Mood Disorders

Major depressionDysthmyic disorderBipolar Type 1

mixed rapid cycling

Bipolar Type 2

Etiology

Genetic factors ---current hypothesisCatecholamine hypothesisSerotonin hypothesis

weaker hypothesisHypothalamus-pituitary-adrenalsHypothalamus-pituitary-thyroidCircadian rhythms

Psychosocial factors

Psychoanalytic theoryCognitive Behavioral

ReinforcementLearned helplessnessCognitive theory

negative cognitive triadself-world-future

Major depression

Depressed moodMarkedly diminished interest in pleasureSignificant weight lossInsomnia or hypersomniaPsychomotor agitation or retardation

Depression

Fatigue or loss of energyFeelings of worthlessnessDiminished concentrationRecurrent thoughts of death

Vegetative Signs of Depression

Severe weight lossPsychomotor retardationSleep disturbance

early morning awakening (EMA)Decreased libido

Dysthymia

Depressed moodPresence of at least 2 of the following:

poor or increased appetiteinsomnia or hypersomnialow energypoor concentrationfeelings of hopelessness for 1 year

Nursing Assessment

Present complaintHx. of problemPast 4 hx.Social hx.Medical hx.Mental status exam

Bipolar Disorders 1 and 2

Type 1RegularMixedRapid cycling

Type 2

Bipolar Disorder

Mania

energy activities self-esteemflight of ideaseasy agitationpoor self controlhyperphagia or appetite need for sleep

Mixed disorderboth sets of symptoms in a 24 hour period

Rapid cycleboth symptoms within one week

Mental Status Exam

AppearanceDepression-poor hygieneMania-bizarre dress-frequent change of clothesSpeech

depressed-retarded & concretemania-flight of ideas-pressured speech-intrusive-expansive

Thought contentDepression-worthlessness-hopelessness-

helplessness-guilt-somatic concernsMania-grandiosity-distractibility

AffectDepression-flat, dull, sad moodMania-labile

PsychomotorDepression- retardationMania- hyperactive

DelusionsDepression-negative triadMania-grandeur, bizarre

Hallucinations

Suicide potentialOrientationConcentration v distractibilityRecent memoryInsight Judgment

Nursing Diagnosis

Risk for self-directed violenceSelf-esteem disturbanceSelf-care deficitSocial isolationAltered nutrition

Nursing Intervention

Suicide preventionSocial interactionMaintain adequate nutritionMaintain fluid & electrolytesMaintain sleep wake cycleSupportive care re: judgmentElectroconvulsive therapy

Sleep therapy

Cognitive behavioral therapydaily activitiestesting of depressive thoughts

Anti-depressant medication

Tricyclic antidepressantsTofranilElavil

Monoamine oxidase inhibitorsParnateNardilMarplan

Serotonin Selective Reuptake inhibitorsProzac ZoloftPaxilCelexa

OthersWellbutrinSerzone

Anti-mania Medication

LithiumAnti-convulsants

Depakote Tegretol Lamictal