MOOD DISORDERS  Twice as common in women and has a 1.

5 to 3
times greater incidence in first-degree relatives
 EVERYONE OCCASIONALLY FEELS sad, low, and than in the general population.
tired, with the desire to stay in bed and shut out  Depression in prepubertal boys and girls occurs
the world. These episodes often are at an equal rate (Kelsoe, 2005).
accompanied by anergia (lack of energy),
exhaustion, agitation, noise intolerance, and BIPOLAR
slowed thinking processes, all of which make  Bipolar disorder involves extreme mood swings
decisions difficult. from episodes of mania to episodes of
 Fluctuations in mood are so common to the depression.
human condition that we think nothing of  During manic phases, clients are euphoric,
hearing someone say, “I’m depressed because I grandiose, energetic, and sleepless.
have too much to do.”  During depressed phases, mood, behavior, and
 Sadness in mood also can be a response to thoughts are the same as in people diagnosed
misfortune. with major depression
 At the other end of the mood spectrum are  A diagnosis of bipolar disorder may not be
episodes of exaggeratedly energetic behavior. made until the person experiences a manic
episode.
 In an elated mood, stamina for work, family,  A person with bipolar mixed episodes alternates
and social events is untiring. This feeling of between major depressive and manic episodes
being “on top of the world” also recedes in a interspersed with periods of normal behavior.
few days to a euthymic mood.
SUICIDE
 Mood disorders, also called affective disorders,
are pervasive alterations in emotions that are  Is the intentional act of killing oneself. Suicidal
manifested by depression, mania, or both. thoughts are common in people with mood
disorders, especially depression.
HISTORY  Chronic medical illnesses, environmental and
 Archeologists have found holes drilled into behavioral factors are associated with increased
ancient skulls to relieve the “evil humors” of risk for suicide.
those suffering from sad feelings and strange  Suicidal ideation means thinking about killing
behaviors. oneself. (nag iisip na patayon iya sarili)
 Active suicidal ideation is when a person thinks
 Babylonians and ancient Hebrews believed that about and seeks ways to commit suicide. (nag
overwhelming sadness and extreme behavior iisip pamaagi kun pano patayon iya sarili)
were sent to people through the will of God or  Passive suicidal ideation is when a person
other divine beings. thinks about wanting to die. (karuyag na
mamatay)
 Until the mid-1950s, no treatment was available
to help people with serious depression or
mania.
DISORDERS CLASSIFIED IN THE DSM-IV-RT
MENTAL DISORDER
DYSTHYMIC DISORDER
Are the most common psychiatric diagnoses
associated with suicide; depression is one of the  Dysthymic disorder is characterized by at least 2
most important risk factors for it (Sudak, 2005). years of depressed mood for more days than
not with some additional, less severe symptoms
MAJOR DEPRESSIVE that do not meet the criteria for a major
depressive episode.
 Major depressive disorder typically involves 2 or
more weeks of a sad mood or lack of interest in CYCLOTHYMIC DISORDER
life activities with at least four other symptoms.
Ex. Anhedonia.  Cyclothymic disorder is characterized by 2 years
of numerous periods of both hypomanic
 symptoms that do not meet the criteria for Postpartum Depression meets all the
bipolar disorder. criteria for a major depressive episode, with onset
within 4 weeks of delivery.

5. POSTPARTUM PSYCHOSIS
SUBSTANCE-INDUCED MOOD DISORDER A psychotic episode developing within 3
 Substance-induced mood disorder is weeks of delivery and beginning with fatigue,
characterized by a prominent and persistent sadness, emotional lability, poor memory, and
disturbance in mood that is judged to be a confusion and progressing to delusions,
direct physiologic consequence of ingested hallucinations, poor insight and judgment, and loss
substances such as alcohol, other drugs, or of contact with reality. This medical emergency
toxins. requires immediate treatment.

MOOD DISORDER DUE TO A GENERAL IMPORTANT CHARACTERISTICS

MEDICAL CONDITION
 Mood disorder due to a general medical
condition is characterized by a prominent and
persistent disturbance in mood that is judged to
be a direct physiologic consequence of a
medical condition such as degenerative
neurologic conditions, cerebrovascular disease,
metabolic or endocrine conditions, autoimmune
disorders, human immunodeficiency virus (HIV)
infections, or certain cancers.

