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CHAPTER 18

MOOD DISORDER

l. Introduction:

Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness
or both. The serious changes in mood that cause disruption to life activity.

MOOD/AFFECTIVE DISORDER
- It is a disturbance in mood or affect which can be depression or elation.
- Frequently seen in females.

Types of mood
1. Unipolar- a major depressive
2. Bipolar- manic and depressive disorder

ETIOLOGY:
- Manic Stage - elevated brain chemicals, norepinephrine, serotonin and dopamine
- Depressive State - deficiency in norepinephrine, serotonin deficiency, possibly [Link] in abandonment of
infant ( oral stage).
- Hormonal Changes
- Circadian Rhythms
- Depression as an anger that turned inward- anger but cannot verbalized, it adds to the depression.
- Loss of person/object.

Depressed
Anergia- is the loss of energy

S/sx
Worthless
Guilt
Helpless
Neglect hygiene
Suicidal
Insomnia

Causes
Death
Divorce
Separation
Poverty
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2 TYPES:

1. DEPRESSIVE DISORDER:

A. DYSTHYMIA
- A chronic depression and normal mood. The person is overly sensitive, have intense guilty feelings, and have
been experiencing chronic anxiety.
- Symptoms may persist for two years on and off.
- The person is often unaware that they have an illness because their functioning is usually not impaired. They go to
work and managed their life but are frequently irritable and often complaining of stress.
 Symptoms:
- poor appetite or overeating
- insomnia
- low energy or fatigue
- low self-esteem
- low concentration
- problem solving difficulties
- hopelessness.

1. POSTPARTUM BLUES /BABY BLUES (PPB)

A mood swings and decrease in daily activity. It hinders interaction with the newborn

 Symptoms:
- Mood swings
- Weeping
- Anxiety
- Irritability
- Difficulty of sleeping
- Decrease interest in any activity.
- This can hinder interaction with the newborn.
Starts: 3 TO 4 DAYS
Worst by: 5 TO 7 DAYS
Goes away by the 12th day
 Because of PROGESTERONE withdrawal.
 Worst symptoms: They thought of harming the infant.
MEDICATION: SSRI (Zoloft for mother who is breastfeeding)
THERAPY:
- Support group
- Individual
- Family therapy

B. POSTPARTUM DEPRESSION - This is an extension of the PPBLUES.

 The S/S is more intense which appears 3 to 6 months or a year.
CAUSES
-Withdrawal of estrogen & progesterone
-History of depression, anxiety or bipolar
-Marital conflict
-Lack of support, financial & emotional
-Unplanned pregnancy
-Stress
-Unemployment
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C. POSTPARTUM PSYCHOSIS - This is a severe and rarest postpartum disorder.
 SYMPTOMS are exaggerated which can be characterized as
- Insomnia
- Hallucination
- Delusion
- Bizarre feeling and behavior
- Has the thought of killing the child.

D. SEASONAL Affective Disorder

Symptoms:
- Climate
- Feeling of sadness
- Decrease activity
- Irritability
- Day time drowsiness
- Increase appetite
- Weight gain
- The climate has something to do with the disorder.
- LAck of energy

Cyclothymic Disorder
A mild form of bipolar symptoms free, intervals are shorter that 2 months
S/s not severe
Temperamental
Unreliabke
Unpredictable
Inconsistent
Moody

Nursing Care
Safe environment
Suicidal precaution
Communicate with the patient ( encourage to verbalize of anger
Build trust
Provide simple activities
Encourage goal setting
Meet physical needs
Monitor I and O (Nutrition/elimination/hygiene)
Spend time with client ( trust)
Teach client to use “Thought- stopping Technique” or command “STOP”
Keep strict records of sleeping pattern
Discourage sleeping in the morning
Photo therapy/light therapy 2,500 lux

