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Mood Disorders

Mood Disorders. Chapter Five. Introduction. What is sadness and how does it differ from a Mood Disorder?. DSM-IV Classifications. Axis One-Clinical Disorder Axis Two-Personality Disorder/Mental Retardation Axis Three-General Medical Condition Axis Four-Psychosocial and Environment

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Mood Disorders

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  1. Mood Disorders Chapter Five

  2. Introduction • What is sadness and how does it differ from a Mood Disorder?

  3. DSM-IV Classifications • Axis One-Clinical Disorder • Axis Two-Personality Disorder/Mental Retardation • Axis Three-General Medical Condition • Axis Four-Psychosocial and Environment • Axis Five- Educational Problems

  4. Terms used in Psychopathology of Depression • Emotion- state of arousal defined by subjective states of feeling such as sadness, anger and disgust. • Affect-pattern of observable behavior associated with subjective feelings such as facial expression, tone of voice and gestures. • Mood- pervasive and sustained emotional response that can color the person’s perception of the world

  5. Additional Terms • Mood Disorders- discrete periods of time when a person’s behavior is dominated by either a depressive or a manic mood. • Mania- flip side of depression that involves a disturbance in mood characterized by elation including inflated self-esteem, euphoria, decreased need for sleep and pressure to keep talking and racing thoughts. • Unipolar Mood Disorder-behavior is dominated by either a depressed or manic mood • Bipolar disorder (aka manic depressive disorder)- person experiences episodes of mania as well as depression. • Relapse- return of active symptoms in a person who has recovered from a previous episode. • Remission-when a person’s symptoms diminish or improve

  6. Symptoms and Considerations when diagnosing clinical depression • Differential symptoms between Clinical Depression and Normal Sadness. • Four General types of symptoms. • Emotional • Cognitive • Behavioral • Somatic

  7. Emotional Symptoms • Dysphoric (unpleasant) mood • Diagnostic distinction made between normal sadness and clinical depression Severity, quality and pervasive impact of the depressed mood. • Anxiety-often a co-morbid diagnosis with depression • Manic symptoms-euphoric and energetic at the beginning of the cycle, changing to irritable, angry, out of control, self-destructive.

  8. Cognitive Symptoms • Slowed thinking, trouble concentrating and easily distracted • Pre-occupied with guilt and worthlessness • Focus attention on the depressive triad: • Self • Environment • Future • Manic symptoms •  easily distracted by random stimuli and often respond inappropriately • Grandiose ideas and inflated self-esteem • Quick to anger, argumentative and abusive

  9. Somatic Symptoms • Sleeping Problems-trouble falling asleep, fatigue, early morning waking, spend more or less time sleeping than usual • Appetite-changes—eating more or less than usual • Libido-loss of sexual desire Manic-drastic reduction in need for sleep, extremely energetic

  10. Behavioral Symptoms • Psychomotor retardation-slowed movements, may walk or talk as if they are in slow motion Manic-gregarious, energetic, provocative, flirtatious and often sexually inappropriate.

  11. Classification of Mood Disorders • Unipolar Disorders • Major Depressive Disorder- • One or more depressive episodes • No manic or hypomanic episode ( hypomanic episode is an episode of increased energy that are not sufficiently severe to classify as full blown mania) • Major Depressive Disorder most often follows a course of repeated episodes through life • Dsythymic Disorder • Depressed mood for at least two years, without cessation or remission of symptoms for longer than 2 months during this period. • No major depressive episodes during the first two years.

  12. Bipolar Disorders • Bipolar I disorder • One or more manic episodes • Usually accompanied by major depressive episodes in between manic episodes • Bipolar II disorder • One or more major depressive episodes • At least one hypomanic episode • No manic episodes • Cyclothymic Disorder • Numerous periods with hypomanic symptoms as well as periods of depressed mood for at least 2 years. • No remission of symptoms for longer than 2 months during the 2 year period. • No major depressive episodes • No manic episodes.

  13. Further Descriptions: Subtypes • Episode Specifier-specific descriptions of symptoms that were present during the most recent episode of depression. melancholia-episode specifier used to describe a particularly severe type of depression, the presence of which indicates the person is likely to be responsive to antidepressant therapy or ECT.  psychotic features- an episodic feature that indicates the presence of hallucinations or delusions during the most recent episode of mania or depression, the presence of which usually requires hospitilization. • Course Specifier-extensive descriptions of the pattern that the disorder follows over time, as well as adjustment between episodes.  rapid cycling-if the person experiences at least four episodes of major depression, mania, or hypomania within a 12-month period.  Seasonal affective disorder-onset of episodes is regularly associated with a change in seasons.

