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Mood disorders

Mood disorders. Fluctuations in mood (happiness & sadness) are so common to the human condition. Mood alterations are normal as it is appropriate & do not interfere person’s life * Mood disorders: ( affective disorders )

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Mood disorders

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  1. Mood disorders • Fluctuations in mood (happiness & sadness) are so common to the human condition. • Mood alterations are normal as it is appropriate & do not interfere person’s life * Mood disorders: (affective disorders) - Alterations in emotions manifested by depression, mania, or both. - Manifested by long-term sadness, agitation, or elation. Psychiatric and Mental Health Nursing

  2. Mood disorders.. Cont. • Alter life activities involve: self-care, occupation, and relationships. • A group of psychiatric illness in which the predominant symptom is the deregulation of mood or emotion. • Sometimes fatal, with a high risk of suicide Psychiatric and Mental Health Nursing

  3. Mood disorders.. Cont. * Epidemiology: • 19.3% of population develop a mooddisorder. • Women more than men develop major depression. Approximately 2-1 • 0.6% Prevalence estimate for bipolar disorder. • Average age of bipolar disorder (mid to late twenties • Bipolar disorders more in higher socioeconomics • Average age of depression (mid-thirties) • Depression more in low socioeconomics. Psychiatric and Mental Health Nursing

  4. Mood disorders.. Cont. * Etiology factors: No specific cause. 1- Biochemical Factors: • * Genetic factors: • First-degreerelatives of depressive people have twice the risk of developing depression compared with the general population. • First-degree relatives of bipolar disorder have a 3% - 8% risk of developing bipolar disorder compared with general population. • Child of one parent with mood disorder 27%. • More in Monozygotic than Dizygotic twins. Psychiatric and Mental Health Nursing

  5. Mood disorders.. Cont. • Altered Neurotransmission: -Norepinephrine and serotonin (decreased with depression. & increased in mania). * Neuroendocrine dysfunction: - 40% of depression clients have high cortisol level. - Hypothyroidism also associated with depression. Psychiatric and Mental Health Nursing

  6. Mood disorders.. Cont. 2- Psychological Factors: * Cognitive theory: - Depression as resulting from specific cognitive distortions (self, world, and future) • Magnification of negative events & minimization of positive events. * Psychoanalytical theories: • In depression: Ego victimized by the superego, e.g. (sadistic mother ) • In Mania: Ego victimized by the Id, “defense” against underlying depression” Psychiatric and Mental Health Nursing

  7. Mood disorders.. Cont. * Behavioral Theory:(Learned Helplessness) • Depression : who receive little positive reinforcement for their activity. *Life Events and stress (sociological) theory: life events cause stress, results in depression or mania. *Personality theory: e.g. depressive personality may lead to depression. **Levels of depression: • Transient , Mild, Moderate, & Severe “major” Depression. Psychiatric and Mental Health Nursing

  8. Major depressive episode Diagnostic criteria): A- 5 (or more) of the following symptoms present during the same 2-week period; at least one of them ( depressed mood or loss of interest or pleasure) 1. Depressed mood most of the day, subjective (e.g., feels sad, empty, or hopeless) or observation made by others. 2. Diminishedinterest or pleasure in activities most of the day, (subjective feeling or observation). Psychiatric and Mental Health Nursing

  9. 3. Significant weightchanges more than 5% of body weight in a month, “loss or gain”. 4. Insomnia or hypersomnia. 5. Psychomotor agitation or retardation. 6. Fatigue or loss of energy. 7. Feelings of worthlessness or excessive guilt. (may be delusional). Psychiatric and Mental Health Nursing

  10. 8. Diminished ability to think/concentrate, or indecisiveness. 9. Recurrent thoughts of death, without a specific suicidal plan, or suicidal attempt. • Significant impairment in social, occupational, or other important areas of functioning. C. Episode is not related to physiological effects of a substance or medical condition. Psychiatric and Mental Health Nursing

  11. 1-Major Depressive Disorder: * The diagnosis MDD : based on: - Single or recurrent episode. - Its severity (mild, moderate, severe) - Currency (current or most recent episode). - Associated features (Melancholic, with psychotic symptoms, and péripartum onset). * Major depressive episode is not explained by otherpsychotic disorders. * Has nevermanic or hypomanic episode. Psychiatric and Mental Health Nursing

  12. 2- Persistent Depressive Disorder (Dysthymia ) • Early and insidious onset (in childhood, adolescence, or early adult life) Criteria of PDD (Dysthymia): A. Depressed mood for most of the day, for at least 2 years. - In children and adolescents, mood can be irritable, duration must be at least 1 year. Psychiatric and Mental Health Nursing

  13. Persistent Depressive Disorder (Dysthymia )… cont. B. Presence, while depressed, (2 or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. Psychiatric and Mental Health Nursing

  14. Persistent Depressive Disorder (Dysthymia) …. Cont. C. During the 2-year period of the disturbance, never been withoutsymptoms for more than 2 months . D. Criteria for PDD may be continuously present for 2 years. E.Never been a manic or a hypomanic episode. F. Not explained by other psychotic disorders. G. Not related to physiological or medical condition (e.g. hypothyroidism). H. Impairment in social, occupational, or other important function. Psychiatric and Mental Health Nursing

