1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21Mood Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood disorders are highly prevalent yet underdiagnosed and undertreated conditions that have a significant impact on quality of life in terms of suffering and functional impairment, disability, health risks, and lifespan. Approximately half of all cases of mood disorder are missed in primary-care practice, and fewer than one quarter of clients who are diagnosed receive adequate care. Culpepper, 2006

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives Briefly describe the historical perspective of mood disorders Explain the following theories of mood disorders: genetic theory, biochemical theory, biological theory, psychodynamic theory, behavioral theory, cognitive theory, and life events and environmental theory Recognize the primary risk factors for developing mood disorders Differentiate among the clinical symptoms of major depressive disorder, bipolar I disorder, and bipolar II disorder Articulate the rationale for the use of the diagnosis mood disorder due to a general medical condition

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Compare and contrast the clinical symptoms of dysthymic disorder, cyclothymic disorder, premenstrual dysphoric disorder, and mood disorder with postpartum onset Articulate the rationale for each of the following modes of treatment for mood disorders: medication management, somatic therapy, interactive therapy, and complementary and alternative therapy Formulate an education guide for clients with a mood disorder Construct a sample plan of care for an individual exhibiting clinical symptoms of major depressive disorder

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Disorder Statistics Approximately 20.9 million adults (or 9.5% of the U.S. population) experience depressive disorders. It affects approximately 14.8 million adults (or about 6.7% of the U.S. population). Nearly twice as many women (6.5 %) as men (3.3 %) suffer from a major depressive disorder. Statistics also reveal that more than 5.7 million adults (or about 2.6 % of the U.S. population) are diagnosed with bipolar disorder. Men and women are equally likely to develop bipolar disorder. By the year 2020, mood disorders are estimated to be the second most important cause of disability worldwide.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Mood Disorders Genetic theory Biochemical theory –Neuroendocrine regulation Biological theory –Neurodegenerative diseases –Immunotherapy –Medical conditions –Pain Psychodynamic theory Behavioral theory: learned helplessness Cognitive theory Life events and environmental theory

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Depressive Disorders Major depressive disorder Dysthymic disorder Depressive disorder not otherwise specified (NOS)

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Bipolar Disorders (BPD) Bipolar I disorder Bipolar II disorder Cyclothymic disorder A client with mania Note the exaggerated dress and hand movements

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Other Mood Disorders Mood disorder due to a general medical condition Premenstrual dysphoric disorder (PDD) Mood disorder with postpartum onset

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Screening tools and assessment scales General description or appearance Communication Mood, affect, and feelings Behavior Risk factors Transcultural considerations

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Activity intolerance Imbalanced nutrition: less than body requirements Fatigue Hopelessness Impaired verbal communication Ineffective coping Situational low self-esteem Disturbed sleep pattern Social isolation

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcome identification for the client with major depression focuses on the following: –Safety and security –Physical health –Acceptance –Belonging –Positive self-concept –Empowerment In addition to those for the client with depression, outcomes for the manic client will focus on the following: –Channeling energy and accurately perceiving reality

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Any plan for clients with depression or BPD should strive to attain and maintain these personal attitudes: –Acceptance –Honesty –Empathy –Patience

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance in meeting basic needs Medication management Pain management Somatic therapies Interactive therapies Complementary and alternative therapies Client education

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Clients who respond to treatment are able to do the following: –Demonstrate the resolution of clinical symptoms –Demonstrate minimal residual symptoms

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Affective disorders Anaclitic depression Anergia Anhedonia Apathy Asthenia Bipolar disorders Depressive disorders Dysthymia Elation Endogenous depression Euphoria Hypomania Mania Poverty of speech content Psychomotor agitation Psychomotor retardation Rapid-cycling Residual symptoms

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote by Culpepper, 2006. What impact on quality of life is experienced by a client diagnosed with a mood disorder? Please explain. ?