mood disorders - complete

8/3/2019 Mood Disorders - Complete

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Group Members

0 Jacqueline Wong - Introduction, Major Depressive Episode

0 Lai Chee Gong - Manic Episode, Hypomanic Episode

0 Ho Kin Wai Mixed Episode, Major Depressive Disorder

0 Lee Chain Yiing - Dysthymic Disorder, Cyclothymic Disorder

0 Lee Chai Mei Bipolar I Disorder, Bipolar II Disorder

0 Kong Peoi Yarn Causes, Treatments


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Prevalence of Depression

Depression is a common and serious disorder

Every year there are 5% of children and 20% ofyoung adolescents experience depression.

The depression in children can be seen at the age of

as young as 3 to 5 years old (NIMH, 2011).


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0 Disturbancein a persons emotional mood

0 Can experience extreme depression (dysphoria),

extreme elation (euphoria) or combination(bipolar)

0 Occurs in episodes with specific intense symptoms

0 Episodes can be mild, moderate, severe

Mood Disorders


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0 Depression = mood is abnormally low

0 Mania = mood is abnormally high

0 Mood disorders are broadly divided into unipolardisorders and bipolar disorders.

0 Nearly all patients who have mania eventually

experience at least one period of depression as well.

0 Individual episodes in mood disorders vary in lengthbut last many months if left untreated. Some patients

have recurrent episodes throughout their lives.

Mood Disorders


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Unipolar vs. Bipolar Disorders

There are two main types of mood disorders, on the

basis of the presence or absence of manic as well

as depressive episodes

Unipolar mood disorderBipolar mood disorder

(manic depression)

patients experience depressive

episodes only

patients experience both

depressive and manic episodes

occurs from adolescence, with

prevalence peaking between 40-50

years, and a gradual decline after the

age of 60 years.

commonly presents earlier than

depression, with most patients

suffering their first manic or

hypomanic episodes by their early

20s.


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MOOD EPISODES


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Criterion (A):

0 Five (or more) of the following symptoms have beenpresent during the same 2-week period and

represent a change from previous functioning; at leastone of the symptoms is either (1) depressed moodor (2) loss of interest or pleasure.

Note: Do note include symptoms that are clearly due to ageneral medical condition, or mood-incongruentdelusions or hallucinations.

Diagnostic Criteria

Major Depressive Episode


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1. Depressed mood most of the day, nearly every day, as indicatedby either subjective report (e.g., feels sad or empty) or observationmade by others (e.g., appears tearful). Note: In children andadolescents, can be irritable mood.

2. Markedly diminished interest or pleasure in all, or almost all,activities most of the day, nearly every day (as indicated by eithersubjective account or observation made by others)

3. Significant weight loss when not dieting or weight gain (e.g., a

change of more than 5% of body weight in a month), or decreaseor increase in appetite nearly every day. Note: In children, considerfailure to make expected weight gains.

4. Insomnia or hypersomnia nearly every day

Diagnostic Criteria



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5. Psychomotor agitation or retardation nearly every day (observable byothers, not merely subjective feelings of restlessness or being sloweddown)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt(whichmay be delusional) nearly every day (not merely self-reproach or guiltabout being sick)

8. Diminished ability to thinkor concentrate, or indecisiveness, nearly

every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidalideation without a specific plan, or a suicide attempt or a specific plan forcommitting suicide

Diagnostic Criteria



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Criterion (B):

The symptoms do not meet criteria for a Mixed Episode.

Criterion (C):

The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

Criterion (D):

The symptoms are not due to the direct physiological effects of a substance (e.g., a

drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

Criterion (E):

The symptoms are not better accounted for by Bereavement, i.e., after the loss of a

loved one, the symptoms persist for longer than 2 months or are characterized by

marked functional impairment, morbid preoccupation with worthlessness, suicidal

ideation, psychotic symptoms, or psychomotor retardation.

