Mood Disorder

MOOD DISORDER
• Mood is a pervasive and sustained feeling tone that is

experienced internally and that influences a person's
behavior and perception of the world. Affect is the
external expression of mood.
• Mood can be normal, elevated, or depressed.
• Healthy persons experience a wide range of moods and
have an equally large repertoire of affective expressions;
they feel in control of their moods and affects.
DEFINITION
• Mood disorders are a group of clinical conditions which are
characterized by a sense of loss of control over one’s mood
and subjective sense of distress, impaired interpersonal,
social and occupational functioning.
• Mood disorders are characterized by a disturbance of mood,

accompanied by a full or partial manic or depressive
syndrome, which is not due to any other physical or mental
disorder.
• It is a disorder in which a person experiences
long periods of extreme happiness, extreme
sadness, or both.
CLASSIFICATION
F30 - Manic Episode
F31 - Bipolar Affective Disorder
F32 - Depressive Episode
F33 - Recurrent Depressive Disorder
F34 - Persistent Mood Disorder (cyclothymia and
dysthymia)
F38 – other mood disorders
F39 – unspecified mood disorder
MANIA
DEFINITION
• Mania refers to a syndrome in which the
central features are over- activity, mood
change and self important ideas.
CLASSIFICATION
F30 - Manic episode
F30.0 - Hypomania
F30.1- Mania without psychotic symptoms
F30.2 - Mania with psychotic symptoms
F30.8 - Other manic episodes
F30.9 - Manic episode, unspecified
ETIOLOGY
• Neurotransmitters and structural hypothesis -
excessive levels of norepinephrine and dopamine,
decreased serotonin
• Genetic considerations
• Psychodynamic theories – faulty family dynamics
CLINICAL FEATURE
APA – DSM 5
7 symptoms
G Grandiosity
S Sleep, decreased
T Talkative
3 symptoms
for a week
P Pleasure and pain
A Activity
I Ideas
D Distractibility
1. Grandiosity
• INFLATED SELF –ESTEEM
2. Sleep – decrease
Stressed
Tensed Loss of sleep
depressed
In mania, pt. sleep only for 3-4 hrs a day
Feel FRESH
3. Talkative
4. Pleasure and Pain
5. Increased activities
• Religious
• Social
• Work
6. Flight of Ideas
7. Distractibility
1. AFFECTIVE SYMPTOMS
Elevated mood: it has 4 stages depending on severity of manic

