Your SlideShare is downloading. ×
  • Like
Mood Disorders
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Mood Disorders

  • 1,481 views
Published

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,481
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
125
Comments
0
Likes
4

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. The Mood Disorders Dr. Kayj Nash Okine
  • 2. The Mood Disorders
    • Unipolar Disorders:
    • Major Depressive Disorder
    • Dysthymic Disorder
    • Bipolar Disorders:
    • Bipolar I Disorder
    • Bipolar II Disorder
    • Cyclothymic Disorder
  • 3. Major Depression
    • Emotional Symptoms:
    • Sadness, depressed mood
    • Anhedonia – lack of interest or pleasure
    • Irritability
    • Excessive or inappropriate guilt
    • Hopelessness
    • Feelings of worthlessness
    • Low self-esteem
  • 4. Major Depression
    • Vegetative Symptoms:
    • Lack of motivation
    • Insomnia or hypersomnia
    • Increased or decreased appetite
    • Weight loss or gain
    • Fatigue, loss of energy
    • Psychomotor retardation or agitation
  • 5. Major Depression
    • Cognitive Symptoms:
    • Impaired concentration & attention
    • Indecisiveness
    • Suicidal ideation
    • Delusions
    • Hallucinations
  • 6. Major Depression
    • Social Symptoms:
    • Social withdrawal & isolation
    • Lack of communication
    • Lack of social initiation
    • Relationship problems & conflict
    • Dependency – clinginess, neediness
  • 7. Diagnostic Criteria for a Major Depressive Episode
    • 5+ symptoms are present for at least 2 weeks:
    • Depressed mood*
    • Loss of interest or pleasure in most activities*
    • Significant increase or decrease in appetite or weight
    • Insomnia or hypersomnia
    • Psychomotor agitation or retardation
    • Fatigue or loss of energy
    • Feelings of worthlessness or excessive or inappropriate guilt
    • Diminished ability to think or concentrate or indecisiveness
    • Suicidal ideation
  • 8. Diagnostic Criteria for a Major Depressive Episode
    • At lease one of the symptoms is either depressed mood or loss of interest or pleasure in most activities.
    • Symptoms represent a change from previous functioning.
    • Symptoms cause significant distress or impairment.
    • Symptoms aren’t better accounted for by bereavement (2 month mourning period after loss of a loved one).
  • 9. Specifiers for Major Depression
    • Mild, Moderate, and Severe
    • Single Episode or Recurrent
    • Chronic
    • With Melancholic Features
    • With Psychotic Features
    • With Catatonic Features
    • With Atypical Features
    • With Postpartum Onset
    • With Seasonal Patterns
    • Longitudinal Course Specifiers
  • 10. Criteria for Specifiers
    • Severity: Mild, Moderate, or Severe level of functional impairment
    • Single Episode: single episode of major depression
    • Recurrent: 2 or more episodes of major depression
    • Chronic: full criteria for a major depressive episode have been met continually for at least the past 2 years
  • 11. Criteria for Specifiers
    • Psychotic Features: delusions or hallucinations
      • Mood Congruent: depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment
      • Mood Incongruent: content doesn’t involve depressive themes, e.g. thought insertion, thought broadcasting, delusions of control, delusions of grandeur, persecutory delusions
  • 12. Criteria for Specifiers:
    • Catatonic Features: at least 2 of the following:
      • Motoric immobility – catalepsy or stupor
      • Excessive motor activity
      • Extreme negativism (resistance to instructions or attempts to be moved) or mutism
      • Posturing, stereotyped movements, prominent mannerisms or grimacing
      • Echolalia or echopraxia
  • 13. Criteria for Specifiers
    • Melancholic Features:
    • 4 or more of the following
      • Loss of pleasure in activities and/or*
