Slide 1 Mood Disorders Chapter Five ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Introduction What is sadness and how does it differ from a Mood Disorder? ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 DSM-IV Classifications Axis One-Clinical Disorder Axis Two-Personality Disorder/Mental Retardation Axis Three-General Medical Condition Axis Four-Psychosocial and Environment Axis Five- Educational Problems ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________
Transcript
Slide 1
Mood Disorders
Chapter Five
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Slide 2 Introduction
What is sadness and how does it differ from a Mood Disorder?
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Slide 3 DSM-IV Classifications
Axis One-Clinical Disorder
Axis Two-Personality Disorder/Mental Retardation
Axis Three-General Medical Condition
Axis Four-Psychosocial and Environment
Axis Five- Educational Problems
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Slide 4 Terms used in Psychopathology of
Depression
Emotion- state of arousal defined by subjective states of feeling such as sadness, anger and disgust.
Affect- pattern of observable behavior associated with subjective feelings such as facial expression, tone of voice and gestures.
Mood- pervasive and sustained emotional response that can color the person’s perception of the world
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Slide 5 Additional Terms
Mood Disorders- discrete periods of time when a person’s behavior is dominated by either a depressive or a manic mood.
Mania- flip side of depression that involves a disturbance in mood characterized by elation including inflated self-esteem, euphoria, decreased need for sleep and pressure to keep talking and racing thoughts.
Unipolar Mood Disorder-behavior is dominated by either a depressed or manic mood
Bipolar disorder (aka manic depressive disorder)-person experiences episodes of mania as well as depression.
Relapse- return of active symptoms in a person who has recovered from a previous episode.
Remission-when a person’s symptoms diminish or improve
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Slide 6 Symptoms and Considerations when
diagnosing clinical depression
Differential symptoms between Clinical Depression and Normal Sadness.
Four General types of symptoms.
• Emotional
• Cognitive
• Behavioral
• Somatic
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Slide 7 Emotional Symptoms
• Dysphoric (unpleasant) mood
• Diagnostic distinction made between normal sadness and clinical depression Severity, quality and pervasive impact of the depressed mood.
• Anxiety-often a co-morbid diagnosis with depression
• Manic symptoms-euphoric and energetic at the beginning of the cycle, changing to irritable, angry, out of control, self-destructive.
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Slide 8 Cognitive Symptoms
• Slowed thinking, trouble concentrating and easily distracted
• Pre-occupied with guilt and worthlessness
• Focus attention on the depressive triad:
Self
Environment
Future
Manic symptoms
easily distracted by random stimuli and often respond inappropriately
Grandiose ideas and inflated self-esteem
Quick to anger, argumentative and abusive
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Slide 9 Somatic Symptoms
• Sleeping Problems-trouble falling asleep, fatigue, early morning waking, spend more or less time sleeping than usual
• Appetite-changes—eating more or less than usual
• Libido-loss of sexual desire
Manic-drastic reduction in need for sleep, extremely energetic
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Slide 10 Behavioral Symptoms
• Psychomotor retardation-slowed movements, may walk or talk as if they are in slow motion
Manic-gregarious, energetic, provocative, flirtatious and often sexually inappropriate.
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Slide 11 Classification of Mood Disorders
Unipolar Disorders
• Major Depressive Disorder-
One or more depressive episodes
No manic or hypomanic episode ( hypomanic episode is an episode of increased energy that are not sufficiently severe to classify as full blown mania)
Major Depressive Disorder most often follows a course of repeated episodes through life
• Dsythymic Disorder
Depressed mood for at least two years, without cessation or remission of symptoms for longer than 2 months during this period.
No major depressive episodes during the first two years.
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Slide 12 Bipolar Disorders
• Bipolar I disorder
One or more manic episodes
Usually accompanied by major depressive episodes in between manic episodes
• Bipolar II disorder
One or more major depressive episodes
At least one hypomanic episode
No manic episodes
• Cyclothymic Disorder
Numerous periods with hypomanic symptoms as well as periods of depressed mood for at least 2 years.
No remission of symptoms for longer than 2 months during the 2 year period.
No major depressive episodes
No manic episodes.
