What is Mood:

Mood is a pervasive and sustained emotion (how the patient feels internally), while Affect is the observable expression of that emotion (what the nurse observes on the patient’s face).

1. Depression

Definition: An affective disorder characterized by a pervasive and persistent low mood, accompanied by low self-esteem and a loss of interest or pleasure in normally enjoyable activities (Anhedonia).

Types of Depression

Major Depressive Disorder (MDD): Symptoms last for at least 2 weeks and severely impact daily functioning.

Dysthymia (Persistent Depressive Disorder): Chronic, milder depression lasting for at least 2 years.

Postpartum Depression: Occurs within 4 weeks of childbirth (can last up to a year).

Seasonal Affective Disorder (SAD): Depressive episodes related to seasons (usually winter). Treatment includes light therapy.

Causes (Etiology)

Biochemical: Decreased levels of Serotonin (5-HT) and Norepinephrine (Most repeated NORCET question).

Genetics: Higher risk if first-degree relatives are affected.

Cognitive Theory (Beck’s Triad): Negative view of self, world, and future.

Clinical Features & Diagnosis

The Classic Triad:

1. Depressed mood

2. Anhedonia (inability to experience pleasure)

3. Anergia (lack of energy/fatigue)

Other Symptoms: Insomnia or hypersomnia, anorexia or weight gain, psychomotor retardation, suicidal ideation.

Diagnosis: DSM-5 criteria, ICD-10, Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS).

Management

Pharmacology:

SSRIs (Fluoxetine, Sertraline): First-line drugs. Side effect to remember: Sexual dysfunction, GI upset.

TCAs (Amitriptyline, Imipramine): Watch for anticholinergic effects (dry mouth, blurred vision) and cardiac toxicity.

MAOIs (Phenelzine): Avoid Tyramine-rich foods (aged cheese, wine, cured meats) to prevent Hypertensive Crisis (High-yield MCQ!).

ECT (Electroconvulsive Therapy): Used for severely depressed, acutely suicidal patients, or those who do not respond to medications.

Psychotherapy: Cognitive Behavioral Therapy (CBT).

🚨 Nursing Responsibilities (Exam Focus)

Priority: Ensure patient safety (suicide risk is highest when the patient starts getting a little energy from antidepressants but still feels depressed).

Communication: Sit in silence if the patient is mute; use simple, direct sentences. Avoid toxic positivity (e.g., do NOT say “cheer up”).

Nutrition: Offer small, high-calorie, high-protein snacks. Monitor weight.

2. Bipolar Disorder

Definition: A mood disorder characterized by extreme mood swings, alternating between episodes of Mania (elevated/irritable mood) and Depression.

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Types

Type	Description
Bipolar I	One or more Manic episodes + Major Depressive episodes.
Bipolar II	One or more Hypomanic (mild mania) episodes + Major Depressive episodes.
Cyclothymic Disorder	Alternating periods of hypomania and mild depression lasting at least 2 years.

Clinical Features of Mania

Remember the mnemonic DIGFAST:

D – Distractibility
I – Insomnia (decreased need for sleep)
G – Grandiosity (inflated self-esteem, delusions of grandeur)
F – Flight of ideas (rapidly shifting thoughts)
A – Activity increased (goal-directed or psychomotor agitation)
S – Speech (pressured, loud, rapid)
T – Thoughtlessness (impulsive, risky behavior like excessive spending or hypersexuality)

Management

Mood Stabilizers (Drug of Choice): Lithium Carbonate.
Anticonvulsants: Valproic Acid, Carbamazepine (used for rapid cyclers).
Antipsychotics: Haloperidol or Olanzapine (used initially to control acute agitation until Lithium takes effect).

Lithium (Crucial for NORCET):

Therapeutic Level: 0.6 to 1.2 mEq/L (Toxic if > 1.5 mEq/L).
Toxicity signs: Tremors, ataxia, severe diarrhea, vomiting, metallic taste.
Dietary note: Maintain adequate Sodium and water intake (2.5-3 liters/day). If sodium is low, lithium toxicity occurs.

