mood disorders
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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 - PowerPoint PPT PresentationTRANSCRIPT
Mood DisordersChapter 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
Axis Five- Educational Problems
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
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
Symptoms and Considerations when diagnosing clinical depression
Differential symptoms between Clinical Depression and Normal Sadness.
Four General types of symptoms.• Emotional• Cognitive • Behavioral• Somatic
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.
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
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
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.
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.
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.
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.
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)
Unipolar Disorder: Course, Episodes and Outcome
Duration
Episodes
Recovery
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-
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.
Etiology and Theories BiPolar DisorderSocial 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.
Biological Endocrine system
Hypothalamic Pituitary Adrenal Axis (HPA)
Neurotransmitter Levels • Serotonin• Current Neurotransmitter theories • Bidirectional effects
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.
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
Two Very Cute Babies
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
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).
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)
Etiology of Suicide Psychological Factors
Biological Factors
Social Factors
Treatment Crisis Hotlines
Psychotherapy
Medication• Serotonin Dysregulation
Involuntary Hospitalization