PSYCHIATRIC MENTAL HEALTH NURSING

| CHAPTER 17: Mood Disorders and Suicide|

BSN3 | 2ND SEM | FINALS |

COMMON LOW MOODS RELATED DISORDERS o Specific Antidepressants

o Description: Temporary feelings of sadness, tiredness, and o Persistent Depressive Disorder: Chronic mild depression - Fluoxetine (Prozac): Has a longer half-life than
a desire to withdraw. with symptoms like low energy, low self-esteem, and other SSRIs, leading to mild agitation and
o Symptoms: Anergia (lack of energy), exhaustion, agitation, hopelessness. weight loss but less sedation.
noise intolerance, slow thinking, difficulty making o Disruptive Mood Dysregulation Disorder: Persistent - Cyclic Antidepressants: These older
decisions. irritability with severe temper outbursts, starting before age antidepressants have varying efficacy in
o Coping: People usually continue with daily responsibilities 10. blocking norepinephrine and serotonin activity.
despite these moods, which typically pass in a few days. o Cyclothymic Disorder: Mild mood swings between They have a lag period before reaching
Everyday Use of "Depressed" hypomania and depression. therapeutic levels and may have more side
o Misconception: Often used to describe a bad day rather o Substance-Induced Mood Disorders: Mood disturbances effects.
than clinical depression. due to substance use. - Atypical Antidepressants: Used when SSRIs
o Examples: Feeling down due to being overwhelmed or o Seasonal Affective Disorder (SAD): are ineffective or cause side effects. Includes
facing misfortune like the death of a loved one, - Winter Depression: Increased sleep, appetite, drugs like venlafaxine, duloxetine, bupropion,
financial problems, or job loss. weight gain, irritability. nefazodone, mirtazapine, and vilazodone, each
ELEVATED MOODS - Spring-Onset SAD: Insomnia, weight loss, poor with unique mechanisms and side effect
o Description: Episodes of high energy and confidence, appetite. profiles.
feeling capable of taking on any task or relationship. Treatment: Often treated with light - Monoamine Oxidase Inhibitors (MAOIs):
o Symptoms: Increased stamina for work and social activities. therapy. Less commonly used due to potential fatal side
o Duration: These moods usually recede in a few days to a - Postpartum Blues: Mood disturbances after effects and interactions, but may be effective for
normal state (euthymia). childbirth, with symptoms like sadness, anxiety, and treatment-resistant depression.
Mood Disorders (Affective Disorders) insomnia. OTHER MEDICAL TREATMENTS AND PSYCHOTHERAPY
o Description: Pervasive alterations in emotions causing o Electroconvulsive Therapy (ECT): Considered for cases
long-term sadness (depression) or elation (mania), where medications are ineffective or intolerable. ECT
interfering with life. MAJOR DEPRESSIVE DISORDER involves inducing controlled seizures to correct brain
o Symptoms: Self-doubt, guilt, anger, impacting self-esteem, ONSET AND CLINICAL COURSE chemistry imbalances associated with depression.
occupation, and relationships. o Duration: An untreated episode of MDD can last from o Psychotherapy: Combined with medications,
weeks to months or even years, with most episodes psychotherapy (e.g., interpersonal therapy, behavior
CATEGORIES OF MOOD DISORDERS
resolving within about 6 months. therapy, cognitive therapy) aims to achieve symptom
MAJOR DEPRESSIVE DISORDER
o Recurrence: Approximately 50% to 60% of individuals remission, psychosocial restoration, and prevention of
o Duration: At least 2 weeks.
experience recurrent episodes of depression, and about relapse or recurrence.
o Symptoms: Depressed mood, loss of pleasure, changes in
20% develop chronic depression. o New and Investigational Treatments
eating habits, sleep disturbances, impaired concentration,
o Severity: Symptoms of depression range from mild to - Transcranial Magnetic Stimulation (TMS):
feelings of worthlessness or guilt, thoughts of death or
severe, often correlating with the individual's sense of Approved for treatment-resistant depression,
suicide, fatigue, pessimism.
helplessness and hopelessness. Around 20% of severe TMS is a non-invasive procedure that stimulates
o Psychotic Features: About 20% experience delusions and
depression cases may include psychotic features. specific brain regions using magnetic fields.
hallucinations.
TREATMENT AND PROGNOSIS: PSYCHOPHARMACOLOGY - Other Treatments: Magnetic seizure therapy,
BIPOLAR DISORDER
deep brain stimulation, and vagal nerve
o Fluctuations: Extremes of mania and depression. o Antidepressants: Various classes of antidepressants are
stimulation are also being investigated for their
o Mania Symptoms: Elevated mood, inflated self-esteem, used, including cyclic antidepressants, monoamine oxidase
efficacy in treating depression.
decreased sleep, excessive speech, racing thoughts, inhibitors (MAOIs), selective serotonin reuptake inhibitors
distractibility, increased activity, risk-taking behavior. (SSRIs), and atypical antidepressants.
o Hypomania: Milder symptoms, does not impair o Mechanism of Action: Antidepressants aim to increase the
functioning. availability of neurotransmitters like norepinephrine and
o Mixed Episodes: Both mania and depression nearly every serotonin by inhibiting their reuptake into nerve terminals
day for at least 1 week. and enhancing postsynaptic receptor sensitivity.
o Types: o Combination Therapy: In cases of acute depression with
o Bipolar I: One or more manic or mixed psychotic features, an antipsychotic may be combined with
episodes with major depressive episodes. an antidepressant.
o Bipolar II: Major depressive episodes with at o Duration of Treatment: Evidence suggests that
least one hypomanic episode. antidepressant therapy should continue for longer periods,
typically 18 to 24 months, to reduce the risk of relapse.