      • Lack of reactivity to pleasurable stimuli*
      • Quality of mood is distinct
      • Depression regularly worse in the morning
      • Early morning wakening (2+ hrs)
      • Marked psychomotor retardation or agitation
      • Significant anorexia or weight loss
      • Excessive or inappropriate guilt
  • 14. Criteria for Specifiers
    • Atypical Features: 3 or more of the following:
      • Mood reactivity*
      • Significant weight gain or increase in appetite
      • Hypersomnia
      • Heavy, leaden feeling in arms or legs
      • Interpersonal rejection sensitivity
  • 15. Criteria for Specifiers
    • Longitudinal Course Specifiers:
      • With Full Interepisode Recovery – full remission is attained between 2 most recent mood episodes
      • Without Full Interepisode Recovery – full remission is not attained between mood episodes
    • Postpartum Onset: Onset of episode within 4 weeks postpartum
  • 16. Criteria for Specifiers
    • Seasonal Pattern:
      • Depressive episodes have developed at a particular time of the year for past 2 years
      • Depression remits or switches to mania or hypomania at a characteristic time of year
      • No nonseasonal major depressive episodes have occurred during the 2 year period
      • Seasonal major depressive episodes substantially outnumber nonseasonal depressive episodes over the course of person’s lifetime
  • 17. Prevalence Rates For Major Depressive Disorder
    • Lifetime prevalence: 10-25% for women; 5-12% for men
    • Point prevalence: 5-9% for women; 2-3% for men
    • Gender: women have 2x the rates as men
    • Age: highest rates among 15-24 year olds
    • Onset: early 20’s
    • Other variables: no consistent differences in rates across levels of ethnicity, education, income, or marital status
  • 18. Diagnostic Criteria For Dysthymia
    • Depressed mood for at least 2 years. For children & adolescents, mood may be irritable and duration may be 1 year.
    • Presence of 2 or more of the following:
    • -Poor appetite or over-eating
    • -Insomnia or hypersomnia
    • -Low energy or fatigue
    • -Low self esteem
    • -Poor concentration or difficulty making decisions
    • -Feelings of hopelessness
  • 19. Diagnostic Criteria For Dysthymia
    • C. During the 2 yr period, the person has not been without symptoms for more than 2 months at a time.
    • D. No major depressive episode has been present during the 1 st 2 yrs of the disturbance. After the initial 2 yrs, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses are given.
  • 20. Dysthymic Disorder
    • Specifiers:
    • Early Onset - onset before 21 yrs old
    • Late Onset - onset at age 21 yrs old or older
    • With Atypical Features
    • Prevalence:
    • Lifetime prevalence: 6%
    • Point prevalence: 3%
    • Gender Differences:
    • 2-3x more likely for women than men
  • 21. Major Depression vs. Dysthymia
    • Major Depression:
    • 5 or more symptoms including depressed mood or loss of interest or pleasure
    • At least 2 weeks in duration
    • Dysthymia:
    • 3 or more symptoms including depressed mood
    • At least 2 years in duration
  • 22. Manic Features
    • Changes in Mood:
    • Irritability
    • Excitability, exhilaration
    • Hostility
    • Anxious
    • Hyper, wound-up
  • 23. Manic Features
    • Increased Energy:
    • Little fatigue, despite decreased sleep; insomnia, and difficulty sleeping
    • Increase in activities; increased productivity
    • Doing several things at once
    • Making lots of plans
    • Taking on too many responsibilities
    • Others seem slow
    • Restlessness, difficulty staying still
  • 24. Manic Features
    • Changes in speech
    • Rapid, pressured speech
    • Incoherent speech, clang associations
    • Impaired judgment
    • Lack of insight
    • Inappropriate humor and behaviors