  15. 3- Depressive Disorder Due to Another Medical Condition * Diagnostic Criteria A. prominent and persistent period of depressed mood or markedly diminishedinterest or pleasure in all activities. B. Disturbance directly related to another medical condition. C. The disturbance is not explained by another mental disorder. D. Does not occur exclusively during delirium course. E. Impairment in social, occupational, or other important function. Psychiatric and Mental Health Nursing

  16. Medical conditions that induce major depression 1- Neuroanatomical: as stroke, Huntington's disease, Parkinson's disease, &traumatic brain injury. 2- Neuroendocrine: as Cushing's disease and hypothyroidism. 3- Neuro-skeletal: as multiple sclerosis. * Huntington's disease (HD), (Huntington's chorea), inhereted disorder results in death of brain cells, lack of coordination, unsteady gait, & jerky body movements. Psychiatric and Mental Health Nursing

  17. Onset and Clinical Course of depression: • Untreated depression episode last(6 –24) months before remitting. • 50% – 60% of people who have oneepisode of depression will have another. • 70% Recurrence after a second episode of depression. Psychiatric and Mental Health Nursing

  18. Management of depression: 1- Antidepressants: • Block reuptake of norepinephrine & serotonin and/or dopamine by the neuron cells. - Antidepressants side effects: • Sedation, Insomnia, agitation, Orthostatic Hypotension, Cardiac arrhythmias, weight gain, dry mouth, blurred vision… etc. Psychiatric and Mental Health Nursing

  19. Antidepressants… cont. A. Tricyclic antidepressants (TCA) oldest antidepressants • Amitriptyline “Elatrole”, Clomipramine “Anfranile”, Imipramine “Tofranile”. • Choice of drug based on symptoms. - (Anfranile) Is used for obsessive compulsive disorder. -(Tofranile) is used in treatment of nocturnal enuresis • Contraindications: - TCAs contraindicated in severe heart disease (myocardialinfarction ) and untreated glaucoma.. - Should be used with caution with impaired liver, renal, and cardiac function. Psychiatric and Mental Health Nursing

  20. Antidepressants… cont. B. Mono Amino Oxidase Inhibitors (MAOIs): • Less used because of danger side effects. • Selegiline “Eldepryl”, Phenelzine “Nardil” C. Heterocyclic Antidepressants: New -Maprotiline “Ludiomil”, &Trazodone “Desyrel” These newer antidepressants with less side effects Psychiatric and Mental Health Nursing

  21. Antidepressants… cont. D- Selective Serotonin reuptake inhibitors (SSRIs): - Fluoxetine “Prozac”, and Paroxitine “paxit”. - The most recent category of antidepressant, specific to serotonin reuptake inhibition. • Few side effects. E- Atypical (bicyclic) anti-depressants: (SNRIs) - Serotonin- norepinephrine reuptake inhibitors as: Venlafaxine (Effexor) Psychiatric and Mental Health Nursing

  22. Antidepressants… cont. Course of response: -Usually 1-6 weeks for initiation of therapeutic effects, during this time Side effects are most pronounced. Asantidepressants begins to act, side effects diminish *NOTE: -Suicide potential increases as the level of depressiondecreases. -The nurse should be alert to sudden lifts in mood Psychiatric and Mental Health Nursing

  23. Management of depression: ..cont. 2. Psychotherapy: • Cognitive therapyis the recommended psychotherapy for depression. • Psychodynamic therapy: assists the patient to become aware of unconscious anger. • Family therapy: assists the patient and family members. Psychiatric and Mental Health Nursing

  24. Management of depression: ..cont. 3- Electro convulsive therapy (ECT): Application of electrical current to the brain. Indications: - Acutely suicidal as in severe depression. - Psychotic symptoms (delusion, hallucination, catatonia) - Psychomotor retardation &disturbances in sleep. - Episodes of acute mania - Pregnant women can safely have ECT with no harm to the fetus. Course: 6 – 12 times , three times per week. Psychiatric and Mental Health Nursing

  25. ECT Procedure: • Informed consent is obtained. • Brief anesthesia to prevent muscle contraction and injury. • Anticholinergic (Atropine) to dry respiratory tract secretion. • Give oxygen, &monitor cardiac functioning. • Client will experience generalized convulsions for nearly 1minute Psychiatric and Mental Health Nursing

  26. Complications of ECT: 1- Mortality: 2 per 100,000 treatments. major cause of death is acute MI or CVA. 2- Memory loss: - Usually temporary, lasting approximately 30minutes - Temporary memory loss, up to 6 to 7 months following ECT. 3- Brain damage: - Not produces any permanent changes in brain structure /functioning. Psychiatric and Mental Health Nursing

  27. Prognosis of depression • Good and will be controlled by medications and psychotherapy. • Dysthymia often continues before individuals seeks for treatment. • Over 50% of dysthymia clients developmajordepression. Psychiatric and Mental Health Nursing

  28. Suicide Risk in depression: -At all times during major depressive episodes. • Risk factors include: 1- A past history of suicide attempts or threats. 2- Male sex. 3- Being single or living alone. 4- Having feelings of hopelessness and helplessness. 5- Presence of borderline personality disorder . Psychiatric and Mental Health Nursing

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