Mood DisordersChapter 7

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Mood DisordersChapter 7

• Barlow and Durand

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Mood Disorders
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Major Depressive Episode

• An extremely depressed mood state that lasts at
  least 2 weeks and includes
• Cognitive Symptoms
• Physical Symptoms

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Major Depressive Episode

• Every action requires an overwhelming effort
• Loss of Interest
• No pleasure in life (anhedonia)
• Average untreated duration is 9 months

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Manic Episode

• Mania
• Find extreme pleasure in every activity
• Extraordinarily active
• Require very little sleep
• Grandiose plans

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Manic Episode

• Believe they can accomplish anything
• Rapid Speech
• Flight of ideas
• Criteria
• Irritability near end of episode
• Duration untreated

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Hypomanic Episode

• Less severe than manic episode

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Unipolar Disorders

• A person experiences either depression or mania

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Bipolar Disorders

• A person experiences BOTH deviations of
  depression and mania

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Major Depressive Disorder Single Episode

• The occurrence of just 1 episode in a lifetime is
  rare

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Major Depressive Disorder - Recurrent

• 2 or more major depressive episodes occur and
  are separated by at least 2 months of no
  depression
• Otherwise symptoms are same for both Major
  Depressive Disorder Single Episode and Major
  Depressive Disorder - Recurrent

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Stats on Depressive Disorders

• Major Depressive Disorder Recurrent usually has
  a family history unlike those with single episodes

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Stats on Depressive Disorders

• Median number of Major Depressive Episodes in a
  lifetime is 4
• Median Duration is
• Mean age of onset is

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Stats on Depressive Disorders

• Born before 1905 only 1 have a depressive
  episode by age 75
• Born since 1955 6 have a depressive episode by
  age 24

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Dysthymic Disorder

• Many of the same Sx of Major Depressive Disorder,
  but milder
• Course of disorder lasts for long periods of time
  unchanged

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Dysthymic Disorder

• Persistently depressed mood that continues for at
  least 2 years and patient has not been symptom
  free for more than 2 months at a time
• Many with dysthymia will eventually develop major
  depressive disorder

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Dysthymic Disorder

• 53 recover at some point but 45 of those will
  relapse
• Dysthymia more likely to attempt suicide than
  Major Depressive Disorder

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Dysthymic Disorder

• If onset is before age 21 it is associated with
• Greater Chronicity
• Poor Treatment Prognosis

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Double Depression

• Dysthymia and Major Depressive Disorder
  co-occurring
• 79 of those with dysthymia also had major
  depressive disorder at some point

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Bipolar Disorders

• Mania Alternates with Depression

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Cyclothymic Disorder

• Milder version of Bipolar Disorder, but symptoms
  last much longer
• More chronic
• Much like dysthymia is to major depression
• Not severe enough to reach criteria for full
  mania or major depressive episodes

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Cyclothymic Disorder

• Criteria

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Bipolar II Disorder

• Major Depressive Episodes alternate with
  Hypomanic Episodes rather than full Manic
  Episodes
• Average age of onset is
• 10-13 will

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Bipolar I Disorder

• Criteria is the same as for Bipolar II Disorder
• However, individual experiences FULL manic
  episodes
• There must be 2 month periods of no symptoms
  between cycling of the episodes (otherwise
  episodes are seen as continuations of the last)

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Statistics on Bipolar Disorders

• These individuals often will not admit they have
  a problem (especially in the manic state)
• When they get into a manic stage the high is so
  wonderful they often stop taking their meds
• 1/3 of cases begin in adolescence
• Rare to develop after age 40
• Chronic

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Statistics on Bipolar Disorders

• Usually can be managed with meds
• Suicide is very common (almost always occurs in a
  Depressive Episode)
• 17 attempt suicide
• 24 attempt suicide
• 12 attempt suicide

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Defining Criteria of Mood Disorders

• There is a great diversity within mood disorders
  so we use specifiers

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6 Specifiers of Most Recent Episode

• Atypical features individuals consistently
  oversleep and overeat during episodes of major
  depressive disorder or dysthymia and gain weight.
  

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6 Specifiers of Most Recent Episode

• Melancholic Features Full criteria of Major
  Depressive Episode must be met includes also
  some of the more severe somatic Sx (early morning
  awakenings, weight loss, loss libido, excessive
  and inappropriate guilt, anhedonia)

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6 Specifiers of Most Recent Episode

• Chronic Features Must have met criteria for
  Major Depressive Episodes for past 2 years
  continuously.

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6 Specifiers of Most Recent Episode

• Catatonic Features Applies to Major Depressive
  Episodes and Manic Episodes. They are very rare.
  A total absence of movement or catalepsy

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6 Specifiers of Most Recent Episode

• Psychotic Features Hallucinations and
  Delusions. Can apply to Major Depressive
  Episodes or Manic Episodes. Delusions can be
  mood congruent, incongruent, or of grandeur

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6 Specifiers of Most Recent Episode

• Postpartum Onset Applies to Major Depressive
  Episodes and Manic Episodes. Severe manic
  episodes or major depressive episodes of a
  psychotic nature that occur during postpartum
  period (4 weeks following childbirth)

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3 Specifiers for Course of Mood Disorders

• Applies to recurrent episodes only

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3 Specifiers for Course of Mood Disorders

• Longitudinal

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3 Specifiers for Course of Mood Disorders

• Rapid Cycling

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3 Specifiers for Course of Mood Disorders

• Seasonal Pattern

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Seasonal Affective Disorder (SAD)

• Mood co-occurs with seasons
• Usually depression in the winter and mania in the
  summer
• 5 of North Americans
• Research has shown the differences in prevalence
  based on the differences in sunlight (2 in
  Florida vs. 10 in New Hampshire)

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Treatment for Seasonal Affective Disorder

• Phototherapy light exposure tends to be helpful
  in many cases.

