MHM92.pdf

11/12/23, 9:23 PM Realizeit for Student Related Disorders Other disorders classified with similarities to mood disorders include: Persistent depressive (dysthymic) disorder is a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low...

11/12/23, 9:23 PM Realizeit for Student Related Disorders Other disorders classified with similarities to mood disorders include: Persistent depressive (dysthymic) disorder is a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression. Disruptive mood dysregulation disorder is a persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or situation, beginning before age 10. Cyclothymic disorder is characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning. Substance-induced depressive or bipolar disorder is characterized by a significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins. Seasonal affective disorder (SAD) has two subtypes. In one, most commonly called winter depression or fall-onset SAD, people experience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities beginning in late autumn and abating in spring and summer. The other subtype, called spring-onset SAD, is less common, with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall. SAD is often treated with light therapy (Leahy, 2017). 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. The symptoms subside without treatment, but mothers do benefit from the support and understanding of friends and family (Langan & Goodbred, 2017). Postpartum depression is the most common complication of pregnancy in developed countries (Langan & Goodbred, 2017). The symptoms are consistent with those of depression (described previously), with onset within 4 weeks of delivery. 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. Women who have a history of serious mental illness are at higher risk for a postpartum relapse, even if they were well during pregnancy (Burgerhout et al., 2017). Premenstrual dysphoric disorder is a severe form of premenstrual syndrome and is defined as recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation. Approximately 20% to 30% of premenopausal women are affected by affective and/or somatic symptoms that can cause severe dysfunction in social or occupational functioning, such as labile mood, irritability, increased interpersonal conflict, difficulty concentrating, feeling overwhelmed or unable to cope, and feelings of anxiety, tension, or hopelessness (Appleton, 2018). Nonsuicidal self-injury involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing. Some persons who engage in self-injury (sometimes called selfmutilation) report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility. Others report the influence of peers or the need to “fit in” as contributing factors (Chesin et al., 2017). Etiology Various theories for the etiology of mood disorders exist. The most recent research focuses on chemical biologic imbalances as the cause. Nevertheless, psychosocial stressors and interpersonal https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXuwWUmQfGm4h3qb9d1OVNy5lAp1kIKpU7q0Q1KeARb… 1/4 11/12/23, 9:23 PM Realizeit for Student events appear to trigger certain physiological and chemical changes in the brain, which significantly alter the balance of neurotransmitters. Effective treatment addresses both the biologic and psychosocial components of mood disorders. Thus, nurses need a basic knowledge of both perspectives when working with clients experiencing these disorders. Biologic Theories Genetic Theories Genetic studies implicate the transmission of major depression in first-degree relatives who are at twice the risk for developing depression compared with the general population. First-degree relatives of people with bipolar disorder have a sevenfold risk for developing bipolar disorder compared with a 1% risk in the general population. For all mood disorders, monozygotic (identical) twins have a concordance rate (both twins having the disorder) two to four times higher than that of dizygotic (fraternal) twins. Although heredity is a significant factor, the concordance rate for monozygotic twins is not 100%, so genetics alone do not account for all mood disorders (Kelsoe & Greenwood, 2017). There are also indications of a genetic overlap between early-onset bipolar disorder and early-onset alcoholism. People with both problems have a higher rate of mixed and rapid cycling, poorer response to lithium, slower rate of recovery, and more hospital admissions. Mania displayed by these clients involves more agitation than elation; clients may respond better to anticonvulsants than to lithium (Akiskal, 2017). Neurochemical Theories Neurochemical influences of neurotransmitters (chemical messengers) focus on serotonin and norepinephrine as the two major biogenic amines implicated in mood disorders. Serotonin has many roles in behavior: mood, activity, aggressiveness and irritability, cognition, pain, biorhythms, and neuroendocrine processes (i.e., growth hormone, cortisol, and prolactin levels are abnormal in depression). Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Positron emission tomography demonstrates reduced metabolism in the prefrontal cortex, which may promote depression. Norepinephrine levels may be deficient in depression and increased in mania. This catecholamine energizes the body to mobilize during stress and inhibits kindling. Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated by reaching a threshold of the cumulative effects of stress, low amounts of electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways. These highly sensitized pathways respond by no longer needing the stimulus to induce seizure activity, which now occurs spontaneously. It is theorized that kindling https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXuwWUmQfGm4h3qb9d1OVNy5lAp1kIKpU7q0Q1KeARb… 2/4 11/12/23, 9:23 PM Realizeit for Student may underlie the cycling of mood disorders as well as addiction. Anticonvulsants inhibit kindling; this may explain their efficacy in the treatment of bipolar disorder. Dysregulation of acetylcholine and dopamine is also being studied in relation to mood disorders. Cholinergic drugs alter mood, sleep, neuroendocrine function, and the electroencephalographic pattern; therefore, acetylcholine seems to be implicated in depression and mania. The neurotransmitter problem may not be as simple as underproduction or depletion through overuse during stress. Changes in the sensitivity, as well as the number of receptors, are being evaluated for their roles in mood disorders (Thase, 2017). Neuroendocrine Influences Hormonal fluctuations are being studied in relation to depression. Mood disturbances have been documented in people with endocrine disorders, such as those of the thyroid, adrenal, parathyroid, and pituitary glands. Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression, with the highest rates found among older clients. Postpartum hormone alterations precipitate mood disorders such as postpartum depression and psychosis. About 5% to 10% of people with depression have thyroid dysfunction, notably an elevated thyroid-stimulating hormone. This problem must be corrected with thyroid treatment, or treatment for the mood disorder is adversely affected (Thase, 2017). Psychodynamic Theories Many psychodynamic theories about the cause of mood disorders seemed to “blame the victim” and his or her family (Markowitz & Milrod, 2017). They include the following beliefs or suppositions: The self-depreciation of people with depression becomes self-reproach and “anger turned inward” related to either a real or perceived loss. Feeling abandoned by this loss, people are then angry while both loving and hating the lost object. A person’s ego (or self) aspires to be ideal (i.e., good and loving, superior or strong), and that to be loved and worthy, must achieve these high standards. Depression results when, in reality, the person is not able to achieve these ideals all the time. The state of depression is like a situation in which the ego is a powerless, helpless child who is victimized by the superego, much like a powerful and sadistic parent who takes delight in torturing the child. Most psychoanalytical theories of mania view manic episodes as a “defense” against underlying depression, with the ID taking over the ego and acting as an undisciplined hedonistic being (child). Depression is a reaction to a distressing life experience, such as an event with psychic causality. Children raised by rejecting or unloving parents are prone to feelings of insecurity and loneliness, making them susceptible to depression and helplessness. Depression is a result of specific cognitive distortions in susceptible people. Early experiences shape distorted ways of thinking about oneself, the world, and the future; these distortions involve magnification of negative events, traits, and expectations and simultaneous minimization of anything positive. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXuwWUmQfGm4h3qb9d1OVNy5lAp1kIKpU7q0Q1KeARb… 3/4 11/12/23, 9:23 PM Realizeit for Student CULTURAL CONSIDERATIONS Other behaviors considered age-appropriate can mask depression, which makes the disorder difficult to identify and diagnose in certain age groups. Children with depression often appear cranky. They may have school phobia, hyperactivity, learning disorders, failing grades, and antisocial behaviors. Adolescents with depression may abuse substances, join gangs, engage in risky behavior, be underachievers, or drop out of school. In adults, manifestations of depression can include substance abuse, eating disorders, compulsive behaviors such as workaholism, gambling, and hypochondriasis. Older adults who are cranky and argumentative may actually be depressed. Many somatic ailments (physiological ailments) accompany depression. This manifestation varies among cultures and may be more apparent in cultures that avoid verbalizing emotions. For example, some people may report multiple physical, problems, backache, headache, or heart problems. How they are experiencing depression may be related to cultural norms or beliefs. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IXuwWUmQfGm4h3qb9d1OVNy5lAp1kIKpU7q0Q1KeARb… 4/4