Objectives:

1. Discuss etiologic theories

of depression and bipolar
disorder.
2. Describe the risk factors for
and characteristics of mood
disorders.
3. Apply the nursing process
to the care of clients and
families with mood
Disorders and a suicidal patient.
Emotional Response and Mood
Disorders

Mood- refers to the

prolonged emotional
state that influences
one’s whole personality
and life functioning.
Mood Disorders ( Affective DO)

are pervasive
alterations in emotions
that are manifested by
depression, mania or
both.
 F:\movies\Catherine Zeta-Jones
Discusses Her Bipolar Disorder.mp4
ETIOLOGY

BIOLOGIC
THEORIES

PSYCHO-
DYNAMIC
THEORIES
BIOLOGIC ETIOLOGY

Genetic

Neurochemical

Neuroendocrine
Psychodynamic Theories:

Bibring-
Object good, Psycho-
Jacobson;
loss analytic
theory- loving ego and
theory of
superior super ego
Freud mania
and strong
ETIOLOGY: Psychodynamic Theories

• Meyer- Depression- reaction to

distressing life experience

• Horney- rejection

• Beck- Cognitive triad

CATEGORIES OF MOOD
DISORDERS:

• Major Depressive
Disorder (Unipolar)

• Bipolar Disorder
(Manic-
Depressive Illness)
 Major Depressive Disorder
(Unipolar Depression)

A major depressive episode

that lasts for at least 2 weeks,
during which the person
experiences a depressed mood
or loss of pleasure in nearly all
activities.
1. Depressed mood most of the day
2. Marked diminished interest or pleasure in all, or almost all activities most
of the day, nearly everyday

3. changes in appetite or significant weight

4. Changes in sleep
5. Psychomotor agitation or retardation nearly
everyday.
6. Fatigue or loss of energy nearly everyday

7. Feelings of worthlessness or guilt

8. Diminished ability to think or
concentrate, or indecisiveness, nearly
everyday

9. Recurrent thoughts of death or

suicidal ideation without a specific
plan, suicide attempts or a specific
plan
BIPOLAR Disorder

Extreme
Depression

Extreme Mania
BIPOLAR Disorder
• is a distinct period during
which mood is abnormally
and persistently elevated,
expansive , or irritable
Mania (usually lasts for 1 week
or longer for some
individuals.
BIPOLAR Disorder

Hypomania- is a
period of abnormally
and persistently
elevated, expansive,
or irritable mood
lasting 4 days
 At least three of the following
symptoms:

Inflated self esteem or grandiosity

Decrease need for sleep

Pressured speech

Flight of ideas

Distractibility

Psychomotor agitation
 At least three of the following
symptoms:

Excessive involvement in
pleasure seeking activities

Mood excessively cheerful,

enthusiastic, expansive, irritable

Some, delusions and

hallucinations
*Rapid Cycling Bipolar DO-

when mania and depression are experienced

almost everyday for at least 1 week.
*Bipolar Mixed- cycles alternate between periods of
mania, normal mood, depression, normal mood, mania,
……………..
Bipolar 1 Disorder-