Nursing management:
1. Remove all potential harmful object.
2. Ask client directly if he has plans of kill himself.
(formulate a short-term contract with the client that he will not harm himself while in your care) (verbalizing of
feelings, specially anger)
3. Spend time with the client.
4. Communicate that crying is acceptable.
(participate in motor activities, brisk walking, jogging, volleyball, punching bag, exercise bike)
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5. Focus on strength and accomplishment (self-esteem)
6. Spend time sitting with the client in silence for a while. Depression is felt in the early part of the day. Later in the
day is the best time for the client to participate. (social isolation)
7. Allow to take responsibility for own self-care.
8. Focus on reality. (patient is hallucinating and deluded)
9. Teach client to use “thought-stopping technique” or command “STOP” or a load noise such as hand clapping. To
interrupt unwanted thoughts.
10. Provide high fiber food, fluid, physical exercise.
11. Keep strict records of sleeping pattern. Discourage sleeping in the morning. Perform measures that promotes
sleep.
12. Provide activities.

SUICIDAL CLIENTS:
S ex-attempts are frequent to female, male actually commit suicide.
A ge-19 below and 45 above
D epression
P revious attempt-70%
E thanol ETOH alcoholics commit suicide
R ational thinker/psychotic so they commit suicide
S ocial support is lacking
O rganized plan
N o spouse
S ickness

SUICIDAL PRECAUTION
- It is meant to provide the client with a sense of security.

Intervention:
1. Primary
- An activity that provide support information and education in a suicidal crisis. Can be practice in school, homes,
hospital, industrial setting.
2. Secondary
- It is the treatment in the actual suicidal crisis. They do not necessarily want to die, but they just do not know
how to go on living in an intolerable situation.
3. Tertiary
- Postvention intervention with the family and friends of a person who tried to commit suicide.
 To decrease traumatic after effect of the attempt.
 Venting of feelings at the time of a trauma or within 24 hours, assist them and cope with their feelings
of shock.
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Suicide Assessment Questions:
1. Are you thinking about killing yourself?
2. Do you have plan to kill yourself?
3. How do you plan to kill yourself?
4. How would you carry out this plan?
5. Do you have access to the means to carry out the plan?
6. Where would you kill yourself?
7. When do you plan to kill ourself?
8. What day or time do you plan to kill yourself?

IF CLIENT WANTS TO COMMIT SUICIDE: Keep him on the line as long as possible, keep on talking
acknowledging his distresses, tell that you understand and is extremely unhappy. LET your client know that:
1. You take his concerns and him seriously.
2. That there is no need to do the act because he is just in distress.
3. Acknowledge that he called you up.
4. Identify his problem and do problem solving approach.

Bipolar disorder
Types of bipolar disorder

Bipolar Manic
A prolonged manic state for at least one week
S/sx
Flight of ideas
Insomnia
Agitated/elated
Manipulative
Demanding
Destructive
Combative
Delusion of gradeur

Bipolar depressed

2. BIPOLAR DISORDER (MANIC - DEPRESSIVE)

2 TYPES:
1. BIPOLAR I – it is a mania with or without a history of depression
Atleast 2 weeks
Symptoms:
- High mood
- Irritable
- Poor judgment
- Impulsive
- Insomnia
- Delusion
- Paranoid
- Hallucination
- Attention seeker
- Sarcastic
- Manipulative

Causes: Excess norepinephrine, serotonin and dopamine. Nursing

Diagnosis:
- High risk for violence
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- Impaired verbal communication
- Anxiety
- Individual coping, ineffective
- Disturbance of self-esteem
- Self-care deficit
- Sleep pattern disturbances
- Alteration in sensory perception

Nursing management:
1. Safe environment(dangerous)
2. Patient may be likeable but needs to be avoided. (during high periods)
3. Set limits (Manipulative) approach quietly.
4. If patient is disturbed separate him from others.
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5. Establish a calm environment
6. Monitor intake and sleep.
7. Provide outlets for physical activity.

