AFFECTIVE/ MOOD DISORDER
D- ecrease ability to concentrate
 Pervasive alteration in emotion that are manifested
by Depression (lost of interest in pleasure) and
Mania (exalted feeling, over activity)
(DSM-IV-TR) 2 CATEGORIES OF AFFECTIVE
DISORDER
I. Depressive/Unipolar Disorder
 Persistent sad or depressed mood loss of interest on
things that were once pleasurable and disturbance in
sleep, appetite, energy and concentration.
 Increase incidence in Women than Man
Cause:
Medical/Biological Theory
- high familial genetic pattern (70%
identical twin, 15% siblings and 7%
grandparent aunts and uncle)
- disregulation of NorEpinephrine and
serotonin
- low level of Tryptophan precursor for
serotonin
Psychodynamic Theory
- disturbance in early mother-child
relationship, weak ego strong Superego
Cognitive Behavioral Theory
- reinforcement theory result of impaired
cognition
- learned helplessness, individual belief of
lack of control
- cognitive triad, negative belief to
SELF,WORLD and FUTURE
DIAGNOSTIC CRITERIA (9 clinical signs)
E- ating disturbance (overeating/under eating)
P- hysical signs (agitation or retardation)
R- eccurent thought of death
E- xcessive feeling of unworthiness
S- leep disturbance (insomnia/hypersomnia)
S- adness/ dysphoria
E- nergy diminished
D- iminished pleasure (anhedonia)
SUBTYPE of DEPRESSION
I. Major Depression
- presence of 5 criteria for depression,
prime symptoms are depressed mood
and loss of interest
- last for at least 2 wks
- occurs in late 20’s
* with psychotic symptoms
* Melancholic type (agitated occurs after
40y/o but before 60 y/o), morning
depression
* Seasonal pattern (3 years pattern onset
II. Dysthymic Disorder
- milder than major depression
- duration at least (2 yrs. For adult and 1
yr. for children and adolescent)
- presence of 2 or more criteria.
- absence of Psychotic features
III. DDNOS
- last for 2 days or 2 weeks
NURSING DIAGNOSIS AND INPLEMENTATIONS
* Potential for Injury directed to Self
- assess for the signs of suicide
- risk factor for SUICIDE
 S- ex more female attempt more male commit
U- nsuccessful previous attempts
I- dentification with family member
C- hronic
I- llness
D- epression/dependent personality
A- ge (18 -25 y/o and 40 above / Alcoholics)
L- ethality of previous attempt
C- aucasians and native Americans
L- iving alone/ No spouse or nagging spouse
A- cts through Gun’s and explosive next is
hanging and poison
F- inancial problems/ unemployed
- common expressions of Suicidal individual
Cry for help Escape
Heroic Manipulation
Martyrdom Rebirth
Redemption Relief of pain
Retaliatory Reunion
Loss of self esteem
- secure rooms (windows lock, break proof glass
and mirror use plastic ware)
- NO cords and sharps
- frequent observation/ unscheduled rounds
- staff communication one on one
- develop therapeutic relationship
- written contract
- restraint as order
- medication as ordered
* Dysfunctional Grieving
- encourage verbalization of thoughts and
feelings
- develop trusting relationship
- assist patient to discharge Pent –up anger
through purge motor activity
* Self Esteem Disturbance
- focus on the strengths and accomplishments
- teach assertive techniques
* Social Isolation
- spend time to client
- then proceed to group activity
* Powerlessness
- take as much responsibility as possible for own
self care
- identify areas that she can control
- verbalize areas in life that cannot control
* Altered Nutrition Less tan Body requirement
-high protein and carbohydrate in diet
- increase fluid consumption
- weight daily
- serve small frequent feeding
PSYCHOPHARMACOLOGY
SSR’I
TCA’S
MAOI’S
II. BIPOLAR/ MANIC DEPRESSIVE DISORDER
Extreme mood swing from Mania to depression
Cause:
Genetic 1st degree family members
Neurobiological (increase NE)
Psychological (poor mother and child relationship)
SUBTYPES
I. BIPOLAR I
- Manic episodes – persistent elevated mood for
a duration of 1 week and 3 out of the
following signs (grandiosity, insomnia,
verbosity, flight of ideas, distractability,
agitation and excessive involvement
into pleasurable activities )
- Major Depression (alternating)
 II. BIPOLAR II.
- Hypomanic – period of elevated irritable
mood lasting for 4 days, it is Less Severe and
manifesting 3 or more signs
- Depressive Disorder
III. CYCLOTHYMIC
- hypomanic episode dispersed with periods of
depressed mood
- No evidence of true major depression and
manic
- alternating moods swing
- last for 2 years
NURSING DIAGNOSIS WITH IMPLEMENTATIONS
* High Risk for violence directed to self and others
- redirect negative feelings into a socially
acceptable manners
- encourage brief contact with patient
- conduct suicide assessment
- seclude, restraint if necessary
- provide frequent “quiet time out”
* Impaired social Interaction
- set limit on behavior
- provide meaningful interactions
* Altered Nutrition
- increase calories, vitamin in diet, provide finger
foods and fruits
- encourage non-competitive solitary play

PSYCHOPHARMACOLOGY
Antimanic (Lithium)
Mood Stabilizers (anticonvulsants)