Therapeutic Optimism in Mood Disorder Recovery

Mood Disorders: Cognition & Perception 2024

• Mood disorders are a common form of mental illness, causing significant distress.
• Mood disorders are categorized into depressive disorders and bipolar affective disorders (types I and II).
• The study explores theories behind mood disorder etiology (causes) and associated mood changes.
• Understanding the impact of mood disorders on individuals and nursing considerations for those experiencing them is vital.
• Understanding common psychopharmacology used in mood disorder treatment is included.
• The CHIME model (Hope and Optimism, Connectedness, Identity, Meaning, Empowerment) for recovery from mood disorders is introduced.

Recovery: Remember CHIME

• Recovery involves aspects of hope, optimism, connectedness, identity, meaning, and empowerment.
• The CHIME approach aims to help individuals recover from mood disorders.

Therapeutic Optimism

• Therapeutic optimism is defined as self-reported expectations for positive outcomes in clinical settings.
• It is essential to support individuals by allowing them to live, work, and love in a contributing and meaningful community.
• This concept encourages the development of social life, employment, routines, and enhance coping skills to manage life's challenges.

Mood Disorder Prevalence

• In 2022/23, one in eight adults (11.9%) in New Zealand experienced high or very high levels of psychological distress, with women (13.2%) experiencing it more frequently than men (10.2%).
• Young people aged 15-24 years showed high rates of psychological distress in 2022/23 (21.2%) compared to 2011/12 (5.1%).
• Māori and Pacific adults experienced psychological distress at higher rates compared to non-Māori and non-Pacific adults after controlling for age and gender.
• Individuals living in more deprived neighborhoods experienced higher rates of psychological distress compared to those in less deprived areas, considering age, gender, and ethnicity.
• Disabled adults experienced higher levels (35.9%) of psychological distress than non-disabled adults (9.5%) in 2022/23.

Mood Disorders: Diagnosis and Prevalence (NZ data)

• The data from the New Zealand Health Survey from June 2022 shows prevalent mood disorders by gender and ethnicity.
• The data shows higher rates of mood disorders among women in most ethnic groups, which includes Asian, European/Other, Māori, and Pacific Peoples.
• There are notable differences in the prevalence of disorders across ethnic groups.

Causation Theories:

• The diathesis-stress model suggests that a combination of factors interacting contributes to mood disorders, specifically depression.
• A predisposition to vulnerabilities and stress from life experiences interact to cause the illness.
• The potential underlying biological factors, including genetics, neurochemicals, hormones, trauma, personality, and environmental factors, can trigger or exacerbate mood disorders.

Causation: Genetic Links

• Mood disorders likely involve multiple genes.
• Genetic mutations are believed to play a role in mood disorder development and the regulation of neurotransmitters.
• Family studies highlight a hereditary probability for mood disorders which potentially interact with pre-natal or environmental factors.
• Children with a relative who has bipolar disorder have a notably increased chance (20%) of experiencing the disorder themselves.

Causation: Hormonal Factors

• The hypothalamic-pituitary-adrenal (HPA) axis and circadian rhythms are important in mood disorders, as they regulate cortisol and thyroid hormone release.
• Elevated levels of cortisol and thyroid hormones were observed during manic episodes.
• Immune responses via pro-inflammatory cytokines may influence mood disorder mechanisms.

Causation: Neurochemical factors

• Lower levels of neurotransmitters (serotonin and other monoamines) in the brain were previously thought to cause depression.
• Current studies suggest that monoamines interact with numerous neurobiological systems creating complex processes related to depression.
• Neurotransmitters (serotonin, noradrenaline, GABA, and glutamatergic) impact hormonal systems contributing to mood disorders.

Causation: Trauma

• Mood disorders can be caused by both single-incident (e.g., accident, trauma, disaster) and chronic trauma (e.g., abuse).
• Ongoing trauma results in stressful events, such as childhood experiences (sexual, physical, emotional abuse).
• Emotional responses to trauma, including numbness, denial, guilt, self-blame, and extreme sadness, may persist.
• Physiological symptoms, such as eating or sleeping disorders and substance abuse, can accompany trauma.
• Trauma and its subsequent effects are frequently associated with the development of depression.

Causation: Personality and Stress

• Certain personality types, such as those with pessimistic views, catastrophic thinking, or rumination, might be more susceptible to mood disorders.
• Learned helplessness from stressful life experiences can contribute to the development of mood disorders, specifically depression.
• The impact of cumulative stressors, and their effect on the development of mood disorders, are of high importance.
• Resilience refers to an individual's capacity to adapt to challenging situations and move forward with life despite adversity.

Causation: Environmental Stress

• Environmental stressors surrounding pregnancy and childbirth are connected to increased mental illness in children.
• This includes factors such as obstetric complications, maternal infections, and exposures to alcohol or drugs during gestation.
• These factors can potentially affect neurodevelopment.

Major Depressive Disorder

• Major depressive disorder (MDD) is characterized by persistent low mood and losing pleasure in everyday activities.
• For a diagnosis, five or more symptoms must be present over a two-week period, representing a change from previous functioning.
• The symptoms should cause significant distress or impairment.

