Unit 7: Mental health Problems & Therapeutic Interventions

Altered mood states:

By: Hina Feroz Ali
 Objectives:
1. Describe the continuum of adaptive and maladaptive emotional response.
2. Discuss phenomenon of ‘depression’
3. Analyze the prevailing psychological, biological, and social theories that serves as
basis for caring for clients with altered mood states.
4. Analyze the human responses to mood alterations
5. Discuss effective nursing and psychosocial interventions for clients with Altered
mood states.
Mood:
Mood is defined as a pervasive and sustained feeling that is endured
internally, and that impacts nearly all aspects of a person’s behavior in the
external world.
Mood Disorder:
• It is a mental health problem that primarily affects a person’s emotions.
• It is a disorder in which a person experiences long periods of extreme
happiness, extreme sadness or both.
 Depression:
• An alteration in mood that is expressed by feelings of sadness, despair, and
pessimism. There is a loss of interest in usual activities, and somatic
symptoms may be evident. Changes in appetite and sleep patterns are
common.
Blues (a feeling of
sadness or
downheartedness)

It is common among healthy people and considered to be a normal response to everyday

disappointments in life. These episodes are short-lived as the individual adapts to the loss,
change, or failure (real or perceived) that has been experienced. Pathological depression
occurs when adaptation is ineffective
 Epidemiology:
• Depression is a wide spread mental health problem affecting many
people.
• Onset is usually after 25-30 years and peak between 40-60 years.
• The incidence of depressive disorder is higher in women than it is in men
by almost 2 to 1.
• Depression is the leading cause of disability as measured and the 4th
leading contributor to the global burden of disease (DALYs, Disability-
Adjusted Life Years) in 2000.
• Today, depression is already the 2nd cause of DALYs in the age category 15-
44 years for both genders combined.
 Types of depressive disorders:
• Major depressive disorder (MDD):
Major depressive disorder (MDD) is characterized by
persistent depressed mood or loss of interest or pleasure in
usual activities.
Core Symptoms and Diagnostic Criteria
for MDD:
• Five (or more) of the following symptoms have been present during the same 2-week and
represent a change from previous functioning.
• at least one of the symptoms is either depressed mood or fatigue, or loss of interest or
pleasure (Anhedonia)
1. Depressive mood
2. Diminished interest/Pleasure
3. Weight loss or gain (e.g., a change of more than 5% of body weight in a month)
4. Loss/gain of appetite
5. Insomnia or hypersomnia
6. Fatigue or loss of energy
7. Lack of concentration or diminish ability to think
8. Suicidal thoughts
 Persistent Depressive Disorder
(Dysthymia):
• Individuals with this mood disturbance describe their mood as sad or “down in the dumps.”
• The symptoms of persistent depressive disorder are less severe than those of major
depression, but the disorder tends to be more chronic.
• The person experiences symptoms on most days — more than 50% of the days — over the
specified time period (2 years for adults, 1 year for children/adolescents).
While depressed, two (or more) of the following symptoms must be present:
1.Poor appetite or overeating
2.Insomnia or hypersomnia
3.Low energy or fatigue
4.Low self-esteem
5.Poor concentration or difficulty making decisions
6.Feelings of hopelessness
 Pre-menstrual dysphoric disorder:
• Pre-menstrual dysphoric disorder include
markedly depressed mood, excessive
anxiety, mood swings, and decreased
interest in activities during the week prior
to menses, improving shortly after the
onset of menstruation, and becoming
minimal or absent in the week post
menses (APA, 2013).
 Season Affective Disorder:
• The depression that coincides with changes in
the season. Most cases begin in the fall or
winter, when there is a decrease in sunlight
• Less often, depression can occur in late
Spring or summer
 Atypical Behavior:
Atypical depression is a specific type of depression in which the symptoms are
different from the traditional criteria.
• One symptom specific to atypical depression is a temporary mood improvement in
response to actual or potential positive events. This is known as mood reactivity.
Other key symptoms include increased appetite and rejection sensitivity.
• “Atypical” doesn’t mean that the condition is odd or unusual. It’s just different
from “typical” depression.

*In typical major depression, your depressed mood is usually constant. Typical depression often causes a loss of
appetite and insomnia
 Predisposing Factors:
• The etiology of depression is unclear.
• Evidence continues in support of multiple causations, recognizing the
combined effects of genetic, biochemical, and psychosocial influences
on an individual’s susceptibility to depression. A number of theoretical
postulates are presented.
 Biological theories:
• Genetics/Hereditary
• Biochemical: (Biogenic Amines) Norepinephrine, Dopamine and
serotonin
Reduced levels of these "biogenic amines" could be responsible for
depressive symptoms.
 Psychosocial theory:
Psychoanalytical Theory:
Freud’s Concept of Melancholia (1917)
Definition: A pathological response to loss, distinct from normal mourning.
Key Features:
• Profound Sadness: Deep emotional pain and dejection.
• Withdrawal: Loss of interest in the external world.
• Emotional Numbness: Inability to feel love or engage in activities.
• Self-Criticism: Harsh self-reproach and feelings of worthlessness.
• Delusional Beliefs: Expectations of punishment without clear cause.
(Sadock & Sadock, 2007)
 Learning Theory:
Seligman’s Theory of Learned Helplessness (1973):
• People (and animals) may learn to feel helpless after repeated failures or
traumatic experiences they cannot control.
• After repeated failures (real or perceived), people may stop trying and
ultimately it leads to helplessness and depression.
 Cognitive Theory:
Beck’s Cognitive Theory of Depression (1979):
Beck and colleagues proposed that the primary disturbance in
depression is cognitive not emotional. According to their theory,
negative emotions stem from distorted thinking patterns.
 Cont.
Beck identified three key cognitive distortions that contribute to and
maintain depression:
1.Negative view of the environment – Belief that the world is overwhelming,
unfair, or full of obstacles.
2.Negative view of the self – Belief that one is inadequate, unworthy, or
inherently flawed.
3.Negative view of the future – Belief that things will never improve, leading
to hopelessness.
 Physiological Influences on depression:
(also known as secondary depression)

