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Mental Health Nursing II
NURS 2310
Unit 14
Affective Disorders
Key Terms
Mood = A pervasive, sustained emotion that
may have a major influence on a person’s
perception of the world (sadness, joy,
anger)
Affect = The emotional reaction associated
with an experience
Depression = An alteration in mood that is
expressed by feelings of sadness, despair,
and pessimism; loss of interest in usual
activities; change in appetite and sleep
patterns; somatic symptoms may be present
Mania = An alteration in mood that is expressed
by feelings of elation, inflated self-esteem,
grandiosity, hyperactivity, agitation, and
accelerated thinking/speaking; can occur as a
biological or psychological disorder, or as a
response to substance use or a general
medical condition
Hypomania = as per above; not severe enough
to cause marked impairment in social or
occupational functioning or to require
hospitalization; psychotic features are absent
Acute mania = as per above; symptomology
becomes intensified to the point of requiring
hospitalization
Acute mania (cont’d) = Characterized by
euphoria/elation, though mood varies
frequently; racing/disjointed thinking which
may include psychotic features; increased
sexual interest w/poor impulse control;
excessive energy; may neglect grooming
Delirious mania = A severe clouding of
consciousness w/accompanying confusion,
disorientation, and possibly stupor; extreme
mood lability; delusional thinking
w/grandiosity, religiosity, or persecution;
auditory and/or visual hallucinations; frenzied
psychomotor activity which places individual
at risk for harming self or others, exhaustion,
and even death if not resolved
Objective 1
Discussing manifestations that
identify and differentiate various
affective disorders
Major Depressive Disorder (MDD)
Characterized by depressed mood or loss of
interest or pleasure in usual activities
 Impaired social/occupational functioning that
has existed for at least 2 weeks w/no history
of manic behavior

Persistent Depressive Disorder
Also known as “dysthymia”
 Chronically depressed mood for most of the
day, more days than not, for at least 2 years;
milder mood disturbance than MDD
 No evidence of psychotic symptoms

Premenstrual Dysphoric Disorder

Depressed mood, anxiety, lability, and
decreased interest in activities just prior to
menses; symptoms improve upon onset
Disruptive Mood Dysregulation
Disorder
Childhood depression; presents before age 10
 Characterized by severe, recurrent temper
outbursts that occur 2-3 times per week
 Other symptoms include hyperactivity,
delinquency, psychosomatic complaints,
sleeping/eating disturbances, social isolation,
delusional thinking, and suicidality

Postpartum Depression
Symptoms range from feeling “blue” to
moderate depression to depressive psychosis
 “Maternity blues” = Begins within 48 hours of
delivery and lasts approximately 2 weeks
 Moderate postpartum depression = Fatigue,
irritability, sleep disturbance, loss of appetite;
mother fears she will be unable to care for
the baby; may last for several months
 Depressive psychosis = depressed mood,
agitation, indecision, lack of concentration,
guilt; often includes lack of interest in or
rejection of the baby; mother may be at risk
of suicide and/or infanticide

Bipolar I Disorder

Individual is experiencing or has
experienced at least one manic episode;
may also have experienced episodes of
depression
Bipolar II Disorder
Recurrent bouts of MDD w/episodes of
hypomania; no history of a full manic
episode
 Presents with symptoms of either
depression or hypomania
 Major depressive episodes may include
psychotic or catatonic features

Cyclothymic Disorder
Recurring episodes of hypomanic symptoms
and depressive symptoms that do not meet
the criteria for either hypomania or MDD
 Intervening periods of normalcy do not
exceed 2 months at a time
 Symptoms are severe enough to cause
marked impairment in social/occupational
functioning and/or to require hospitalization
 Mood disturbance is chronic in nature,
persisting at least 2 years

Objective 2
Recalling safety interventions
necessary for the depressed and
the manic client

Medication management

Anger management

Support groups

Individual psychotherapy

Crisis hotline

Hospitalization
Objective 3
Examining therapies
appropriate for
clients with an
affective disorder

Individual psychotherapy

Group therapy

Family therapy

Cognitive behavioral therapy (CBT)

Psychopharmacology

Electroconvulsive therapy (ECT)
Objective 4
Reviewing the use,
classifications, side effects, and
nursing care related to
medications for depression and
mania

Antidepressants elevate mood and alleviate
other symptoms associated with moderate
to severe depression
– SSRIs and tricyclics increase the concentration
of norepinephrine, serotonin, and/or dopamine
in the body by blocking the reuptake of these
neurotransmitters
– MAOIs inhibit monoamine oxidase enzymes
that inactivate norepinephrine, serotonin
and/or dopamine in the body

Mood stabilizers help to suppress swings
between mania and depression
– Enhances reuptake of norepinephrine and
serotonin, decreasing levels in the body and
resulting in decreased hyperactivity

Antidepressants
– Tricyclics
 Amitriptyline (Elavil)
– SSRIs
 Citalopram (Celexa)
 Fluoxetine (Prozac)
 Sertraline (Zoloft)
– MAOIs
 Phenelzine (Nardil)
– Miscellaneous Agents
 Bupropion (Zyban, Wellbutrin)
 Trazodone (Desyrel)
 Venlafaxine (Effexor)
 Duloxetine (Cymbalta)

Mood Stabilizers
– Antimanics
 Lithium carbonate (Eskalith, Lithobid)
– Anticonvulsants
 Valproic acid (Depakote)
 Lamotrigine (Lamictal)
 Topiramate (Topamax)
– Calcium Channel Blockers
 Verapamil (Isoptin)
– Antipsychotics
 Aripiprazole (Abilify)
 Quetiapine (Seroquel)
 Risperidone (Risperdal)

Side effects of antidepressants may include
– Dry mouth, sedation, nausea
– Decreased seizure threshold
– Increased suicide potential
– Discontinuation syndrome
 Gradual termination reduces withdrawal symptoms
– Serotonin syndrome with SSRI use
– Hypertensive crisis with MAOI use

Side effects of mood stabilizers are specific to
medication class
– Lithium carbonate has narrow margin of safety
 Lithium toxicity can be fatal
 Monitor sodium intake
Objective 5
Applying the nursing process to a
client with an affective disorder

Assessment
– Gather information about client’s mood and
level of anxiety, thoughts to harm self/others

Diagnosis
– Risk for self-directed violence R/T suicidal
feelings
– Risk for violence directed toward others R/T
homicidal ideation
– Imbalanced nutrition, less than body
requirements R/T lack of interest in food
– Disturbed sleep pattern R/T depression
– Anxiety R/T panic disorder
– Social isolation R/T agoraphobia

Planning
– Care plan
– Concept map

Implementation
– Establish trust
– Provide for safety
– Perform risk assessment
– Administer scheduled and PRN medications

Evaluation
– Mental health/psychiatric assessment tool
– Review safety plan/contract
– Assess for medication side effects