SEASONAL AFFECTIVE DISORDER (SAD)

SYMPTOMS
1. WINTER DEPRESSION OR FALL ONSET
 Anhedonia
SAD
 Changes in appetite
People experience increased sleep,  Changes in weight
appetite, and carbohydrate cravings; weight gain;  Changes in sleep
interpersonal conflict; irritability; and heaviness in  Psychomotor Activity
the extremities beginning in late autumn and  Decreased energy
abating in spring and summer.  Feelings of worthlessness or guilt
 Difficulty thinking and concentrating or making
2. SPRING-ONSET SAD decisions
Spring-onset SAD less common, with  Recurrent thoughts of death or suicidal ideation
symptoms of insomnia, weight loss, and poor plans or attempts
appetite lasting from late spring or early summer
until early fall. SAD is often treated with light
therapy.

3. POSTPARTUM or "MATERNITY" BLUES

They are characterized by labile mood and
affect, crying spells, sadness, insomnia, and anxiety.
Symptoms begin approximately 1 day after delivery,
usually peak in 3 to 7 days, and subside rapidly with
no medical treatment.

4. POSTPARTUM DEPRESSION
 Includes 1 major depressive episode with an
episode of hypomania.

c. CYCLOTHYMIA
Has less intense episodes of depression and
hypomania.
d. BIPOLAR DISORDER, UNSPECIFIED

Doesn’t meet the criteria for any other type but still
has periods of abnormally elevated mood.

PHASES
MANIC PHASE

During manic phases, clients are euphoric,

grandiose, energetic, and sleepless. They have poor
judgement and rapid thoughts, actions, and speech.

DEPRESSED PHASE

During depressed phases, mood, behavior,

and thoughts are the same as in people diagnosed
with major depression.

TYPES OF BIPOLAR DISORDER

a. BIPOLAR I DISORDER
Characterized by at least 1 manic episode.

b. BIPOLAR II DISORDER
  Suicide involves ambivalence. Many fatal
accidents may be impulsive suicides.

WHO ARE AT RISK FOR SUICIDE?

(Rhimer & Pompili, 2017)
HYPOMANIA  Clients with psychiatric disorders, especially
depression, bipolar disorder, schizophrenia,
 Symptoms lasts at least 4 days.
substance abuse, posttraumatic stress disorder,
 Hypomania is a period of abnormally and
and borderline personality disorder, are at
persistently elevated, expansive, or irritable
increased risk for suicide.
mood and some other milder symptoms of
 Chronic medical illnesses associated with
mania. The difference is that hypomanic
increased risk for suicide include cancer, HIV or
episodes do not impair the person’s ability to
AIDS, diabetes, cerebrovascular accidents, and
function (in fact, he or she may be quite
head and spinal cord injury.
productive), and there are no psychotic features
 Environmental factors that increase suicide risk
(delusions and hallucinations).
include isolation, recent loss, lack of social
MIXED EPISODE support, unemployment, critical life events, and
family history of depression or suicide.
A mixed episode is diagnosed when the
 Behavioral factors that increase risk include
person experiences both mania and depression
impulsivity, erratic or unexplained changes from
nearly every day for at least 1 week. These mixed
usual behavior, and unstable lifestyle.
episodes are often called rapid cycling (Akiskal,
2017). SUICIDAL IDEATION
- Suicidal ideation means thinking about killing
Remember…
oneself.
People with bipolar disorder may
ACTIVE SUICIDAL IDEATION
experience a euthymic or normal mood and affect
between extreme episodes, or they may have a Active suicidal ideation is when a person
depressed mood swing after a manic episode before thinks about and seeks ways to commit suicide.
returning to a euthymic mood. For some, euthymic People with active suicidal ideation are considered
periods between extremes are quite short. For more potentially lethal.
others, euthymia lasts months or even years.
PASSIVE SUICIDAL IDEATION
OTHER RELATED DISORDERS
Passive suicidal ideation is when a person
1. Persistent Depressive (Dysthymic) Disorder thinks about wanting to die or wishes he or she
2. Disruptive Mood Dysregulation Disorder were dead but has no plans to cause his or her
3. Cyclothymic Disorder death.
4. Substance-induced Depressive or Bipolar
Disorder ATTEMPTED SUICIDE
5. Seasonal Affective Disorder (SAD)  Is a suicidal act that either failed or was
6. Postpartum Depression incomplete.
7. Postpartum Psychosis
8. Premenstrual Dysphoric Disorder  In an incomplete suicide attempt, the person
9. Nonsuicidal Self-Injury did not finish the act because
10. Postpartum or “Maternity” Blues
• someone recognized the suicide attempt and
SUICIDE responded or

 Suicide is the intentional act of killing oneself. • the person was discovered and rescued.
Suicidal thoughts are common in people with
WARNINGS OF SUICIDAL INTENT
mood disorders, especially depression.