one or more manic or mixed

episodes usually accompanied
by major depressive episodes
Bipolar 2 Disorder-

one or more major depressive

episodes accompanied by at least
one hypomanic episode
 Related Disorders
1. Dysthymic Disorder (depressive neurosis)
Less severe than MDD
Insidious onset, lasts for at least 2 yrs.
May co exists with, SRD, PD, and OBC DO
Symptoms (2 of the ff.):
-poor appetite, over eating, sleep problems,
fatigue, low self esteem, poor concentration or
diff. making decisions, and feelings of
hopelessness
2. Cyclothymic- less severe bipolar DO with
alternating periods of hypomania and moderate
depression. S/S present for at least two years
 Related Disorders
 Substance – induced mood disorders-
characterized by a prominent and persistent
disturbance in mood that is judged to be a
direct physiological consequence of ingested
substances such as alcohol, other drugs, or
toxins.
 Disruptive Mood Regulation DO- persistent
angry or irritable mood; severe recurrent
temper tantrums even if no provocation and
begins before age 10
 Related Disorders
 Seasonal Affective Disorder
 1. Winter depression or fall onset SAD-
beginning late autumn and abating in
spring and summer, increase sleep,
appetite (specially carbo), weight gain,
interpersonal conflict, irritability, and
heaviness in extremities
 2. Spring onset – from late spring or early
summer until early fall- insomnia, weight
loss, and poor appetite
Seasonal affective
disorder
Related Disorders
 Postpartum depression- meets all criteria
for a major depressive episode, onset
within 4 weeks of delivery
 Postpartum psychosis- a psychotic
episode developing within 3 weeks of
delivery beginning with fatigue, sadness,
emotional lability , poor memory, and
confusion progressing to delusions,
hallucinations, poor insight and
judgment, and loss of contact with reality
Related Disorders
 Postpartum or “maternity” blues-
characterized by labile mood and
affect, crying spells, sadness,
insomnia, and anxiety.
- A day after delivery of a baby,
peaks in 3 to 7 days, and
disappear rapidly with no medical
treatment
Related Disorders
 Premenstrual Dysphoric DO-
severe form of pre menstrual
syndrome, recurrent, moderate
psychological and physical
symptoms
 Nonsuicidal self- injury –
intentional cutting, burning,
scrapping, hitting or interference
with wound healing.
Nursing Diagnosis (Depression)
 Risk for suicide
 Imbalance Nutrition: less than body
requirements
 Anxiety
 Ineffective coping/ role performance
 Hopelessness
 Self- care deficit
 Chronic low self- esteem
 Disturbed sleep pattern
 Impaired social interaction
Nursing Diagnosis (Manic)
 Risk for other directed violence
 Risk for injury
 Imbalance nutrition: Less than body
requirements
 Ineffective coping
 Noncompliance
 Ineffective role performance
 Self- care deficit
 Chronic low self- esteem
 Disturbed sleep pattern
 Nursing Intervention
(Depression)
 Providing for safety
 Promoting therapeutic relationship
 Promoting activities of daily living and physical
care (Global tasks to smaller segments)
 Establish adequate nutrition and hydration
 Promote sleep and rest
 Using therapeutic communication
 Work with the client to manage medications
and side effects
 Providing client and family teaching
 Treatment:
 1. Psychopharmacology
 - SSRI (Selective Serotonin Reuptake Inhibitor)
 Ex. Prozac, Motivest, Zoloft, Lexapro, Paxil, Celexa
 - Cyclic Antidepressant (tricyclic)
 Ex. Elavil, Tofranil
 (tetracyclic) Ex.Asendin and Ludiomil
 Atypical Antidepressants
 Ex. Efexor, Remeron, Esketain (Spravato)
 MAOIs (Monoamine Oxidase Inhibitors)
 Ex. Marplan, Parmate, Nardil
 2. Electroconvulsive Therapy\
 3. Psychotherapy, Interpersonal Therapy, T, Behavior
therapy, Cognitive therapy
Nursing Intervention (Bipolar DO)

1. Providing safety
2. Providing therapeutic
communication
3. Meeting Physiologic Needs
4. Promoting appropriate
behaviors
5. Managing Medications
6. Providing client and family
with teachings
Symptoms and Interventions
of Lithium Toxicity
Serum Lithium level -s/s lithium toxicity Interventions
1.5-2 mEq/L Nausea and Withhold next dose,
Vomiting, diarrhea, increase fluid intake
reduced if still tolerated by
coordination, the patient, call
drowsiness, slurred physician, SLD
speech, muscle
weakness
2-3 mEq/L - ataxia, agitation, Withhold future
blurred vision, doses, call
tinnitus, confusion, physician, stat SLD,
muscle fasciculation, gastric lavage, IVF
hypereflexia, with saline and
electrolytes
 Hypertonic muscles,
myoclonic twitches,
pruritus,
maculopapular rash,
movement of limbs,
slurred speech,
large output of dilute
urine, incontinence
of bowel or bladder,
vertigo
- Cardiac
3.0 and above arrhythmia, HPON, All preceding int.+
peripheral vascular lithium ion excretion,
collapse, focal/ (aminophylline,
generalized seizure, mannitol, urea),
hemodialysis
Dec. LOC, coma….
Treatment: (Bipolar)
1. Psychopharmacology (anti manic and
anticonvulsant)
2. Psychotherapy
 Goals:
 - symptom remission
 - Psychosocial restoration
 - prevention of relapse or recurrence
 - reduce secondary consequences
(marital discord, occupational difficulties)
 - increasing treatment compliance
3. ECT (Electroconvulsive Therapy)
 SUICIDE
 An intentional act of killing oneself.
 Suicidal Ideation- thinking about killing oneself
 A. Active suicidal ideation
 B. Passive suicidal ideation

