MOOD or AFFECTIVE DISORDERS AND SUICIDE

🧠 Mood vs. Affect & Mood Disorders

🧠 Mood vs. Affect & Mood Disorders

• Internal, sustained emotional state

• Describes how a person feels

• Exists on a continuum (e.g., happy ↔ depressed)

Affect

• Outward expression of mood (verbal/nonverbal)

• Describes how the person shows their feelings

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Examples

Happy Mood

• 😊 Affect: Smiling, active, well-groomed, cooperative, creative
  Depressed Mood

• 😔 Affect: Gloomy, inactive, neglectful, flat, unmotivated, withdrawn

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Mood Continuum

1. Euthymic Mood – Normal, appropriate mood responses

2. Dysthymic Mood – Mild but chronic depression

3. Disruptive Mood Dysregulation Disorder (DMDD) – Persistent irritability with temper outbursts (starts before age 10)

4. Cyclothymia – Mild ups and downs (hypomania ↔ mild depression), no major social/work impairment

5. Seasonal Affective Disorder (SAD) – Depression during fall/winter; ↑ sleep, appetite, carb cravings

6. Postpartum Mood Disorders

   • Blues: Common, mild

   • Depression: Treated with IV brexanolone

   • Psychosis: Severe, needs urgent care

7. Premenstrual Dysphoric Disorder (PMDD)

   • Severe mood symptoms before menstruation: irritability, anxiety, overwhelm, resolves after period

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Key Notes

• Mood disorders = exaggerated, prolonged emotional states

• More common in women

• Linked to high socioeconomic status

• Impacts social, physical, and psychological functioning

Depression Overview

Depression Overview

Types of Depression:

• Transient Depression: Normal reaction to loss (e.g., death, disappointment); self-limiting.

• Reactive Depression: Sadness linked to specific events; relieved when circumstances change.

• Major Depression (Unipolar): Persistent sadness, loss of interest, impaired social/occupational function, often with anxiety and substance abuse.

Pathophysiology & Etiology:

• Neurotransmitters: Imbalance in serotonin, norepinephrine (NE), and dopamine.

  • Serotonin: Linked to sadness, obsession, and compulsions.

  • NE: Causes psychomotor retardation and anxiety.

  • Dopamine: Affects pleasure and causes guilt, low self-worth.

• Neuroendocrine Imbalance: Altered hormone levels from pituitary, thyroid, and adrenal glands, affecting mood.

• Genetics: Higher risk in those with family history (3x higher in relatives).

• Environmental Factors: Major life losses, chronic illness, violence, and abuse increase risk.

Signs & Symptoms (SADIMAGES):

• S: Sad mood

• A: Appetite changes

• D: Disturbed sleep

• I: Inability to concentrate

• M: Marked decrease in pleasure

• A: Apathy (lack of interest in activities, sex)

• G: Guilt feelings

• E: Energy changes

• S: Suicidal thoughts

Grief vs Depression:

• Grief: Self-limiting, linked to real loss, improves with time.

• Depression: Can occur without identifiable loss, increases in severity without intervention.

Diagnosis (DSM-V Criteria):

• At least 5 symptoms in 2-week period, including depressed mood or loss of interest, with weight changes, psychomotor retardation, fatigue, guilt, poor concentration, and thoughts of death or suicide.

Subtypes:

• Post-Partum, Atypical, Melancholic, Dysthymia

Suicidal Client Assessment and Intervention

Suicidal Client Assessment and Intervention

Risk Factors for Suicide:

• Demographics: Male (3x higher success rate), ages 15-24 or above 45, separated/divorced individuals, alcoholics, and those with lack of social support or terminal illnesses.

• Psychiatric History: Depression, history of prior attempts, and ambivalence about life.

Types of Suicidal Ideation:

• Active Suicidal Ideation: Thoughts of suicide with plans.

• Passive Suicidal Ideation: Wish to be dead, but no plans to end life.

Myths vs. Facts:

• Myth: "People who talk about suicide never commit suicide."

  • Fact: Suicidal individuals often give subtle or direct cues; threats should always be taken seriously.

• Myth: "Suicidal people only want to hurt themselves."

  • Fact: Suicidal behavior may involve directed anger and ambivalence; intervention can help redirect destructive thoughts.

Client Statements & Nurse Responses:

• Example Statements:

  • "I just want to go to sleep and not think anymore."

  • "It will just be the end of the story."

• Nurse's Response:

  • "Do you mean you want to die?"

  • "Are you planning to end your life?"

Behavioral Clues:

• Giving away possessions, writing a suicide note, making funeral arrangements, and buying items for self-harm (e.g., pills, gun).

