Mood Disorder

• Types of Mood Disorder

  • Unipolar
  • Bipolar
• Unipolar


  Describes depression without elation
• Major Depressive Disorder


  Characterized by less interest, changes in eating patterns, hypersomnia, insomnia, impaired concentration, unplanned weight gain or loss lasting 2 weeks or more
• Dysthymic Disorder


  Chronic low-grade depression with irritability lasting 2 years
• Bipolar


  Occurs with elation and depression
• Manic


  Characterized by two alternate moods of mania and depression
• Bipolar 1


  Includes mania and depression, with at least days of mania requiring hospitalization
• Bipolar 2


  Shifts between hypomanic and not full manic states
• Cyclothymic


  Characterized by short series of mild depression and hypomania
• Seasonal Affective Disorder


  Occurs by season, characterized by sleepiness, irritability, fatigue, and other symptoms of depression
• Substance-Induced Mood Disorder


  Caused by medications or alcohol
• Postpartum/Maternity Blues


  Occurs after giving birth, symptoms include labile mood
• Mood disorders involve crying spells, sadness, insomnia, and anxiety
• Causes of Mood Disorder

  • Genetic
  • Biochemical
  • Endocrine Disorders
  • Psychosocial
• Genetic cause: Family history increases risk, with first-degree relatives of people with BP disorder having a sevenfold risk compared to a 1% risk
• Genetic cause: Identical twins have a concordance of 2-4 times higher than fraternal twins
• Biochemical cause: Imbalance in neurotransmitters, with serotonin and norepinephrine affecting bipolar disorder
• Biochemical cause: Decreased serotonin leads to depression, while increased norepinephrine leads to mania
• Biochemical cause: Besides GABA, catecholamines reduce disorder by mobilizing the body during stress
• Biochemical cause: Kindling is the seizure activity in specific areas of the brain triggered by cumulative stress reaching a threshold
• Endocrine Disorders cause: Elevated glucocorticoids and increased cortisol found in depressed individuals, especially in older people
• Endocrine Disorders cause: Women are at higher risk due to sudden hormonal changes
• Psychosocial cause: Stress, life events, and environment contribute to mood disorders
• Psychosocial cause: Self-depreciation in depression leads to self-reproach and anger turned inward
• Psychosocial cause: Unloving and rejecting parents make children susceptible to depression
• Common Presentation of Depression includes low energy, sleep problems, anxiety, changes in appetite, belief of worthlessness, excessive guilt, indecisiveness, restlessness, and suicidal thoughts
• 8 Symptoms of Bipolar Disorder include elated mood, irritability, grandiosity, hyperactivity, impulsivity, reckless decisions, unusual risks, and being distracted
• Symptoms of anxiety


  • Changes in appetite (weight loss or gain)
  • Belief of worthlessness
  • Excessive guilt
  • Indecisiveness
  • Restlessness/agitation
  • Hopelessness
  • Suicidal thoughts & acts
• 8 Symptoms of Bipolar

  • Elated mood
  • Irritable
  • Grandiosity
  • Hyperactive
  • Impulsive
  • Make reckless decisions
  • Takes unusual risks
  • Distracted ability
• It should take 4 weeks before a person is considered bipolar as indicated by the Philippine Psychiatric Association
• 5 Assessments of mood disorders

  • Assess for medical-related conditions
  • Assess for history of manic episodes
  • Assess for reaction to major loss
  • Assess for difficulty in daily functioning (all aspects)
  • Assess for suicide ideation
• 5 Interventions for Unipolar

  • Psychotherapy
  • Cognitive therapy
  • Behavioral therapy
  • Interpersonal therapy
  • Electroconvulsive therapy
• 9 Nursing Interventions


  • Provide a safe environment
  • Assess for suicidal thoughts
  • Observe client closely
  • Reinforce reality orientation
  • Allow expression of feelings through active listening
• Interventions for Bipolar


  • Redirect negative feelings to socially acceptable ways
  • Brief but frequent interaction
  • Reduce environmental stimulation
  • Provide positive feedback to correct behavior
  • Set limits for interruptive behavior
  • Reorient the client
  • Only make promises you can keep
  • Encourage appropriate expression of feelings toward discharge and treatment
  • Provide medications
• 5 Depression Management


  • Psychoeducation
  • Reduce stress and strengthen social support
  • Promote daily functioning
  • Psychotherapy
  • Pharmacology
• When to refer to a mental health specialist: psychotic symptoms
• When to refer to a mental health specialist

  • Bipolar disorders
  • Pregnant/breastfeeding
  • "Had" self-harm/suicidal attempts
  • Nonresponsive to treatment
  • Serious side effects of medications
  • Need more medications for physical comorbidities
  • "Risk" for self-harm and suicide
• Do not prescribe antidepressants if the symptoms of depression last less than 4 weeks, if pregnant/breastfeeding, or if psychosocial intervention is more appropriate