MOOD DISORDERS

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MOOD DISORDERS
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MOOD DISORDERS CLASSIFICATION

• Major depressive episode
• Single episode/recurrent
• Severity
• With psychotic features
• Melancholic/atypical
• Dysthymia
• Bipolar disorder I (hypomania)
• Bipolar disorder II (mania)
• Cyclothymic disorder
• Bipolar disorder NOS
• Substance induced mood disorder
• Mood disorder due to a general medical condition
• Mood disorder NOS
• Seasonal affective disorder
• Bereavement
• Postpartum depression

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Epidemiology

• Lifetime prevalence 15 but up to 25 for women.
• Depression present in 5
• Bipolar I 1
• Present 21 in womenmen
• Present all throughout life
• Less common amongst people with meaningful
  relationships
• No difference from SE status

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Major depressive episode

• Five or more symptoms, present for at least two
  weeks and represents a change from previous
  functioning
• Depressed mood most of the day (irritable in ch
  a)
• Diminished interest or pleasure in most
  activities
• Significant weight loss (gt5) or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Feelings of worthlessness or guilt
• Incapacity to think, concentrate, loss of
  immediate memory, distractibility, indecisiveness
• Recurrent thoughts about death
• Symptoms are present for more than two months,
  cause important dysfunction and are not accounted
  for by other factors (loss, drugs, disease,
  medications, etc)

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Mania

• Distinctive period of mood change that lasts at
  least a week (less if hospitalized)
• Abnormal and persistent elevated, expansive,
  irritable mood
• Accompanied by 3 of the following symptoms (4 if
  only irritable)
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep
  talking
• Flight of ideas or thought racing (subjective)
• Distractibility
• Increased goal directed activities or psychomotor
  activities
• Excessive high risk pleasurable activities
• Causes severe functional impairment
• Not accounted for by other factors (loss, drugs,
  disease, medications, etc)

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Hypomania

• Same criteria than that of mania except
• Symptoms have been present for four days
• Clinical picture is different from usual changes
  in mood
• Causes observable but not severe functional
  impairment

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Dysthymic disorder

• Predominantly depressed mood for at least two
  weeks
• Two or more of the following
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration and indecisiveness
• Feelings of hopelessness
• No more than two months symptom-free in a two
  year period (1 year for adolescents)
• Not major depressive episode in remission or
  chronic
• Could have superimposed MDE
• Has not had manic episodes and does not qualify
  as cyclothymia
• Causes significant dysfunction
• Is not accounted for by other factors

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Cyclothymia

• Two years (1 for adolescents) of numerous periods
  with hypomanic symptoms and other periods with
  depressive symptoms but not MDE
• Not free of symptoms for more than two months at
  a time
• No MDE, manic episode or mixed episode present in
  those two years unless superimposed
• Symptoms cause significant distress
• Not accounted for by other factors

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Neurophysiopathology

• Lower activity in the subgenual region of the
  prefrontal cortex as per PET and fMRI associated
  with decrease in grey matter in familial cases of
  uni and bipolar dpression
• Increased activity of the same region in people
  affected by manic episodes.
• Region connected with amygdala, lateral
  hypothalamus, nucelus accumbens and
  noradrenergic, serotoninergic and dopaminergic
  systems in the brain
• Lesions in this area have difficulties
  experiencing emotions, disregulated autonomic
  responses and difficulties making rational
  decisions
• Irritation of this region causes anger and
  aggressive behaviour

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Neurophysiopathology

• Depression/mania deficit/excess of NTs?
• Reserpine depletes 5HT, dopamine, and
  norepinephrine by preventing vesicle uptake

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Neurophysiopathology

• Why clinical improvement takes so long?
• Increased sensitivity of receptors
• Decreased sensitivity/density of inhibitory
  autoreceptors
• The former theory is not valid anymore
• Several disorders with similar underlying
  pathology?
• Actions upon cholinergic and GABAergic systems
• Excessive norepinephrine and acetylcholine
  secretion of CTRH (hypothalamus) excessive ACTH
  excessive cortisol excessive anxiety
• Not suppressed by dexamethasone

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Family studies

• Bipolar depression average risk 8 in 1st degree
  relatives (base rate 1)
• Major depression average risk 9 (base rate3)
• Relatives of MDE patients do not have higher risk
  for BAD, but relatives of BAD patients are at
  higher (11) risk for MDE hence
• Familial risk for BAD is higher
• BAD patients have excess of MDE relatives
• MDE patients do not have many BAD relatives
• Higher risk for offspring of patients who had
  depression earlier than 20 years of age but not
  in childhood

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Twin studies

• Concordances
• MDE 40 MZ, 11 DZ
• BAD 70 MZ, 40 DZ
• Weaker concordances for less severe forms of the
  disorder
• Discordant MZ twins transmit the same liability
  for the disease to their offspring regardless of
  being affected or not

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Adoption studies

• One study focusing on BAD
• Bio-parents of BAD patients were more often
  affected (7 vs. 0) than those of non affected
  individuals
• They showed higher rates for MDE (21) compared
  to non affected individuals

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Identifying genes

• Not sex linked
• Linkage in chromosomes 18, 11, 4, 12, 16 and 21
  has not been replicated as needed
• Association studies with serotonin transporter
  seem interesting but not conclusive