MH 6

Mood Disorders – Nursing Notes

Overview

• Mood disorders are also known as affective disorders.

• Characterized by:
    - Depression
    - Mania
    - Or both, known as bipolar disorder.

• Cause significant impairment in daily functioning.

Normal vs Clinical Depression

• Feeling “down” is a normal feeling that is temporary.

• Clinical depression is defined by:
    - Persistence: Symptoms last for an extended period.
    - Severity: Symptoms are intense and debilitating.
    - Interference: Symptoms significantly interfere with daily life.
    - Duration: Lasts for two weeks or longer.

Major Depressive Disorder (MDD)

Definition

• Major Depressive Disorder is characterized by:
    - Single episodes or recurrent episodes of depression.
    - Requires the presence of at least 5 symptoms.
    - Symptoms must last for two weeks.
    - Symptoms must occur most of the day, nearly every day.

Symptoms of Major Depressive Disorder

• Symptoms include:
    - Depressed mood
    - Changes in sleep patterns (either increased or decreased)
    - Poor concentration
    - Suicidal ideation
    - Weight changes (greater than 5% change)
    - Fatigue
    - Anhedonia (loss of pleasure)
    - Psychomotor changes

Types of Depression

• Various types of depression include:
    - Psychotic features: Presence of hallucinations or delusions.
    - Postpartum depression: Occurring within 4 weeks after giving birth.
    - Seasonal affective disorder (SAD): Symptoms typically occur during the winter months.
    - Chronic depression: Lasting more than 2 years.
    - Dysthymia: Milder, long-term depression.

Causes of Depression

• Potential causes include:
    - Genetics: Increased risk observed in twins.
    - Neurotransmitters:
      - Reduced levels of serotonin.
      - Reduced levels of norepinephrine.
    - Sleep disturbances.

Risk Factors for Depression

• Risk factors include:
    - Female gender
    - Age: 65 years and older
    - Stressful life events
    - Poor support systems
    - Substance abuse
    - Medical illness
    - Postpartum period

Nursing Process – Depression

Assessment

• Assessment tools may include:
    - Depression scales.

• Observation should include:
    - Sad or flat affect.
    - Poor hygiene.
    - Low energy levels.
    - Decreased communication.
    - Somatic complaints such as fatigue or pain.

• ALWAYS assess suicide risk.

Nursing Diagnoses

• Possible nursing diagnoses might include:
    - Hopelessness
    - Ineffective coping
    - Low self-esteem
    - Self-care deficit
    - Risk for self-directed violence

Interventions

• Key nursing interventions include:
    - Maintain safety, implementing suicide precautions.
    - Provide one-on-one observation when needed.
    - Use therapeutic communication.
    - Offer simple, clear instructions.
    - Encourage patient’s activities of daily living (ADLs).
    - Promote adequate sleep and nutrition.
    - Encourage physical activity/exercise.
    - Provide education on antidepressants.

Bipolar Disorder

Definition

• Bipolar disorder is characterized by alternating episodes of:
    - Mania
    - Depression.

Types of Bipolar Disorder

• Types of bipolar disorder include:
    - Bipolar I: Characterized by episodes of both mania and depression.
    - Bipolar II: Characterized by episodes of hypomania and depression.
    - Cyclothymia: Involves milder mood swings over a period of over 2 years.

Symptoms of Mania

• Symptoms of mania consist of:
    - Euphoria or irritability
    - Rapid speech (pressured)
    - Flight of ideas
    - Decreased need for sleep
    - Grandiosity
    - Poor judgment
    - Risk-taking behaviors
    - Hyperactivity

Depressive Phase

• Symptoms during the depressive phase include:
    - Sadness
    - Fatigue
    - Withdrawal
    - Poor hygiene
    - Anhedonia

Nursing Interventions (Mania)

• Nursing interventions for managing mania should include:
    - Reducing environmental stimulation.
    - Providing a safe environment.
    - Setting firm limits for behavior.
    - Using short, simple communication.
    - Offering high-calorie finger foods.
    - Promoting rest/sleep.
    - Assisting with hygiene.

Suicide

Definition

• Defined as intentional self-harm causing death.

Key Facts

• Important statistics related to suicide include:
    - Men are more likely to complete suicide.
    - Women are more likely to attempt suicide.
    - It is the 2nd leading cause of death in ages 15–24.

Suicide Ideation

• Defined as thoughts of killing oneself.

Myths About Suicide

• All of the following are false:
    - “People who talk about suicide won’t do it.”
    - “You can’t help them.”
    - “Talking about suicide causes it.”

Suicide Assessment

Indicators to Look For

• Indicators may include:
    - Verbal threats of self-harm.
    - Previous attempts at suicide.
    - Scars or lacerations from prior self-harm.
    - A specific plan regarding how, when, and where self-harm may occur.
    - Access to means for self-harm.
    - Giving away belongings.

Nursing Interventions for Suicide

• Nursing interventions should prioritize:
    - Safety FIRST.
    - Implementation of suicide precautions.
    - Stay with the patient.
    - Limit the patient’s time alone.
    - Remove harmful objects from the environment.
    - Build trust with the patient.
    - Develop a support system for the patient.

No-Suicide Contract

• A no-suicide contract is an agreement that the patient will not harm themselves and must notify staff if feeling unsafe.

KEY NCLEX TAKEAWAYS

• Suicide = #1 priority in nursing care.

• Depression is defined as lasting ≥2 weeks and having ≥5 symptoms.

• Mania includes symptoms of increased energy, decreased need for sleep, and poor judgment.

• Use simple communication for clarity.

• Promote sleep, nutrition, and safety in patients.

• Never ignore any statements related to suicide.

Additional Note

• Familiarize with different types of bipolar disorder for comprehensive understanding.