20 Feb Mood Disorders: Assessment & Treatment

NRNP 6665 Week 6 Study Notes
Mood Disorders: Assessment & Treatment
Introduction
Mood disorders are among the most common psychiatric conditions encountered in clinical practice. They include Major Depressive Disorder (MDD), Bipolar Disorders, Persistent Depressive Disorder (Dysthymia), Cyclothymic Disorder, and related conditions. These disorders profoundly affect emotional regulation, cognition, behavior, and physical health.

For nurses and advanced practice providers, accurate assessment, diagnosis, and treatment planning are critical to improving patient outcomes. This guide explores the pathophysiology, clinical features, diagnostic tools, nursing interventions, pharmacological and non‑pharmacological treatments, and long‑term management strategies.

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. 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.

6. 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).

7. Pharmacological Management
Antidepressants
SSRIs: Fluoxetine, sertraline, citalopram.

SNRIs: Venlafaxine, duloxetine.

Atypical antidepressants: Bupropion, mirtazapine.

Tricyclics/MAOIs: Reserved for resistant cases.

Mood Stabilizers
Lithium: Gold standard for bipolar disorder.

Anticonvulsants: Valproate, carbamazepine, lamotrigine.

Antipsychotics
Atypical antipsychotics (quetiapine, olanzapine, risperidone) for mania or adjunctive depression treatment.

Nursing Role
Monitor side effects (weight gain, metabolic syndrome, tremors, GI upset).

Educate about adherence, lab monitoring (e.g., lithium levels).

Assess therapeutic response.

8. Non‑Pharmacological Treatments
Psychotherapy: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT).

Electroconvulsive Therapy (ECT): For severe, treatment‑resistant depression.

Transcranial Magnetic Stimulation (TMS): Non‑invasive option for depression.

Psychoeducation programs: Relapse prevention, adherence support.

9. Psychosocial Considerations
Stigma and discrimination against individuals with mood disorders.

Family burden and caregiver stress.

Importance of social support networks.

Nurses as advocates for mental health awareness and policy change.

10. Long‑Term Outcomes
Untreated mood disorders increase risk of suicide, substance abuse, poor occupational outcomes.

Early intervention improves prognosis.

Lifelong management may be required, especially for bipolar disorder.

Nurses should emphasize coping strategies, adherence, and relapse prevention.

11. Case Study Example
Patient: 32‑year‑old woman with recurrent depressive episodes.
Assessment: Persistent sadness, poor concentration, suicidal thoughts.
Interventions: Initiated SSRI, CBT referral, suicide safety plan.
Outcome: Improved mood, reduced suicidal ideation, better functioning at work.

12. Summary of Nursing Priorities
Accurate assessment and diagnosis.

Safety and suicide prevention.

Medication monitoring and education.

Psychotherapy and lifestyle support.

Family involvement and empowerment.