Surgeon General’s Report 1999 (Part 2)

Mood Disorders

and

Schizophrenia

MOOD DISORDERS

7 % of Americans suffer from mood disorders

Rank among the top ten causes of WORLDWIDE disability

The two that will be covered today:

~Major Depressive Disorder

~Bipolar Disorder

Comorbidities(what Mood Disorders coexist with)

Anxiety Disorders

Substance Abuse Disorders40% of people with mood disorders

also have substance abuse disorders

Clinical Depressionvs.

Normal Sadness(what distinguishes Major Depressive Disorder?)

AnhedoniaHopelessnessLoss of mood

reactivity

Suicidal thoughtsDelusions

Characteristicsof Major Depressive Disorder

One or more episodes lasting at least 2 weeksCardinal Symptoms:

Depressed moodLoss of interest or pleasure

When untreated:Lasts 9 months50% will recur

Dysthymia

a CHRONIC form of depression

BIPOLAR DISORDER

Episodes of mania mixed with episodes of depression

Recurrent

How is Bipolar Disorder DIFFERENT from Major

Depressive Disorder?

Manic episodesEarlier age at onsetReversed vegetative symptoms

Oversleeping, overeating

Lithium salts are therapeutically effective

The MANIA Phase

Thought content is GRANDIOSE and PARANOID

Speed of thought increasesSleep deprivation contributes to delirious

maniaEqually common in both men and women

CYCLOTHYMIA

a MILDER form of Bipolar Disorder

ETIOLOGYof Mood Disorders

Biological factorsMonoamine Hypothesis

Deficiency of monoamine transmittersSSRI’s boost serotonin levels

Depressed patients have too much activity in the HPA axis

Depressed patients have higher levels of CRH

ETIOLOGY, continued… Psychosocial FactorsStressful life events

The most stressful:Death of a loved one

Cognitive factorsIt’s all about perception

Temperament & Personality

Neuroticism predisposes

GenderAll over the world,

Major Depressive Disorder is more common in women

GeneticTend to run in

families

TREATMENTof Mood Disorders

Biggest problem= getting people into treatment at allMore than 50% of depressed people don’t

get treatmentMore than 40% of bipolar people don’t get

treatmentReasons…

TREATMENT, continued…Stages of Therapy Acute phase

Usually requires 6-8 weeks Electroconvulsive Therapy

Most common adverse effects: confusion and memory loss

Continuation phaseAt least 6 months of continued treatment

Maintenance phasePurpose is to prevent future occurrences

TREATMENTfor specific episodes of Depression and Mania

Four major classes of drugsTCAs, HCAs, MAOIs, SSRIs

Newer therapies for DepressionCognitive-Behavioral therapyInterpersonal psychotherapy

Newer treatments for ManiaVerapamil is a calcium channel blocker

SCHIZOPHRENIA

…the BRIEFEST of overviews…

CHARACTERISTICSof Schizophrenia

Profound disruption in cognition and emotion

Symptoms frequently include:psychotic manifestationsAssigning unusual significance to normal

eventsHaving delusions

POSITIVE symptoms(excess/distortion of normal functions)Delusions

Hallucinations

Disorganized speech

Catatonic behaviorsDisorganized

thinkingGrossly distorted

behavior

NEGATIVE symptoms(diminution or loss of normal functions)

Affective flattening

Alogia

Avolition

Recovery Factors

Family/Home atmosphere

Personal motivation

Availability of skill-building assistance

ETIOLOGYof Schizophrenia

Immediate biological relatives have 10 times greater risk

Discordance among identical twins indicates environmental factors also important

Brain abnormalities include:Enlarged cranial ventriclesDecreased cerebral size

PHYSIOLOGYof Schizophrenia

Positive symptoms linked to

TEMPORAL LOBE dysfunction

Negative symptoms linked to PREFRONTAL LOBE dysfunction

Pharmacotherapy Interventions

Chlorpromazine (older) and Clozapine (newer) reduce the POSITIVE symptoms of Schizophrenia

Newer meds also reduce the NEGATIVE symptoms

Moderate levels of dosage are most effectiveProblem: SIDE EFFECTS

40% of patients have side effects (parkinsonism and tardive dyskinesia)

Clozapine is the prototype of the newer meds

THE END