Mood Disorders Overview

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Questions and Answers

What is a key characteristic of a major depressive episode?

Involvement in pleasure-seeking activities

Depressed mood or loss of pleasure in nearly all activities lasting at least 2 weeks (correct)

Distinct periods of elevated mood

Inflated self-esteem or grandiosity

Which symptom is NOT typically associated with major depressive disorder?

Changes in eating habits

Feelings of worthlessness

Excessive and pressured speech (correct)

Impaired concentration

What duration is typically considered for a manic episode in bipolar disorder?

3 days

2 weeks

1 week (correct)

1 month

Which of the following disorders is mentioned as having an increased risk for suicide?

Schizophrenia Signup and view all the answers

Which of the following describes hypomania as opposed to a full manic episode?

Less severe symptoms Signup and view all the answers

What is the primary neurotransmitter associated with depression that is often found decreased in patients?

Serotonin Signup and view all the answers

Which of the following is NOT a common characteristic of major depressive disorder?

Increased interest in life activities Signup and view all the answers

What percentage of clients with depression is known to have thyroid dysfunction?

25% Signup and view all the answers

Which treatment approach is emphasized for managing depression over longer periods?

18 to 24 months of antidepressant therapy Signup and view all the answers

In psychodynamic theories, depression is often conceptualized as a reaction to what type of experience?

An event with psychic causality Signup and view all the answers

What characterizes bipolar I disorder?

One or more manic or mixed episodes usually accompanied by major depressive episodes Signup and view all the answers

Which statement about hypomania is true?

It is characterized by an elevated mood without impairment in functioning. Signup and view all the answers

What distinguishes a mixed episode in mood disorders?

Simultaneous experiences of mania and depression nearly every day Signup and view all the answers

Which of the following disorders is characterized by a chronic, persistent mood disturbance milder than major depression?

Persistent depressive (dysthymic) disorder Signup and view all the answers

Which mood disorder is directly linked to physiological changes from substance use?

Substance-induced depressive or bipolar disorder Signup and view all the answers

What is one of the essential criteria for diagnosing Major Depressive Disorder?

Five or more symptoms present during a 2-week period. Signup and view all the answers

Which symptom is an indicator of Major Depressive Disorder but not exclusively present in all patients?

Recurrent thoughts of death or suicide. Signup and view all the answers

What common side effect is associated with SSRIs such as fluoxetine?

Sexual dysfunction. Signup and view all the answers

How long does it typically take for tricyclic antidepressants to reach full effect?

6 weeks. Signup and view all the answers

Which statement is true regarding the differences between SSRIs and tricyclic antidepressants?

SSRIs are typically safer for older adults. Signup and view all the answers

Which group of clients is most likely to benefit from electroconvulsive therapy (ECT)?

Clients who have intolerable side effects from antidepressants Signup and view all the answers

What is the main goal of combining psychotherapy with medications for treating depressive disorders?

Achieve symptom remission and prevent relapse Signup and view all the answers

During electroconvulsive therapy, what is the purpose of administering a muscle relaxant?

To reduce the outward signs of seizure activity Signup and view all the answers

Which cognitive distortion involves viewing experiences in black or white terms?

Absolute, dichotomous thinking Signup and view all the answers

What is a notable feature of transcranial magnetic stimulation (TMS) for treating depression?

It is FDA-approved for major depression in treatment-resistant clients Signup and view all the answers

What is a common management strategy for clients taking tricyclic antidepressants to minimize dizziness?

Assisting the client in rising slowly from sitting Signup and view all the answers

Which of the following side effects is commonly associated with amitriptyline?

Weight gain Signup and view all the answers

Which medication should be monitored closely for cardiac function due to potential side effects?

Nortriptyline Signup and view all the answers

What crucial guideline is associated with the administration of Esketamine nasal spray?

Clients must remain in the office for 2 hours post-administration. Signup and view all the answers

What type of antidepressants may be used when clients have an inadequate response to SSRIs?

Atypical Antidepressants Signup and view all the answers

What should be reported to the physician when a client is taking Amoxapine?

Rashes Signup and view all the answers

Which of the following atypical antidepressants is marketed for smoking cessation?

Bupropion Signup and view all the answers

What is the most serious side effect of MAOIs when consuming tyramine-containing foods?

Hypertensive crisis Signup and view all the answers

What symptom might indicate an overdose of MAOIs?

