Mood Disorders (B)

7/28/2019 Mood Disorders (B)

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Mood disorders (depression) represent a major health

problem in this country and across the world. Out textindicates that the total cost or “disease burden” (cost

of treatment, missed work, etc) in the U.S. alone isestimated to be $83 billion dollars.

Mood disorders represent a significant disturbance in our normal emotional states. All of us have fluctuations inour affect or emotion, but mood disorders are either moresevere or chronic in nature.

Mood vs. Affect - Affect involves moment to momentvariations in our emotional tone or states. Mood isthe more stable, prevalent emotional quality of our day to day existence. Analogy: affect is to mood as

weather is to climate



WHAT ARE MOOD DISORDERS?

We may speak of mood as having a normal baseline (euthymia) withelevations (mania or euphoria) and depression (dysthymia). Whenthese variations from the baseline become more extreme or chronicwe think of them as disorders.

Since it the highs and the lows that are the deviations, we callthe “highs” mania and the “lows” depression. Mania involves

extremely elevated, euphoric mood, while depression involvesextremes of sadness, despair and hopelessness.



PREVALENCE OF MOOD DISORDERS

Mood disorders, especially the depressive (unipolar) variety arevery common in clinical practice. Lifetime prevalence isestimated at about 17%. Rates for depression are higher for

women than men. Prevalence for bipolar mood disorders(cycling mood disorders) are much lower than for unipolar mooddisorders, ranging around 1-2% for lifetime prevalence. Nodifference by sex is seen with bipolar disorder.



MOOD EPISODES





UNIPOLAR MOOD DISORDERS(Depressive only)

DYSTHYMIC DISORDER

MAJOR DEPRESSIVE DISORDER



Dysthymic Disorder

(A) Depressed mood for most of the day, for more days than not,for at least 2 years (1 year for children & adolescents)

(B) Presence of two or more of the following: poor appetite or

overeating, insomnia or hypersomnia, low energy, low self esteem, poor concentration or decision making difficulty, feelingsof hopelessness

During 2-year period person has never been without symptoms (Aor B ) for more than 2 months at a time

No Major Depressive Disorder has been present during the 2years of disturbance

Sx cause clinically significant distress or impairment in functioning




SINGLE EPISODE

Presence of a single Major Depressive Episode (previousslide)

The Major depressive Episode is not better accounted for byanother disorder

There hasn’t been a manic, hypomanic or mixed episode




RECURRENT

Presence of two or more Major depressive Episodes

Episodes must have an interval in between of at least two months

in which Major Depression not seen

There has never been a manic or hypomanic episode



SPECIFIERS OF MAJOR DEPRESSIVE DISORDERS

With Melancholic Features - Three of the following: early a.m.awakening, depression worse in a.m., marked psychomotor agitation, loss of appetite/weight, excessive guilt, qualitativelydifferent depressed mood

With Psychotic Features - Delusions (false beliefs) or hallucinations (false perceptions); feelings of guilt & worthlessnessare common

With Atypical Features - Mood reactivity…brightens to positiveevents; 2 of the following sx: weight gain or increase in appetite,hypersomnia, leaden paralysis, acutely sensitive to interpersonalrejection

With Seasonal Pattern – (SAD) at least 2 episodes occur at sametime of year, usually fall or winter




More symptoms than with Dysthymic Disorder

Sx are more severe than with Dysthymic Disorder

Several subtypes: Single episode, Recurrent, Specifiers(SAD, etc)

More acute than Dysthymic Disorder



CAUSAL FACTORS IN

UNIPOLAR DEPRESSION

Genetic factors –probably pretty important in Major

Depressive Disorders (may account for up to 40% of thevariance). There may be a gene which is involved in thetransmission and reuptake of serotonin.

Neurotransmitters – serotonin and norepinephrine

imbalances important but causation not clear.

Problems with Hormone Regulation in HPA axis



BIOLOGICAL CAUSAL

FACTORS

Disturbance in sleep and biological rhythms (circadian)

Sunlight and Seasons



PSYCHOLOGICAL CAUSAL

FACTORS

Stressful life events, especially losses

Cognitive styles that are especially pessimistic

The personality factor of neuroticism (temperament –

negative affectivity)

Early adversity & parental loss as a diathesis



Beck’s Cognitive theory – people develop patterns of negative thinking which become automatic, pessimistic

predictions about self and the world.

Learned Helpless model - Seligman

Hopelessness & attribution - generalized expectationsabout why things work as they do. Person believes badthings will happen to them because they are bad andbecause they have no control over the bad events thathappen to them.

Lack of social support system, poor social skills,loneliness



SUICIDE

Suicide, the taking of one’s own life, is not a disorder but an action

frequently associated with depressive disorders and importantenough to be looked at separately.

Depressed people are 50x more likely to commit suicide than nondepressed people. It is the 8th leading cause of death in thiscountry. It is the 2nd leading cause of death among adolescents(college students). Persons between the ages of 18 and 24 have

the highest rates of suicide. Most attempts are related tointerpersonal difficulties.

Women attempt 3x more often than men but men are far more

“successful” in their attempts.



Historically suicide rates among children have been verylow but are increasing rapidly. Suicide is now the 7th leading cause of death among children.

Historically, the highest rates of completed suicides areamong elderly men, but the rates have been coming down.

People who are divorced and living alone are at greater risk, as are people with chronic illness and disability.

Alcohol is a frequent factor in many suicide attempts



Why do people attempt suicide?

There is a tendency for people who attempt suicide to have a familyhistory of relatives who attempted suicide as well as a history of familypathology.

There is a significant interpersonal factor in the majority of suicides atall ages but especially younger age groups.

There are significant cultural differences in suicide rates with Orientalsmuch higher than westerners. Whites have higher suicide rates thanBlacks.

Distortions in thinking – suicide as a way to “punish” others. Suicide

often seen as a “way out” of suffering.



Do Suicidal People Give “Warnings”?

Somet imes – about 40-50% give some indication of their intentahead of time. However, if someone is determined to commitsuicide they will not only not give warnings, they will deny intent.

Predicting and preventing suicide is extremely difficult, so allwarnings and “hints” should be treated as significant. Most

(around 50%) successful suicide attempts are by people who have

never sought professional help.

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Mood Disorders (B)

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