Chapter 21 Mood Disorders

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 21Mood DisordersChapter 21Mood Disorders


Mood disorders are highly prevalent yet underdiagnosedand undertreated conditions that have a significantimpact on quality of life in terms of suffering andfunctional impairment, disability, health risks, and lifespan.Approximately half of all cases of mood disorder aremissed in primary-care practice, and fewer than onequarter of clients who are diagnosed receive adequate care.

Culpepper, 2006


Learning ObjectivesLearning 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


Learning Objectives (cont.)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


Mood Disorder StatisticsMood 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.


Etiology of Mood DisordersEtiology 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


Clinical Symptoms and Diagnostic Characteristics of Depressive DisordersClinical Symptoms and Diagnostic Characteristics of Depressive Disorders

• Major depressive disorder

• Dysthymic disorder

• Depressive disorder not otherwise specified (NOS)


Clinical Symptoms and Diagnostic Characteristics of Bipolar Disorders (BPD)Clinical Symptoms and Diagnostic Characteristics of Bipolar Disorders (BPD)

• Bipolar I disorder

• Bipolar II disorder

• Cyclothymic disorder

A client with mania

Note the exaggerated dress and hand movements


Clinical Symptoms and Diagnostic Characteristics of Other Mood DisordersClinical 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


The Nursing ProcessThe Nursing Process

• Assessment

• Nursing diagnoses

• Outcome identification

• Planning interventions

• Implementation

• Evaluation


AssessmentAssessment

• Screening tools and assessment scales

• General description or appearance

• Communication

• Mood, affect, and feelings

• Behavior

• Risk factors

• Transcultural considerations


Nursing DiagnosesNursing 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


Outcome IdentificationOutcome 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


Planning InterventionsPlanning Interventions

• Any plan for clients with depression or BPD should strive to attain and maintain these personal attitudes:

– Acceptance

– Honesty

– Empathy

– Patience


ImplementationImplementation

• Assistance in meeting basic needs

• Medication management

• Pain management

• Somatic therapies

• Interactive therapies

• Complementary and alternative therapies

• Client education


EvaluationEvaluation

• Clients who respond to treatment are able to do the following:

– Demonstrate the resolution of clinical symptoms

– Demonstrate minimal residual symptoms


Key TermsKey Terms

• Affective disorders

• Anaclitic depression

• Anergia

• Anhedonia

• Apathy

• Asthenia

• Bipolar disorders

• Depressive disorders

• Dysthymia

• Elation

• Endogenous depression

• Euphoria

• Hypomania

• Mania

• Poverty of speech content

• Psychomotor agitation

• Psychomotor retardation

• Rapid-cycling

• Residual symptoms


ReflectionReflection

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.

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Chapter 21 Mood Disorders