    • Impulsive or thrill-seeking behaviors: increased alcohol consumption; financial extravagance, spending too much money; dangerous driving; sexual promiscuity
  • 25. Manic Features
    • Changes in Thought Patterns
    • Distractibility, inability to concentrate
    • Creative thinking
    • Flight of ideas
    • Racing thoughts
    • Disorientation
    • Disjointed thinking
    • Grandiose thinking
  • 26. Manic Features
    • Changes in Perceptions
    • Inflated self esteem, feeling superior
    • More sensitive than usual: noises seem louder & lights seem brighter than usual
    • Hallucinations
    • Paranoia
    • Increased appetite
    • Increased Social Behavior
    • Unnecessary phone calls
    • Increased sexual activity
    • Talkative & sociable
  • 27. Criteria for Mania & Hypomania
    • 4+ of the following symptoms have persisted to a significant degree for at least a week:
    • Elevated, expansive, irritable mood*
    • Inflated self-esteem, grandiosity
    • Decreased need for sleep
    • Flight of ideas, racing thoughts
    • More talkative than usual, pressured speech
    • Distractibility
    • Increase in goal-directed activity, psychomotor agitation
    • Excessive involvement in pleasurable but dangerous activities, e.g. unrestrained shopping sprees, sexual indiscretions, reckless driving
  • 28. Differential Diagnosis
    • MANIC EPISODE
    • (Bipolar I)
    • Mood disturbance is severe
    • Causes marked impairment in social or occupational functioning
    • Necessitates hospitalization
    • Has psychotic features
    • HYPOMANIC EPISODE
    • (Bipolar II & Cyclothymia)
    • Mood disturbance is less severe
    • Does not cause marked impairment in functioning
    • The person’s behavior and mood significantly & noticeably change
    • The person no longer seems like him/herself
  • 29. Mixed Episode
    • The criteria are met (except for duration) for both Mania & Major Depression nearly every day for at least a week
    • Mood disturbance is severe enough to:
      • cause marked impairment in functioning
      • necessitate hospitalization
      • contain psychotic features
  • 30. Bipolar I Disorder
    • Characterized by the occurrence of:
    • 1 or more Manic or Mixed Episodes
    • (usually) 1 or more Major Depressive Episodes
  • 31. Bipolar II Disorder
    • Characterized by the occurrence of:
    • 1 or more Major Depressive Episodes
    • At least 1 Hypomanic Episode
    • There has never been a Manic or Mixed Episode
  • 32. Cyclothymic Disorder
    • Characterized by:
    • Chronically fluctuating mood states – numerous periods of hypomania and depression
    • Duration of at least 2 years in adults & 1 year in adolescents and children
    • Person is not without symptoms for more than 2 months at a time
    • There are no Major Depressive, Manic, or Mixed Episodes during the initial 2 years. After the initial 2 years, there may be superimposed Manic, Mixed, or Depressive episodes
  • 33. Bipolar Specifiers
    • Current or Most Recent Episode
    • Longitudinal Course Specifiers
    • With Rapid Cycling (at least 4 episodes of mood disturbances in the past 12 months)
    • Mild, Moderate, Severe
    • With Psychotic Features
    • With Postpartum Onset
    • With Catatonic Features (very rare in manic episodes)
    • With Seasonal Pattern
  • 34. Prevalence Rates
    • Lifetime Prevalence Rates:
      • Bipolar I: 0.4%-1.6%
      • Bipolar II: 0.5%
      • Cyclothymia: 0.4%-1.0%
  • 35. Course
    • Average age of onset: 18 for Bipolar I, 22 for Bipolar II, midteens for Cyclothymia
    • 1/3 of bipolar cases begin in adolescence
    • 1/3 of cyclothymics develop full-blown bipolar
    • Chronic & lifelong course
    • Suicide attempts: 17% for Bipolar I & 24% for Bipolar II
    • Rapid cycling responds poorly to treatment
  • 36. Gender Features
    • Bipolar I and Cyclothymia are equally common in men and women
    • Bipolar II is more common in women.
