PSYCHIATRIC NURSINGMood and somatic disorders

Dr. Naiema Gaber El-sayed

Learning objectives

• Define mood and mood disorders• Determine Categories of Mood disorders • Differentiate between MDD and Bipolar

Disorders.• Identify the nursing management of mood

disorders • Discuss somatoform disorders.

Mood disorders(AFFECTIVE DISORDERS)

• Mood is invasive and sustained emotion that colors one’s perception of world and how one functions in it.

• Mood Disorders: Is persisting or recurrent disturbances in

mood that caused psychological stress and behavior impairment over years. There is no alteration in thought. It is associated with severe and painful sadness or abnormal elation, changes a person’s behavior, cognition, motivation, and emotions.

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Categories of Mood disorders

1. Major Depressive Disorder (MDD)• A person experiences one or more

episodes of depression with no manic or hypomanic manifestations.

• Affects women more than men.

• Onset is usually early - mid 20’s.

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2. Bipolar Disorders• A person experiences major depression with one or more manic or hypomanic episodes;

• Female and male ratio is the same

• Onset is usually late 20’s.

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Etiologies of MAJOR DEPRESSION

a.Biochemical Theory-Altered or deficient levels of

norepinephrine and serotonin. (Dopamine, Acetylcholine)

-Alterations in the functions of the hypothalamic-pituitary-adrenal system

-Alterations in the circadian rhythm (wake-sleep cycle) will cause problem with sleep patterns, arousal, activity, and hormonal secretions.

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b. Psychodynamic or Psychoanalytical Theory

Depression occurs as a result of a person’s ego loss in relationship to early life occurrences.

Aggressive behavior inappropriately directed at self.

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c. Cognitive Theory Depression results when a person

perceives all stressful situations as being negative.

d. Interpersonal Theory Stated that persons difficulties,

coping with individuals, life events, and life changes can be stressful and may lead to depression.

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e. Behavioral Theory Depression develops when one

feels helpless and unworthy.

f. Sociological Theory Stated that depression is caused

by abnormal medical, social learning, stress, and response mechanism by an individual;

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Clinical manifestation of Major Depressive Disorder

1. **Depressed mood (lake of interest).

2. **Anhedonia – inability to experience or even imagine any pleasant emotion.

3. Sleep disturbances – insomnia or hypersomnia.

4. Possible weight loss or weight gain.

5. Fatigue or energy loss.

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6. Reduced recognition and concentration.

7. Psychomotor agitation – increase or decrease activities.

8. Feelings of worthlessness or guilt.

9. Suicidal thoughts.

∞ Symptoms must persists for a minimum of 2 weeks.

∞ A person must have at least 5/9, one of which is a depressed mood and/or anhedonia.

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• Other symptoms of depression1. Apathy and sadness

2. Hopelessness and helplessness

3. Unworthiness and guilt

4. Anger

5. Decreased libido

6. Private verbal berating (shouting and criticizing) of self

7. Sudden crying without a cause

8. Dependency and Passiveness

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Nursing Diagnosis for MDD 1. Ineffective individual coping

2. Hopelessness

3. Potential for injury

4. Potential for violence

5. Powerlessness

6. Altered nutrition

7. Sleep pattern disturbances

8. Impaired verbal communication

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Management:A. Nurse Interventions

D – drugsE – expression of feelingsP – patient involvement in physical

activitiesR – reinforce decision makingE – never reinforce hallucination or

delusions S – suicide precautionS – safe environment

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B. Pharmacotherapy1. Fluoxetine (Prozac)

2. Imipramine (Tofranil)

3. Phenelzine (Nardil)

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BIPOLAR DISORDERS

• Approximately 2 million people yearly suffer from bipolar disorders.

Types of Bipolar Disorders:1.Bipolar I Disorder

• Has major depression and mania.

2.Bipolar II Disorder• The person has major depression

and hypomanic rather than mania.

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• In women, it is depressive symptoms that come first before the manic signs.

• Characterized by episodes of mania and depression (loss of interest for weeks) with periods of normal mood and activity in between. The somatic complains are more than sadness.

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Clinical Manifestations of Mania

– Denial**, distractibility, and delusions

– Resistance to treatment**– Hyperactivity**– Anorexia**– Pleasurable activity involvement– Irritability and insomnia – Elevated mood– Flight of ideas – Loud and rapid speech – Anger with labile mood – Grandiosity – or inflated self-esteem

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Hypomanic Episode• Is almost similar to mania but with

less severe level of impairment.

• Not severe enough to cause major problems in school, work, or home.

• Manic episodes only last at least 4 days in duration and does not warrant hospitalization.

Goals of treatment

• Reduce and remove symptoms • restore occupational and psychological

functioning• Reduce likelihood of relapse• Maintain safety and assess suicide risk

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B. Pharmacotherapy

– Antianxiety drugs.

– **Antipsychotics – for psychotic episodes during the manic phase of Bipolar I.

