Quiz 19: Pharmacotherapy of Mood Disorders

Nursing

A mood disorder is defined as a continuous trouble in mood that anguishes a person's ability to effectively deal with normal day-to-day activities. There are mainly two main categories of mood disorder namely depression and bipolar disorder , however mood disorders can be classified into many categories according to the wide range of symptoms which results in their classification. • Major depressive disorder: Also known as clinical depression • Dysthymic disorder: A chronic form of depression that might persist for approximately two years. • Bipolar disorder: Also known as manic depression. The patient suffering from it depicts intense excitement called as "mania" and otherwise major depressive disorder. • Manic and hypomanic episodes: Also includes mania symptoms lasting for approximately one week and can severely impact social life. Symptoms can also be mild sometimes as hypomania and will be persistent for 4 days only. • Cyclothymic disorder: A less severe form of bipolar disorder in which the patient oscillates between hypomania and mild depression. It is generally escapes undiagnosed. Cyclothymic disorder is seen to develop into bipolar disorder in about 33% of the people.

Depression is one of the most frequently diagnosed mental conditions and oldest in nature. There are several theories and components to depression that relate to the fact that why in some people it is more prone to occur. Pathophysiological depression has following components: • Biological component : - This focuses on the levels of neurotransmitters in brain and limbic system (system that regulates emotions). Major depression has been associated with extremely low levels of hormones such as serotonin, dopamine, and norepinephrine. Antidepressant medications act by increasing the levels of these neurotransmitters. Scientists are yet to find the direct involvement of these neurotransmitters with depression. Certain hormones of endocrine system in the body are also associated with the symptoms of depression. Generally half of those suffering from depression have unusually high levels of serum cortisol levels. Cortisol released in the body at the time of stress situations and is believed to reduce levels of serotonin in brain leading to depression. Also, thyroid hormone (T 3 ) therapy has shown positive effects on mood enhancement at times of depression. • Genetic component : Depression also has genetic roots; major depression is seen in a person who has a first-degree relative suffering from the same when compared with general population. The chances of having depression increases 1.5 to 3 times in these people. When one twin is suffering from depression the other twin has about 50% chances of acquiring the same. As a matter of fact even fraternal twins show 19% relatedness in terms of acquiring depression, which is higher as compared to general population. • Environmental component : This component includes various factors such as prolonged work related stress, loss of a beloved, sexual or physical abuse, separation from a loved one, severe mental illness of parent, or death.

For complete diagnosis and treatment of depression to occur, it should be a collaborative effort of healthcare providers, especially nurses should be skillful in the assessment and care of the patients associated with this ailment. The following steps should be taken for assessment in case of depression by the nurse's: - • Conducting a complete medical examination on the patient for ruling out any medical condition such as oral contraceptives use, CNS disorders, corticosteroid consumptions, beta blockers etc. • Initial period of hospitalization and continuous monitoring. • Assessment of sleep patterns as a part of patients screening, and if insomnia is diagnosed then appropriate treatment should be started to re-establish sleeping patters to improve sleep quality and reduce depression. • Weekly and maybe daily contact with patient • Careful monitoring of prescribed drugs and medications.

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