Elsevier items and derived items © 2005 by Mosby, Inc. 0 CHAPTER 21 Depression and Other Mood Disorders.

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Elsevier items and derived items © 2005 by Mosby, Inc.

CHAPTER 21 Depression and

Other Mood Disorders

CHAPTER 21 Depression and

Other Mood Disorders

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http://showcase.commedia.org.uk/article/articleview/356/1/75/

http://www.healthyplace.com/Communities/Bipolar/toc_video.asp

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• Emotion: A nonintellectual response in the affective realm of human functioning

• The spectrum of human emotion ranges from elation to despair.

• Emotional responses can be growth promoting and adaptive or can lead to ineffective behaviors that evolve into maladaptive behaviors.

The Continuum of Emotional ResponsesThe Continuum of Emotional Responses

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• Biological evidence When sad moods deepen and persist, individuals are unable to restore

emotional equilibrium, owing to unusual stress or poor internal regulation. Defects in the immune system have been implicated in depression. Genetics may be a factor in mood disorders?prevalence of depression and

bipolar illness high in individuals with relatives who have mood disorders. Neurotransmitters and hormones have revealed that behaviors and body

chemistry are interrelated. Biological rhythms of depressed persons are different from those of non-

depressed persons.(Cont’d…)

Theories Relating to Emotions and Their Disorders


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(…Cont’d)

• Psychoanalytic theories see mood disorders as anger turned inward.

• Behaviorists view depression as a group of learned responses.• Social theorists consider depression the result of faulty social

interactions.• Beck’s cognitive theory blames faulty beliefs and assumptions.• A holistic viewpoint is usually used by health care providers.



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• Infancy When basic needs are met, infants feel contentment. Delays in having needs met often triggers crying.

• Toddler stage Struggle to cope with new emotions Act out many feelings because they know no other way of expressing them

• School age Learn to identify, express, and control emotions

(Cont’d…)

Emotions throughout the Life Cycle


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(…Cont’d)

• Adolescence Struggle to develop identity and gain control over and

express emotions Moods often swing from feeling vulnerable and dependent to

knowing it all.

• Adulthood Adults are expected to practice emotional control



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Situational Depression

Depression tied to a specific event Called acute or situational depression Traced to a recognizable cause

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Emotions in Childhod Depression-

– Hopelessness, low self-esteem,take blame for negative event

– Incr. Time spent alone esp. watching Tv– May engage in in aggressive or disruptive behavior– Most episodes fade with family and emotional

support

If self esteem fails to grow or coping mech. Fail to develop mood disorder or other mental problems may arise

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• Depression that is severe and lasts more than 2 weeks Behaviors associated with severe depression range from paralysis

to agitation. Feelings of worthlessness, guilt, and despair Personal appearance declines Eating and sleeping habits deteriorate Poor concentration and an inability to follow through on tasks lead

to feelings of powerlessness and helplessness Suicidal thoughts

Depressive EpisodeDepressive Episode

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Emotions in Adolescence

Teens- struggle to identify, gain control over, and express their emotions

Moods swing– Vulnerable to dependent– ‘know it all’

Depression r/t: (4 factors)– Self esteem– loneliness– family strengths– parent-teen communication

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Teens cont’d Loneliness is an aspect of depression in all age

groups Family relationships have an influence Teens rebel against what they feel are

impossible standards – withdraw into depression

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Emotions in Adulthood Society – expects people to practice emotional

control Coping- with situations, events, dev. Tasks,

responsibilities Challenged- physical illness, dysfunction Resort to- drug use, dieting, refusal to seek

assistance

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Mood disorders are seen as being caused by a locak of willpower or a character flaw

People with mood disorders are stigmatized by themselves and the public

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Emotions in Older Adulthood Depression is common in elderly High rate- elderly women, medically ill and

those who receive LTC

Depression is NOT a normal part of aging process

Sudden onset depression in elderly most likely has a physical cause

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Characteristics of Mood Disorders

Affect- outward expression of emotions– Blunted, flat, inappropriate, labile

Mood Disorder-disturbance in the emotional dimension of human functioning

Mania-elevated, expansive and irritable mood accompanied by a loss of identity

Depression- sadness, disappointment and despair

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Mood Disorders Bipolar-

– Bipolar I– Bipolar II– Cyclothymic

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Levels of Depression Mild-short lived, triggered by life events

– Common after important loss– Lost, let down, disappointed– Self limiting and subsides

Moderate- persists over time– Interferes with daily living, lack energy to get

through day– Fatigued, eating and sleeping is difficult– Dejected, gloomy, unable to find joy in life