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DABON, A.D.
PSYCHIATRIC MENTAL HEALTH NURSING
| CHAPTER 17: Mood Disorders and Suicide|
BSN3 | 2ND SEM | FINALS |

SUICIDE o Family Response: Suicide impacts families profoundly,

o Suicide is the deliberate act of ending one's life and is often often leading to complex emotions of guilt, shame, and
associated with mood disorders like depression. grief.
o In the United States alone, over 45,000 suicides are o Nurse's Role: Nurses adopt a nonjudgmental, empathetic
reported annually, with a troubling 30% increase in the past stance, focusing on client safety and emotional support,
two decades. while navigating legal and ethical considerations
o Suicide attempts outnumber completed suicides by 8 to 10 surrounding assisted suicide.
times.
o Men account for about 72% of suicides, although women
attempt suicide more frequently.
PREVALENCE AND RISK FACTORS
o Demographics: Men, young women, whites, and
separated/divorced individuals face increased suicide risks.
o Age Groups: Suicide is the second leading cause of death
among 15 to 24-year-olds, with a rapidly rising rate among
45 to 65-year-olds.
o Mental Health and Environmental Factors: Suicidal
Ideation and Attempts
SUICIDAL IDEATION AND ATTEMPTS
o Active vs. Passive Ideation: Active ideation involves
planning and seeking methods for suicide, while passive
ideation involves thoughts of wanting to die without
specific plans.
o Ambivalence: Suicidal individuals often experience
conflicting feelings about death and may reach out for help
despite their desire to end their lives.
ASSESSMENT AND WARNING SIGNS
o Previous Attempts: A history of previous attempts
increases suicide risk, especially within the first two years
post-attempt.
o Family History: Relatives of suicide victims, especially
close relatives, are at higher risk due to familial acceptance
or "copycat suicides."
o Seasonal and Behavioral Patterns: Suicides often peak in
spring and on Monday mornings, linked to increased
energy levels. Antidepressant treatment can inadvertently
provide the energy needed for suicide attempts.
INTERVENTION STRATEGIES
o Assessment for Lethality: Assessing suicide plans, means,
preparations, timing, and beliefs about lethality is crucial in
determining intervention urgency.
o Authoritative Role: Nurses prioritize safety over client
preferences, especially during heightened suicide risk
periods.
o Safe Environment: Hospitals remove potential suicide
tools and provide varying levels of observation based on
lethality risk.
o Support Systems: Creating support lists and involving
community resources can bolster a suicidal individual's
support network.

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DABON, A.D.