IzBen C. Williams, MD, MPH Instructor. Lecture - 8 MOOD DISORDERS.
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Transcript of IzBen C. Williams, MD, MPH Instructor. Lecture - 8 MOOD DISORDERS.
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BEHAVIORAL SCIENCE
IzBen C. Williams, MD, MPHInstructor
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Lecture - 8
MOOD DISORDERS
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MOOD DISORDERS
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MOOD DISORDERS
DEFINITIONS:The essential feature of mood disorders is a disturbance of one’s emotional state along the happy-sad axis causing subjective distress and problems in functioning.
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MOOD DISORDERSDEFINITIONS:Subjectively, the person may feel: Somewhat worse than would be expected
(dysthymia) Very much worse than would be expected
(depression) Somewhat better than would be expected
(hypomania) Very much better than would be expected
(mania)
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MOOD DISORDERS
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MOOD DISORDERSDIAGNOSIS:The diagnosis of mood disorder requires the identification of mood episodes , which are building blocks for making a diagnosis of mood disorder.Mood episodes:A. Major depressive episode (MDE)B. Manic episodeC. Mixed episodeD. Hypomanic episode
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MOOD DISORDERSEPIDEMIOLOGY:There are no differences in the occurrence of mood disorders associated with ethnicity, education, marital status, or income.The lifetime prevalence of mood disorders is:A. Major depressive disorder: M 5-12% and F 10-20%B. Bipolar disorder: 1% overall, no sex differenceC. Dysthymic disorder: 6% overall; M : F = 1 : 3D. Cyclothymic disorder: < 1% overall; no sex
difference
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MOOD DISORDERSMajor Depressive Disorder
Characteristics: Recurrent episodes of depression, each continuing for at least two weeks Signs and Symptoms of Depression (qv)
S – sadness, sleep, I – interests in pleasurable activity G – guilt and negativity E – energy, C – cognitive problems (eg. Concentration and memory) A – appetite, anhedonia, anger (at self), anxiety P – Psychomotor, poor grooming, psychotic symptoms (sometimes) S - suicidality
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MOOD DISORDERSMajor Depressive Disorder
Characteristics: Recurrent episodes of depression, each continuing for at least two weeks Symptoms of depression (qv)
Masked depression: being unaware of or in denial of depression; (50% of depressed patients) Usually complain to 1° care doctor of vague physical
symptoms These complaints may be mistaken for hypochondriasis
Seasonal affective disorder (light Tx)Suicide risk (see table of risk factors for suicide)
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MOOD DISORDERSMajor Depressive Disorder
Associated clinical features:Psychotic features (mood congruent)Melancholia (profound anhedonia and
neurovegetative symptoms. Significant wt. loss)Mortality and morbidity (additional risk of
illness or death due to medical causes)Psychiatric comorbidity
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MOOD DISORDERSDysthymic Disorder
Diagnosis: chronic depression (at least two years duration) but not severe enough to meet the criteria for MDE. Requires only 2 rather than 5 MDE symptoms.
Associated clinical features: social impairment, health problems, abuse of alcohol and other drugs, major depression (double depression)
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MOOD DISORDERSBipolar I Disorder (misnomer)
Diagnosis: at least one manic or mixed episode Associated clinical features:
Psychotic features (mood congruent) Morbidity and Mortality Psychiatric comorbidity
Epidemiology: Mean age of occurrence 21 yrs; Likelihood of recurrence 90%
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MOOD DISORDERSBipolar II Disorder
Diagnosis: at least one MDE and one hypomanic episode in the absence of manic or mixed episodes.
Associated clinical features: suicide risk particularly during depressive episodes
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MOOD DISORDERSCyclothymic Disorder
Dysthymia with intermittent hypomanic episodes.Like dysthymia it is chronic rather than episodic
Diagnosis: experienced over at least two years at least one MDE and one hypomanic episode in the absence of manic or mixed episodes.
Associated features: substance abuse and social and occupational dysfunction are commonly seen
Epidemiology: up to 50% may ultimately develop bipolar disorder
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MOOD DISORDERS
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MOOD DISORDERSEtiology: The etiology is multifactorial
BiologicGenetic factors (family studies, adoption
studies) Neurochemical factors (NE, 5-HT and less
solidly Dopamine); and other neurotransmitters such as GABA and neuropeptides also implicated
Other biologic factors (neuroendocrine regulation, sleep and circadian rhythm, kindling
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Bipolar disorderThe Genetics of Bipolar Disorder
GROUP % Occurrence
The general population 1%
Person with one bipolar parent or sibling (or dizygotic twin)
20%
Person with two bipolar parents 60%
Monozygotic twin of a person with bipolar disorder 75%
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MOOD DISORDERSEtiology:
Psychosocial:StressLoss of a parent before age 11, linked to
depression in adulthoodAnger turned inward, intrapsychic processing
of loss ….depression and self hatredLearned helplessness, (animal model)Negative cognitions
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MOOD DISORDERSTreatment: Overall treatment planning:
Mood disorders vary in symptoms and severity, but some overall guidelines exist Treatment settingDiagnostic evaluationAssessment of safety
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MOOD DISORDERSTreatment: Treatment of major depressive disorder:
Hospitalization: may become necessary for safety, treatment (including ECT), or support
Outpatient treatment: combination of ψTx and medication, there are several models of ψTx for depression, support in its various forms
Somatic therapies (medication and ECT)
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MOOD DISORDERSTreatment: Treatment for bipolar I and Bipolar II disorders:
Hospitalization: containment of manic behavior, initial or reinstituted treatment, compliance
Outpatient treatment: combination of ψTx and medication,
Somatic therapies: Lithium, Valproate, Carbamazepine, et al
Other drugs: antipsychotics, benzodiazepines, antidepressants
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Mood Disorder Vignettes
1. Major Depressionhttps://www.youtube.com/watch?v=4YhpWZCdiZc2. Manic Depressive Disorder: commentaryhttps://www.youtube.com/watch?v=cqMcAeLWO9c3. Manic episodehttps://www.youtube.com/watch?v=zA-fqvC02oM