Mood Disorders

• Mood Disorders


  Characterized by disturbances in feelings, thinking, and behavior ranging from severe depression to severe mania
• Depression


  A state where an individual feels very sad, despondent, has no energy or sense of future
• Types of depression


  • Agitated depression
  • Anxious depression
  • Chronic depression
  • Endogenous depression
  • Involutional depression
  • Masked depression
  • Paranoid depression
  • Postpartum depression
  • Psychotic depression
  • Reactive depression
  • Retarded depression
  • Seasonal depression
  • Drug-induced depression
• Postpartum depression


  1. Within the first 3 to 4 days after delivery, the patient may feel 'blue' and sad

  2. About the 3rd week after delivery, other symptoms of depression appear lasting about one year

  3. About 3 months after delivery, confusion and disturbances in thought processes begin to accompany other symptoms
• Drug-induced depression


  • Results from patient's use of prescription, over-the-counter, or other types of drugs like statins, proton pump inhibitors, H2 Blockers, stimulants, anticonvulsants, Parkinson's drugs, and more
• Risk factors for depression

  • Prior episodes of depression
  • Family history of depressive episodes
  • Female gender
  • Prior suicide attempts
  • Age of onset younger than 40 years
  • Postpartum period
  • Illness
  • Lack of social support
  • Stressful life events
  • Current use of alcohol or substance abuse
• Initiating factor for withdrawal from reality and social contacts
• Risk factors for depression

  • Prior episodes of depression
  • Family history of depressive episodes
  • Female gender
  • Prior suicide attempts
  • Age of onset younger than 40 years
  • Postpartum period
  • Illness
  • Lack of social support
  • Stressful life events
  • Current use of alcohol or substance abuse
  • Presence of anxiety, eating disorder, obsessive-compulsive disorder, somatization, personality disorder, grief, adjustment reactions
  • 5 to 10 - moderate level
  • 11 plus - high level depression
• Clinical symptoms of depression

  1. Mild depression: Exhibited by affective symptoms of sadness or the ‘blues’- an appropriate response to stress. The person may complain of physical discomfort and may be less responsive to the environment. Recovery within a shorter period

  2. Moderate depression (dysthymia): Clinical symptoms are less severe compared to severe depression and do not include psychotic manifestations

  3. Major depressive disorder: Person may manifest hallucinations and delusions without a known reason or cause
• Diagnostic criteria for depressive disorders

  Major depressive disorder: Symptoms interfere with social, occupational, or other important areas of functioning. Symptoms are not due to physiological effects of a substance or general medical condition. Clinical symptoms of major depressive episodes include specific criteria
• Dysthymic disorder


  Similar symptoms to major depressive disorder but less severe. No delusions, hallucinations, impaired communication, or incoherence. Symptoms last for 2 years or more and may be continual or intermittent with normal mood swings. Overly sensitive, intense guilt feelings, chronic anxiety. Specific symptoms present
• Diagnostic criteria for Bipolar Disorders

  Bipolar I disorder: Recurrent disorder with manic episodes or mixed episodes. Specific criteria for manic episodes
• Clinical symptoms of manic episode


  Specific symptoms present during manic episodes
• Bipolar II


  Characterized by recurrent episodes
• Mania


  • Talkative than usual or pressure to keep talking
  • Flight of ideas of subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-oriented activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences
• Bipolar II


  • Characterized by recurrent major depressive episodes with hypomania (a mood between euphoria and excessive elation) episodes
  • Common in women
  • Diagnostic criteria require the presence or history of one or more major depressive episodes, alternating with manic episodes
• Cyclothymic disorder


  • Used when an individual displays numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for major depressive episodes
  • Symptoms occur for at least 2 years, during which they do not subside for more than 2 months
• Medications correlated with depression

  • Analgesics, non-steroidal anti-inflammatory drugs: narcotics, ibuprofen, indomethacin
  • Antimicrobials: sulfonamides and isoniazid
  • Anti-neoplastic agents: asparaginase and tamoxifen
  • Antiparkinsonian agents: levodopa and amantadine
  • Cardiac medications and anti-hypertensives: digoxin, propranolol, methyldopa, clonidine, and hydralazine
  • Central nervous system agents: alcohol, benzodiazepines, haloperidol, barbiturates, and fluphenazine
  • Histamine blockers: cimetidine and ranitidine
  • Steroids: corticosteroids and estrogens
• Medical illnesses