Hyperthermia Signup and view all the answers

What nursing implication is recommended for patients taking duloxetine?

Administer with food Signup and view all the answers

Which medication requires clients to remain in a clinic for 2 hours post-administration?

Esketamine Signup and view all the answers

What is a key precaution when administering phenelzine (Nardil)?

Assist client in rising slowly from sitting Signup and view all the answers

Which symptom is commonly associated with serotonin syndrome?

Tachycardia Signup and view all the answers

Which medication is associated with an increased seizure threshold?

Bupropion Signup and view all the answers

What is a primary nursing implication for administering venlafaxine?

Administer with food and encourage fluid intake Signup and view all the answers

What is the recommended washout period before starting another class of antidepressant after discontinuing MAOIs?

5-6 weeks Signup and view all the answers

Which of the following describes the effect of the transdermal patch of selegiline compared to oral preparations?

It decreases the risk of hypertensive crisis Signup and view all the answers

Study Notes

Mood Disorders

Mood disorders or Affective disorders are characterized by pervasive changes in emotions, manifested by depression, mania, or both.
Mood disorders interfere with an individual's life, causing prolonged sadness, agitation, or elation.
Accompanying feelings of self-doubt, guilt, and anger can significantly affect self-esteem, work, and relationships.

Categories of Mood Disorders

Major Depressive Disorder: Lasts at least 2 weeks, marked by a depressed mood or loss of interest in activities.
- Symptoms include changes in eating habits, sleep disturbances, impaired concentration, feelings of worthlessness, thoughts of death, fatigue, and pessimistic thinking.
- Around 20% of individuals with major depressive disorder experience delusions and hallucinations, referred to as psychotic depression.
Bipolar Disorder: Characterized by mood fluctuations between extreme mania and depression.
- Mania: A distinct period of abnormally elevated, expansive, or irritable mood lasting about a week.
  - Symptoms include inflated self-esteem, decreased sleep needs, pressured speech, flight of ideas, distractibility, increased activity, and risky behaviors.
- Hypomania: A milder form of mania with similar symptoms, but without significant impairment in functioning or psychotic features.
- Mixed Episode: Experiences of both mania and depression almost daily for at least a week.
Bipolar I Disorder: One or more manic or mixed episodes, often accompanied by major depressive episodes.
Bipolar II Disorder: One or more major depressive episodes accompanied by at least one hypomanic episode.

Persistent Depressive Disorder (Dysthymia): Chronic, persistent mood disturbance with milder symptoms of depression, including insomnia, loss of appetite, low energy, and feelings of sadness.
Disruptive Mood Dysregulation Disorder: Persistent angry or irritable mood with severe temper outbursts beginning before age 10.
Cyclothymic Disorder: Mild mood swings between hypomania and depression without significant impairment in functioning.
Substance-Induced Depressive or Bipolar Disorder: Mood disturbance caused by ingested substances like alcohol, drugs, or toxins.
Seasonal Affective Disorder (SAD): Two subtypes:
- Winter Depression (Fall-onset SAD): Increased sleep, appetite, carbohydrate cravings, weight gain, irritability, and heaviness in extremities starting in late autumn.
- Spring-onset SAD: Less common, with symptoms of insomnia, weight loss, and poor appetite from late spring/early summer until early fall.
- Often treated with light therapy.
Postpartum Blues: Mild, predictable mood disturbance in the first few days after childbirth, including mood swings, crying, sadness, insomnia, and anxiety. Resolves without treatment.
Postpartum Depression: One of the most common pregnancy complications in developed countries, with symptoms similar to major depression.
- Brexanolone (Zulresso) is a neuroactive steroid used to treat postpartum depression, administered intravenously over a 60-hour period.
Postpartum Psychosis: A severe psychiatric illness with rapid onset in the days following childbirth.
- Symptoms progress from fatigue, sadness, and confusion to delusions, hallucinations, and loss of contact with reality. Requires immediate treatment.
Premenstrual Dysphoric Disorder: Severe form of premenstrual syndrome, causing significant distress and dysfunction, with symptoms like mood swings, irritability, difficulty concentrating, and feelings of anxiety.
Nonsuicidal Self-Injury: Deliberate, intentional harming of oneself, often motivated by the desire to alleviate negative emotions, self-punishment, or attention-seeking.