Depressive Symptoms

• Various severity levels of depressive symptoms exist, ranging from mild feelings of sadness to severe disability and thoughts of self-harm.
• The symptoms include prolonged low mood, loss of interest in activities, feelings of worthlessness or guilt, withdrawal from social activities, fatigue, significant weight changes, difficulty concentrating and insomnia.

Other Types of Depression

• Persistent depressive disorder (Dysthymia), characterized by persistently low mood, is an enduring type.
• Perinatal and postpartum depression (during and after childbirth) can also occur.
• Premenstrual Dysphoric Disorder (PMDD) shows mood fluctuations that can include severe fatigue, sadness, hopelessness, and self-criticism during the menstrual cycle.
• Seasonal affective disorder (SAD) typically emerges during certain seasons, causing mood disturbances alongside circadian rhythm disruption.

Nursing Considerations: Depression

• Establishing a therapeutic relationship is crucial.
• Encourage clients to express their emotions and support them in defining smaller, manageable goals.
• Assist patients to develop routines and participate in social and recreational activities.
• Promote healthy lifestyles, such as regular meals, exercise, and mindfulness.
• Actively listen and validate clients' feelings and acknowledge their distress.
• Assess for suicidal thoughts and self-harm, and prioritize safety.
• Avoid alcohol and other drugs. Culturally specific care is crucial.
• Consider medication and therapy (ECT).
• Hospitalization might be necessary.

Electro Convulsive Therapy (ECT)

• ECT is occasionally prescribed for severe cases of depression, psychosis, and mania where other methods haven't worked.
• It typically involves a series of treatments, not a single session.

Bipolar Affective Disorder

• Bipolar disorder is characterized by mood fluctuations between mania and depression.
• Bipolar I disorder is defined by episodes of mania or mixed episodes of mania and depression.
• Bipolar II disorder is characterized by episodes of hypomania and depression.
• Mood fluctuations have a notable pattern over time.

Mania

• Mania involves a persistently elevated mood, which may manifest as elation or irritability; heightened activity; and poor judgment.
• Three or more of the criteria have to persist for an extended period, and represent a considerable change from their baseline behavior.

Bipolar Disorder Criteria

• Various symptoms are associated with hypomania that differ from mania, including less severe impairment in functioning.
• Experiencing both depression and mania simultaneously or in fairly close succession is common in bipolar disorder.
• Cyclothymia involves recurrent hypomanic periods and depressive periods which don't meet the full criteria of bipolar II, and usually lasts for at least two years.

Nursing Considerations: Mania

• Monitor and document sleep patterns and the need to address the cause of the insomnia.
• Support the client in maintaining a regular meal schedule, offering small meals and snacks.
• Counsel against stimulants like coffee.
• A supportive team approach is paramount with clear directions and consistent team interactions.
• Address potential harm to the client or others, prioritizing safety.
• Reinforce reality as needed for the client in times of psychosis.

Psychopharmacology

• Common mood stabilizers include lithium, sodium valproate, carbamazepine, and lamotrigine, among others.
• Antidepressants, such as SSRIs and SNRIs, are frequently used.
• Antipsychotics may be necessary for clients experiencing psychotic symptoms.

Neurotransmitters

• Neurotransmitters, such as serotonin, norepinephrine, and dopamine, are fundamental brain chemicals that have direct effects on mood, while their imbalance can contribute to depressive symptoms.

Serotonin Syndrome

• Excess serotonin can cause the serotonin syndrome, associated with agitation, autonomic instability (specifically cardiovascular, renal, gastrointestinal issues), and neuromuscular symptoms (e.g., hyperreflexia, myoclonus, tremor).

SSRI Discontinuation Syndrome

• Withdrawal symptoms, including flu-like symptoms, sleep disorders, sensory issues, and electric shock-like experiences, can follow discontinuation of SSRI treatment.

Mood Stabilizers

• Mood stabilizers, used to maintain mood stability, are a group of drugs, not a specific pharmacological class. These include lithium carbonate, sodium valproate and others—they help prevent mood relapses associated with bipolar disorder. They have a shared sodium channel-blocking effect.

Sodium Valproate:

• First used as an anticonvulsant, Valproate interacts with GABA, reducing electrical impulses, and stabilizing neuronal firing.
• Its side effects include gastrointestinal issues, loss of weight or weight gain, irregularities in menstruation, issues with blood cells, and liver problems.

Lithium Carbonate

• This is a common salt used to treat mood disorders.
• Lithium stabilizes the second message system in nerve cells, impacting the regulation of nerve impulses, impacting mood, including in bipolar disorder and mania.
• Side effects of lithium include gastrointestinal issues, impacting liver, thyroid, hair, nails and cardiovascular and potential kidney and cardiac problems.

Lithium Toxicity

• Lithium toxicity is a potential consequence of lithium use.
• Symptoms can be serious, from gastrointestinal problems to more severe cardiovascular complications and potentially death.
• Frequent blood tests and monitoring to ensure proper level are crucial.

Further Resources

• Information links to online educational resources for deeper understanding are available.
• Resources are available to assist further study in psychology, mental health, and specific medications like SSRIs.