MOOD DISORDER

Mood Persistent emotional state or tone Affect (external display of feelings or observed emotional response) Pervasive and sustained feeling or tone that is experienced internally and that influences a persons behaviour and perception of the world (can be normal, elevated or depressed) Primary disturbance in mood Disabling disturbances in emotional state Continuum with normal moodMood Disorder Group of clinical conditions characterized by a loss of that sense of control and a subjective experience of reat distress; virtually always results in impaired interpersonal, social and occupational functioning Pervasive & significant change in mood Beyond normal happiness during good times Beyond normal sadness during bad times Onset often associated with stressful events or situation Recurrence common DSM-IV Unipolar mood disorders Major depressive disorder Dysthymic disorder Bipolar mood disorders BipoIar I disorder Bipolar II disorder Cyclothymic disorder Known etiology Substance-induced mood disorder Mood disorder due to a general medical conditionCriteria for Depressive Episode Sad, depressed mood, most of the day, nearly everyday for two weeks or loss of interest and pleasure in usual activities, plus at least four of the following Difficulties in sleeping (insomnia); not falling asleep initially; not returning to sleep after awakening in the middle of the night, and early morning awakenings; or, in some patients, a desire to sleep a great deal of the time Shift in activity level, becoming either lethargic (psychomotor retardation) or agitated Poor appetite and weight loss, or less often increased appetite and weight gain Loss of energy, great fatigue Negative self-concept, self-reproach and self-blame; feelings of worthlessness and guilt Complaints or evidence of difficulty concentrating, such as slowed thinking and indecisiveness Recurrent thoughts of death or suicideCriteria for Manic Episode Elevated or irritable mood for at least one week, plus three of the following (four if mood is irritable) Increase in activity level at work, socially, or sexually Unusual talkativeness; rapid speech Flights of ideas or subjective impression that thoughts are racing Less than usual amounts of sleep needed Inflated self-esteem; belief that one has special talents, powers, and abilities Distractibility; attention is easily diverted Excessive involvement in pleasurable activities that are likely to have undesirable consequences, such as reckless spendingAdditional notes: The symptoms do not meet criteria for a mixed episode. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, ot to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The symptoms are not due to direct physiological effects of a substance or a general medical condition.** Mixed-like episodes that are clearly caused by somatic antidepressant treatment should not count toward a diagnosis of bipolar 1 disorder.Hypomanic Episode Same features as a manic episode but less severe intensity lasting at least 4 days Not severe enough to caused marked impairment in social or occupational functioning, does not require hospitalization and no psychotic symptomsAdditional notes:DSM IV TR Criteria for Hypomanic Episode A distinct period of persistently elevated, expansive or irritable mood lasting throughout at least 4 days that is clearly different from the usual nondepressed mood. During the period of mood disturbance, 3 or more of the ff symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: Inflated self-esteem or grandiosity Decreased need for help (e.g feels rested after only 3hrs of sleep) More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractability (e.g attention too easily drawn to unimportant or irrelevant external stimuli) Increased in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g the person engages in unrestraining buying sprees, sexual indiscretions or foolish business investments) The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic The disturbance in mood and the change in functioning are observable by others The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization and there are no psychotic features The symptoms are not due to the direct physiological effects of a substance or a general medical condition** Hypomanic0like episodes that are clearly caused by somatic antidepressant treatment should not count toward a diagnosis of bipolar 2 disorder. Mixed Episode Meets criteria for both a manic and a major depressive episode nearly every day during at least a 1 week periodAdditional notes: The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, ot to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The symptoms are not due to direct physiological effects of a substance or a general medical condition.** Mixed-like episodes that are clearly caused by somatic antidepressant treatment should not count toward a diagnosis of bipolar 1 disorder.Mood Disorders Major Depression, formerly called Unipolar Depression, affects around 5.2% to 17.1% of the population at any given time. Prevalence rates suggest that it is increasing in the 20th Century and that its age of onset is deceasing. Depression affects people differently across the lifespan. Children typically have disturbances in behavior, or somatic complaints and dont necessarily admit to or recognize changes in mood. Elderly typically are distractible or have memory loss. Shift in activity level, becoming either lethargic (psychomotor retardation) or agitated. In rare instances, patients have the opposite reaction, particularly psychotic symptoms. Poor appetite and weight loss or increased appetite and weight gain Loss of energy, great fatigue Negative self concept, self-reproach and self-blame; feelings of worthlessness and having inappropriate feelings of guilt Difficulty of concentrating such as slowed thinking and indecisiveness which impairs the ability of the patient to fulfil certain responsibilities Recurrent thoughts of death or suicide what you should always have to evaluate for.Additional notes: The symptoms do not meet criteria for a mixed episode. The symptoms cause clinically significant distress or impairment in social, occupational or other areas of functioning. The symptoms are not due to direct physiological effects of a substance (e.g drugs) or a general medical condition (e.g. hypothyroidism) The symptoms are not better accounted for by bereavement (e.g death of a loved one).Depression There are also cultural differences in depression. Sometimes depression is mild and more acute (short term) while at other times it can be very intense reaching psychotic proportions. Other times it is more chronic and last years. Episodes of depression tend to recur. Bipolar I and II Involves patients who may manifest both spectrum of mood disturbances (extremes of the mood spectrum) bipolar I - History of at least one manic or mixed episode. Involves episodes of both mania and depression Episodes of mania tend to reoccur true for all