Etiology

Biologic Theories
- Genetic Theories: First-degree relatives (parents, siblings, children) have a higher risk (twice the risk) of developing depression compared to the general population.
  - A genetic link between early-onset bipolar disorder and early-onset alcoholism is suggested.
- Neuroendocrine Influences:
  - Hormone fluctuations are linked to mood disorders.
  - Elevated glucocorticoid activity associated with stress response, particularly in older clients with depression.
  - Hypothyroidism and hyperthyroidism are related to depression.
Psychodynamic Theories:
- Depression is seen as a reaction to a real or perceived loss, resulting in self-reproach and anger turned inward.
- The ego strives for ideal standards, and depression arises when those standards are unattainable.
- Depression can be viewed as a state of vulnerability, where the ego is dominated by a harsh superego.
- Mania is often seen as a defense mechanism against underlying depression, where the ID has taken over the ego.
- Depression is sometimes related to a traumatic life event.
- Depression is associated with a lack of love and support during childhood, contributing to feelings of insecurity and helplessness.
- Cognitive distortions lead to depression, including magnification of negative events, minimization of positive events, and distorted self-perception.

Cultural Considerations

The Hamilton Rating Scale for Depression is widely used to assess depression, with symptoms like depressed mood, guilt, loss of interest, and suicidal ideation reliably identified across diverse cultures.
Somatic Ailments: Physical symptoms of depression vary across cultures, and are more common in cultures that discourage verbalizing emotions.
Prevalence:
- Major depressive disorder is twice as common in women.
- Incidence of depression decreases with age in women and increases with age in men.
- Singles and divorced individuals have a higher incidence of depression.
- Depression occurs at equal rates in prepubertal boys and girls.

Onset and Clinical Course

Untreated depression can last for weeks to months, or even years, with most episodes lasting about 6 months.
About 50% to 60% of individuals experience recurrent depression.
Approximately 20% develop chronic depression.
The severity of depression is correlated with feelings of hopelessness and helplessness.
Some experience psychotic features.

Treatment and Prognosis

Psychopharmacology:
- Antidepressants increase levels of neurotransmitters, particularly norepinephrine and serotonin.
- Antidepressant Categories:
  - Cyclic Antidepressants (Tricyclics): Relieve symptoms of hopelessness, guilt, and mood variations. Used for panic disorder, obsessive-compulsive disorder, and eating disorders.
  - Monoamine Oxidase Inhibitors (MAOIs): Inhibit an enzyme that breaks down neurotransmitters.
  - Selective Serotonin Reuptake Inhibitors (SSRIs): Most frequently prescribed antidepressants. Specifically inhibit serotonin reuptake, reducing side effects.
  - Atypical Antidepressants: Broader range of antidepressant effects.
  - Antipsychotics: Used in combination with antidepressants to treat psychotic features of depression.
- Antidepressant Treatment Duration: 18 to 24 months is recommended to reduce relapse.
- Antidepressant Discontinuation: Dosage should be tapered before discontinuing treatment.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Effects: SSRIs are effective for many clients, with fewer sedating, anticholinergic, and cardiovascular side effects.
- Improvements in symptoms:
  - Insomnia: Decreases in 3 to 4 days.
  - Appetite: Returns to normal in 5 to 7 days.
  - Energy: Returns in 4 to 7 days.
  - Mood, concentration, and interest in life: Improve in 7 to 10 days.
Side Effects:
- Fluoxetine (Prozac): Headache, nervousness, anxiety, sedation, tremor, sexual dysfunction, anorexia, constipation, nausea, diarrhea, and weight loss. Half-life of over 7 days. Administer in a.m. (if nervous) or p.m. (if drowsy).
- Sertraline (Zoloft): Dizziness, sedation, headache, insomnia, tremor, sexual dysfunction, diarrhea, dry mouth, nausea, vomiting, and sweating. Administer in p.m. if drowsy.
- Paroxetine (Paxil): Dizziness, sedation, headache, insomnia, weakness, fatigue, constipation, dry mouth, nausea, vomiting, diarrhea, and sweating. Administer with food, p.m. if drowsy.
- Citalopram (Celexa): Drowsiness, sedation, insomnia, nausea, vomiting, weight gain, constipation, and diarrhea. Administer with food.
- Escitalopram (Lexapro): Drowsiness, dizziness, weight gain, sexual dysfunction, restlessness, dry mouth, headache, nausea, and diarrhea. Check orthostatic blood pressure.

