Psychology of Mood Disorders

Seasonal Affective Disorder (SAD)

• SAD is a subtype of depression, with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall.
• Light therapy is often used to treat SAD.

Postpartum or "Maternity" Blues

• Postpartum or "maternity" blues is a mild, predictable mood disturbance occurring in the first several days after delivery of a baby.
• Symptoms include labile mood and affect, crying spells, sadness, insomnia, and anxiety.
• Symptoms subside without treatment, but mothers do benefit from the support and understanding of friends and family.

Postpartum Depression

• Postpartum depression is the most common complication of pregnancy in developed countries.
• Symptoms are consistent with those of depression, with onset within 4 weeks of delivery.

Postpartum Psychosis

• Postpartum psychosis is a severe and debilitating psychiatric illness, with acute onset in the days following childbirth.
• Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion, and progress to delusions, hallucinations, poor insight and judgment, and loss of contact with reality.
• This medical emergency requires immediate treatment.

Premenstrual Dysphoric Disorder (PMDD)

• PMDD is a severe form of premenstrual syndrome, defined as recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolve with menstruation.

Assessment of Depression

• The nurse collects assessment data from the client, family, or significant others, and previous chart information.
• Assessment may take several short periods to complete due to the client's exhaustion and overwhelm.
• The nurse asks about behavioral changes, including when they started, what was happening when they began, their duration, and what the client has tried to do about them.
• Assessing the history is important to determine any previous episodes of depression, treatment, and the client's response to treatment.

General Appearance and Motor Behavior

• Clients with depression often look sad, with slouched posture, minimal eye contact, and slow body movements.
• They may have psychomotor retardation, with slow cognitive processing and slow verbal interaction.
• Responses to questions may be minimal, with only one or two words.
• Latency of response is seen when clients take up to 30 seconds to respond to a question.

Thought Process and Content

• Clients with depression experience slow thinking processes, with negative and pessimistic thoughts.
• They may believe they will always feel this bad, things will never get any better, and nothing will help.
• They tend to ruminate, repeatedly going over the same thoughts.

Suicide

• It is important to assess suicidal ideation by asking about it directly.
• Clients may have thoughts of dying or committing suicide, and it is essential to ask about suicidal thoughts.

Sensorium and Intellectual Processes

• Clients with depression may have difficulty with orientation, especially if they experience psychotic symptoms or are withdrawn from the environment.
• Memory impairment is common, and they may have extreme difficulty concentrating or paying attention.

Judgment and Insight

• Clients with depression experience impaired judgment, unable to use their cognitive abilities to solve problems or make decisions.
• Insight may be intact, especially if clients have been depressed previously.

Self-Concept

• Sense of self-esteem is greatly reduced, with clients often viewing themselves as "good for nothing" or "just worthless".
• They feel guilty about not being able to function and often personalize events or take responsibility for incidents over which they have no control.

Roles and Relationships

• Clients with depression have difficulty fulfilling roles and responsibilities, including going to work or school, and caring for family responsibilities.
• The more severe the depression, the greater the difficulty.

Hamilton Rating Scale for Depression

• The scale rates the range of the client's behaviors, including depressed mood, guilt, suicide, and insomnia.
• It also scores diurnal variations, depersonalization, paranoid symptoms, and obsessions.