Mood Disorder

Definition

In the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, the term "mood disorder" refers to a group of diagnoses where a person's mood disturbance is hypothesized to be the primary underlying feature. In the International Classification of Diseases, this category is known as mood (affective) disorders.

A mood disorder is only when the mood swing is excessive in severity and duration and when it interferes with a persons day to day activities. Depression and mania are examples of mood disorder

Types of Mood Disorders

The types of mood disorders are:

Depressive Disorders:

Although common, depression goes undiagnosed in regular hospital and primary care settings. All clinicians must be able to identify depressed disorder, treat milder cases, and determine which patients need specialized care because untreated depression can hinder recovery and worsen the prognosis for physical illnesses. Depressive illnesses come in a variety of forms. As follows:

• Major depressive disorders.
• Atypical depression.
• Psychotic major depression.
• Postpartum depression.
• Depressive personality disorder.
• Minor depressive disorder.

Mania: 

A mood disorder called mania is characterized by abnormally high levels of energy, mood, and thought.

Etiology

The precise reason for a mood problem is still a mystery. The development of a mood disorder is, nevertheless, predisposed by certain variables, they are:

• Biological Factors:

  • Genetic: Relationship-affected people have a higher incidence of bipolar disorder than the general population.
  • Biochemical: Mania is thought to result from an excess of biogenic amines in the brain, not from epinephrine or serotonin.

• Psychological Factors: The dynamics of our family structure, early adverse experiences, and more stressful life events give us a strong sense of identity (uncontrollable impulsive behavior). Mania, according to the psychoanalytic concept, is depression's denia counterpart.

Diagnostic Criteria for Manic Episode According to DSM-IV-RT

• A distinct week-long period of abnormality marked by a persistently high, expansive, or irritated mood.
• Three or more of the following symptoms remained during the depressive episode:
  • Enhanced self-confidence or grandiosity 2. Reduced requirement for sleep
  • More chatty than usual or feeling under pressure to talk more 4. The subjective feeling of ideas flying through one's head
  • Distractibility
  • An increase in goal-directed behavior in social, occupational, or educational contexts, or in sexual or psychomotor excitement
  • Excessive indulgence in enjoyable pursuits with a significant risk of unpleasant outcomes
  • Mood disruption is severe enough to significantly affect daily functioning, regular social interactions, and interpersonal relationships.
• The symptoms are not caused by a medical condition or the direct physiological effects of drugs (e.g. hyperthyroidism). Source: (APA, 2000) (APA, 2000)
• The acronym DIGFAST is used to remember the signs of mania.
  • D= Distractibility
  • I = Indiscretion
  • G = Grandiosity
  • F = Flight of ideas
  • A = Activity increased
  • S = Sleep (decreased need for)
  • T = Talkativeness (pressured speech)

Management of Mania

• Hospitalization: If the patient is unable to care for oneself, is dangerously overexcited, or poses a safety concern.
• drug detoxification Antipsychotic drugs, such as injections of haloperidol, olanzapine, and respidon, as well as mood stabilizers including carbamazepine, sodium valproate, and lithium carbonate, can be used to manage violent symptoms. Clonazepam has the ability to sedate.
• ECT is a successful treatment for people who are aggressive and have relapsed.
• Get psychological therapy when the acute episode has subsided.

Depression

Definition

Depression is a common mental health condition characterized by a persistently low mood, loss of interest in routine activities, and a reduced capacity for pleasure.

Epidemiology

• The age range of 30 to 40 is the most usual for people who deal with this problem.
• The lifetime chances of developing this condition are 7–12% for men and 20–25% for women, respectively.
• Two times more typical in women than in males.

Etiology

• Biological Factors: Depression is a heritable condition that runs in families. Major depression is 1.5 to 3 times more prevalent among first degree biological relatives of patients with the condition than it is in the general population, according to the majority of family research (APA, 1994).

• Biochemical Factors: An imbalance of biological amines in the brain is the cause of depression. Epinephrine, serotonin, and dopamine are the amines in question. In people with depression, the levels of these amines are decreased.

• Physiological Influences:
  • Certain medications: Antihypertensive, anti ulcer drugs
  • Neurological disorder: Cerebrovascular accidents, brain tumor
• Hormonal Imbalance:
  • Hypothalamic pituitary adrenocortical axis: In depressed patients, the normal hormonal inhibition system malfunctions, leading to an overproduction of cortisone.
  • About 25% of depressed patients show a diminished thyroid stimulation hormone response to thyroid releasing factor administered. Hypothalamic pituitary thyroid axis.