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Prevalence of Mood Disorders

• Woman are twice as likely to develop Major
  Depression and Dysthymia
• Bipolar Disorders tend to occur evenly across
  gender
• Major Depressive Disorder and Dysthymia are much
  more common among whites and Hispanics than blacks

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Mood Disorders and Children and Adolescence

• Can occur
• Fundamentally similar in adults and children
• Vulnerable to low
• Depressive Disorders are less frequent in
  children than adults, but more frequent in
  adolescence than in adults

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Mood Disorders and Children and Adolescence

• In young children dysthymia is more common than
  major depression, but major depression is more
  common in adolescence than dysthymia
• Children under 9 present with irritability and
  emotional swings rather than classic manic states
  and are often mistaken as hyperactive

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Mood Disorders and Children and Adolescence

• Mood Disorders tend to be more chronic in
  children whereas they are more episodic in adults
• Boys tend to become aggressive and destructive
  during periods of depression and often get
  misdiagnosed with conduct disorders or ADHD

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Mood Disorders and the Elderly

• 18-20 develop major depression
• Associated with marked sleep difficulties,
  hypochondriasis, agitation
• Looks like physical illness or dementia
• The Prevalence of mood disorders is less in
  elderly than in the general population
• Depression in the elderly is comorbid often with
  anxiety disorders
• Here the sex ratio for depression becomes
  balanced again

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Mood Disorders Across Cultures

• Varies in somatic complaints from culture to
  culture
• Expression and subjective feelings are often
  shown in different ways

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Anxiety and Depression
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Causes of Mood Disorders?
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Causes of Mood Disorders?
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Causes of Mood Disorders?

• Sleep and Circadian Rhythms
• Decreased slow wave sleep (deepest sleep)
• Enter REM sleep too quickly and is overly intense
• Depriving patients of sleep during the 2nd half
  of the night improves their condition temporarily
• Increased sensitivity to light (Greater
  suppression of melatonin)
• Insomnia can trigger mania

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Causes of Mood Disorders?

• Psychological Causes
• Stressfull life events tend to precipitate the
  first of recurrent episodes

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Psychological Causes of Mood Disorders

• Learned Helplessness Martin Seligman
• If rats can control shocks theyre fine, if they
  can not they get the animal equivalent of
  depression

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More Learned Helplessness
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Psychological Causes of Mood Disorders

• Negative Cognitive Styles
• Making the worst of everything
• Set-backs are catastrophes
• Aaron Beck

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Negative Cognitive Styles Cont.

• Arbitrary Inference Depressed individuals
  emphasize the negative rather than the positive
  in all situations
• Overgeneralizations

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Negative Cognitive Styles Cont.

• Cognitive Triad
• Negative Schema look at everything negatively

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Social and Cultural Causes

• Marital Relations
• In marital relations it is much more likely for
  men to develop mood disorders
• Women women appear to be more susceptible to
  developing all mood disorders except Bipolar
  Disorders
• This is consistent across the world
• Lack of social support facilitates depression

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Best Approach to Determining Causes

• INTEGRATE ALL THEORIES!!!

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Treatments for Mood Disorders

• Meds
• For Depressive Disorders
• Tricyclic Antidepressants (Tofranil, Elavil)
  Relieves 65-70 - but are lethal if taken in
  large doses so clinicians must be very careful
  with suicidal patients

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Antidepressants Cont.

• Monoamine Oxidase Inhibitors (MAOIs)
• Serotenergic Reuptake Inhibitors (SSRIs)
  (Fluoxetine, Prozac)

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Meds for Bipolar Disorders

• Lithium
• Mood Stabilizer
• Treats Bipolar Disorders
• Dosages must be exact and very careful or can be
  lethal
• Weight Gain
• 66 helped 34 relapse
• Depakote is most recent form

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ECT Electroconvulsive Therapy

• Shock Therapy
• When someone does not respond to meds
• Patients are anesthetized
• Given muscle relaxing drugs
• Shock directly through the brain for less than 1
  second in duration

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ECT Electroconvulsive Therapy

• Produces a seizure and several minutes of
  convulsions
• Once every other day for 6-10 treatments
• Few Side Effects
• Short term memory loss and confusion which
  subsides in a week or two
• Relapse rate is 60

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Psychosocial Treatments for Mood Disorders
(Depressive)

• Cognitive Therapy
• 15-20 sessions once per week
• Highly structured
• Automatic Thoughts
• Correct Cognitive Errors
• Substitute less depressive and more realistic
  thoughts

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Psychosocial Treatments for Mood Disorders
(Depressive)

• Interpersonal Psychotherapy (IPT)

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Preventing Relapse

• Cognitive therapy has a 50 less relapse rate
  than drugs alone
• Integrate techniques situation specific

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Psychosocial Treatment for Bipolar Disorder

• Lithium is preferred
• Family therapy has been used

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Suicide Statistics

• 30,000 people per year in the US alone
• 8th leading cause of death in the US
• Actual number is 2-3 times higher
• Adolescent rates are rising
• 3rd leading cause of death for teens
• Females attempt 3 times more than males

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Suicide Statistics

• Males are 4-5 times more likely to commit than
  females types of attempts are more fatal
• Males tend to use guns/hang
• Females tend to overdose or cut wrists

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Suicide Terms

• Suicide attempt
• Suicidal Ideation

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Suicide Risk Factors
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Suicide Risk Factors

• Has the person created a plan?
• Are they giving away possessions?
• Have they taken precautions against being
  discovered?

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MHP Suicide Plan of Action

• If a MHP can not get a person to sign a no
  suicide contract or they have doubts about the
  sincerity at the time of signing and the risk is
  high then hospitalization is required even
  against the will of the patient