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MOOD DISORDERS
• Associated with severe and painful sadness or abnormal elevated mood.
• Changes a person’s behavior, cognition, motivation, and emotions;
• Most common psychiatric diagnosis:
– 5% of people have mood disorder;
– 25% of people with depression have a family member with mood disorder;
– 50% of people with bipolar disorder have a family member with mood disorder;

• Two Diagnostic Categories:

1. Major Depressive Disorder (MDD)

• A person experiences one or more episodes of depression with no manic
or hypomanic manifestations;
• Twice as many women than men;
• Onset is usually early to mid 20’s;

2. Bipolar Disorders
• A person experiences major depression with one or more manic or
hypomanic episodes;
• Female and male ratio is the same;
• Onset is usually mid to late 20’s (late adolescence to early adulthood)
• High prevalence among professionals and well-educated persons;

MAJOR DEPRESSION
• Is one of the most prevalent mental health problem within the US;
• Depressive symptoms are experienced by 9-20% of adult persons, and half of these
persons will develop clinical depression within a year;
• About 80% will eventually have recurrent episodes;
• In elderly, 6 – 12% have depression (MELANCHOLIC DEPRESSION)
• Children of parents who suffered from depression are at risk to develop the disorder;
• The onset of childhood depression predisposes a child to develop recurrent adult
depression;

• Events that will predispose children and adolescent to depression:

• Loss of parents
• Death of very important persons
• Death of a beloved pet
• Move to another neighborhood or town
• Academic problems or failures
• Physical illness or injury

• THEORIES OF DEPRESSION:
a. Biochemical Theory
• Decreased norepinephrine and serotonin.
• Alterations in the functions of the hypothalamic-pituitary-adrenal system
may cause depression;

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• Alterations in the circadian rhythm (wake-sleep cycle) will cause problem

with sleep patterns, arousal, activity, and hormonal secretions;
b. Psychodynamic or Psychoanalytical Theory
 Depression occurs as a result of a person’s ego loss in relationship to early life
occurrences;
 Anger inappropriately directed TO SELF often triggered by the loss of a loved
one or object.
 Unresolved grieving in the early stage of child-parent relationship;

c. Cognitive Theory
 Depression results when a person perceives all stressful situations as
being negative;
 Reacts to all situations as if they are stressful and relate himself or others
in a negative light;
 Arise from negative experiences during childhood such as loss of loved
ones, leaving home, or divorce;

d. Interpersonal Theory
 Person’s difficulties, coping with individuals, life events, and life changes can
be stressful and may lead to depression;
 Role dispute, social isolation, prolonged grief reaction, and role transition are
major interpersonal themes;

e. Behavioral Theory
 Depression develops when one feels helpless and unworthy

f. Sociological Theory
 Stated that depression is caused by abnormal medical, social learning, and
stress and response mechanism by an individual;

DSM-IV Criteria for Major Depression:

1. DEPRESSED MOOD
2. ANHEDONIA
3. Sleep disturbances
4. Possible weight loss or weight gain.
5. Fatigue or energy loss.
6. Reduced recognition and concentration;
7. Psychomotor agitation – increase or decrease activities;
8. Feelings of worthlessness or guilt;
9. Recurrent death or suicidal thoughts;

 Symptoms must persists for a minimum of 2 weeks.

 A person must have at least 5/9, one of which is a depressed mood or anhedonia.