  • Central nervous system: Parkinson’s disease, strokes, tumors, hematoma, neurosyphilis, and normal pressure hydrocephalus
  • Nutritional deficiencies: folate or B12, pernicious anemia, and iron deficiency
  • Cardiovascular disturbances: congestive heart failure, and acute and sub-acute bacterial endocarditis
  • Metabolic and endocrine disorders: diabetes, hypothyroidism or hyperthyroidism, hypoglycemia or hyperglycemia, parathyroid disorders, adrenal diseases, and hepatic or renal disease
  • Fluid and electrolyte disturbances: hypercalcemia, hypokalemia
  • Infections: meningitis, viral pneumonia, hepatitis and urinary tract infections
• Planning and implementation for depressive disorders

  1. Facilitate adequate nutrition e.g. provide smaller or larger portions, consider food preferences, stay with the patient during meals

  2. Assist the patient in developing a daily schedule that balances activity and rest

  3. Promote sleep with daily exercise and activities and bedtime relaxation interventions

  4. Assist with hygiene and grooming as needed

  5. Have brief, therapeutic interactions with the patient

  6. Don’t force conversation, but encourage participation in social interaction and activity

  7. Assist the patient to identify feelings and reduce negative cognition

  8. Institute suicide precaution as necessary

  9. Facilitate successful problem solving and reinforcement by structuring simple, manageable tasks

  10. Administer anti-depressant medications as ordered
• Planning and implementation for bipolar disorders

  1. Promote adequate nutrition e.g. offer the patient high-calorie foods that can be eaten ‘on the run’; stay with the patient during meals

  2. Reduce stimulation throughout the day, especially during bedtime

  3. Promote rest periods; enhance relaxation e.g. reduce noise, promote quiet time

  4. Assist with self-care as necessary

  5. Promote bowel regularity through adequate dietary roughage, adequate fluid intake, and establish a regular schedule for defecation

  6. Provide the patient with simple tasks that focus attention and yield successful completion

  7. Assist the patient to think through consequences of behavior and to control his behavior

  8. Provide a safe environment and patient monitoring to reduce the risk of accidents and injury

  9. Administer lithium as ordered
• Genetic and biologic predisposition theory

  • 70% chance for identical twins
  • 15% chance for siblings, parents or children with the disorder
  • 7% chance for grandparents, aunts and uncles
  • A dominant gene may influence an individual to react more readily to experiences of loss or grief, thus manifesting the symptoms of depression
• Biochemical theory


  • Biogenic amine hypothesis- decreased amount of chemical compounds norepinephrine and serotonin at the receptor sites of the brain can cause depression
  • High level of cortisol
  • Abnormally low levels of thyroid hormones may cause chronic depression
• Psychodynamic theory


  • Depressed persons are like mourners who do not make a realistic adjustment to living without the loved one
  • In childhood, they are bereft of a parent or other loved person, usually by the absence or withdrawal of affection
  • Any loss or disappointment later in life reactivates a delayed grief accompanied by self-criticism, guilt, and anger turned inward
  • Because the source of the grief is unconscious (childhood), symptoms are not resolved, but rather persist later in life
• Behavioral theory: learned helplessness


  • It is a formed or learned behavior, people who received little positive reinforcement for their activity become withdrawn, overwhelmed and passive
  • The perception that things are beyond their control will promote feelings of helplessness and hopelessness
• Cognitive theory


  • Depressed people are convinced that they are worthless, that the world is hostile, that the future offers no hope, and that every accidental misfortune is a judgment of them
• Environmental theory


  • Factors like financial hardships, physical illness, perceived or real failure, midlife crises
  • Dramatic changes in one’s life
• Interpersonal theory

  • The person is abandoned by or separated from parent early in infancy causing incomplete bonding
  • Traumatic separation from a significant other in adulthood can be a precipitating factor; the person then withdraws from reality and social contacts