🚨 Nursing Responsibilities (Exam Focus)

Nutrition: Provide High-calorie, high-protein “Finger Foods” (sandwiches, bananas, chicken nuggets) because the manic patient will not sit down to eat.
Environment: Decrease environmental stimuli (low lighting, quiet room, keep away from the nurse’s station if it’s noisy).
Safety: Set clear, firm, and consistent limits on manipulative behavior. Never argue or try to debate a grandiose delusion.

3. Suicide Risk Assessment

Definition: Evaluating a patient’s intent, plan, and means to commit self-harm or end their life.

Risk Factors (SAD PERSONS Scale)

S – Sex (Males complete suicide more often; females attempt more often)
A – Age (Highest risk: <19 and >45 years)
D – Depression
P – Previous attempt (Highest predictor of future suicide)
E – Ethanol/Alcohol abuse
R – Rational thinking loss (Psychosis/Schizophrenia)
S – Social supports lacking
O – Organized plan (Having a specific method and time)
N – No spouse (Divorced, widowed, single)
S – Sickness (Chronic illness)

Assessment Techniques

Direct Questioning: Never beat around the bush. Always ask directly: “Are you thinking of hurting or killing yourself?” (Asking this does NOT plant the idea in their head—this is a classic exam trap).
Evaluate the Plan:

Is the plan specific?
Is the method lethal? (e.g., gun vs. swallowing a few vitamins).
Does the patient have access to the method?

Sudden mood improvement: If a severely depressed patient suddenly appears calm and happy, suicide risk has increased because they have made the final decision to end their life.

4. Self-Harm Prevention & Nursing Responsibilities

The primary nursing diagnosis is always Risk for self-directed violence.

Observation Levels:

High Risk (Active suicidal thoughts/plan): Implement 1:1 constant visual observation (a staff member is within arm’s reach of the patient at all times, including the bathroom).
Moderate Risk: 15-minute irregular checks.
Environmental Safety (Ligature-Proofing):

Remove all sharp objects (razors, glass, metal utensils).
Remove cords, shoelaces, belts, ties, and drawstrings.
Ensure windows are locked and use shatterproof glass.
Medication Administration:
Always perform mouth checks after giving oral meds to prevent “cheeking” (hoarding pills to overdose later).
No-Suicide Contract:
A verbal or written agreement where the patient promises not to harm themselves for a specific period and agrees to tell staff if suicidal thoughts arise. (Note: This is used, but it does NOT replace strict observation).
Promote Expression: Encourage the patient to express anger and hostility in a safe, non-judgmental environment.

Mood Disorders Quiz Part 1 – Nurses Preparation and Jobs alerts

nursingmcqs.com

Nurses Preparation and Jobs alerts

Mood Disorders Quiz Part 1

Mood Disorders Quiz Part 2 – Nurses Preparation and Jobs alerts

nursingmcqs.com

Nurses Preparation and Jobs alerts

Mood Disorders Quiz Part 2

Disclaimer for Educational and Medical Content

1. Educational Purposes Only:

The notes and materials provided are strictly for educational and exam preparation purposes (such as NORCET, NIMHANS, DSSSB, and other nursing officer exams). They are designed to serve as a study aid and summarize key concepts from standard psychiatric nursing literature.

2. Not Medical Advice:

This information should not be used as a substitute for professional medical advice, clinical judgment, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

3. Accuracy and Updates:

While every effort is made to ensure the accuracy of the information based on standard nursing textbooks, medical knowledge and clinical guidelines (such as DSM-5 criteria, pharmacological dosages, and therapeutic ranges) are constantly evolving. Always cross-reference crucial data—especially medication dosages, therapeutic levels (like Lithium), and institutional protocols—with the latest official textbooks, your nursing instructors, and current clinical guidelines before applying them in a real-world clinical setting.

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