• Medication side effects

• Substance Abuse
• Hormonal Disturbance
• Electrolyte Disturbance
• Nutritional Deficiency
• Neurological Disorders
 Bipolar Disorder:
• A bipolar disorder is characterized by mood swings from profound
depression to extreme euphoria (mania), with intervening periods
of being normal.
Mania:
It is defined as an extremely unstable euphoric or irritable mood
along with an excess activity or energy level, excessively rapid thought
and speech, reckless behavior and feeling of invincibility.
Hypomania:
A somewhat milder degree of the above clinical symptom picture is
called hypomania. Hypomania is not severe enough to cause marked
impairment in social or occupational functioning or to require
hospitalization, and it does not include psychotic features.
 Types Of Bipolar Disorder:
• Bipolar Type 1:
Bipolar I disorder is the diagnosis given to an individual who is experiencing a
manic episode or has a history of one or more manic episodes. Depressive
episodes are common but not required for diagnosis.
• Bipolar Type 2:
The bipolar II disorder diagnostic category is characterized by recurrent episodes
of major depression with episodic occurrence of hypomania.
• Cyclothymic Disorder:
The essential feature of cyclothymic disorder is a chronic mood disturbance of at
least 2 years. With cyclothymia, you experience periods when your mood
noticeably shifts up and down from your baseline. You may feel on top of the
world for a time, followed by a low period when you feel somewhat down.
Between these cyclothymic highs and lows, you may feel stable and fine.
 Tip for Students:
"I" for Intense (Bipolar I)

"II" for In-between (Hypomania)

"Cyclo" for Cycle (frequent ups and downs).

 Causes Of Bipolar Disorder:
•Stress
•Imbalance in neurotransmitters.
•Genetics
•Physical illness
•Chemical substance
•Drug or alcohol use
•Environmental factor
•Losing someone close to you
•Sleep deprivation
 Drug of choice in bipolar disorder:
•lithium (Lithobid),
•valproic acid (Depakene),
•divalproex sodium (Depakote),
•carbamazepine (Tegretol, Equetro, others)
•lamotrigine (Lamictal).
Nursing Assessment:
• History
• General Appearance and motor behavior
• Mood and affect
• Thought process and cognition
• Behavioral: some crying possible.
• Cognitive: some difficulty getting mind off of one’s disappointment.
• Physiological: feeling tired and listless.
 Nursing Diagnosis:
• Risk of injury related to extreme hyperactivity, destructive behavior
• Risk for other-directed violence related to manic excitement, suspicion of
others and paranoid ideation
• Imbalanced Nutrition: less than body requirements related to refusal to sit
still long enough to eat meals
• Disturbed sensory perception related to sleep deprivation, psychotic
process.
• Self-care deficit (hygiene, grooming)
• Spiritual distress related to expresses lack of meaning in life, sudden
changes in spiritual practices, refuses interactions with significant others or
with spiritual leaders.
 Goals:
• Client will not self harm or harm others
• Client will have sufficient food to meet daily dietary requirements.
• Client will be able to recognize his or her position in the grief process,
while progressing at own pace toward resolution.
 Nursing care plan:
•Nursing care planning goals for clients with bipolar disorder include providing a
safe environment, improving self-esteem
•Enhancing social support,
•Encouraging self-care independence, guiding clients toward socially
Appropriate behavior
•Promoting family involvement
•Providing education about the condition
•Be direct. Talk openly and matter-of-factly about suicide. Listen actively and
encourage expression of feelings, including anger. Accept the client’s feelings in
a nonjudgmental manner.
 Cont.
• Encourage the client to reach out for spiritual support.
• Develop a trusting relationship with the client. Show empathy, concern,
and unconditional positive regard. Be honest and keep all promises.
 Concept Care Mapping:
• Judith, age 56, has been despondent since her husband of 30 years left her 3
months ago to live with a 26-year-old secretary from his office. She has lost
weight and rarely goes out of her house. Today the divorce was finalized.
When Judith’s daughter, Cathy, went to her mother’s house, she found
Judith going through her medication saying she was going to “take enough
to put me to sleep for good.” Cathy convinced her mother to go to the
hospital, and Judith was admitted to the psychiatric unit with a diagnosis of
Major Depressive Disorder. Judith tells the nurse, “I’m so angry at my
husband, I could just kill him! How could he do this to me? I guess it’s my
fault. I’m not as pretty as his girlfriend.” Then she says, “What’s the use of
going on? No one would want me now. I’m old, and I don’t have anything to
live for.” The nurse develops the following concept map care plan for Judith
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• Allen, M.H. (2003). Approaches to the treatment of mania. Medscape Psychiatry. Retrieved from http://www.medscape
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• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:
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