Mood Disorders

ETIOLOGY Neurobiology

Genetics

Neurotransmission

Neuroendocrine

Psychosocial Psychoanalytic Cognitive Learned

Helplessness Life Events Stress Personality

Epidemiology

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All Bipolar Major Dep Dysthym.

MenFemales

Types of Mood Disorders Depressive Disorders Bipolar Disorders Mood Disorders due to a general medical

condition Substance-Induced Mood Disorder Mood Disorders NOS Seasonal Affective Disorder

Depressive Disorders Major Depressive

Episode Major Depressive

Disorder Dysthymic Disorder Seasonal Affective

Disorder Depression NOS

Symptoms of DepressionIf a person experiences five or more of the following symptoms each day

during a two-week period or if these symptoms interfere with work or family activities, criteria for

a major depressive episode are met:Prolonged sadness or unexplained crying spells Significant changes in appetite, sleep patterns Irritability, anger, worry, agitation, anxiety

Pessimism, indifference Loss of energy, persistent tiredness

Feelings of guilt, worthlessness Inability to concentrate, indecisiveness

Inability to take pleasure in former interests, social withdraw Unexplained aches and pains

Recurring thoughts of death and suicide

Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar NOS

Symptoms of ManiaHeightened mood, exaggerated optimism and self-confidence

Decreased need for sleep (less than three hours) without fatigue Grandiose delusions, inflated sense of self-importance

Excessive irritability, aggressive behavior Increased physical, mental activity

Racing speech, flight of ideas, impulsiveness Poor judgement, easily distracted, difficulty concentrating

Reckless behavior without concern for consequences, such as spending sprees, rash business decisions,

erratic driving, sexual indiscretions In severe cases, auditory hallucinations (hearing voices) or

delusions (strong convictions about things that aren't true)

Other Mood Disorders Mood Disorders due

to a General Medical condition

Substance Induced Mood Disorder

Mood Disorder NOS

Specifiers Mild, Moderate, Severe with or without psychosis Partial or Full remission, Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset Longitudinal Course with or without full interepisode

recovery With Seasonal Pattern With Rapid Cycling

Postpartum Depression Feeling sad or crying a lot. Having no energy. Having headaches, chest pains, heart palpitations (the heart being fast

and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing).

Not being able to sleep or being very tired, or both. Not being able to eat and weight loss. Overeating and weight gain. Trouble focusing, remembering, or making decisions. Being overly worried about the baby. Not having any interest in the baby. Feeling worthless and guilty. Being afraid of hurting the baby or yourself. No interest or pleasure in activities, including sex. Feeling restless or

irritable.

Treatment Pharmacology

antidepressants Tricyclics

Clomipramine(anafranil) Amitriptyline(elavil) Mirtazapine(remeron)

MAOIs Phenelzine(nardil)

SSRIs Fluoxetine(prozac) Sertraline(zoloft) Bupropion(wellbutrin)

Mood Stabilizers Lithium

0.5-1.2 mEq/L acute treatment and maintenance

toxic above 2.0

Carbamazepine Valproate acid

Foods with High Tyramine Levels Aged Cheese, Yogurt Red Wine, Beer, Liqueurs Smoked or Pickled Foods, Pate Overripe fruit, avocados Yeast Fava Beans Certain Over the Counter Medications

Side Effects and Lithium ToxicityMild<1.5 mEq/L Moderate 1.5-2.5 Toxicity <2.5

Metallic taste Severe Diarrhea Nystagmus

Fine hand tremor N and V Course tremors

Nausea Ataxia Dysarthria

Polyuria Blurred vision Confusion

Polydipsia Tremors, twitching Halluciations

Diarrhea Slurred speech Oliguria

Fatique Tinnitus Convulsions

Dizziness Coma

Uncoordination Death

Treatment Electroconvulsive

Therapy Phototherapy Family Intervention Group Intervention

Psychotherapeutic Intervention Cognitive Behavioral Interpersonal Psychodynamic

Phototherapy

Electroconvulsive Therapy Indication- Major Depression with Psychosis, Mania Action- Unknown. Thought to increase levels of

norepinephrime and serotonin the brain. Contraindication: Increased intracranial pressure High Risk: Recent MI or CVA, aneurysm, severe

hypertension, respiratory infection, cardiac arrhythmias, thrombophlebitis, narrow-angle glaucoma

Side effects: Temporary memory loss, headache and confusion

Medications: Atropine, short acting anesthetic and muscle relaxant given IV

Pre and post care as a surgery patient

Nursing Diagnosis Depression

Risk for Violence Self-care deficit Sleep alterations Fatigue Constipation Impaired social

interactions Sexual Dysfunction Knowledge deficit

Mania Self-care deficit Impaired

communication Altered thought

processes Self-esteem

disturbances Noncompliance Altered family

The End