- Mood: Internal personal, emotional state acting as barometer influencing outlook and perception.

# Includes: Grief // joy // happiness // elation // Euthymic mood state - In the "normal" range
- Affect: Refers to the behavioral expression of the mood. Outward, external manifestation of mood.

Types of Mood/Affective Disorder

(A) - Depressive Disorders
1- MDD Major Depressive Disorder (Unipolar depression)
# DSM–5 hallmark criteria:
Extreme depressed mood // Anhedonia for at least 2 consecutive W // Hopelessness,Helplessness // Loss of appetite & interest // Impaired libido
Cognitive disturbance // Feelings of guilt or worthlessness.
2- PDD Persistent Depressive Disorder (Dysthemia)
# Symptoms maybe atypical:
Low energy // fatigue // low self esteem // poor concentration // Most may develop into MDD eventually // Entry diagnosis for MDD
3- Pre-menstrual Dysphoric Disorder
Mostly manifesting to women during and may not be consistent and consecutive before start of the menstrual cycle.
4- Perinatal Depression
Condition of abnormal depressive conditions mostly occurring the different periods (Pre, during, post) of pregnancy
Mostly because of bodily changes and personal body image changes as perceived by the mother.
5- Disruptive Mood Regulation Disorder
Children displaying persistent irritability and out-of- control behavior.
May develop into unipolar depressive disorder or into another form of anxiety disorder.
6- Substance/Medication-induced Depressive Disorder
Depression may appeared due to & maybe related to taking meds (prescribed or otherwise) or of any type of substances (legal or illegal)
7- Depressive Disorder due to another Medical Condition
Condition of depression that maybe related to an existent or newly diagnosed other medical condition.
8- Other (Specified or Unspecified) Depressive Disorder
Depressive conditions that may not be classified elsewhere.

(B)- Bipolar & Related Disorders

1- Bipolar I
An illness in which people have experienced one or more episodes of mania and major depression.
# Mania includes: (exaggerated elation // energy // joy or euphoria // irritability // anger // rage or uncooperative behavior.)
Excessive and pressured speech (rapid ,loud talk and without pause)
2- Bipolar II
Subset of bipolar disorder, people experience major depressive episodes. Shifting back &forth with hypomanic episodes
BUT never a “full" manic episode
3- Cyclothymic Disorder
Chronically unstable mood state of unclear change in hypomania & mild depression experienced at least 2Y with possible Euphemia(normal mood)
4- Other Bipolar Due to another Medical Condition
5- Substance/Medication-induced Bipolar or Related Disorder
6- Pediatric Bipolar Disorder

Etiology
(A)- Genetic
- Transmitted by the X-linked dominant gene.
- First-degree relatives of people with bipolar disorder have a sevenfold risk for developing bipolar disorder compared with 1% risk in general population

(B)- Biological
- Electrolyte metabolism: disturbance in the distribution of sodium and potassium
- Catecholamine deficiency or excess in the central nervous system
- Serotonin, norepinephrine disturbance

(C)- Aggression-turned-inward Theory by Sigmund Freud

Depression —> Aggression-turned-inward // Aggression-turned-outward —> Mania

(D)- Object-loss theory

# Depression result of lose (family, friend, beloved ones, money, ect…)

(E)- Cognitive model (Aaron Beck)

#Depression resulting from:
1- Negative view of self 2- Negative cognitive set (Hopelessness // Helplessness // Worthlessness)
3- View of adverse event as a personal shortcoming: expectations of failure (Ex: sees the empty half of the glass)

(F)- Learned helplessness (Seligman)

# Anxiety replaced by depression then the person feel no control for any situation and couldn’t find any solution for any problem

(G)- Behavioral model (P. Lewiston)

# Depression caused by:
1- Person-behavior-environment interaction 2- Low rate of positive: reinforcement or lack of rewarding interactions

(E)- Sociological theories and stress factors

1- Loss 2- Major life events 3- Role strain 4- Change in familiar environment 5- Change in economic conditions or coping resources.
6- Physiologic changes
 Nursing Process Application on Depressive reactions

(A)- Assessment:
# Characteristics of Severe Depression
1- Intense, pervasive , and persistent depression
2- Altered reality orientation.
3- Affective changes (despair and hopelessness, worthlessness, helplessness, loneliness)
4- Cognitive changes: (confusion ,indecisiveness, self-blame and self-deprecation, wish to die, possible delusions or hallucination)
5- Behavioral changes: (psychomotor retardation; agitation, slow responses, neglect appearance, social withdrawal)
6- Physiologic changes: (constipation, urine retention, amenorrhea, lack of sexual interest, impotence, marked weight loss, insomnia)

(B)- Nursing Diagnoses:

1- Ineffective Coping
2- Impaired Social Interaction
3- Bathing Self-Care Deficit
4- Dressing Self-Care Deficit
5- Feeding Self-Care Deficit
6- Toileting Self-Care Deficit
7- Chronic Low Self-Esteem

(C)- Nursing Goals/Plans:

