Mood Disorders

1
Mood Disorders

• Depressive Disorders
• Major Depressive Disorder
• Dysthymic Disorder

2
Major Depressive Disorder

• At least one of the following three abnormal
  moods which significantly interfered with the
  person's life (for at least 2 weeks, nearly every
  day)
• Abnormal depressed mood or dysphoric mood most of
  the day.
• Abnormal loss of all interest and pleasure most
  of the day.
• If 18 or younger, abnormal irritable mood most of
  the day.

3
Major Depressive Disorder

• At least five of the following symptoms have been
  present during the same 2 week depressed period.
• Abnormal depressed mood (or irritable mood if a
  child or adolescent).
• Abnormal loss of all interest and pleasure as
  defined in criterion A2.
• Appetite or weight disturbance, either
• Abnormal weight loss (when not dieting) or
  decrease in appetite.
• Abnormal weight gain or increase in appetite.
• Sleep disturbance, either abnormal insomnia or
  abnormal hypersomnia.

4
Major Depressive Disorder

• (contd)
• Activity disturbance, either abnormal agitation
  or abnormal slowing (observable by others).
• Abnormal fatigue or loss of energy.
• Abnormal self-reproach or inappropriate guilt.
• Abnormal poor concentration or indecisiveness.
• Abnormal morbid thoughts of death (not just fear
  of dying) or suicide

5
Major Depressive Disorder

• The symptoms are not due to a mood-incongruent
  psychosis.
• There has never been a Manic Episode, a Mixed
  Episode, or a Hypomanic Episode.
• The symptoms are not due to physical illness,
  alcohol, medication, or street drugs.
• The symptoms are not due to normal bereavement.

6
Assessment

• Self-report instruments screening
• Beck Depression Inventory
• MMPI -2
• Clinical Interview
• Suicide Risk

7
Incidence

• Males and females are equally affected by Major
  Depressive Disorder prior to puberty
• After puberty, this disorder is twice as common
  in females as in males
• Greatest incidence ages 25-44
• Up to 15 of patients with severe Major
  Depressive Disorder die by suicide

8
Treatment Plans

• Psychotherapies
• Biological therapies
• Family therapies
• Suicide intervention

9
Treatment PlansPsychotherapies

• Cognitive
• Rational Emotive Behaviour Therapy
• Behaviour Therapy
• Interpersonal Psychotherapy
• Family Therapies

10
Treatment PlansSuicide Intervention plans

• Active vs passive ideation
• No-suicide contracts
• Modify maladaptive cognitions

11
Treatment PlansBiological Therapies

• Psychotropic medications
• SSRIs (selective serotonin reuptake inhibitors)
• Prozac, Zoloft
• Tricyclic Antidepressants
• MAOIs (monomine oxidase inhibitors)
• Electro-Convulsive Therapy

12
Bipolar Disorders
Manic Phase

• Abnormally expansive, elevated or irritable mood
• At least three additional symptoms ( 4 if
  irritable) during 1 week period
• Inflated self-esteem
• Decreased need for sleep
• Talkativeness (loud, nonstop, rapid)
• Racing ideas
• High distractibility
• Increased goal-directed activity or physical
  agitation
• Excessive involvement in sexual or other
  risk-related pleasurable activities

13
Bipolar Disorders
Hypomanic Episodes

• Parallel manic episodes
• At least three additional symptoms ( 4 if
  irritable) during a four day period
• Inflated self-esteem
• Decreased need for sleep
• Talkativeness (loud, nonstop, rapid)
• Racing ideas
• High distractibility
• Increased goal-directed activity or physical
  agitation
• Excessive involvement in sexual or other
  risk-related pleasurable activities

14
Bipolar Disorders
Mixed Episodes

• Both manic and depressive episodes nearly every
  day for at least a one-week period.
• Rapid cycling bipolar
• Bipolar I a past or present manic episode
  despite past history of depressive episodes
• Bipolar II in absence of past manic episode or
  mixed episodes, a person experiencing hypomania
  and a past major depressive episode

15
Cyclothymia

• Sustained period of vacillation between spirited
  dispirited moods
• Hypomania but not all the way to manic episodes
• And numerous periods of sub-clinical depression