mOoD disORdeRS

Types of Mood Disorders

Depressive disorders
Bipolar disorders

Depressive Disorders
Disruptive Mood Dysregulation
Disorder
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Substance/Medication Induced
Depressive Disorder
Depressive Disorder Due to
Another General Medical Condition
Unspecified Depressive Disorder
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Bipolar Disorders

Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced
Bipolar and Related Disorder
Bipolar and Related Disorder Due to
Another Medical Condition
Other Specified Bipolar and Related
Disorder
Unspecified Bipolar and Related

Possible specifiers to describe

the episode

Clinical status:
mild, moderate, severe with or without psychotic
features
in Partial/Full Remission
Features:
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset
Longitudinal Course:
with seasonal pattern
with rapid cycling

Comparison of affect in Mood Disorders

Possible specifiers to describe

Depressive Disorders

Clinical status:
Single Episode or Recurrent Episode
mild, moderate, severe, with psychotic features
in Partial/Full Remission
Unspecified
Features:
With Anxious Distress (mild, moderate, moderate-severe,
severe)
With Mixed Features
With Melancholic Features
With Atypical Features
With Mood-congruent psychotic features
With Mood-incongruent psychotic features
With Catatonia
With Peripartum onset
With Seasonal pattern

Disruptive Mood
Dysregulation Disorder
DMDD is characterized by severe &
recurrent temper outbursts that are
grossly out of proportion in intensity or
duration to the situation. These occur,
on average, three or more times each
week for one year or more

Major Depressive Disorder

Characterized by depressed mood
Loses interest or pleasure in usual
activities
Social and occupational functioning
impaired for at least 2 weeks
No history of manic behavior
Cannot be attributed to use of
substances or a general medical
condition
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Key Features of MDD

Client must have 5 of 9 S&S for most of the day during the same 2 week
period & represents a change from previous level of functioning
One of the 5 must be depressed mood, or loss of interest
1. Depressed mood, irritability
2. Anhedonia
3. Appetite disturbance/weight change (5% change in a mo)
4. Sleep disturbance
insomnia: difficulty falling or staying asleep
hypersomnia: sleeps >usual
5. Psychomotor agitation or
retardation
Decreased everything

Thinking

Body movements

Speech slowed/absent

6. Fatigue or loss of energy

7. Worthlessness/guilt
8. Indecision/poor
concentration
Ability to concentrate or make decisions
9. Recurrent thoughts of death/ suicide (with or without plan)
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Persistent Depressive
Disorder
Essential feature is a chronically
depressed mood for
Most of the day
More days than not
For at least 2 years

No evidence of psychotic
symptoms, mania or cyclothymia

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Premenstrual Dysphoric
Disorder
Is characterized by depressed or
labile mood, anxiety, irritability,
anger, and other symptoms
occurring exclusively during the
week preceding menses, improve
within a few days of starting menses
and are minimal to absent in the
week postmenses
The symptoms must be severe
enough to interfere with occupational
and social functioning, in contrast

Substance/Medication
Induced Depressive
Disorder
A Substance Related Mood Disorder
is diagnosed when the clinician
believes a drug or other chemical
substance or withdrawal from a drug
causes symptoms suggestive of a
Depressive episode

Drugs that may exacerbate or cause Depression

Analgesics
Anticonvulsants
Antiinflammatori
es
Antineoplastics
Antiparkinson
agents
Antituberculars

Cardiovascular
agents
Cimetidine
Disulfiram
Psychotropics
Antihypertensiv
es
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Depressive Disorder Due to Another

General Medical Condition

This Mood Disorder is diagnosed

when the clinician believes a specific
general medical condition causes
symptoms suggestive of a
Depressive episode

Unspecified Depressive
Disorder
Client exhibits some or all of the
symptoms from the various types of
mood disorders, but does not neatly
fit any one specifically

Depression: Key
Interventions
Accept patient; focus on strengths
Opportunity to experience
accomplishment and receive positive
feedback
Provide activities designed for success
Reinforce efforts to make decisions
For severe indecision, nurse makes
decision
Help avoid embarrassment
Never reinforce hallucinations/delusions
Accept anger
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Milieu Interventions
Assistance with grooming and hygiene
Assistance with nutrition and sleep