Suicide Triad: Loss of spouse, job, or feeling alone.

Assessment Tools:

• Beck Depression Inventory: Self-assessment tool.

• Hamilton Rating Scale: Assesses severity of depression and response to treatment.

Risk Levels:

• High Lethality Methods: Hanging, shooting, jumping from heights.

• Low Lethality Methods: Overdose, wrist cutting.

Key Considerations:

• Always take threats and verbal cues seriously.

• Assess for suicidal plans and feasibility to gauge risk.

• Ambivalence: Suicidal individuals often prefer life over death if they feel hope.

Intervention: Immediate help and support to resolve the suicidal crisis, focusing on situational factors.

Major Depression Nursing Management

Major Depression Nursing Management

Nursing Diagnoses & Interventions

• Risk for Suicide

  • Close observation (1:1 or checks every 10-15 minutes)

  • Place near nurse’s station; no single rooms

  • Accompany to off-ward activities

  • Remove hazardous items

  • Use an authoritative role, safe environment, and no-suicide contract

• Complicated Grieving

  • Encourage verbalization of feelings

  • Acknowledge grief stages (guilt, anger, etc.)

Nurse-Patient Relationship

• Depressed patients often have low self-esteem

• Develop meaningful relationships based on empathy

• Avoid reinforcing delusions or hallucinations

• Encourage completion of ADLs and emotional expression

Common Nursing Diagnoses for Depressed Clients

• Imbalanced Nutrition: Less than body requirements

• Disturbed Sleep Pattern

• Risk for Suicide

• Social Isolation

• Low Self-Esteem

• Complicated Grieving

Electroconvulsive Therapy (ECT)

• Stimulates brain chemistry to correct depression

• Indications: major depression, unresponsive schizophrenia

• Contraindications: MI, pacemaker, glaucoma, severe osteoporosis

• Pre-ECT: NPO 6-8 hours, secure consent, prepare equipment

• Post-ECT: Re-orient, monitor vital signs, watch for memory loss or fractures

Medications & Treatment

• Antidepressants: SSRIs (e.g., Fluoxetine, Sertraline), SNRIs (e.g., Venlafaxine), TCAs, MAOIs

• ECT: Usually 6-15 sessions for sustained improvement

• Risk for Suicide: Monitor during early antidepressant treatment

Psychotherapy

• Cognitive Behavioral Therapy: Addresses negative thinking patterns

• Interpersonal Therapy: Resolves role-related conflicts

Drug Alerts & Side Effects

• SSRIs: Milder side effects, quick onset

• TCAs: Risk of overdose, severe side effects

• MAOIs: Hypertensive crisis with tyramine-rich foods

Key Reminder:

• Always monitor suicidal ideation closely in the first weeks of antidepressant therapy.

Summary

Depression:

• D – Dahan-dahan (hypoactive)

• E – Evasive

• P – Puyat

• R – Recurrent headaches

• E – Eating habits compromised

• S – Stressed

• S – Suicidal

• I – Irritable

• O – Cry/sad

• N – Nu po un?

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Nursing Diagnosis (Depression):

• Nutrition, Less than body requirement – Small frequent feeding, Assist in eating.

• Risk for injury (self) – SUICIDAL

  • Use direct and clarify responses.

  • No HARM CONTRACT.

  • No curtains, linens, belts, shoelaces, sharps.

  • 1:1 supervision.

  • History!! (planned) risk.

• Impaired Social Interaction

  • Gradual involvement in activities.

  • Initially – prepare and assist (1-3 days), then gradually allow independent decision-making.

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Antidepressants:

• TCA (Tricyclic Antidepressant)

  • Most sedative (also for panic).

  • May cause cardiac arrhythmias.

• SSRI (Selective Serotonin-norepinephrine Reuptake Inhibitors)

  • Safest and latest drug.

  • Physician’s choice.

• MAOI (Monoamine Oxidase Inhibitors)

  • Most effective but with more side effects.

  • PA – Parnate

  • NA – Nardil

  • MA – Marplan/Mannerix

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Antidepressant Timeline:

• 1–2 weeks:

  • Initial – sedation (antukin).

  • Depressed pa rin.

• 2-4 weeks:

  • Positive/therapeutic response: Initiation of self-care, participation in activities.

  • Monitor “suicidal risk.”

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MAOIs:

• Avoid Tyramine-rich foods to prevent hypertensive crisis.

• Signs/Symptoms of hypertensive crisis:

  • Increased BP

  • Occipital headache

  • Blurring of vision