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• Major depressive episodes routinely repeat for more than 2 years

• Associated with a high mortality rate

• Occur twice as often in adolescent girls and women than in adolescent boys and men

• Average age of onset of symptoms is early 20s

Major Depressive DisordersMajor Depressive Disorders

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Dysthymic Disorder

Moderate depression lasting more than 2 years

Chronically sad, self critical See selves as incapable and uninteresting Experience moderate depression symptoms During intense stress these individuals may

experience major depressive episodes

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• Hallmark is sudden and dramatic shifts in emotional extremes between mania and depression

• Thoughts, moods, and behaviors swing cyclically from normal, to grandiose, to depressed

• A return to normal functioning follows one cycle and lasts until next cycle begins. Intervals between manic episodes vary. People who cycle rapidly have poorer prognosis.

(Cont’d…)

Bipolar DisordersBipolar Disorders

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Rapid cyclers- have poorer prognosis Hypomania-exaggerated sense of cheerfulness,

begins the cycle Cheerfulness – accels to unstable ‘high’ Can lead to delirium and death from

exhaustion

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(…Cont’d)

• Bipolar I Episodes of depression alternate with episodes of mania. More severe and incapacitating form of bipolar illness Delusions common during periods of mania Hallucinations may occur.

• Bipolar II Major episodes of depression alternate with periods of hypomania. Often marked by 1 to 2 weeks of severe lethargy, withdrawal, and melancholy

followed by several days of mania

Bipolar DisordersBipolar Disorders

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• Affects many people from October to April with sadness and tendency to social withdrawal.

• Levels of mild and moderate depression are experienced during short winter days and long nights.

• Symptoms begin to lift with the coming of spring.• Daily exposure to full-spectrum light lessens

symptoms.

Seasonal Affective DisorderSeasonal Affective Disorder

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• A connection between hormone balance and emotions is implicated as cause.

• Tearfulness, irritability, hypochondria, sleeplessness, poor concentration, headache are characteristics.

• Mild episodes clear within days.• Symptoms lasting longer than 2 weeks need to be

investigated.

Postpartum DepressionPostpartum Depression

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Medical Problems and Mood Disorders

Common among hospitalized Common for people to feel depressed

when ill

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• Classes—each alters some element of neurochemical balance Tricyclics Nontricyclics Monoamine oxidase inhibitors (MAOs) Selective serotonin reuptake inhibitors (SSRIs) Atypical antidepressants

• Often takes 2 to 4 weeks before effects are observed and client improves; client must be told of this delay

(Cont’d…)

Drugs Used to Treat DepressionDrugs Used to Treat Depression

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Treatment and Therapy 3 phases: Acute Treatment

– 6-12 weeks– Goal is to reduce symptoms and behaviors

Continuation– 4-9 months– Goal is to prevent relapses– education

Maintenance– Preventing recurrences in clients with prior episodes– Psychotherapy and meds

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Standards of Treatment Psychotherapy

– Cognitive behavior therapy-correct self defeating thoughts

– Interpersonal therapy-relationship and interactions– Psychodynamic therapy-growth of personal insight

ECT-controlled grand mal seizure– Electrical current through the brain– Raises level of neurotransmitter– 15 minutes, 6-12 treatments over several weeks

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ECT

Outpatient or inpatient (out of order for you highlighters out there)

Contraindicated:– MI, heart disease, high or low blood pressure,

stroke, CHF, incr ICP, and tumors of nervous system

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(…Cont’d)

• Tricyclic antidepressants were once the first choice for depression.• Interact with barbituates, anticonvulsants, drugs and alcohol

• The SSRIs are now preferred because of their low incidence of side effects.• Prevents uptake of serotonin• Headaches, nausea, nervousness and insomnia most

common side effects

• MAOs are last resort because of severe and potentially fatal side effects.• Tyramine-overexcitation, severe high BP, hypertensive

crisis

• New antidepressants are chemically unrelated to other classes.

Drugs Used to Treat DepressionDrugs Used to Treat Depression

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• Holistic approach Physical realm: focus is on helping client with personal

hygiene, maintaining adequate nutrition, and encouraging physical activity

Emotional realm: care revolves around therapeutic relationship

Intellectual realm: patience Social realm: gentle encouragement to begin interacting with

others

Nursing InterventionsNursing Interventions

Elsevier items and derived items © 2005 by Mosby, Inc. 0 CHAPTER 21 Depression and Other Mood Disorders.

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