Ensure adequate nutrition

Prevent constipation
Monitor and promote nighttime sleep
Discourage daytime sleep

Supportive group activities

Assertiveness training
Brief and frequent interpersonal contacts
Spend time with withdrawn patients
Protection from suicide intent
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Bipolar I Disorder
Individual is experiencing, or has
experienced, a full syndrome of manic
or mixed symptoms
May also have experienced one or more
major depressive episodes

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Assessment
Acute mania: intensification of hypomanic S&S;
requires hospitalization
Mood: euphoria and elation; irritability, may
be labile
Cognition and perception: fragmented,
disjointed thinking; pressured speech; flight
of ideas or c/o racing thoughts; hallucinations
and delusions - grandiose, persecutory,
somatic
Activity & behavior: increased goal directed
activity or psychomotor agitation, decreased
sleep, appetite, bizarre dress and/or
make-up,
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Bipolar II Disorder
At least one episode of major depression
At least one episode of hypomania
Has not experienced an episode that
meets the full criteria for mania
Symptoms of depression or
unpredictability caused by alternation
between periods of depression and
hypomania causes significant distress or
impairment
For Bipolar II, depressed, many
specifiers are possible, e.g. with peri21
partum onset

Nursing
Process/Assessment
Symptoms may be categorized by degree of
severity

Hypomania: Symptoms not sufficiently severe to

cause marked impairment in social or
occupational functioning or to require
hospitalization
Mood: cheerful and expansive (not the
persons usual mood)
Cognition and perception: self-confident;
easily distracted
Activity and behavior: increased motor
activity; extroverted; superficial; reckless
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behavior (may be sexual); initially

Cyclothymia
A person has experienced many periods of
depressive symptoms (not a full depressive
episode), and periods of hypomanic symptoms
for a minimum of two years. One year for
children and adolescents.
The person has not been free of the
hypomanic or depressive symptoms for more
than two months at a time.
Throughout the first two years of the illness
the person has not had a manic, mixed, or
major depressive episode.
Essentially, a person's mood alternates
between a less severe mania (known as
hypomania) and a less severe depression.
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Substance/MedicationInduced Bipolar and Related

Disorder
A Substance Related Mood Disorder
is diagnosed when the clinician
believes a drug or other chemical
substance or withdrawal from a drug
causes symptoms suggestive of a
Bipolar Disorder

Bipolar and Related

Disorder Due to Another
Medical Condition
This Mood Disorder is diagnosed
when the clinician believes a specific
general medical condition causes
symptoms suggestive of a Bipolar
Disorder

Other Specified Bipolar and

Related Disorder
e.g., certain types of hypomania and
cyclothymia

Unspecified Bipolar and

Related Disorder
Client exhibits some or all of the
symptoms from the various types of
mood disorders, but does not neatly
fit any one specifically

Nursing Diagnoses
Risk for Injury related to:
Extreme hyperactivity evidenced
by increased agitation and lack
of control over purposeless and
potentially injurious movements
Imbalanced Nutrition less than
body requirements related to:
Refusal or inability to sit still long
enough to eat evidenced by loss of
weight, amenorrhea
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Nursing Diagnoses (cont.)

Risk for violence: Self-directed
or other-directed related to:
Manic excitement
Delusional thinking
Hallucinations

Impaired Social Interaction

related to:
Egocentric and narcissistic behavior

Disturbed sleep pattern

related to:
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Excessive hyperactivity and agitation

Planning/Implementation
Nursing interventions are aimed
at:
Maintaining safety of client and
others
Restoring client nutritional status
Encouraging appropriate client
interaction with others
Meeting clients self-care needs

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Advanced Practice Interventions

Psychotherapy

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Cognitive-behavioral therapy (CBT)

Interpersonal therapy (IPT)
Time-limited focused psychotherapy
Behavior therapy
Group therapy
Family Therapy

Other Treatments for

Depression
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
(TMS)
Vagus nerve stimulation
Deep brain stimulation
Light therapy
St. Johns wort
Exercise
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Nursing Process
Evaluation
Suicide ideation
Intake
Sleep pattern
Personal hygiene and grooming
Self-esteem
Social interaction

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