Types of Depression:
1. Atypical Depression
• Mood disturbance that occurs in younger populations;
• May involve other mental conditions such as schizophrenia;
• Char by increased appetite, weight gain, hypersomnia, leaden paralysis, and

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extreme sensitivity to interpersonal rejection;

2. Melancholic or Endogenous Depression

• Occurring most often in older persons (at least 40 years old)
• Char by anhedonia and an inability to be cheered up;

3. Postpartum Depression
• Symptoms of depression occurs in the first 30 days postpartum but may last for
one year;

4. Psychotic Depression
 Manifests with signs of depression accompanied by delusions and hallucinations;

5. Seasonal Affective Disorder (SAD)

 Depression occurring in relation to seasonal change most often beginning in fall or
winter and remitting in spring;

6. Chronic Depression
 About 10% of depressed patients will fall under this category;
 Depression last longer than two years;

7. Paranoid Depression
 Patient have depressed symptoms with paranoid ideation;

8. Drug-induced Depression
 Depression developed due to use of prescription, OTC, or other types of drugs;

9. Retarded Depression
 Depression manifested by decreased psychomotor activities;

10. Dysthymic Disorder

• Depressed mood with 3 other signs of depression.
• Duration is at least 2 years.

Diagnostic Examinations related to Depression:

1. Dexamethasone Suppression Test (DST)
• A positive result occurs when serum and urinary cortisol do not fall or not
suppressed;

2. Growth Hormone determination

• Some depressed children may have decreased secretion of GH during the day and
increased secretion while asleep;

3. Polysomnographic Patterns
• In depressed adults, the REM phase is shortened which result in frequent night
and early morning awakening;

4. Thyrotropin-releasing Hormone Test

• In depressed persons, thyroid hormone secretions are decreased;

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Management:
A. Nurse Interventions
• Assess px for signs of suicide.
• Create a safe and structured environment.
• Accept the patient who they are, where they are, and focus on their strengths;
• Reinforce decision making by patients;
• Never reinforce hallucinations or delusions;
• Respond to anger therapeutically;
• Spend time with withdrawn patients;
• Make decisions for patients that are not yet ready to make decisions;
• Involve px in activities in which they can experience success and increase in self-
esteem;
• Monitor px for cheeking or hoarding of drugs;
• Assess px for adverse drug reactions;
• Assess for signs of toxicity;

B. Psychotherapy
C. Behavioral therapy
D. Cognitive therapy
E. Electroconvulsive therapy
F. Pharmacotherapy
1. SSRI – Fluoxetine
2. TCA – Imipramine
3. MAOI – Phenelzine

BIPOLAR DISORDERS
• Also known as manic-depressive disorder;
• Characterized by episodes of mania and depression with periods of normal mood and
activity in between;
• Bipolar disorders are those in which individuals experience the extremes of mood polarity
like he/she may feel very euphoric or very depressed;
• Bipolar disorders appear equally common among men and women;
• In men, the first episode is usually of manic manifestations;
• In women, it is depressive symptoms that come first before the manic signs;

THEORIES OF MANIA:
1. Psychodynamic Theory
• Faulty family relationship and communication during early life are responsible for
manic behaviors in later life;
• Manic behaviors are defense against or massive denial of depression;
2. Biological Theory
• Related to excessive levels of neurotransmitters such as norepinephrine,

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serotonin, and dopamine.

• High consideration is also given to genetic considerations (twins and with family
history)

Clinical Manifestations of Mania:

1. ELEVATED MOOD
2. Loud and rapid speech
3. Flight of ideas
4. Anger
5. Distractibility
6. Grandiosity or inflated self-esteem
7. Increase irritability
8. Hyperactivity
9. Anorexia
10. Insomnia
11. Pleasurable activity involvement
12. Hypersexuality
13. Resistance to treatment
14. Depression and delusion
15. Labile mood and lack of illness awareness

Types of Bipolar Disorders:

• Bipolar I

• Bipolar II

• Cyclothymic Disorder

Management:
A. Nursing Management
o Create a safe environment.
o Reduce environmental stimuli.
o Limit the patient’s participation in group activities.
o Provide clear and concise comments and directions.
o Provide physical exercise as a substitute for increased motor activity.
o Reinforce reality especially if the px have altered perception.
o Provide positive feedback for socially acceptable behaviors.
o Monitor sleeping and eating patterns.
 High-protein, high-caloric “finger foods”
 Avoid stimulants like caffeine or cola.

o Assist the px to focus on a single task.

o Encourage rest periods.