types of mood disturbances bipolar II - History of at least one major depressive episode and at least one hypomanic episode. Epidemiology Incidence - 7 per 100,000 Prevalence - lifetime Bipolar I 4 to 24 per 1000 Bipolar II 3 to 50 per 1000 Hypomania 26 to 78 per 1000Heterogeneity within Diagnoses There is great heterogeneity among the mood disorder categories. Patients with the same disorders can vary tremendously The length of time that symptoms persist varies greatly, too. Some patients experience mania (symptoms last at least one week and greatly impairs functioning) while other patients experience hypomania (symptoms last at least four days and does not greatly impair functioning). Some patients experience melancholia which is a specific pattern of symptoms and includes an inability to feel pleasure in anything and usually feel worse in the morning. Both mania and depression can take on psychotic symptoms as well including both mood congruent and mood incongruent features. This psychotic symptomatology can include catatonia which includes both motoric immobility or excessive, purposeless activity and agitation.Chronic forms of Mood Disorders Cyclothymic Disorder form of mania that includes frequent periods of depression and hypomania that can recur with asymptomatic periods lasting no longer than two months. Often the symptoms are not as severe as a full blown episode of mania or depression Dysthymic Disorder form of depression that includes chronically present symptoms of depression. The difference between major depression and dysthymia is the duration of the symptoms (longer in dysthymia) and that dysthymia has fewer symptoms for a diagnosis (3 instead of 5). Dysthymic Disorder can last for many years. Sometimes mood disorders can be brought on by general medical conditions (i.e., cancer or arthritis) or can be the result of substance abuse. Sometimes substance abuse can mask the presence of a mood disorder so when the substance is not present the mood disorder is present. Seasonal Affective Disorder typically happens in the Winter and may result from the loss of hours of sunlight.Etiology and Treatment of Mood Disorders Psychoanalytic Etiology loss, dependent on external approval, anger directed inward. Mania a defense against depression. Treatment Theory of depression: depression was introjected anger the treatment involves learning how to not hold your anger in. Free association Hypnosis Catharsis Behavioral learned helplessness Etiology Maladaptive learning May involve the loss of and/or lack of reinforcers in the environment Treatment Relearn appropriate/effective behaviors Social skills training Assertiveness trainingRelaxation training Humanistic Etiology Thwarted human growth and potential Treatment Unleash or unblock growth and nurture the healthy potential in the individual Basic empathy Unconditional positive regard Genuineness Relationship is especially important Frank discussion of these can concerns can be very useful Other - Existential Therapy All of the difficulties of human existence can result in anxiety and depression Cognitive Etiology Maladaptive thoughts Becks The Negative view of self The Negative interpretation of experiences The Negative expectation of the future Treatment Alter distortions and maladaptive thoughts Confrontation Skills trainingProblems solving approach Biological -The Genetic/Family Data Bipolar disorder 10-25% of 1st degree relatives have experienced an episode of mood disorder 70% identical twins 25% fraternal twins Dominant gene on 11th chromosome Unipolar depression Less risk as compared to bipolar disorder Monozygotic twins>dizygotic twins concordances Women>men concordances Biological biochemical data This area of mood disorders has advanced perhaps more than any area in the treatment of mood disorders Etiology Underlying biological issues Based on the assumption that there is an imbalance of neurotransmitters in the nervous system Treatment Provide symptomatic relief of mood symptomatology Re-establish the proper level of neurotransmitters in the brain The wide use of anti-depressant medications is evidence of the trend in the field of psychiatry MAO-I Tricyclic SSRI ECT Encourage lifestyle changes Systematically provide education to support life changesSuicide Assessment and PreventionRisk Factors for Suicide Previous suicide attempt(s) History of mental disorders, particularly depression and alcohol or other substance abuse Family history of suicide Acute or chronic losses (relational, social, work, financial or physical) Chronic physical illness, particularly if associated with chronic pain Easy access to lethal methods Impulsive or aggressive tendencies Feelings of hopelessness or isolation Protective Factors An individual's genetic or neurobiological make-up Attitudinal or behavioral characteristics Family and community support Effective and appropriate clinical care for mental, physical and substance abuse disorder Easy access to effective clinical interventions and support for help-seeking. Restricted access to highly lethal methods of suicide Cultural and religious beliefs that discourage suicide and support self-preservation instincts Support from ongoing medical and mental health care relationships Acquisition of learned skills for problem solving, conflict resolution and non-violent management of disputesWarning Signs Talking or writing about suicide, death or dying Giving direct verbal cues, such as "I wish I were dead" and "I'm going to end it all" (suicidal threats) Giving less direct verbal cues, such as "What's the point of living?," "Soon you won't have to worry about me," and "Who cares if I'm dead, anyway?" Looking for ways to kill him- or herself: seeking access to pills, weapons or other means. Increasing alcohol or other drug abuse Global insomnia Isolating him- or herself from friends and family Exhibiting a sudden and unexplained improvement in mood after being depressed or withdrawn Neglecting his or her appearance and hygiene. What can we do to help? Take it seriously Remember: suicidal behavior is a cry for help. Be willing to give and get help sooner rather than later. Listen. Ask questions If the person is acutely suicidal, do not leave him alone. Urge professional help. No secrets. Crisis to RecoveryQuestions to Ask Do you ever wish you could go to sleep and never wake up? Sometimes when people feel sad, they have thoughts of harming or killing themselves, Have you had such thoughts? Are you thinking about killing yourself? When was the last time that you thought about suicide? Factors to Warrant Intermediate Intervention Past incidents of suicidal behavior or self-harm A family history of suicide A history of psychiatric disorders or the abuse of alcohol and other drugs The patient's admission that he or she has considered suicide The patient's expressed wish to die Any evidence of a current psychiatric disorder Sources: lectures ppt and some notes

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