  14. Unipolar Disorder: Outcome, Incidence and Prevalence & Etiology • Incidence and Prevalence: • One of the most common forms of psychopathology, the lifetime risk of suffering from this disorder for the general population is 5%. • Gender • Cross Cultural-Universal • Incidence increasing at earlier ages (M=45 years)

  15. Unipolar Disorder: Course, Episodes and Outcome • Duration • Episodes • Recovery

  16. Bi-Polar Disorders: Course and Outcome Onset-usually occurs between the ages of 18-22 years which is younger than the average age of onset for unipolar Course and Duration-intermittent. Most patients tend to have more than one episode, however the length of time between episodes is difficult to predict. Incidence and Prevalence-

  17. Etiology and Theories Unipolar Mood Disorder • Social • Interpersonal loss or separation • Major disappointments dealing with acceptance such as getting fired • Stressful events • Psychological • Cognitive Vulnerability:Beck-Depressive Triad • Theory of Hopelessness • Interpersonal Perspective • Biological-Genetic contribution appears to be highest for bipolar disorder then major depressive disorder and relatively minor for dysthymia.

  18. Etiology and Theories BiPolar Disorder Social Factors • Increased frequency of stressful life events the weeks preceding a manic episode. • Schedule disrupting events such as loss of sleep, holidays • Goal attainment events, such as a major job promotion, acceptance to medical school and graduate school or a new romance. Social Environments • Aversive emotional stress in the family. Biological-Genetic contribution appears to be highest for bipolar disorder. Men and women are equally likely to develop bipolar disorder.

  19. Biological • Endocrine system • Hypothalamic Pituitary Adrenal Axis (HPA) • Neurotransmitter Levels • Serotonin • Current Neurotransmitter theories • Bidirectional effects

  20. Treatment- Unipolar • Cognitive-focus on helping patients replace self-defeating thoughts with more rational self statements • Interpersonal Therapy-attempts to improve the patient’s relationships with other people by building communication and problem solving skills. • Antidepressant Medications –Selective Serotonin re-uptake inhibitors developed in the 1980’s. They are the most frequently prescribed treatment, however medication with other mechanisms of action are also used.

  21. Antidepressant Therapy • Selective Serotonin Re-uptake Inhibitors • Mechanism of action-reuptake pump • Side Effects • Tricyclics (Tofranil) • Mechanisms of action ( Considered 5 drugs in one) • SRI- reuptake pump • NRI-reuptake pump • Anti-Cholinergic • Alpha 1 antagonists (blocks) • Histaminergic • Side Effects • Onset of Effectiveness • Comparisons of TCA & SSRI • Monoamine Oxidase Inhibitors-Inhibits the breakdown of NE into its by-products. Not used as often due to its interaction with tyrosine which is found in many foods such as cheese, chocolate and wine which must be completely avoided. • Serotonin Norepinephrine Reuptake inhibitor

  22. Two Very Cute Babies

  23. Treatment-Bipolar Disorders • Antidepressants-sometimes used in combination with a mood stabilizer. • Lithium Carbonate-first line treatment-eliminates manic episodes. Large number of non-responders ( up to 40%) • Anti-convulsants-more effective in treating rapid cyclers. • Anti-psychotics-sometimes used to alleviate symptoms of psychosis—not always present. • Psychotherapy

  24. Psychotherapy as a treatment of BiPolar Disorder • Used as a supplement to medication. • Cognitive Therapy- • Interpersonal Therapy-emphasis on monitoring the interaction between symptoms and social interaction. Help patients lead more orderly lives, especially with regard to sleep wake cycles and work patterns ( aka-social rhythm therapy).

  25. Suicide • DSM IV-TR-Classification of Suicide • Four types of Suicide (Durkheim) • Egoistic suicide-(diminished integration) • Altruistic suicide-(excessive integration) • Anomic suicide-(diminished regulation) • Fatalistic suicide-(excessive regulation)

  26. Etiology of Suicide • Psychological Factors • Biological Factors • Social Factors

  27. Treatment • Crisis Hotlines • Psychotherapy • Medication • Serotonin Dysregulation • Involuntary Hospitalization

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