• Psychological Factor: When a person's thinking is distorted, they see everything around them, including themselves and their future, negatively and pessimistically, which makes them feel depressed.

Sign and Symptoms

• Appearance:
  • Neglecting grooming and attire.
    Face: downturned head, downward-blinked eyes, possibly slower blinking, depressed expression.
    Gestural activity is diminished.
• Mood:
  • Feelings of sadness.
  • Loss of interest.
• Speech:
  • Slow and retarded speech.
• Depressive cognition (Negative thoughts):
  • Worthlessness (Negative thought towards self).
  • Helplessness (Negative thought towards others).
  • Hopelessness (Negative thought towards future).
• Goal-directed behavior:
  • Lack of fun and interest.
  • Slowly moves and speaks.
• Biological symptoms:
  • Sleep disturbances.
  • Weight loss.
  • Loss of appetite.
  • Self-destruction.
• Others:
  • Obsessional symptoms.
  • Poor concentration.
  • Poor memory.

Common Types of Depression

• Unipolar Depression (Major depression / Endogenous depression): Depressive symptoms predominate in the absence of a mania or hypomania history define it. Unipolar depression can manifest as mild, moderate, severe, and severe depression with signs of psychosis. The number and severity of the symptoms serve as a guide to the different types of depression.
• (Psychotic depression) Depression with psychotic characteristics severe depressive symptoms, including impaired reality testing, delusional experiences, and hallucinations.
• Depression with Catatonic Features: This category designates the existence of psychomotor disturbances, such as severe psychomotor retardation, with or without waxy flexibility, stupor, or excessive motor activity. The person may exhibit negative, mute, echolalia, or echopraxia symptoms.
• Dysthymic Depression: A persistently depressed state that lasts for at least two years and is felt the majority of the day. No manic, hypomanic, or mixed episode has ever occurred. Compared to unipolar or bipolar depression, it is a less severe kind of depression.
• Post-partum Depression: When major depressive disorder symptoms appear within four weeks of giving birth, this is used.
• Bipolar Depression: Mania or hypomania alternates with depression. Additionally possible are mixed symptoms of mania and depression.

Management of Depression

• Patients with severe depression and those who have suicidal thoughts must be hospitalized, although mild to moderate depression can be treated outpatiently.
• Drug therapy: Antidepressant drugs like Amitriptyline, Imipramine, Sertaline, Fluoxetine, etc. might be used depending on the severity and nature of the depression.
• Electro convulsive treatment (ECT) is a highly effective physical method of treating severe depression and suicidal thoughts (ECT). It is possible to combine ECT with antidepressant medication.
• Psychotherapy is a psychological approach to treating depression in people. It is a method for understanding the patient's illness status in connection to his problems and providing him with helpful assistance. Psychotherapy offers confidence and support along with encouragement to freely discuss one's problems. The signs of depression are often diminished by emotional ventilation. Depending on their issues, each patient receives a combination of individual psychotherapy, family therapy, marriage therapy, cognitive therapy, and other psychotherapy methods.

Nursing Interventions

• Strengthening coping and sense of hope
  • Engage the patient in conversation at the appointed time.
  • Be sure to consider the patient's major losses.
  • Determine the cultural and societal influences that may affect the patient's coping mechanisms for grief and other emotions.
  • Analyze the patient's network of supporters.
  • Encourage the patient to list the instances that make them feel uneasy.
  • With the patient, discuss the causes and effects of the depressive symptoms.
  • Validate your sentiments in accordance with the circumstances.
  • Describe your personal feelings regarding the patient's actions in a direct and honest manner.
  • Encourage the verbalization of emotions.
• Maintaining safety/safety precautions/ suicidal precautions
  • Analyze the present risk of suicide. Ask the client directly if they have ever considered hurting themselves in any manner. What are your plans, if applicable? Have you have the tools to execute this plan?
  • Implement the proper amount of surveillance in accordance with your suicide risk assessment (ie. constant visual observation or at regular or irregular intervals, each 15 minutes). Give one-on-one attention, situate the room near the nursing station, avoid assigning a private room, and be prepared to be escorted to the restroom.
  • Participate in therapeutic and psychological rehabilitation activities with the patient.
  • Take extra caution when administering medications.
  • Encourage the patient to come to an agreement with themselves not to damage themselves or commit suicide.
  • Adjust the degree of observation on the monitor.
  • Assess the environmental safety of the patient's room and unit, remove any dangerous items from the patient's possession, and (sharp objects, straps, belts, ties, glass items, alcohol, medication etc.). As required, do a room search.
• Encouraging participation in Activities of Daily Living (ALDS) desicion