B. Pharmacotherapy
– Antimanic Drugs

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• Lithium carbonate
• Carbamazepine
• Valproic acid

– Anxiolytics

– Antipsychotics
Name : Patient X
Sex : Female
Age : 25 y/o
Address : Filvelle Subd. Sta. Cruz Guiguinto Bulacan
Civil Status : Married
Birth date : March 12 1985
Birthplace : N Andres Romblon
Religion : Catholic
Nationality : Filipino
Date Admitted : April 20 2010
Admitted Doctor :
Diagnosis : Bipolar Affective Disorder Arrest episode manic with psychotic
symptoms, unstable
General data :
History of Present Illness:

The patient has been mentally ill since 2004, after she gave birth to his son. After she gave birth
she was noticed with behavioral oddities such as impaired sleep, irritate and restless. She was noted to
be repeatedly taking a bath and wandering around their area. She was noted to be laughing and talking to
self. She was tolerated at home.
December 2009 patient leave their house in Romblon, she was found and take cared by a
concerned citizen in Bulacan.
According to the concerned citizen who takes care of her, patient was assaultive as she hit
children and she seen climbing on the wall which prompted consults hence admission.

I. Goal Interaction
 To gain rapport of my patient.
 Establish trust, acceptance, and open communication
 To understand the patient’s problems.
 To demonstrate genuine care and understanding.

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 To mutually formulate a contract with the patient

II. General Objectives

 To distinguish the sickness of the client thru the observation done.
 To reduce the anxiety felt by the client towards the nurse.

 To discuss the contract to my patient.

 To explore patient’s thoughts, feelings, and actions

III. Short-term Objectives

 To be able to introduce myself to my patient and getting to know one another.
 To gain trust from my patient.
 To reduce the level of fear

 To observe and assess my patient’s personality.

Mental Status Examination

Seen and examined as an adult female, thinly built in hospital gown. Mood was irritable with
constricted affect and poor eye contact. The patient has poor impulse control. She uses regression,
evasion and acting-out as Defense Mechanism. She has no appropriate answers when questioned. She
admits hearing of vices “meron” but don’t elaborate

Nurse-Patient Interaction (NPI) – Orientation Phase

NPI Inference Rationale

N: Magandang hapon sa iyo Broad Opening To establish open-ended

P: Magandang hapon communication

To establish open-ended
N: Ano po ba ang pangalan mo? Broad Opening communication
P: Rose
To gain rapport and trust

N: Ako nga pala po si Carelle May Giving Information

Casiano student nurse po ng
Perpetual Help College of
Manila Simula po ngayon
Magkakasama po tayo at pag
Uusapan natin ang inyong
Talambuhay, hanggang sa
Byernes po sa susunod na

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linggo
P: (no response)

N: Kamusta ka naman Rose?

Broad Opening To establish open-ended
P: ok lang .
communication

N: Anung araw ngayon?

P: di ko alam

N: San ka po nakatira?
P: Sa Romblon

N: Ilang taon kana?

P: 23

N: Kailan ang birthday mo?

P: March 12 1985
Confirms a statement
Validation
N: Bali ilang taon ka na nga ulit?
P: 24

N: Nakapag aral kaba?

P: Oo. College.

N: Anong Course mo sa Collge

Rose?
P: Pang Kalahatan.
Encourage client to make
idea more
Clarification
N: Anong pangkalahatan yon understandable
Rose, maari mo bang ipaliwa-
nag?
P: Ewan

N: Hanggang ilang taon ka sa

College?
P: 1ST Year Encourage client to
express feelings or ideas.
Exploring
N: Anong dahilan at hanggang 1st
Year lang ang tinapos mo?
P: Ewan ko

N: Kamusta ka ngayong araw?

