habits

100. Endogenous Depression Neurotic depression
Causedby factors within the
individual
Caused by stressful events
Premorbidpersonality:
cyclothymicor dysthymic
Premorbidpersonality: anxious
or obsessive
Early morning awakening: late
insomnia
Difficulty in falling asleep: early
insomnia
Patient feels more sad in the
morning
Patient feels more sad in the
evening
Feels better when alone Feels better when in a group
Psychotic features are commonPsychotic features are not
common
Relapses are common Relapses are uncommon
Insight: absent Insight Present

101. CLASSIFICATION OF MOOD DISORDERS:
❖ACCORDING TO ICD10-
F30-F39 MOOD (AFFECTIVE) DISORDERS
F30-Manic episode
F31-Bipolar affective disorder
F32-Depressive episode
F33-Recurrent depressive episode
F34-Persistent mood (affective) disorder
F38-Other mood (affective) disorder
F39-Unspecified mood disorder

102. SUMMARY

103. Any