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Slide 13 Further Descriptions: Subtypes
Episode Specifier-specific descriptions of symptoms that were present during the most recent episode of depression.
melancholia-episode specifier used to describe a particularly severe type of depression, the presence of which indicates the person is likely to be responsive to antidepressant therapy or ECT.
psychotic features- an episodic feature that indicates the presence of hallucinations or delusions during the most recent episode of mania or depression, the presence of which usually requires hospitilization.
Course Specifier-extensive descriptions of the pattern that the disorder follows over time, as well as adjustment between episodes.
rapid cycling-if the person experiences at least four episodes of major depression, mania, or hypomania within a 12-month period.
Seasonal affective disorder-onset of episodes is regularly associated with a change in seasons.
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Slide 14 Unipolar Disorder: Outcome, Incidence and
Prevalence & Etiology
Incidence and Prevalence:
• One of the most common forms of psychopathology, the lifetime risk of suffering from this disorder for the general population is 5%.
• Gender
• Cross Cultural-Universal
• Incidence increasing at earlier ages (M=45 years)
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Slide 15 Unipolar Disorder: Course, Episodes
and Outcome
Duration
Episodes
Recovery
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Slide 16 Bi-Polar Disorders: Course and
Outcome
Onset-usually occurs between the ages of 18-22 years which is younger than the average age of onset for unipolar
Course and Duration-intermittent. Most patients tend to have more than one episode, however the length of time between episodes is difficult to predict.
Incidence and Prevalence-
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Slide 17 Etiology and Theories
Unipolar Mood Disorder
Social Interpersonal loss or separation
Major disappointments dealing with acceptance such as getting fired
Biological-Genetic contribution appears to be highest for bipolar disorder then major depressive disorder and relatively minor for dysthymia.
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Slide 18 Etiology and Theories
BiPolar Disorder
Social Factors Increased frequency of stressful life events the weeks
preceding a manic episode.
Schedule disrupting events such as loss of sleep, holidays
Goal attainment events, such as a major job promotion, acceptance to medical school and graduate school or a new romance.
Social Environments Aversive emotional stress in the family.
Biological-Genetic contribution appears to be highest for bipolar disorder. Men and women are equally likely to develop bipolar disorder.
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Slide 19 Biological
Endocrine system
Hypothalamic Pituitary Adrenal Axis (HPA)
Neurotransmitter Levels
• Serotonin
• Current Neurotransmitter theories
• Bidirectional effects
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Slide 20 Treatment- Unipolar
Cognitive-focus on helping patients replace self-defeating thoughts with more rational self statements
Interpersonal Therapy-attempts to improve the patient’s relationships with other people by building communication and problem solving skills.
Antidepressant Medications –Selective Serotonin re-uptake inhibitors developed in the 1980’s. They are the most frequently prescribed treatment, however medication with other mechanisms of action are also used.
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Slide 21 Antidepressant Therapy
Selective Serotonin Re-uptake Inhibitors• Mechanism of action-reuptake pump• Side Effects
Tricyclics (Tofranil)• Mechanisms of action ( Considered 5 drugs in one)
• Side Effects• Onset of Effectiveness• Comparisons of TCA & SSRI
Monoamine Oxidase Inhibitors-Inhibits the breakdown of NE into its by-products. Not used as often due to its interaction with tyrosine which is found in many foods such as cheese, chocolate and wine which must be completely avoided.
Serotonin Norepinephrine Reuptake inhibitor
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Slide 22
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Slide 23
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Slide 24
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Slide 25 Two Very Cute Babies
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Slide 26 Treatment-Bipolar Disorders
Antidepressants-sometimes used in combination with a mood stabilizer.
Lithium Carbonate-first line treatment-eliminates manic episodes. Large number of non-responders ( up to 40%)
Anti-convulsants-more effective in treating rapid cyclers.
Anti-psychotics-sometimes used to alleviate symptoms of psychosis—not always present.
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Slide 27 Psychotherapy as a treatment
of BiPolar Disorder
Used as a supplement to medication.
Cognitive Therapy-
• Interpersonal Therapy-emphasis on monitoring the interaction between symptoms and social interaction. Help patients lead more orderly lives, especially with regard to sleep wake cycles and work patterns ( aka-social rhythm therapy).