P: OK lang, susunduin na ba ako? Encourage the client to
Asan yung sundo ko? continue
Restating
N: Sino po sa tingin nyo susundo
sayo?
P: Yung ate ko

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N: Nasaan po ang ate nyo? To promote easy

P: Nasa Romblon yata understanding on the
Presenting Reality problem
N: Naku ate wala pong susundo
Ngayon sa inyo kasi po,
pinalabas po Kayo para po
makausap po naming kayo. Verbalizing what the
P: ok nurse perceives
Making Observations
N: Mukang tulala ka, may buma-
Gabag ba saiyo? Encourage client to
P: wala introduce the topic, or
Broad Opening start a conversation
N: Anung gusto mong pag usapan Encourage client to
Natin Rose? express feelings or ideas.
P: Buntis ako.
Exploring
N: Sa palagay mo ilang buwan na Encouraging the client to
Yang pinag bubuntis mo? stay focus on the topic
P: July ngaun, bali April…May…
June… July… mga 3 buwan na Encourage client to
Focusing express feelings or ideas.
N: Sabi mo buntis ka, Kelan ba
ang huling regla mo?
P: april yun e.
To establish open-ended
Exploring
N: Ano ang nasa isip mo at nasabi communication
mong buntis ka?
P: Wala, baka hangin lang to.
(ngiti)
Broad Opening
N: May asawa ka ba?
P:Oo

N: Nasaan sya?
P: Nasa Romblon

N: Kailan kayo huling nagkita?

P: Ewan

N: Ano naalala mo?

P: Yung mga anak ko

N: Nasaan sila Rose?

P: Nandon sa Romblon

N: Ilang anak meron ka?

P: 2

N: Ilang taon na sila?

P: 7 at 3

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N: Anong pangalan ng mga anak

Mo?
P: “silence”

N:
P:

N: Naalala mo pa ba kung ilang

Buwan kana dito?
P: Oo, bago lang ako dito nung
April 10 2010 lang, bali mga 3
Buwan na ako dito

N: Pano ka nakapunta dito?

P: May pumuntang DSWD samin
Kinuha ako.

N: Ano sa tingin mo ang dahilan at

Kinuha ka nila?
P:Kumakain kasi ako nun, may
Nag bigay sakin ng pagkain.

N: Sino yung nag bigay sayo ng

Pagkain?
P: yung babae.

N: Anong pagkain ang binigay nya

Sayo?
P: Basta masarap

N: Ok Rose nagkaroon ka ba ng
Trabaho?
P: Oo.

N:Anong trabaho naman yun

Rose?
P: silence

N: San ka nagtrabaho Rose?

P: Sa Bulacan

N: Maari ko bang malaman kung

Anong trabaho meron ka nun
Sa Bulacan?
P: Kumakain lang,

N:Mayron ka bang amo sa

Bulacan?
P: Oo

N: Mababait ba sila?

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P: Oo

N: Rose ano nga ulit yung trabaho

Mo sa Bulacan?
P: Naghuhugas, at naglalaba.

N: Bali pumasok ka bilang

Katulong?
P: Oo

N: Pinapasweldo ka ban g ayos

Ng mga amo mo?
P: Oo

N: Pinapakain ka ba nila?
P: Oo

N: Anong madalas nilang ipakain

Sayo?
P: Kanin, sinigang na baboy.

N: ahhh Rose Masaya ka ba

ditto?
P: Oo..

N: Ano nag papasaya sayo sa pag

tira mo ditto?
N: May libreng pagkain dito,at
natutulog lang ako ditto.

N: Minsan ba nalulungkot ka?

P:Hindi

N: May mga bumabagabag sayo

Rose?
P: Wala

N: Rose tingin ka skin, nakatulala

Ka na naman
P: (mabgal na titingin ng bahagya)

N: Salamat po sa iyong tiwala sa

paglahad ng mga bagaybagay..
P: (silence)

N: Papasok ka na ulit sa loob

Rose, bukas nandito ulit ako,
Maari bang magkwentuhan ulit
Tayo bukas?
P: Sige.

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