DSM-5-TR Diagnostic Criteria: Major Depressive Disorder

A. Five (or more) of the following symptoms present during the same 2-week period, representing a change from previous functioning:
- Depressed mood or loss of interest or pleasure.
- Depressed mood, nearly every day (subjective or observed).
- Markedly diminished interest or pleasure in activities, nearly every day (subjective or observed).
- Significant weight loss or gain, or change in appetite.
- Insomnia or hypersomnia, nearly every day.
- Psychomotor agitation or retardation.
- Fatigue or loss of energy, nearly every day.
- Feelings of worthlessness, or excessive guilt.
- Diminished ability to think or concentrate.
- Recurrent thoughts of death, suicidal ideation, or suicide attempts.
B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. Episode is not attributable to the physiological effects of a substance or another medical condition.
D. Episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, etc.
E. Never previously experienced a manic or hypomanic episode.

Depression

Clients suffering from depression may exhibit apathy, sadness, and lack of emotional expression.
These individuals withdraw from social interaction, preferring to be alone and avoiding stimulation.
Their thought processes may be slow, they may not respond to questions, and they tend to be pessimistic and engage in self-deprecating thoughts and rumination.
In severe cases, individuals may experience psychotic symptoms, including delusions and command hallucinations.
Those with depression often struggle with memory impairment, difficulty concentrating, and impaired judgment.
Depression significantly impacts self-esteem, leading individuals to feel worthless and guilty about their inability to function.
They struggle to fulfill roles and responsibilities, resulting in isolation and strained relationships.
Depression can lead to physiological changes such as weight loss, sleep disturbances, decreased sexual interest, and neglect of personal hygiene.
Clients may experience constipation and dehydration due to decreased food and fluid intake.

Assessment and Tools

Depression rating scales like the Zung Self-Rating Depression Scale and the Beck Depression Inventory are used for case finding and to track improvement during treatment.
The Hamilton Rating Scale for Depression is a clinician-rated scale that assesses various aspects of depression, including mood, guilt, suicide, and sleep disturbances.

Plan of Care for a Client with Depression

The priority for a client with depression is ensuring safety, especially if they exhibit suicidal ideation or command hallucinations.
A therapeutic relationship with the client is crucial, providing a non-demanding space for them to express themselves.
Providing reorientation, repeated presentation of reality, and consistent staff presence can aid in grounding the client.
Active listening and accepting the client's feelings, including anger, is essential.
Encouraging the client to ventilate feelings through verbal or nonverbal expression is important.
Introducing and practicing stress management techniques can contribute to improved coping skills.
Use of a problem-solving process can help clients make choices and implement solutions, enhancing their confidence.

Nursing Actions

Safety: Institute suicide precautions when necessary and closely monitor the client for potential self-harm.
Therapeutic Relationship: Engage in non-demanding interactions with the client, prioritize their needs and provide a safe space.
Daily Living: Promote activities of daily living by offering necessary assistance.
Nutrition and Hydration: Assist with ensuring adequate food and fluid intake.
Sleep and Rest: Support the client's sleep patterns and encourage restful periods.
Engage in Activities: Motivate participation in activities that may be beneficial for their well-being.
Verbalize Emotions: Encourage the client to express their emotions and assist in processing feelings.
Medication Management: Assist in managing medication administration and help them understand the potential side effects.

Managing Medications

Increased energy and mood elevation from antidepressants can increase the risk of suicide.
Closely monitor clients for changes in mood and potential suicide risk even while they are on medication.
Ensure careful administration of medication and address any concerns regarding potential overdose.

Client and Family Education

Teach clients and families about depression as an illness, understanding its potential for relapse.
Emphasize the importance of support groups and assist in locating resources for both the client and their family.
Explain the benefits of therapy and follow-up appointments in achieving successful treatment outcomes.

Evaluation

Evaluation of the plan of care is based on the achievement of individual client outcomes.
Prioritize the client's safety and ensure they feel secure and free from suicidal urges.
Therapy participation and medication compliance contribute to positive outcomes for clients with depression.
Encourage clients to be aware of the signs of relapse and seek treatment promptly to mitigate the severity of future episodes.

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Description

Explore the characteristics and categories of mood disorders, including Major Depressive Disorder and Bipolar Disorder. This quiz examines symptoms, duration, and the impact on individuals' lives. Test your knowledge on affective disorders and their effects on mental health.