 Suicide attempts are estimated to be 8 to 10

times higher than completed suicides.
 Most people with suicidal ideation send either
direct or indirect signals to others about their
intent to harm themselves.
 The nurse never ignores any hint of suicidal
ideation regardless of how trivial or subtle it
seems and the client’s intent or emotional
status.
 Often, people contemplating suicide have
ambivalent and conflicting feelings about their
desire to die; they frequently reach out to PSYCHOPHARMACOLOGY OF MOOD
others for help. DISORDER
 Asking clients directly about thoughts of suicide
MOOD DISORDERS have been recognized since
is important.
antiquity, occur worldwide, affect every
RISKY BEHAVIORS demographic group and are one of the greatest
challenges to human health and well-being.
 A few people who commit suicide give no Psychopharmacology has a key role in both the
warning signs. Some artfully hide their distress treatment and understanding of mood disorders,
and suicide plans. Others act impulsively by and although great progress has been made in both
taking advantage of a situation to carry out the domains, much remains to be done.
desire to die.
 The nurse must be alert to clues to a client’s PSYCHOPHARMACOLOGY
suicidal intent—both direct (making threats of
 Antidepressants the most commonly prescribed
suicide) and indirect (giving away prized
psychiatric medications. Antidepressants work
possessions, putting his or her life in order,
through the neurotransmitter serotonin and
making vague goodbyes).
may also have effects on norepinephrine and
LETHALITY ASSESSMENT dopamine. There are multiple types of
antidepressants including SSRIs.
 Involves determining the degree to which the
person has planned his or her death, including Commonly use drugs:
time, method, tools, place, person to find the
1. Fluoxetine (Prozac)
body, reason, and funeral plans. (in planohan
2. Sertraline (Zoloft)
an iya pag pakamatay, api an oras tas an
3. Citalopram (Celexa)
lugar, or an tawo nak un pano mahahanap an
4. Venlafaxine (Effexor)
iya lawas pag mamatay siya)
 Specific and positive answers to these questions
 Benzodiazepines are prescribed to treat severe
all increase the client’s likelihood of committing
anxiety, panic attacks and at times insomnia.
suicide. It is important to consider whether the
These medications are controlled substances
client believes his or her method is lethal even if
with the potential to cause addiction, so they
it is not. Believing a method to be lethal poses a
require close monitoring.
significant risk.
Commonly use drugs:
1. Alprazolam (Xanax)
2. Lorazepam (Ativan)
3. Clonazepam (Klonopin)
4. Stimulants are used predominately to treat
ADHD.
Commonly use drugs:
1. Dextroamphetamine salts (Adderall)
2. Methylphenidate (Ritalin)

 Antipsychotics important adjunct in the

treatment of mood disorder
Commonly use drugs:  Pharmacologic intolerance or poor response to
1. Lurasidone drugs
2. Risperidone  Catatonia
3. Haloperidol  Neuroleptic malignant syndrome
4. Olanzapine
5. Clonazepam

 Lithium drug of choice for treatment of main

episode (acute phase) CONTRAINDICATIONS OF ECT
 900-1500mg of lithium carbonate/day  Increased intracranial pressure, including
 Need to be closely monitored by repeated tumors, hematomas, and subarachnoid
blood levels, as the difference between the hemorrhage.
therapeutic and  Acute myocardial infarction
 Lethal blood level is not very wide.  Hypertension
 Tricyclic antidepressants (TCAs) prevent re-up  Cardiac disease, aneurysm, thrombophlebitis,
take of norepinephrine and serotonin bleeding disorders or where there is increased
1. Imipramine (75-150mg up to 300mg) risk of embolism
 Newer antidepressants
1. Selective serotonin reuptake inhibitors (SSRIs) PREPARATION FOR ECT
➡️Fluoxetine, Sertraline, Citalopram.
 NPO
2. Serotonin NE reuptake (SNRIs) ➡️ Venlafaxine,
 Removes any fingernails
duloxetine, Mirtazapine
 Receives a short-acting anesthetic
 Other Mood Stabilizer
 Receives muscle relaxant/paralytic
1. Sodium valproate (1000-3000mg/day)
 Receives Oxygen
2. Carbamazepine (600-1600mg/day)
 Monitor Vital Sign
3. T3 and T4 as adjuncts
AFTER ECT TREATMENT
MEDICAL TREATMENTS 1. Mildly confused or briefly disoriented
1. Electroconvulsive Therapy (ECT) 2. Fatigue
2. Psychotherapy (Talk Therapy) 3. Headache
4. Short time memory loss