Therapy: - Individual psychotherapy - Family - Group - ECT

Medication: Lithium (antimanic) Lithane, Eskalith, Lithonate, Lithotab

 A Greek word that means “stone” was banned previously but resumed in 1970’s.
 TOXICITY MAY INCLUDE ORGANS WHICH LEADS TO COMA.
 If it happens D/C meds. NSS IVF and gastric lavage
 Serum lithium level is being monitored
 Normal is SL 0.6 to 1.2 toxic effect 1.5
 Advice patient to take normal salt intake it interferes with the blood result.
 If NA intake increases, plasma lithium level decreases and if NA intake is
decrease, plasma lithium level increases.
 Avoid giving diuretics. (tea, coffee, cola) It increases urine output and sodium output.
May provoke toxicity.
 Avoid aminophylline causes decrease therapeutic effect of the Lithium because of increase urinary
excretion.
 Avoid Iodine preparation causes hypothyroidism. (Lugol’s sol. K iodine sol.)
 Avoid Haloperidol. (Causes neuron toxicity)
 Avoid giving to pregnant mother. (Teratogenic effect)
 Administer between meals. (Nausea, vomiting and diarrhea)
 Other side effects: Ataxia (involuntary movements),restlessness, tremors, jaundice, abdominal pain,
sweating, muscle weakness.

2. BIPOLAR II
– It is a disorder with a history of major depression and hypomania. (it is not a full scale mania)

Symptoms:
- Loss of ambition and activity
- Decrease libido
- Decrease self-esteem
- Crying
- Helpless
- Worthless sluggish
- Poor hygiene

Nursing Diagnosis:
- Disturbance of self-esteem
- Impairment in activity

Nursing care
Safe environment
Provide frequent feeding and increase fluid
Set limits
If patients is disturbed separate him from others/ least restrictive intervention
Establish a calm environment
Monitor intake and sleep
Privide utlets for physical activity
Firm and consistent
Medication: ANTIDEPRESSANT are used to treat mood disorders.
SSRI TCA MAOI ECT
 MAOI (Nardil, marpan, Parnate) It takes effect (10 days to 4 wks.)
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 SSRI/TCA (Ludiomil, Elavil, Norpramin, Adapin) It takes effect (2 to 4 wks)
 It is absorbed in the GIT and metabolized in the liver.
 Avoid OTC drugs
 Tyramine rich food causes HYPERTENSION which should be avoided:
- Cheese
- Yogurt
- Soy
- Yeast extract
- Alcoholic beverages
- Bananas
- Canned goods
- Processed food
- Dried fish
Lithium last result
(antimanic/mood stabilizer)
-Lithane, Lithonate, Lithotab
-Normal level is SL 0.6 to 1.2
-Toxic effect 1.5 meq/I or increase
-Death 2.5- 5.0 meq/I

TOXIC EFFECT
-Diarrhea
-Slurred speech
-Muscle twitching
-Coma

Effects of the meds

5 to 7 day full effect 2 to 3 weeks
Advice pt. To maintain constant NA intake
Avoid giving diuretics (tea, coffee, cola)
Avoid giving it to pregnant mother
Administer between meals
Intake of 2,000 ml/day of water

Management
D/C
Diamox (sometimes)
IVF (fast drip however if may sakit sa puso) hemodialysis
Gastric lavage (last resort) do inside the ward,
Hemodialysis
(in lithium discontinue medication at once) in pychiatric ward
(slurred speech, justify)

If sobra ang salt intake

Oculo gyri
SOME antidepressant is not given at night because it causes INSOMNIA. ANTICONVULSANT: (Dilantin,
Luminal, Valium) it is used in the treatment of seizures disorder or epilepsy. It suppresses the start of the
seizures (abnormal brain electrical activity)

Indication: seizure disorder (AURA) Common

causes:
 NEONATES - congenital defects LIKE malformation of the brain
 Infection meningitis, encephalitis, abscess
 Hypoxia (during delivery and in utero)
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 INFANTS - exposure to toxins drug/drug abuse, x ray and the above.
 CHILDREN - chronic diseases, brain tumors, infection, head trauma, fever, cardiovascular
diseases, poisons or toxins and the above.
 YOUNG ADULT - alcohol, drug abuse/misuse, head injuries
 ADULT - ALL of the above.

MEDICAL TEST: EEG (it records brain activity by applying electrodes on the scalp).