20 Feb Assessing and Diagnosing Mood Disorders

NRNP 6665 Week 4 Study Notes
Assessing and Diagnosing Mood Disorders
Introduction
Mood disorders are among the most prevalent psychiatric conditions, profoundly impacting emotional regulation, cognition, and behavior. They include Major Depressive Disorder (MDD), Bipolar Disorders, Persistent Depressive Disorder (Dysthymia), Cyclothymic Disorder, and related conditions. Accurate assessment and diagnosis are essential for effective treatment planning and improved patient outcomes.

Nurses and advanced practice providers play a critical role in screening, risk assessment, differential diagnosis, and patient education. This guide explores the pathophysiology, clinical features, diagnostic tools, nursing interventions, and challenges in diagnosing mood disorders.

1. Classification of Mood Disorders
Major Depressive Disorder (MDD)
Persistent sadness, loss of interest, changes in appetite/sleep, fatigue, impaired concentration.

Symptoms last ≥2 weeks and cause functional impairment.

Bipolar Disorders
Bipolar I: At least one manic episode (may include depressive episodes).

Bipolar II: Hypomanic episodes with major depressive episodes.

Cyclothymic Disorder: Chronic fluctuating mood disturbances with hypomanic and depressive symptoms not meeting full criteria.

Persistent Depressive Disorder (Dysthymia)
Chronic low mood lasting ≥2 years in adults (≥1 year in children/adolescents).

2. Pathophysiology
Neurotransmitter dysregulation: Serotonin, norepinephrine, dopamine imbalances.

Neuroendocrine factors: Dysregulation of hypothalamic‑pituitary‑adrenal (HPA) axis.

Genetics: Family history increases risk; heritability ~40–70% for bipolar disorder.

Structural brain changes: Reduced hippocampal volume, altered prefrontal cortex activity.

Psychosocial stressors: Trauma, chronic stress, loss events.

3. Clinical Features
Depressive Symptoms
Emotional: Sadness, hopelessness, guilt.

Cognitive: Poor concentration, indecisiveness, suicidal ideation.

Physical: Sleep/appetite changes, fatigue, psychomotor retardation.

Manic/Hypomanic Symptoms
Elevated or irritable mood.

Increased energy, decreased need for sleep.

Grandiosity, pressured speech, flight of ideas.

Risky behaviors (spending sprees, sexual indiscretions).

4. Nursing Assessment
History taking: Onset, duration, severity, family history, substance use.

Mental status exam: Mood, affect, thought process, cognition, insight.

Screening tools:

PHQ‑9 (depression)

Hamilton Depression Rating Scale (HAM‑D)

Mood Disorder Questionnaire (MDQ) for bipolar disorder

Risk assessment: Suicidal ideation, self‑harm, impulsivity.

Functional impact: Work, school, relationships.

5. Differential Diagnosis
Medical conditions: Thyroid disorders, neurological diseases, chronic pain.

Substance‑induced mood changes: Alcohol, stimulants, corticosteroids.

Other psychiatric disorders: Anxiety disorders, personality disorders, psychotic disorders.

6. Nursing Diagnoses
Risk for suicide related to hopelessness.

Disturbed sleep pattern related to mood disturbance.

Imbalanced nutrition related to appetite changes.

Ineffective coping related to chronic stress.

Impaired social interaction related to withdrawal or irritability.

7. Nursing Interventions
Safety
Suicide precautions, close monitoring.

Remove harmful objects.

Crisis intervention protocols.

Therapeutic Communication
Active listening, empathy, non‑judgmental approach.

Encourage expression of feelings.

Psychoeducation
Teach patients/families about symptoms, treatment adherence, relapse prevention.

Provide resources for support groups.

Lifestyle Support
Encourage regular sleep, balanced diet, exercise.

Stress management techniques (mindfulness, relaxation).

8. Diagnostic Challenges
Overlap of symptoms: Depression vs. bipolar depression.

Cultural variations: Expression of mood symptoms differs across cultures.

Age differences: Children may present with irritability rather than sadness.

Stigma: Patients may underreport symptoms.

9. Case Study Example
Patient: 28‑year‑old man with alternating periods of sadness and elevated mood.
Assessment: Poor concentration, suicidal thoughts, episodes of risky behavior.
Interventions: Initiated mood stabilizer, psychoeducation, suicide safety plan.
Outcome: Improved mood stability, reduced suicidal ideation, better functioning at work.

10. Summary of Nursing Priorities
Accurate assessment and diagnosis.

Safety and suicide prevention.

Medication monitoring and education.

Psychotherapy and lifestyle support.

Family involvement and empowerment.

Long‑term follow‑up and advocacy.