Mood Disorders

Neurotransmission altered by stress

The external manifestation of feeling or emotion that can be assessed by a nurse by observing facial expression, tone of voice, and body language. For example, a patient may be said to have a flat affect, meaning that there is an absence or a near absence of facial expression. Some people, however, use the term loosely to mean a feeling, emotion, or mood.

Defined by the American Psychiatric Association as a pervasive and sustained emotion that, when extreme, can markedly color the way the individual perceives the world.

• 3 most common initial symptoms:
• 1. elated mood (or irritability in some pts)
• 2. increased activity
• 3. reduced sleep

An unstable elevated mood in which delusion, poor judgment, and other signs of impaired reality testing are evident. During a manic episode, patients have marked impairment of social, occupational, and interpersonal functioning.

Overactivity of neurotransmission

• Associated with bipolar 2 disorder.
• Must be evident for at least 4 (FOUR) days.

• When people are hypomanic they have voracious appetites for food as well as for indiscriminate sex. Although the constant activity of the hypomanic prevents proper sleep, short periods of sleep are possible.

associated with bipolar disorder

A continuous flow of speech in which the person jumps rapidly from one topic to another. Sometimes the listener can keep up with the changes; at other times it is necessary to listen for themes in the incessant talking. Themes often include grandiose and fantasized evaluation of personal sexual prowess, business ability, artistic talents, and so forth.

Events viewed as uncontrollable result in the development of helplessness, apathy, powerlessness, and depression.

A depressive syndrome frequently accompanies other psychiatric disorders

• inability to experience pleasure
• common symptom of depressive disroders

• lack of energy
• passivity

indifferent

A chronic mood disturbance (of a least 2 years' duration) involving both hypomanic and dysthymic mood swings. Delusions are never present, and these mood swings usually do not warrant hospitalization or grossly impair a person's social, occupational, or interpersonal functioning.

A mild to moderate mood disturbance characterized by a chronic depressive syndrome that is usually present for many years. The depressive mood disturbance is hard to distinguish from the person's usual pattern of functioning, and the person has minimal social or occupational impairment.

related to overactivation of the central serotonin receptors, caused by either too high a dose or interaction with other drugs. Symptoms include abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change. Severe manifestation can induce hyperpyrexia (excessively high fever), cardiovascular shock, or death.

rare side effect of SSRI's

1. Serotonin - important regulator of sleep, appetite, and libido.

2. Norepinephrine - decreased levels may lead to anergia, anhedonia, decreased concentration, and decreased libido.

Form of manic depression, with full manic episodes & major depressive episodes. A person does not need to experience depression to qualify as Bipolar I (Unipolar Mania).

Psychosis PRESENT.

• Major depressive episodes & hypomanic episodes.
• Psychosis NOT present.

Bipolar II is often a first step to Bipolar I. Over 5 years, between 5% and 15% of those will Bipolar II will change diagnosis to Bipolar I.

Selective Serotonin Reuptake Inhibitor

selectively block the neuronal uptake of serotonin leaving more serotonin available at the synaptic site.

Ex: Prozac

inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS. Therefore the amount of time that norepinephrine and serotonin are available to the postsynaptic receptors is increased. This increase in norepinephrine and serotonin in the brain is believed to be responsible for mood elevations when TCAs are given to depressed people.

inhibit the enzyme and interfere with destruction of monoamines. This in turn increases the synaptic level of the transmitters and makes possible the antidepressant effects of these drugs.