episodes-
• EUPHORIA (stage-I) : (mild elevation of mood) increased sense of
psychological well being & happiness not in keeping with ongoing
events
• ELATION (stage-II) : moderate elevation of mood with increased
psychomotor activity
• EXALTATION (stage-III) : (moderate elevation of mood) intense
elation of mood with Delusions of Grandeur.
• ECSTASY (stage-IV) : (severe elevation of mood) , intense sense of
rapture or blissfullness seen in delirious or stuporous mania
AFFECTIVE SYMPTOMS cont…
• Elevated mood
• Expensiveness
• Humorousness
• Inflated self esteem
• Intolerance of criticism
• Lack of shame or guilt
• May shift from Euphoria to Depression or Anger
2. BEHAVIORAL SYMPTOMS
• Aggressiveness
• Grandiose acts
• Hyperactivity
• Increased motor activity
• Irresponsibility
• Irritability
• Argumentativeness
• Poor personal grooming
• Increased social activity
• Dressed up in gaudy or flamboyant clothes
• Sexual hyperactivity
3.PHYSIOLOGICAL SYMPTOMS
• Dehydration
• Inadequate nutrition (due to over-activity)
• Little need of sleep
• Weight loss
4. COGNITIVE SYMPTOMS
• Ambitiousness
• Denial of realistic danger
• Easily distracted
• Flight of ideas
• Speaks loudly
• Delusions of grandeur
• Delusion of persecution
• Lack of judgment
5. OTHER SYMPTOMS
• Over religiosity
• Over spending/ expansive ideas
• Over familiarity
• Appetite may be increased, but decreased food intake due
to over-activity
• Decreased need for sleep
DIAGNOSIS
• Psychological tests such as Young mania Rating
Scale
• ICD-10 diagnostic criteria
• DSM-IV-TR Criteria for Manic Episode
• MSE
• Based on sign and symptoms
1. Young Mania Rating Scale (YMRS)
1. Elevated Mood
0 Absent
1 Mildly or possibly increased on questioning
2 Definite subjective elevation; optimistic, self-
confident; cheerful; appropriate to content
3 Elevated; inappropriate to content; humorous
4 Euphoric; inappropriate laughter; singing
2.Increased Motor Activity-Energy
0 Absent
1 Subjectively increased
2 Animated; gestures increased
3 Excessive energy; hyperactive at times; restless (can
be calmed)
4 Motor excitement; continuous hyperactivity (cannot
be calmed)
3. Sexual Interest
4. Sleep
5. Irritability
6. Speech (Rate and Amount)
7. Language-Thought Disorder
8. Content
9. Disruptive-Aggressive Behavior
10. Appearance
11. Insight
Scoring of YMRS
• The YMRS total score ranges from 0 to 60 where
higher scores indicate more severe mania, thus, a negative
change (or decrease) from baseline indicates a reduction (or
improvement) in manic symptoms.
• Total score ≤12 indicates remission
• 13-19=minimal symptoms;
• 20-25=mild mania,
• 26-37=moderate mania,
• 38-60=severe mania)
Treatment modalities
1. Pharmacotherapy
• Mood stabilizers
• Antimanic – Lithium
• Anticonvulsant - clonazepam, valproic acid
• Calcium channel blocker – verapamil
• Antipsychotics - Olanzapine, Risperidone, Quetiapine
Chlorpromazine, Haloperidol
• Sedatives/hypnotics• benzodiazepines
2. Electro convulsive therapy
3. Psychosocial treatment
Nursing management for mania
pt.
1. High risk for injury related to extreme hyperactivity and

impulsive behavior, evidenced by lack control over
purposeless and potentially injurious movements.
2. High risk for violence; self-directed at others related to
manic excitement, delusional thinking and hallucinations.
3. Altered nutrition, less than body requirements related to
refusal or inability to sit still long enough to eat, evidenced
by weight loss, amenorrhea.
4. Disturbed thought processes related to biochemical alterations
in the brain evidenced by delusions of grandeur and
persecution.
5.Disturbed sensory perception related to biochemical alterations
in the brain, possible sleep deprivation, evidenced by auditory
and visual hallucinations
6.Impaired social interaction related to egocentric and narcissistic
behavior, evidenced by inability to develop satisfying
relationships.
7. Disturbed sleep pattern related to excessive hyperactivity and
agitation, evidenced by difficulty falling asleep and sleeping
only short periods
1. RISK FOR INJURY
Nursing Actions:
– Reduce stimuli
– Assign private room
– Remove hazardous objects from area
– Stay with client when he/she is agitated
– Provide physical activities
– Tranquilizers as ordered
2. Risk for Self- or Other-Directed Violence
Nursing Actions:
– Observe client q 15 min
– Remove sharps, belts, and other dangerous objects
from environment
– Maintain calm attitude
– Sufficient staff for show of strength if necessary
– Tranquilizers as ordered
– Mechanical restraints if necessary
3. Imbalanced Nutrition: Less than body
requirements
Nursing Actions:
– High protein, high calorie finger foods
– Juice and snacks on unit
– I&O, calorie count, daily weights
– Provide favorite foods
– Supplement with vitamins and minerals
– Sit with client during meals

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MOOD DISORDER

• Mood is a pervasive and sustained feeling tone that is

• Mood disorders are characterized by a disturbance of mood,

In mania, pt. sleep only for 3-4 hrs a day

Elevated mood: it has 4 stages depending on severity of manic

1. High risk for injury related to extreme hyperactivity and

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