1- Promote adequate nutrition, hydration, elimination, rest, sleep, and activity
2- Stop withdrawn behavior
3- Prevent the client from self-harm
4- Decrease disorientation, hallucinations, and delusions
5- Promote feelings of self-worth and articulation of feelings

(D)- Nursing Intervention

# Behavioral Needs:
1- Mobilize the client to productive activity by assigning therapeutic tasks
2- Provide opportunities for increased involvement in activities
3- Select activities that ensure success and accomplishment
4- Provide opportunities for exercise

# Cognitive Needs:
1- Increase self-esteem and sense of control over behavior
2- Modify negative expectations and explore the extent of negative thinking
3- Substitute positive thoughts for negative
4- Establish realistic goals

# Emotional Needs:
1- Slowly and cautiously make the client aware of unconscious feelings.
2- Plan activities that allow for physical sublimation of aggressive feelings
3- Talk about the universality of feelings
4- Encourage constructive expression when the client discusses anger
5- Provide hope

# Spiritual Needs:
1- Assess the client’s loss of belief
2- Help the client explore spiritual beliefs or a meaningful philosophy of life
3- Arrange for a spiritual advisor to visit, if appropriate

# Other Treatments
1- Electroconvulsive therapy (ECT)
2- Antidepressant medication
3- Group and individual therapies
4- Phototherapy
5- Sleep manipulation
6- Lithium therapy
# Mood-stabilizing drugs OR Antimanic OR lithium carbonate
- Treats bipolar disorder, stabilizing client’s mood, preventing or minimizing highs & lows (that characterize bipolar illness) & treat acute eps of mania
- Lithium is the most established mood stabilizer
- Some anticonvulsant drugs, particularly carbamazepine (Tegretol) & valproic acid (Depakote, Depakene), are effective mood stabilizers
- Available in tablet, capsule, liquid, and sustained-release forms; no parenteral forms are available.
- The effective dosage of lithium is determined by monitoring serum lithium levels and assessing the client’s clinical response to the drug
- Daily dosages generally range from 900 to 3,600 mg
- Serum lithium level should be about 1 mEq/L
- Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic
- Serum lithium levels of more than 1.5 mEq/L are usually considered toxic
- The lithium level should be monitored every 2 to 3 days while the therapeutic dosage is being determined
- Then, it should be monitored weekly
- When the client’s condition is stable, the level may need to be checked once a month or less frequently
 Nursing Process Application on Manic Reactions
(A)- Assessment:
# General Characteristics of Mania:
1- Condition that usually develops more rapidly than depressive reactions
2- Failure to view behavior as inappropriate
3- Maladaptive defense against depression

# Physical Manifestations of Mania:

1-Deteriorated physical appearance
2- Increased energy: feeling of being “charged up ”
3- Increased sexual interest and activity
4- Decreased sleep disturbance

# Emotional Manifestations of Mania:

1- Mood labiality: euphoria
2- Feelings of grandiosity
3- Inflated sense of self-worth

# Cognitive Manifestations of Mania:

1- Difficulty concentrating
2- Flight of ideas
3- Delusions of grandeur
4- Impaired judgment

# Behavioral Manifestations of Mania:

1- Hyperactivity
2- Impulsiveness, lack of inhibition, recklessness
3- Increased social contacts
4- Hyper sexuality
5- Verbosity
6- Bizarre and eccentric appearance
(B)- Nursing Diagnoses:
1- RiskforSelf/Other-Directed Violence
2- Defensive Coping
3- Disturbed Thought Processes
4- Self-Care Deficit
5- Deficient Knowledge (Specify)
(C)- Nursing Care Goals/Plans:
1- Prevent the client from self-harm
2- Decrease disorientation, delusions, bizarre behavioranddress,sexualacting-out, hyperactivity, restlessness, agitation
3- Promote rest, sleep, and a nutritious diet
4- Assist with activities of daily living
5- Provide emotional support
6- Promote medication compliance
(D)- Nursing Intervention
# Physical Needs:
1- Decrease environmental stimuli
2- Offer finger foods
3- Encourage short rest periods
4- Enforce minimal standards of personal hygiene
5- Monitor medications
# Behavioral Needs:
1- Suggest sedentary activities, and offer motor activities in moderation
2- Define and explain acceptable behaviors, then set limits
3- Negotiate limits on demanding, manipulative behaviors
4- Avoid frustrating the client unnecessarily
# Cognitive Needs:
1- Safeguard the client from physical risks
2- Discourage the client from expensive purchases
3- Help the client identify behaviors that lead to a manic episode
4- Explore effects of behavior on others
5- Intervene when the client has DELUSIONS
6- Increase the client’s self-esteem
# Emotional Needs:
1- Help the client become aware of underlying anger
2- Verbally acknowledge resistance to therapy
3- Teach the client to make decisions and accept responsibility
# Spiritual Needs:
1- Help the client explore a meaningful philosophy of life
2- Arrange for a spiritual advisor to visit, if appropriate