C- Electro-convulsive therapy

D-light therapy

Nursing assessment

• Systemic review (endocrine, CNS, anemia, pain..)

• Physical examination (palpation of neck for thyroid abnormalities)

• Appetite and weight status• Sleep disturbances and decreased energy

Nursing diagnosis

• Disturbed sleep pattern• Imbalance nutrition• Fatigue• Pain• Bathing and hygiene deficit• Failure to thrive (succeed)

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A. Nursing Management

M - Maintain a safe environment. Monitor sleeping pattern.A - Always limit group activities.N - Never reinforce altered

perceptions and delusions.I - Institute motor programs

(running, walking)A - Avoid stimulants. Provide finger

foods.In addition to

* assessment scale and self report.*being worm and empathic

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SOMATOFORM DISORDERS

• Complains of physical symptoms or illness for which no organic or physiologic cause can be identified. The symptoms are severe enough to interfere with patient’s ability to do social or occupational activities. Interpersonal and psychological problems are present

• The nurse or health team must never *assume that patients are not sick

*refer to psychiatrics*tell the patient that they do not have

any problem

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Types of somatoform disorders1- BODY DYSMORPHIC DISORDER

Preoccupation with an imaginary defect in one’s physical appearance even though the person appears normal to others.

Complaints of facial or body deformities

Client may have slight physical deformity but the reaction or preoccupation is out of proportion to the degree of deformity

Usually encountered during adolescence

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Tendency to seek unnecessary surgery to correct the imaginary defect or minor flaws.

May manifest with social impairment and altered work performance resulting from the client’s desire to hide the imaginary defect.

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2-CONVERSION DISORDER

Pt experience one or more neurological disorders symptoms that can not be explained. (eg. Paralysis, blindness). It is associated with aggressive, historical or antisocial personality

Most symptoms are unconscious

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3- HYPOCHONDRIASIS

– Preoccupation with fear or belief that one has a serious disease based on personal interpretation of physical health as Paralysis, Blindness, Seizures.

– No physical evidence of serious disease.

– May show “LA BELLE INDIFFERENCE.”- *Lack of concern regarding the severity of

the above symptoms

- *The client explains a severe disease calmly…

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4- PAIN DISORDER– Preoccupation with pain with no diagnostic

findings which doesn’t follow anatomical nervous system distribution.

– Have long history of several consultations with numerous doctors, use of drugs, or alcohol abuse.

– There is clear connection between a psychological stressor and onset of symptoms with marked impairment in lifestyle and ADL.

– Treatment: individual psychotherapy, biofeedback, hypnosis, nerve blocking, and sometimes antidepressant.

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5- SOMATIZATION DISORDER

– These individuals verbalize recurrent, frequent, and multiple somatic complaints for several years without physiologic cause.

– Begins before age 30.

– Clients usually see several physicians and even have exploratory and unnecessary surgeries.

– May also have social and occupational impairments.

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– These px’s may have anxiety or depression. sleep disturbances, nervousness and experience suicidal because of hopelessness about getting better.

– Common symptoms:» Nausea and vomiting» Dizziness» Shortness of breath» Dysmenorrhea» Chest pain

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Other Types of Somatoform Disorders:

1. MALINGERING• It is not mental disorders

• Intentional production of false or grossly exaggerated physical or psychological symptoms to get external compensation (leave, evading prosecution, compensation)

• May have no real symptoms or over exaggerated minor symptoms.

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2. FACTITIOUS DISORDER

• When physical or psychological symptoms are intentionally produced or feigned TO GAIN ATTENTION.

• they may inflict injury to themselves to receive attention.

• Munchausen’s by proxy – person inflicts injury or illness on SOMEONE else to gain attention or to be a hero.

Psychological intervention

• individual psychotherapy• Must have single identified physician as care

taker• Patient should be seen during regularly

schedule brief monthly visit

Feedback questions1- Invasive and sustained emotion

that colors one’s perception of world is

a- Mood b-egoc-personalityd-superego

(a)

2- Miss Magda is a 23 years old, has experienced 3 intermitted episodes of depressive mode with anhedonia, lack of concentration, guilty feeling, loss of weight, fatigue and insomnia for about 4 weeks.

1- the medical diagnosis of miss Magda isa- maniab-bipolar I disorder c-bipolar II disorderd- MDD (Major Depressive Disorders)

(d)

3- One of the nursing diagnosis does miss Magda has is:

a- potential for injuryb-powerfulnessc-paind-paralysis

(a)

4- One of the nursing intervention is a-putting her in group activitiesb- enforce altered perceptionc-never enforce decision makingd-never enforce feeling expression

(a)

5- Nr Ali experiences blindness that can not be explained. It is associated with aggressive, and antisocial personality. Mr. Ali has

a-Conversion DISORDERb- hypochondriacsc- BODY IMAGE DISORDERd-SOMATIZATION DISORDER

(a)

THANK YOU