Understanding mood disorders holds paramount importance for nursing students due to their profound impact on patient care and overall well-being. As future healthcare professionals, nurses play a vital role in not only recognizing the signs and symptoms of mood disorders but also in providing essential support and interventions.
Mood disorders encompass a range of conditions, such as depression, bipolar disorder, and anxiety disorders, which can significantly affect a patient's emotional, psychological, and physical health.
By grasping the underlying mechanisms, diagnostic criteria, and treatment modalities of mood disorders, nursing students can offer empathetic and informed care, contribute to accurate assessments, administer appropriate interventions, and effectively collaborate within interdisciplinary healthcare teams
Moreover, this knowledge proves invaluable when addressing questions related to mood disorders on the NCLEX exam, ensuring that aspiring nurses are well-prepared to demonstrate their expertise and competence.
Mood - emotional states are subjective and difficult to define and are long-term.
1. Mood disorders
a. Emotional extremes and challenges regulating moods (think long-term)
i. Example: Bipolar disorder and depressive disorders
1. Bipolar includes periods of mania and depression with normal periods in between
a. Extremely high highs
b. Extremely low lows
c. Inability to self-regulate
2. Mania definition: a mood disorder marked by a hyperactive, wildly optimistic state
3. Depression: 5+ depressive symptoms for 2+ weeks
1. Goals
a. Manage acute episodes
b. Provide support and resources for long-term management
2. Meds
a. Anti-anxiety medication can be used during manic episodes. Caution should be used with clients who have a history of substance abuse
b. Antipsychotics:
i. olanzapine (Zyprexa), aripiprazole (Abilify), risperidone (Risperdal)
Mood stabilizer
i. Lithium
1. Clients will need regular labs to check the therapeutic level
2. Toxicity can result if stable sodium intake and fluid intake (2-3L/day) is not maintained
d. sodium valproate (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol) are given to clients with mood disorders
3. Interventions for Mania
a. Make sure the environment is safe, watch for dangerous hyperactivity
b. Reorient as necessary
c. Promote appropriate sleep/wake cycles
d. Controlled, calm, focused interactions to help control the hyperactive personality
e. High-calorie finger foods because they are manic and hyperactive
f. Set boundaries related to behaviors
g. Ensure medication compliance
Case Study: Managing Bipolar Disorder in a Young Adult
Patient Profile:
Jane Doe, a 24-year-old female, is admitted to the psychiatric unit with a history of bipolar disorder type I. She has a previous medical history of major depressive episodes, followed by manic episodes characterized by impulsivity, increased energy, and decreased need for sleep.
Jane's family reports that she has been non-compliant with her medication regimen and has experienced deteriorating mental health over the past few weeks. She has been experiencing extreme irritability, racing thoughts, and engaging in risky behaviors, such as excessive spending and promiscuity. Jane's mood swings have strained her relationships and made it difficult for her to maintain employment or attend college.
Assessment:
Upon admission, Jane's mood is elevated, and she demonstrates pressured speech. She reports feeling invincible and that her thoughts are racing. She admits to discontinuing her mood stabilizers because she believes they are unnecessary.
She exhibits signs of poor impulse control, engaging in sporadic and grandiose planning. Jane's sleep pattern is disrupted, with minimal sleep reported over the past week. She has lost weight and appears physically agitated. The assessment reveals a lack of insight into her condition and its impact on her life.
Diagnosis:
Jane's presentation aligns with a manic episode associated with bipolar disorder type I. This diagnosis is supported by her history of mood swings and the current manic symptoms, including elevated mood, decreased need for sleep, impulsivity, and risk-taking behaviors.
Interventions:
Stabilization: The immediate focus is on stabilizing Jane's acute manic symptoms. She is started on mood stabilizers, with close monitoring of her response and any potential side effects. Medication adherence is emphasized through education about the importance of consistent pharmacotherapy.
Psychoeducation: A collaborative approach involving Jane and her family is initiated to educate them about bipolar disorder, its cyclic nature, and the importance of treatment adherence. Psychoeducation aims to enhance their understanding of warning signs and strategies to manage the condition.
Cognitive Behavioral Therapy (CBT): Individual therapy sessions are introduced to help Jane recognize and challenge distorted thought patterns, manage stressors, and develop coping strategies to prevent future mood swings.
Sleep Hygiene: Since disrupted sleep exacerbates manic symptoms, a structured sleep routine and relaxation techniques are incorporated to improve sleep quality.
Collaboration with Interdisciplinary Team: Psychiatrists, psychiatric nurses, social workers, and occupational therapists collaborate to provide comprehensive care. Weekly team meetings are conducted to assess Jane's progress and adjust the treatment plan as needed.
Outcome:
Over the course of treatment, Jane's manic symptoms gradually subside, and her mood stabilizes. She gains insight into her condition, acknowledging the importance of medication adherence and therapy. With the support of her treatment team and family, she develops a relapse prevention plan and learns to manage stressors effectively. Jane's successful management of her bipolar disorder enhances her overall quality of life, allowing her to rebuild relationships, pursue her education, and maintain stable employment.
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