PSYCHOTHERAPY
ELECTROCONVULSIVE THERAPY
 ECT involves application of electrodes to the  Psychotherapy (sometimes called talk therapy)
head of the client to deliver an electrical refers to a variety of treatments that aim to
impulse to the brain; this causes a seizure. help a person identify and change troubling
 Clients usually receive a series of 6 to 15 emotions, thoughts, and behaviors.
treatments scheduled thrice a week. Generally,  A combination of psychotherapy and
a minimum of six treatments are needed to see medications is considered the most effective
sustained improvement in depressive treatment for depressive disorders. There is no
symptoms. one specific type of therapy that is better for
 Maximum benefit is achieved in 12 to 15 the treatment of depression (Rush,2005).
treatments.  The goals of combined therapy are symptom
remission, psychosocial restoration, prevention
INDICATIONS FOR ECT
of relapse or recurrence, reduced secondary
 Severe major depression consequences such as marital discord or
 Suicide Risk occupational difficulties, and increasing
 Mania treatment compliance.
 Psychosis of schizophreniform disorders
TYPES OF PSYCHOTHERAPY
 Good response to previous ECT
1. INTERPERSONAL THERAPY
 Interpersonal therapy focuses on difficulties 18. Channel client’s need for movement into
in relationships, such as grief reactions, role socially acceptable motor activities.
disputes, and role transitions. For example, a person
who, as a child, never learned how to make and
trust a friend outside the family structure has
difficulty establishing friendships as an adult.

Interpersonal therapy helps the person to INTERVENTION FOR SUICIDAL IDEATION

find ways to accomplish this developmental task. 1. Using an Authoritative Role
2. Providing a Safe Environment
2. BEHAVIOR THERAPY 3. Creating a Support System List
Behavior therapy seeks to increase the HEALTH TEACHING
frequency of the client’s positively reinforcing
interactions with the environment and to decrease Client Family Education for Depression
negative interactions.
 Teach about the illness of depression.
It also may focus on improving social skills.  Identify early signs of relapse.
 Discuss the importance of support groups and
3. COGNITIVE THERAPY assist in locating resources.
Cognitive therapy focuses on how the  Teach the client and family about the benefits
person thinks about the self, others, and the future of therapy and follow-up appointments.
and interprets his or her experiences.  Encourage participation in support groups.
 Teach the action, side effects, and special
This therapy focuses on the person’s instructions regarding medications.
distorted thinking, which, in turn, influences  Discuss methods to manage side effects of
feelings, behavior, and functional abilities. medication
NURSING INTERVENTION FOR DEPRESSION Client Family Education for Mania
1. Provide for the safety of the client and others.  Teach about bipolar illness and ways to manage
2. Institute suicide precautions if indicated. the disorder.
3. Begin a therapeutic relationship by spending  Teach about medication management, including
nondemanding time with the client. the need for periodic blood work and
4. Promote completion of activities of daily living management of side effects.
by assisting the client only as necessary.  For clients taking lithium, teach about the need
5. Establish adequate nutrition and hydration. for adequate salt and fluid intake.
6. Promote sleep and rest.  Teach the client and family about signs of
7. Engage the client in activities. toxicity and the need to seek medical attention
8. Encourage the client to verbalize and describe immediately. Educate the client and family
motions. about risk-taking behavior and how to avoid it.
9. Work with the client to manage medications  Teach about behavioral signs of relapse and
and side effects. how to seek treatment in early stages
10. Provide for client’s physical safety and those
around.
11. Set limits on client’s behavior when needed.
12. Remind the client to respect distances between
self and others.
13. Use short, simple sentences to communicate.
14. Clarify the meaning of client’s communication.
15. Frequently provide finger foods that are high in
calories and protein.
16. Promote rest and sleep.
17. Protect the client’s dignity when inappropriate
behavior occurs.