1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 10Mood Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Disorder Defined A condition in which a person experiences a prolonged alteration in mood

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Relevant Terms Mood: prolonged emotion that colors a person’s entire psychological thinking Affect: facial expression displayed in association with mood Euphoria: excessive feeling of happiness Mania: frenzied, unstable mood Hypomania: lesser mild-to-moderate form of mania

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Disorders Depressive disorders Dysthymic disorder –Recurrent state of depression over a period of at least two years Bipolar disorder—manic depression Cyclothymic disorder –Milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Major Depressive Disorder Persistent, prolonged mood of sadness extending beyond two weeks duration –No episodes of mania or hypomania (unipolar) –Depressed mood –Decreased neurotransmitter action in brain Usually responds to antidepressant medication –May have precipitating event –May be seasonal

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Precipitating Factors Chronic pain Loss of job Lack of support system Financial difficulties Conflict with a friend or loved one Recovery from the impact of a difficult situation

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Depression Signs and Symptoms Hopelessness, guilt, and self-blame Somatic complaints (h/a, body pains, GI disturbances) Anxiety and melancholy Decreased sex drive Anergia/anhedonia –Marked decrease in energy level, dependent on others for basic needs –Lack of pleasure in things an individual previously enjoyed Apathy Lack of eye contact Recurrent thoughts of death or suicide Box 10.1 Page 141

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Depression: Incidence and Etiology At least 25% of population will experience in lifetime Predisposition runs in families Women at a greater risk Average age of onset is mid-20s 15% in major depression will attempt suicide Possible functional deficit of serotonin in the brain –Leads to a chemical imbalance

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dysthymic DisorderSigns and Symptoms Chronic depression Often ineffective at coping with loss Pessimistic attitude Negativism Low self-esteem Poor concentration, decision making Box 10.2 Page 142

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dysthymia Incidence and Etiology Occurs 2-3 times more frequently in women than in men More likely to occur in first-degree biologic relatives with depressive disorders Usually an early onset beginning anytime from childhood through early adulthood May eventually develop bipolar disorder

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorders (Manic Depression) Brain dysfunction that causes abnormal and erratic shifts in mood, energy, and functional ability Moods range from high manic episodes to low depressive periods Severity of symptoms from mild to severe

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

14. Bipolar I and II Bipolar I—severe manic episodes Bipolar II—hypomanic episodes Rapid cycling—4+ mood shifts within one year

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs and Symptoms of Hypomania/Mania Extreme euphoria Inflated self-esteem or grandiosity Excessive energy Extreme irritability, moodiness Reckless and impulsive behaviors Sexual indiscretions Poor hygiene, bizarre dress Auditory and visual hallucinations Grandiosity – unrealistic or exaggerated sense of self- worth, importance, wealth, or ability Clang Associations – rhyming phrases Box 10.3 Page 143

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mania http://www.youtube.com/watch?v=p9hbXPVaOuk http://www.youtube.com/watch?v=LLVEQgkbw9Y Person has a continued mental flood of overly confident self-expectations that lead to frenzied psychomotor activity.

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder: Incidence and Etiology Genetic factor – familial pattern of illness Environmental factors Possible link with substance abuse, stressful life events Women at a greater risk If occur in adolescents – may lead to school failure, behavioral problems, and substance use

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cyclothymic Disorder Milder form of bipolar disorder characterized by mood disturbances, which involve periods of hypomanic symptoms and periods of depression –Not longer than two months –No psychotic symptoms –Functioning is not severely impaired –Short periods of normalcy –Equal occurrence in men and women –Begins in adolescence or early adulthood

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cyclothymic Disorder Signs and Symptoms Recurrent episodes of hypomania or dysthymia States not as severe as in bipolar disorders Short periods of normalcy No psychotic symptoms Functioning not severely impaired Box 10.4 Page 144

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide Women attempt more often than men Men are more successful than women Need for relief from agonizing emotional pain Eleventh leading cause of death in the United States All ages, races, socioeconomic status Often preventable

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors for Suicide Depressive and bipolar disorders/other mood disorders Family history Stressful life events Substance abuse Childhood abuse Chronic illness Decreased levels of serotonin have been found in those with depression and other mood disorders and in the brains of those who have died by suicide Loss of a love object, health Escape from the realities of life

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide Warning Signs Difficulty eating and sleeping Increased substance abuse Social withdrawal Preoccupation with death and dying, talks about suicide Giving away possessions Previous suicide attempt Recent major loss Unnecessary risk taking Lack of attention to personal hygieneBox 10.5 Talks about suicidePage 144

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Risk Suicidal ideation –Indicates a desire toward self-harm Suicidal threat –Statement of intent and behavioral changes Suicidal gesture –Act of suicide an imminent threat Suicide attempt –Involves definite risk

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins If You Think Someone Might be Suicidal Do not leave the person alone Try to get the person immediate medical help Call 911 Eliminate access to firearms or other potential suicide tools Remove any unsupervised access to prescription or over- the-counter drugs Listen and find support for the person

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Mood Disorders Pharmacologic Psychotherapeutic –Antidepressants and Mood-Stabilizing Agents Psychosocial –Interpersonal and Cognitive Behavior Therapy Electroconvulsive therapy

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins ECT Electrical current through the brain Chanes the neurotransmitter system that leads to the expected mood elevation Unilateral ECT can lead to short-term memory deficits Bilateral ECT can lead to long-term memory deficits

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied Assessment –Mood and affect –Thinking and perceptual ability –Somatic complaints –Sleep disturbances –Changes in energy level –Character of speech patterns

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Nursing diagnoses –Page 146 Expected outcomes –Page 147

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Interventions –Individual for each client –Implemented according to the priority of need –Page 147

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions for a Suicidal Client Assess the client for risk factors Determine the content of suicidal thoughts or ideations Assess the lethality of method if the client has a plan Suicide precautions Active listening Sense of caring

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (Cont.) Evaluation –Improvement in thought processes, behavior, overall functioning

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Individuals with bipolar disorder experience symptoms of both mania and depression.

33. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Those with bipolar disorder have moods that range from high manic episodes to low depressive periods.

34. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A marked decrease in energy level is also called A. Anergia B. Anhedonia C. Dysthymic disorder D. Negativism

35. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Anergia Rationale: Anergia is a noticeable decrease in energy level, which may make a person depend on others for basic needs.

36. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Psychotic symptoms are a sign of cyclothymia.

37. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: A person with cyclothymia does not have psychotic symptoms.

38. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which phrase is used to label the first level of suicide risk? A. Suicide attempt B. Suicidal threat C. Suicidal ideation D. Suicidal gesture

39. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Suicidal ideation Rationale: Suicidal ideation is the first level of risk for suicide; it is a verbalized thought or idea that indicates a desire to do self-harm.

40. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 10.1 “Sad and Lonely” 10.2 “Out of Control” 10.3 “Life on the Edge”