Diagnostic Criteria



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Depressive vs. Manic Episodes

Depressive episodes Manic episodesDepressed mood Inflated self-esteem or grandiosity

Decreased interest or pleasure in

nearly all activities Frantic work activity andincreased talkativenessFatigue and loss of energy Decreased need for sleep

Recurrent thoughts of death Flights of ideas or racing thoughtsAppetite disturbances


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Diagnostic Criteria

Manic EpisodeCriterion (A):

A distinct period of abnormally and persistentlyelevated, expansive, or irritable mood, lasting at least 1

week(or any duration if hospitalization is necessary)

Criterion (B):

During the period of mood disturbance, three (or

more) of the following symptoms have persisted (fourif the mood is only irritable) and have been to asignificant degree:


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1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (e.g., feels rested after only 3 hours of

sleep)

3. More talkative than usual or pressure to keep talking4. Flight of ideas or subjective experience thatthoughts are racing

5. Distractibility (1.e., attention too easily drawn to unimportant or

irrelevant external stimuli)

6. Increase in goal directed activity (either socially, at work or

school, or sexually) or psychomotor agitation

7. Excessive involvementin pleasurable activities that have a high

potential for painful consequences (e.g., engaging in unrestrained

buying sprees, sexual indiscretions, or foolish business

investments)

Diagnostic Criteria

Manic Episode


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Criterion (C):

The symptoms do not meet criteria for a Mixed Episode.

Criterion (D):

The mood disturbance is sufficiently severe to cause marked impairment in

occupational functioning or in usual social activities or relationships with others, or

to necessitate hospitalization to prevent harm to self or others, or there are

psychotic features.

Criterion (E):

The symptoms are not due to the direct physiological effects of a substance (e.g., adrug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant

treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count

toward a diagnosis ofBipolar I disorder.

Diagnostic Criteria

Manic Episode


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Diagnostic Criteria

Hypomanic EpisodeCriterion (A):

A distinct period of persistently elevated, expansive, or

irritable mood, lasting throughoutat least 4 days, that is

clearly different from the usual non-depressed mood.

Criterion (B):

During the period of mood disturbance, three (or more) of

the following symptoms have persisted (four if the mood isonly irritable) and have been present to a significant degree:

Symptoms are same as Manic Episode


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Criterion (C):

The episode is associated with an unequivocal change in functioning that is uncharacteristic of

the person when not symptomatic.

Criterion (D):The disturbance in mood and the change in functioning are observable by others.

Criterion (E):

The episode is not severe enough to cause marked impairment in social or occupational

functioning, or to necessitate hospitalization, an there are no psychotic features.

Criterion (F):

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of

abuse, a medication) or a general medical condition (e.g., hypothyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g.,

medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of

Bipolar II disorder.

Diagnostic Criteria

Hypomanic Episode


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Mania vs. Hypomania

0 Although both symptoms are the same, but they are different.

0 Mania0 dangerousbecause people dont just act abnormally; they typically

endanger themselves or vital parts of their lives.0 Requires hospitalization due to the damage they are doing, psychotic

problems.

0 Happens in Bipolar I (Hallucination, Paranoia)

0 Hypomania0

An unusual mood0 May cause some harm to the person or their lifestyle, butnotto the

point where they need to be hospitalized.

People in hypomania buy 5 pairs of shoes, people in a mania buy 50


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Diagnostic Criteria

Mixed EpisodeCriteria (A)

The criteria are metboth for a Manic Episode and for a Major Depressive Episode (except for

duration) nearly every day during at least a 1-week period.

Criteria (B)The mood disturbance is sufficiently severe to cause marked impairment in occupational

functioning or in usual social activities or relationships with others, or to necessitate

hospitalization to prevent harm to self or others, or there are psychotic features.

Criteria (C)

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of

abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Mixed-like episodes that are clearly caused by somatic antidepressant treatment (e.g.,

medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of

Bipolar I disorder.


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DEPRESSIVE DISORDERS


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296.2x Major Depressive

Disorder, Single EpisodeCriteria (A)

Presence ofa single Major Depressive Episode.

Criteria (B)

The Major Depressive Episode is not better accounted for by Schizoaffective

Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder,

Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Criteria (C)

There has never been a Manic Episode, a Mixed Episode, or a Hypomanic

Episode. Note:This exclusion does not apply if all of the manic-like, mixed-like, or

hypomanic-like episodes are substance or treatment induced or are due to the direct

physiological effects of a general medical condition.


