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Chapter 12:
Mood Disorders:
Depression, Bipolar, and
Adjustment Disorders
Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Mood Disorders
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Group of psychiatric illnesses in which the
predominant symptom is the dysregulation of
mood or emotion
Occur throughout the life span
Sometimes fatal, with a high risk of suicide
World’s leading cause of disease burden or
years lost to disability
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Mood Disorders: Biologic
Theories
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Altered neurotransmission
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Depression: Underactivity of neurotransmission
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Mania: Overactivity of neurotransmission
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Kindling: Neurotransmission altered by stress
Neuroendocrine dysregulation (depression)
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Hyperactivity of HPA axis
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Disturbed chronobiology
Genetic transmission
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First-degree relatives of people with mood
disorders at greater risk
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Mood Disorders:
Ethologic Factors
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Evolutionary psychobiology/biology
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Mood disorders serve a purpose.
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Mood Disorders:
Psychosocial Factors
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Psychoanalytic theory
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Cognitive
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Depression-related perceived lack of control over events
Life events and stress
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Depression related to negative processing of thoughts
Learned helplessness
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Depression related to loss
Mania as a defense against depression
Life events cause stress, leading to mood disorders
Personality
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Personality characteristics predispose one to mood disorders
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Mood Disorders:
Epidemiology
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19.3% of general population
Depression occurs in 21.3% of women
and 12.7% of men
Bipolar onset: Mid- to late 20s
Depression onset: Mid 30s
Depression frequency greater in Caucasians,
Hispanics, and lower socioeconomic groups
Bipolar frequency greater in higher
socioeconomic groups
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Emotional Symptoms of
Depression
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Anhedonia
Depressed mood
Irritability
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Cognitive Symptoms of
Depression
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Diminished ability to think, concentrate, make
decisions
Preoccupation with death
Excessive focus on worthlessness and guilt
Sometimes delusional
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Behavioral Symptoms of
Depression
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Weight loss or gain
Change in appetite
Insomnia or hypersomnia
Psychomotor retardation or agitation
Fatigue
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Social Symptoms of Depression
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Withdrawal from family and social interactions
Work problems: organizing, initiating,
completing
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Dysthymia
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Chronic, low-level
depression
Poor appetite or
overeating
Insomnia or
hypersomnia
Low energy/fatigue
Low self-esteem
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Negative thinking/guilt
Poor concentration/
decision making
Hopelessness
Irritability/anger
Anhedonia/withdrawal
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11
Emotional Symptoms of Mania
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Persistently elevated, expansive mood or
irritable mood
Mood swings: Euphoria  anger
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Cognitive Symptoms of Mania
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Inflated self-esteem
Grandiosity
Thought flow disturbance
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Racing thoughts
Flight of ideas
Impaired judgment
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Behavioral Symptoms of Mania
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Increased talkativeness
Increased goal-directed behavior
Agitation
Excessive involvement in activities
Decreased need for rest/sleep
Too busy to eat
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Social Symptoms of Mania
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Increased sociability
Intrusive
Interrupts
Disruptive
Highly directive
Loud
Sometimes witty
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Perceptual Symptoms of Mania
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Distractible
Hallucinations
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Hypomania
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Elevated mood without interference with
social or occupational functioning
Happy, congenial
Easy conversation
Humorous
Productive
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Co-occurring Mood
and Medical Disorders
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Mood disorder
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As stress response to illness
As physiologic response to pathology
As physiologic response to medication
Exacerbated by medical pathology
Medical disorder
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May develop in client with mood disorder
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Mood Disorders:
Assessment
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Mental Status
Mood
Affect
Temperament
Emotion
Emotional reactivity
Emotional regulation
Range of affect
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Mood Disorders:
Assessment, cont’d.
Physiologic Disturbances
 Appetite
 Vital signs
 Hydration
 Sleep pattern changes
 Activity level
 Fatigue
 Constipation
 Weight loss
 Sex drive
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Mood Disorders:
Interventions
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Family interventions
Group interventions
Psychotherapy
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Cognitive
 Behavioral
 Interpersonal
 Psychodynamic
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Self-management
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Psychopharmacology
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Antidepressants
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SSRIs
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TCAs
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MAOIs
Antipsychotics
Anxiolytics
Sedative-hypnotics
Mood stabilizers
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Lithium
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Carbamazepine
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Valproate
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Lamotrigine
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Gabapentin
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Biologic Interventions
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Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
Vagal nerve stimulation
Phototherapy
Alternative and complementary therapy
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Adjustment Disorders
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Problematic responses to life events
Affecting otherwise mentally healthy people
Transient episodes of dysfunction in response
to specific stressors
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Problematic Responses
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Behaviors, feelings, or thoughts that interfere
with functioning or sense of well-being
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Precipitating Events
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Divorce
Relocation
Adolescence
Psychologically challenging events
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Subtypes
Adjustment Disorder with:
 Depressed mood
 Anxiety
 Mixed anxiety and depressed mood
 Disturbance of conduct
 Mixed disturbance of emotions and conduct
 Unspecified
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Duration
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Acute: symptoms last 6 months or less
Chronic: symptoms persist for 6 months or
more
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Adjustment Disorders:
Etiology
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Crisis and stress models
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Precipitating factors
Loss
Developmental influences
Cultural, social, psychologic influences
Contributions of nursing research
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Crisis Model
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Inability to use former methods or create new
methods in response to a situation
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Loss
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Life change often involves loss
Involves overlapping stages
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Recognition
Adjustment
Resolution
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Adjustment Disorders:
Assessment
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Assess for precipitating stressors
Symptoms:
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Sensory-perceptual
Thought disturbances
Feeling disturbances
Behavioral and relational disturbances
Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Mood and Adjustment Disorders:
Outcome Identification
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Discuss plans for goal achievement.
Analyze coping resources/plans for using
resources.
Describe stressors.
Describe effective ways of managing stress in
past.
Evaluate planned life changes in advance or
potential sources of stress.
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Mood and Adjustment Disorders:
Nursing Interventions
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Assess risk of suicide.
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Help identify coping strategies.
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Support activities to increase socialization.
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Help to name thoughts, feelings, concerns.
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Teach about disorder.
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Engage in therapeutic alliance.
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Support progress toward goals.
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Collaborate with treatment team.
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Help identify symptoms of anxiety.
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Help recall successes.
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Additional Treatment Modalities
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Medications
Adjunctive
Supportive
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