 Attempted suicide- suicidal act

 A. complete
 B. Incomplete
 Greater Risk for Suicide:
 With psychiatric disorders
 Chronic medical illness
 Environmental factors
 Behavioral factors
 Greater Risk
 History of previous suicide attempt
 With relative who commit suicide
 Copycat suicide

Suicidal Ideations: Client statement

 “I just want to go to sleep and not think
anymore.”
 “I want it to be all over.”
 “It will just be the end of the story.”
 “You have been a good friend.”
 “Remember me’”
 “Here is my chess set that you have
always admired.”
 “If there is ever any need for anyone
to know this, my will and insurance
papers are in the top drawer of my
dresser.”
 “I can’t stand the pain anymore.”
 “Everyone will feel bad soon.”
 “I just can’t bear it anymore.”
 “Everyone would be better off
without me.”
 Assessment findings
 1. Verbal Cues:
 A. overt- “I’m going to kill myself.”
 B. Disguised- “I have the answer to my
problems.”
 2. Behavioral Cues:
 A. Giving away prized possessions
 B. Getting financial affairs in order,
making a will
 C. Suicidal ideations/gestures
 Indications of hopelessness/ depression
 D. Behavioral and attitudinal changes;
neat person becomes sloppy, depressed
becomes alert, increase use of drugs
and/or alcohol
 Lethality Assessment
 Plan for suicide
 Means available
 Lethality of means
 Possibility of rescue
 Support systems available or sense of isolation
 Availability of alcohol or drug
 Severe/panic level of anxiety
 Hostility
 Disorganized thinking
 Preoccupation with thought of suicide plan
 Prior suicide attempts
 Intervention
 Using an authoritative Role
 Providing a safe environment
 Ex. Of a Protocol for Suicidal Pts.
 The patient has to be watched by a 24
hour watcher provided by the family or
nursing service
 The NIC/watcher will search patient’s
belongings for potentially harmful
objects
 The NIC/watcher will monitor patient’s
intake of medication to prevent hoarding
 The competent watcher will make sure
that utensils are returned every meal.
 The NIC will inform/explain to the
patient reasons for precautionary
measures.
 HN or SSN will endorse patients on
suicidal precaution to all nurses
every shift as well as other members
of the health team
 A list of patients on SP must be
coded on the patient’s directory at
the nurse’s station.
 Initiating a No-Suicide Contract
 Creating a support system list;
family/relatives, friends or
religious, occupational,
community support groups
 Mental health clinics, hotlines,
psychiatric emergency evaluation
services, student health services,
church groups, and self help
groups
 Myths and Facts About
Suicide
Myths Facts
People who talk about suicide Suicidal people often send out
never commit suicide subtle and direct messages of
suicide
Suicidal people only want to May hurt others physically and
hurt themselves, not others emotionally

There is no way to help Cry for help

someone who wants to kill
him/herself Mentioning suicide will not
Do not mention word suicide cause the suicide
to a suicidal person
Ignoring verbal cues Should not be ignored,
and challenging will dismissed or challenged
reduce use of suicide

Once a suicide risk, Suicidal could have

always a suicide risk positive resolution to the
suicidal crisis
Thank you!!!