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296.3x Major Depressive

Disorder, RecurrentCriteria (A)

Presence oftwo or more Major Depressive Episodes.

Note: To be consideredseparate episodes, there must be an interval ofat least2 consecutive months in which criteria are not met for a Major DepressiveEpisode.

Criteria (B)

The Major Depressive Episodes are not better accounted for by SchizoaffectiveDisorder and are not superimposed on Schizophrenia, SchizophreniformDisorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Criteria (C)There has never been a Manic Episode, a Mixed Episode, or a HypomanicEpisode. Note: This exclusion does not apply if all of the manic-like, mixed-like,or hypomanic-like episodes are substance or treatment induced or are due to thedirect physiological effects of a general medical condition.


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Subtypes / Specifiers of

Major Depressive DisorderThe DSM-IV-TR recognizes five further subtypes of MajorDepressive Disorders, called specifiers, in addition to notingthe length, severity and presence of psychotic features:

0 Catatonic depression (pg 202) Motoric immobility as evidenced by cataplexy or stupor

Excessive motor activity

Extreme negativism or mutism

Peculiarities of voluntary movement as evidenced by

posturing, stereotyped movements, prominent mannerismsor prominent grimacing

Echolalia or echopraxia


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Major Depressive Disorder0 Melancholic depression (pg 203)

Loss of pleasure in most or all activities

A failure of reactivity to pleasurable stimuli or events

Distinct quality of depressed mood

Early morning awaking

Psychomotor retardation

Significant weight loss

Excessive guilt


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Major Depressive Disorder0 Atypical depression (pg 203)

Mood reactivity

Significant weight gain or increased appetite

Hypersomnia

Leaden paralysis

Long-standing pattern of interpersonal rejection

sensitivity that results in significant social or

occupational impairment


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Major Depressive Disorder0Postpartum onset(pg 204)

Uncommon depressive episode that begins

within four weeks of giving birth to a child

0 Seasonal pattern (pg 207)

Occurs for 2 months during a particulartime of the year (usually winter) but they

return to normal functioning


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Challenges

Affects all aspects of a person's life

Fatigue, tired, lack of energy

Not interested in anything

Panic attacks may occur

Separation anxiety may occur in children

Substance abuse

Eat too much or too little = obese and anorexic Isolation, impair social relationship

Induce suicidal ideation


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300.4 Dysthymic Disorder

Criteria (A)

Depressed mood for most of the day, for more days than not, as indicated either by subjective

account or observation by others, for at least 2 years. Note:In children and adolescents, mood

can be irritable and duration must be at least 1 year.

Criteria (B)

Presence, while depressed, oftwo (or more) of the following:

1. Poor appetite or overeating

2. Insomnia or Hypersomnia

3. Low energy or fatigue4. Low self-esteem

5. Poor concentration or difficulty making decisions

6. Feelings of hopelessness


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Criteria (C)

During the 2-year period (1 year for children or adolescents) of the disturbance, the

person has never been withoutthe symptoms in Criteria A and B for more than 2

months at a time.

Criteria (D)

No Major Depressive Episode has been present during the first 2 years of the

disturbance (1 year for children and adolescents); i.e., the disturbance is not better

accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In

Partial Remission.

Note: There may have been a previous Major Depressive Episode provided there was a full

remission (no significant signs or symptoms for 2 months) before development of theDysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents)

of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in

which case both diagnoses may be given when the criteria are met for a Major Depressive

Episode.


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Criteria (E)

There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria

have never been met for Cyclothymic Disorder.

Criteria (F)

The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder,

such as Schizophrenia or Delusional Disorder.

Criteria (G)

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug ofabuse, a medication) or a general medical condition (e.g., hypothyroidism).

Criteria (H)

The symptoms cause clinically significant distress or impairment in social, occupational, or

other important areas of functioning.


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Dysthymic Disorder vs. Major

Depressive Disorder0 The levels of severity, duration and persistence are different

in both disorders.

0 Major Depression Disorder Mood disturbance occurs nearlyevery day during a period of two weeks

0 Dysthymic Disorder Mood disturbance occurs for most of the

day, for more days than not, for at least 2 years

0 Dysthymia may be reported less than major depression, as its

symptoms are less severe and easier to live with.


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Challenges0 Dysthymia is simply chronic depression which lasts for years. It does not have to

be as severe as the major depression; however people who suffer from dysthymia

do not even remember a day that they did not felt depressed.

0 In adults, dysthymia has a big risk to turn into major depressive disorder.

0 In children, there is a risk of having hyperactivity disorder, learning disorders

and mental retardation.

0 Adolescents have bad school performance,low self esteem and poor social

interaction.

0 Although dysthymia was traditionally considered less severe than major

depression, the consequences of dysthymia are increasingly recognized as grave

and include severe functional impairment, increased morbidity from

physical disease, and increased risk of suicide.


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BIPOLAR DISORDERS


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301.13 Cyclothymic DisorderCriteria (A)

For atleast 2 years, the presence of numerous periods with hypomanic symptoms and

numerous periods with depressive symptoms thatdo not meet criteria for a Major

Depressive Episode.Note: In children and adolescents, the duration must be at least 1 year.

Criteria (B)

During the above 2-year period (1 year in children and adolescents), the person has not been

without the symptoms in Criterion A for more than 2 months at a time.

Criteria (C)

No Major Depressive Episode, Manic Episode, or Mixed Episode has been presentduring thefirst 2 years of the disturbance

Note:After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there

may be superimposed Manic or Mixed Episodes (in which case both Bipolar I disorder and

Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar

II Disorder and Cyclothymic Disorder may be diagnosed)


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301.13 Cyclothymic Disorder

Criteria (D)

The symptoms in Criterion are not better accounted for by Schizoaffective

Disorder and is not superimposed on Schizophrenia, Schizophreniform

Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Criteria (E)

The symptoms are not due to the direct physiological effects of a substance

(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,

hyperthyroidism).

Criteria (F)

The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.


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Cyclothymic Disorder vs.

Bipolar Disorder0 Cyclothymic is usually considered to be a type of bipolar disorder, albeit

on a lesser scale.

0 The reasons for Cyclothymic may be genetic, but with predominantly

environmental roots. A bipolar disorder is mainly genetic and is caused bychemical imbalances in the brain

0 The symptoms for the two conditions are similar. However, in the case of a

bipolar disorder, they are more long standing.

0 Treatment for Cyclothymic will mainly rely on self help or mild

medications. However, a patient with bipolar disorder is usually put on

stronger medications or even hospitalized.


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Challenges

0 Left untreated, cyclothymic can result in significant

emotional problems thataffect every area of life.

0 In addition, cyclothymic significantly increases risk

of developing bipolar disorder.


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296.0x Bipolar I Disorder,

Single Manic EpisodeCriteria (A)

Presence ofonly one Manic Episode and no pastMajor Depressive Episodes.

Criteria (B)

The Manic episode is not better accounted for bySchizoaffective Disorder and is not superimposed on

Schizophrenia, Schizophreniform Disorder, DelusionalDisorder, or Psychotic Disorder Not OtherwiseSpecified.


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296.40 Bipolar I Disorder, Most

Recent Episode HypomanicCriteria (A)

Currently (or most recently) in a Hypomanic Episode

Criteria (B)

There has previously been at least one Manic Episode or Mixed Episode

Criteria (C)

The mood symptoms cause clinically significant distress or impairment insocial, occupational or other important areas of functioning.

Criteria (D)

The mood episodes in criteria A and B are not better accounted for bySchizoaffective Disorder and are not superimposed on Schizophrenia,Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NotOtherwise Specified.


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Most Recent Episode ManicCriteria (A)

Currently (or most recently) in a Manic Episode

Criteria (B)There has previously been at least one Major DepressiveEpisode, Manic Episode or Mixed Episode.

Criteria (C)

The mood episodes in criteria A and B are not better accounted forby Schizoaffective Disorder and are not superimposed onSchizophrenia, Schizophreniform Disorder, Delusional Disorder, orPsychotic Disorder Not Otherwise Specified.


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Most Recent Episode MixedCriteria (A)

Currently (or most recently) in a Mixed Episode

Criteria (B)There has previously been at least one Major DepressiveEpisode, Manic Episode or Mixed Episode.

Criteria (C)



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296.5x Bipolar I Disorder, Most

Recent Episode DepressedCriteria (A)

Currently (or most recently) in a Major Depressive Episode

Criteria (B)There has previously been at least one Manic Episode or MixedEpisode.

Criteria (C)



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296.7 Bipolar I Disorder, Most

Recent Episode UnspecifiedCriteria (A)Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a

Mixed or a Major Depressive Episode

Criteria (B)

There has previously been at least one Manic Episode or Mixed Episode.

Criteria (C)

The mood symptoms cause clinically significant distress or impairment in social, occupational,

or other important areas of functioning.

Criteria (D)

The mood episodes in criteria A and B are not better accounted for by Schizoaffective Disorder

and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or

Psychotic Disorder Not Otherwise Specified.

Criteria (E)

The mood episodes in criteria A and B are not due to the direct physiological effects of

substance or a general medical condition


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Summary

Major

Depressive

Episode

Manic EpisodeHypomanic

EpisodeMixed Episode

Single Manic

Episode- Only this - -

Most RecentEpisode

Hypomanic

- Previously Recently Previously

Most Recent

Episode ManicPreviously

Recently

Previously

-Previously

Most Recent

Episode MixedPreviously Previously -

Recently

Previously

Most Recent

Episode

Depressed

Recently Previously - Previously

Most Recent

Episode

Unspecified

RecentlyRecently

PreviouslyRecently

Recently

Previously


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296.89 Bipolar II Disorder

Criteria (A)

Presence (or history) ofone or more Major Depressive Episodes.

Criteria (B)

Presence (or history) ofat least one Hypomanic Episode.

Criteria (C)

There has never been a Manic Episode or Mixed Episode.

Criteria (D)

The mood episodes in criteria A and B are not better accounted for by Schizoaffective Disorder

and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or

Psychotic Disorder Not Otherwise Specified.

Criteria (E)

The symptoms cause clinically significant distress or impairment in social, occupational, or

other important areas of functioning.


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Challenges of Bipolar

Disorder0 Not recognize that they are ill and resist treatment

0 Engage in bizarre activities, dramatic style, travel

impulsively

0 Gambling and antisocial behaviour

0 Hostile, and threaten to others

0 Suicidal

0 Substance Abuse0 Law or financial problems due to manic behavior

0 Might shift from manic to depressive


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CAUSES AND TREATMENTS

FOR MOOD DISORDERS


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Biological Dimensions

0 Inherited vulnerability

High risk if relatives have mood disorder

0 Neurotransmitters and endocrine systems

Low levels of norepinephrine, serotonin

High levels of stress hormones


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Psychological Dimensions

0 Stressful life events

Traumatic events

Life stressors (eg. Examination, works, financial, death)

0 Cognitive styles

Negative views on everything cyclical process

Cognitive distortion illogical rules, overgeneralization

0 Behavioral Lack of positive reinforcement

Learned helplessness


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Social and Cultural

Dimensions0 Inequality and oppression

Women and minority higher risk

0 Lack of social support

Isolated

0

Relationship problems Divorce

Argument


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Medication

0 Antidepressant

Lithium for bipolar disorder

Tricyclics

Monamine oxidase inhibitors (MAOIs) Selective serotonergic reuptake inhibitors (SSRIs)

0 To control symptoms and restore neurotransmitterfunctioning

0 Can have side effects, thus dosage must be carefullyregulated


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Cognitive Behavioral Therapy

(CBT)0 Help people to:

Learn to replace negative depressive thoughts and

attributions with more positive cues

Develop more effective coping behavior and skills


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Interpersonal Psychotherapy

0 Help people to:

Focus on social and interpersonal triggers for their

depression (eg. Loss of the love one)

Develop skills to resolve interpersonal conflicts and

build new relationship


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Others

0 Light Therapy

For seasonal affective disorder

0 Electroconvulsive Therapy (ECT)

For severe depression, when other treatments are

ineffective

May have temporary side effects, such as memory loss


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