. possible deficit in vitamin intake or
reduced sleep
metabolism: (vitamin B complex, folic acid)
v. genetics may be involved
G. Types of mood disorders: mania, bipolar,
depression
4. Mania - DSM IV criteria for mania
a. period of abnormally/persistently
elevated mood or irritability
b. at least three of these six signs
i. grandiosity
ii. decreased sleep
iii. hypertalkative, with pressured speech
and flight of ideas or racing thoughts
iv. highly goal-directed activity (sexual,
work)
v. highly distractible
vi. pursues pleasure, but overestimates own
skill and luck
2. Bipolar disorders onset usually before
age 30
a. bipolar disorder, mixed: both manic and
depressive episodes present
i. bipolar I
• consists of one or more periods of major
depression plus one or more periods of
clear-cut mania
• findings as in Definition of mood disorder
(on page 15 of this lesson)
• no marked drop in social and job
functioning
• manic episode requires hospitalization
ii. bipolar II
• consists of one or more periods of major
depression plus periods of hypomania
• includes all symptoms in Definition of
mood disorder (on page 15 of this lesson)
and does not require hospitalization
b. bipolar disorder, manic: fulfills criteria for
manic episode (see Findings below)
c. bipolar disorder, depressed: major
depressive episode and at least one manic
episode, current or past
d. cyclothymic mood disorder:
i. many milder findings of mania and
depression
ii. periods of normal mood are short
iii. usually does not require hospitalization
3. Depression
a. includes all 7 typical traits of mood
disorders
b. specific criteria for depression (see
Findings below)
I. Findings
2. Mania
a. elation, euphoria; inappropriate laughter;
very talkative
b. irritable, hostile, aggressive
c. flight of ideas, delusions of grandeur,
exhibitionism, sexual acting-out
d.
e. unlimited energy; no time for food or
drink
f. impulsive, easily distracted
g. manipulative behavior
2. Depression
a. melancholia, crying, absence of pleasure;
slumped posture
b. apathy; loss of desire for food and/or sex
c. slower reactions
d. low self-confidence; inhibition,
introversion
e. ruminating, decreased communication,
social isolation
f. fatigue and/or insomnia
g. decreased concentration
h. poor hygiene
i. hopelessness, pessimism
j. self-destructiveness
J. Treatments
2. Treatments for mania
a. pharmacologic
i. lithium carbonate (Lithane),
carbamazapine (Carbatrol), valproic acid
(Depakene)
ii. antipsychotics: chlorpromazine
(Thorazine), haloperidol (Haldol)
b. occupational therapy
c. recreational therapy
2. Depression
a. pharmacologic antidepressants
i. tricyclic antidepressants - amitriptyline
HCl (Elavil), doxepin (Sinequan),
imipramine (Tofranil)
ii. monoamine oxidase inhibitors -
phenelzine (Nardil), tranylcypromine
(Parnate)
iii. selective serotonin reuptake inhibitors
(SSRI) - fluoxetine (Prozac), sertraline
(Zoloft)
b. ECT: electroconvulsive therapy
c. psychotherapy
d. occupational therapy
e. recreational therapy
f. cognitive therapy
K. Nursing care in mood disorders
2. Mania
a. protect client and others from harm
b. provide quiet environment with few
stimuli
c. give medications as ordered; be sure
client swallows meds
d. establish trust relationship
e. do not argue with client or provoke
hostility
f. redirect client to task at hand
g. set firm, consistent limits; explain them
simply
h. allow client to express anger in positive
ways in windows
i. offer finger foods 9. Do not assign a private room
j. increase client's fluid intake to at least
1000cc/day
k. allow client to pace
l. teach client
i. acceptable ways to release anger
ii. medications and side effects
iii. importance of taking medication
IV. Types
J. Tricyclics and tetracyclic antidepressants
0. Prevent nerve endings from taking up
norepinephrine and serotonin
1. Increase the action of norepinephrine and
serotonin in nerve cells
K. MAO Inhibitors (Monoamine oxidase
inhibitors)
0. Lower the production of monoamine
oxidase
1. Thus the central nervous system stores
more endogenous epinephrine,
norepinephrine, serotonin, and dopamine
V. Contraindications: convulsive disorders,
prostatic hypertrophy, severe renal, cardiac
or hepatic disease
VI. Administer with food to prevent GI
disturbance
VII. Therapeutic effect may take up to three
weeks
VIII. Teach client about potential for
drowsiness or dizziness
IX. Teach client to avoid drinking alcohol
X. Do not stop taking antidepressants
suddenly
0. Depression
a. monitor suicidal thoughts
b. take suicide precautions as indicated and
observe for
SUICIDE PRECAUTIONS
1. Remove all harmful objects from the
environment
2. One to one monitoring of the client day
and night, having the client in view at all
times even during toileting, gradually
progress to 15 minute and then hourly
checks
3. Ask client exactly how she/he would
commit suicide. Assess how lethal the
attempt would be, and how quickly it could
be carried out.
4. Keep client within one arm's length
distance or less at all times
5. Use plastic utensils
6. Keep electrical cords to a minimum
length
7. Take all potentially harmful gifts from
visitors
8. Keep all windows locked and if possible
keep client in room with unbreakable glass