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Mood Disorders: 

Mood Disorders Chapter Five

Introduction: 

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

Terms used in Psychopathology of Depression: 

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: 

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 : 

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 Disorders: 

Emotional Disorders 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: 

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: 

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: 

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.

DSM-IV Classifications: 

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

Classification of Mood Disorders: 

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 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: 

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: 

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)

Course of the Disorder and Outcome : 

Course of the Disorder and Outcome Duration Episodes Recovery

Etiology and Theories : 

Etiology and Theories 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.

Biological : 

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

Biopolar Disorders: Etiology & Theories: 

Biopolar Disorders: Etiology & Theories Stressful Events Social Environment Biological

Treatment- Unipolar: 

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: 

Antidepressant Therapy Selective Serotonin Re-uptake Inhibitors Mechanism of action Side Effects Tricyclics (Tofranil) Mechanisms of action 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.

Treatment-Bipolar Disorders : 

Treatment-Bipolar Disorders Antidepressants Lithium Carbonate Anti-convulsants Anti-psychotics Psychotherapy

Suicide: 

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: 

Etiology of Suicide Psychological Factors Biological Factors Social Factors

Treatment: 

Treatment Crisis Hotlines Psychotherapy Medication Serotonin Dysregulation Involuntary Hospitalization