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Chapter 21Mood Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mood disorders are highly prevalent yet underdiagnosed
and undertreated conditions that have a significant
impact on quality of life in terms of suffering and
functional impairment, disability, health risks, and lifespan.
Approximately half of all cases of mood disorder are
missed in primary-care practice, and fewer than one
quarter of clients who are diagnosed receive adequate care.
Culpepper, 2006
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
•
Briefly describe the historical perspective of mood disorders
•
Explain the following theories of mood disorders: genetic
theory, biochemical theory, biological theory, psychodynamic
theory, behavioral theory, cognitive theory, and life events
and environmental theory
•
Recognize the primary risk factors for developing mood
disorders
•
Differentiate among the clinical symptoms of major
depressive disorder, bipolar I disorder, and bipolar II disorder
•
Articulate the rationale for the use of the diagnosis mood
disorder due to a general medical condition
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
• Compare and contrast the clinical symptoms of
dysthymic disorder, cyclothymic disorder, premenstrual
dysphoric disorder, and mood disorder with postpartum
onset
• Articulate the rationale for each of the following modes
of treatment for mood disorders: medication
management, somatic therapy, interactive therapy, and
complementary and alternative therapy
• Formulate an education guide for clients with a mood
disorder
• Construct a sample plan of care for an individual
exhibiting clinical symptoms of major depressive
disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mood Disorder Statistics
• Approximately 20.9 million adults (or 9.5% of the U.S.
population) experience depressive disorders.
• It affects approximately 14.8 million adults (or about
6.7% of the U.S. population).
• Nearly twice as many women (6.5 %) as men (3.3 %)
suffer from a major depressive disorder.
• Statistics also reveal that more than 5.7 million adults (or
about 2.6 % of the U.S. population) are diagnosed with
bipolar disorder.
• Men and women are equally likely to develop bipolar
disorder.
• By the year 2020, mood disorders are estimated to be the
second most important cause of disability worldwide.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Mood Disorders
•
Genetic theory
•
Biochemical theory
– Neuroendocrine regulation
•
Biological theory
– Neurodegenerative diseases
– Immunotherapy
– Medical conditions
– Pain
•
Psychodynamic theory
•
Behavioral theory: learned helplessness
•
Cognitive theory
•
Life events and environmental theory
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Depressive Disorders
• Major depressive disorder
• Dysthymic disorder
• Depressive disorder not otherwise specified (NOS)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Bipolar Disorders (BPD)
• Bipolar I disorder
A client with mania
• Bipolar II disorder
• Cyclothymic disorder
Note the exaggerated dress and
hand movements
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Other Mood Disorders
• Mood disorder due to a general medical condition
• Premenstrual dysphoric disorder (PDD)
• Mood disorder with postpartum onset
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment
• Screening tools and assessment scales
• General description or appearance
• Communication
• Mood, affect, and feelings
• Behavior
• Risk factors
• Transcultural considerations
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Activity intolerance
• Imbalanced nutrition: less than body requirements
• Fatigue
• Hopelessness
• Impaired verbal communication
• Ineffective coping
• Situational low self-esteem
• Disturbed sleep pattern
• Social isolation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Identification
• Outcome identification for the client with major depression
focuses on the following:
– Safety and security
– Physical health
– Acceptance
– Belonging
– Positive self-concept
– Empowerment
• In addition to those for the client with depression, outcomes
for the manic client will focus on the following:
– Channeling energy and accurately perceiving reality
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning Interventions
• Any plan for clients with depression or BPD should strive
to attain and maintain these personal attitudes:
– Acceptance
– Honesty
– Empathy
– Patience
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementation
• Assistance in meeting basic needs
• Medication management
• Pain management
• Somatic therapies
• Interactive therapies
• Complementary and alternative therapies
• Client education
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation
• Clients who respond to treatment are able to do the
following:
– Demonstrate the resolution of clinical symptoms
– Demonstrate minimal residual symptoms
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Affective disorders
• Endogenous depression
• Anaclitic depression
• Euphoria
• Anergia
• Hypomania
• Anhedonia
• Mania
• Apathy
• Poverty of speech
content
• Asthenia
• Bipolar disorders
• Depressive disorders
• Dysthymia
• Elation
• Psychomotor agitation
• Psychomotor retardation
• Rapid-cycling
• Residual symptoms
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Reflect on the chapter-opening quote by Culpepper, 2006.
• What impact on quality of life is experienced by a
client diagnosed with a mood disorder? Please
explain.
?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins