Mood Disorders

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Mood Disorders

• Overview of Depression and Mania

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Major Depressive Episode

• DSM-IV
• Depressed mood state
• And/Or
• Anhedonia
• 2 weeks

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Major Depressive Episode

• Cognitive symptoms
• Feelings of worthlessness
• Guilt
• Indecisiveness
• Suicidal ideation
• Physical changes
• Altered sleeping patterns
• Weight --vegetative symptoms
• Appetite
• Sleep
• Energy level

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Major Depressive Episode

• Major Depressive Disorder, single episode
• If two or more depressive episodes occurred,
  were separated by at least 2 months
• Major depressive disorder, recurrent
• 80
• Onset
• 25 yrs
• Duration
• 6-9 months if untreated

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Dysthymic Disorder

• Symptoms somewhat milder
• Persistent depressed mood for at least 2 yrs
• Double Depression
• People who suffer from MDE and Dysthymia
• Dysthymia typically develops first

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From grief to depression

• Severe depression following death of loved
  one-62
• Problematic for 10-20
• Pathological grief reaction

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Mania

• Manic Episode
• Elevated/expansive/irritable mood, lasting at
  least 1 wk
• During mood disturbance
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual/pressure to keep
  talking
• Flight of ideas/racing thoughts
• Distractibility
• Increase in goal-directed activity
• Excessive involvement in pleasurable activities
  that have a high potential for painful
  consequences

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Mania

• Hypomanic Episode
• Elevated/expansive/irritable mood lasting at
  least 4 days
• Same characteristics as manic episode
• Unlike manic episode, not severe enough to cause
  marked impairment in social/occupational
  functioning or to necessitate hospitalization
• No psychotic features

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Mania

• Bipolar I Disorder, Single Manic Episode
• Presence of only 1 manic episode
• No past MDE
• Bipolar I Disorder, Most recent episode Hypomanic
• Currently in hypomanic episode
• Has had at least 1 manic episode

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Mania

• Bipolar I Disorder, most recent episode Manic
• Currently in a manic episode
• Previously 1 MDE or Manic episode
• Bipolar I Disorder, most recent episode Depressed
• Currently in a depressed episode
• Previously 1 manic episode

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Mania

• Bipolar II Disorder
• MDE alternates with hypomanic episodes
• Never has been a manic episode
• Cyclothymic Disorder
• Milder, but more chronic version of bipolar

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Mania

• Onset
• Bipolar I18 yrs
• Bipolar II22 yrs
• Rare for one to develop BP after age of 40
• Suicide
• 9-60 among BP

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Additional Defining Criteria

• Specifiers
• Atypical Features
• Melancholic Features
• Catatonic Features
• Psychotic Features
• Postpartum onset

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Prevalence of Mood Disorders

• Women twice as likely to have mood d/o as men
• Except for bipolar d/o
• Lower prevalence of MDE among African Americans
• Few receive appropriate care

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Prevalence of Mood Disorders

• Mood disorders
• Occur less frequently in children than adults
• Rises dramatically in adolescence
• Children less than 9
• Present with more irritability and emotional
  swings
• After age of 9
• Present with more manic states
• Mistaken for hyperactive
• Elderly

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Mood Disorders

• Learned Helplessness Theory of Depression
• Martin Seligman
• Attributional Style
• Internal
• Stable
• Global
• Depressive Cognitive Triad (Aaron Beck)
• Self
• World
• Future

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Suicide

• 8th leading cause of death
• For teenagers 3rd leading cause
• Growing incidence among elderly w/ medical
  illness
• Culture/race
• Gender
• Males more likely to commit suicide
• Females more likely to attempt

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Suicide

• Suicidal attempts
• Suicidal ideation
• Suicidal intent

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Suicide

• Risk Factors (Edward Shneidman)
• Psychological autopsy
• Family history
• Twin Study 10/26 0/9
• Neurobiology
• Psychological disorder
• 90
• 60 mood
• 25-50 etoh
• 10 Borderline PD
• Stressful life events
• Past Attempts
• Occupation
• Climate

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Treatment

• Medications
• Tricyclic Antidepressants
• Imipramine (Tofranil)
• Amitriptyline (Elavil)
• Monoamine Oxidase (MAO) Inhibitors
• Parnate
• Nardil
• Selective serotonergic re-uptake inhibitors

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Treatment

• Psychosocial Treatment
• Cognitive-Behavioral Therapy
• Psychodynamic Therapy
• Interpersonal Therapy
• ECT