    • Men tend to have more Manic Episodes
    • Women tend to have more Major Depressive Episodes
    • Women are more likely to be rapid cyclers
  • 37. Biological Theories for Mood Disorders
    • Genetic Theories:
    • If an individual has a mood disorder, the rates of mood disorders in his/her relatives is 2-3x greater
    • If one twin has a mood disorder, an identical twin is 2-3x more likely than a fraternal twin to have a mood disorder
    • Severe mood disorders have a stronger genetic contribution
    • Bipolar disorder has a stronger genetic loading
    • Women have a stronger genetic contribution for depression than men do
  • 38. Biological Theories for Mood Disorders
    • Neurotransmitter Theories:
    • Low levels of serotonin (5HT)
    • Permissive hypothesis: when 5HT levels are low, other neurotransmitters, such as norepinephrine and dopamine, range more widely & become dysregulated, contributing to mood irregularities
    • Kindling-sensitization model: neurotransmitter systems become more easily dysregulated with each episode of depression or mania
    • Dopamine may play a role in manic episodes
  • 39. Biological Theories for Mood Disorders
    • Neurophysiological Abnormalities
    • Sleep EEG abnormalities:
      • Sleep continuity disturbances – the person takes longer to fall asleep, wakes more throughout the night, & wakes much earlier than usual in the morning
      • Reduced slow wave sleep
      • Earlier onset of REM sleep
      • Increased duration & intensity of REM sleep
  • 40. Biological Theories for Mood Disorders
    • Neurophysiological Abnormalities
    • Alterations in cerebral blood flow & metabolism:
      • Increased blood flow to limbic system
      • Decreased blood flow to prefrontal cortex
      • Overactivation of nondominant side of brain
  • 41. Biological Theories for Mood Disorders
    • Hormonal Factors (“The Stress Hypothesis”)
    • Chronic hyperactivity in the hypothalamic-pituitary-adrenal (HPA) axis
    • Inability of HPA axis to return to normal following a stressor
    • Heightened HPA activity produces excess of the stress hormone cortisol, which may inhibit monoamine receptors
    • Chronic stress  poorly regulated neuroendocrine systems
  • 42. Drug Treatments for Mood Disorders
    • Drug Treatments for Major Depression –
      • Monoamine Oxidase Inhibitors (MAOI’s)
      • Tricyclic Antidepressants (TCA’s)
      • Selective Serotonin Reuptake Inhibitors (SSRI’s)
      • SNRI’s
      • Dopamine Agonists
    • Drug Treatments for Bipolar Disorder - Lithium, anticonvulsants, calcium channel blockers, antipsychotics
    • Electroconvulsive Therapy (ECT)
    • Light Therapy (for SAD)
  • 43. Biological Treatments
    • Electroconvulsive Therapy (ECT): person is anesthetized & given muscle relaxant drugs & then electric shock is administered directly to the brain, producing a seizure and convulsions
    • Transcranial Magnetic Stimulation (TMS): magnetic coil is placed over the indiviuals head to generate a precisely localized electromagnetic pulse
  • 44. Behavioral Theories of Mood Disorders
    • Lewinsohn’s Behavioral Model
    • Depression is due to:
    • A lack of rewarding, pleasurable experiences or reinforcement.
    • Stressful, negative life events or aversive consequences.
    • Behavioral deficits and excesses, such as a lack of social skills, continued complaining, & self-preoccupation.
    • Passive, repetitious, unrewarding behavior.
  • 45. Stressor leads to reduction in reinforcers Person withdraws Reinforcers further reduced More withdrawal and depression Lewinsohn’s Behavioral Theory of Depression Behavioral Theories of Mood Disorders
  • 46. Behavioral Theories of Mood Disorders
    • Learned Helplessness Theory
    • Exposure to Frequent, Chronic,
    • Negative Uncontrollable Events
    • Sense of Helplessness
    • Learned Helplessness Deficits:
      • Lack of motivation
      • Passivity – the person stops trying
      • Indecisiveness
      • Inability to effect change or establish control,
      • even in controllable situations
  • 47. Behavioral Therapy for Mood Disorders
    • Increase positive reinforcers & decrease aversive events
    • Change aspects of the environment related to depression
    • Teach person skills for addressing negative circumstances and social interactions more effectively
    • Teach person skills for managing their emotions and moods.
  • 48. Cognitive Theories
    • Aaron Beck’s Theory The Negative Cognitive Triad: Depressed people tend to have negative views of: (1) themselves; (2) the world; (3) the future.
    • Cognitive distortions cause or maintain depression:
    • Distorted Automatic Thoughts – pervasive, negative thoughts regarding oneself, one’s experience, and one’s future, e.g. “Nothing I do works out.”
    • Maladaptive Assumptions – rigid, punitive, unreasonable rules or guiding principles, e.g. “I don’t deserve to be happy.”
    • Negative Schemas – core beliefs about oneself and others, e.g. “I’m such a loser.”
  • 49. Cognitive Theories
    • Seligman’s Theory of the Depressive Attributional Style
    • Self-critical depression and helplessness stem from certain patterns of causal attributions for negative events or failure:
      • Internal (vs. external) – blame self, e.g. lack of effort
      • Global (vs. specific) – touches many areas of one’s life
      • Stable – e.g. lack of ability or aptitude
  • 50. Cognitive-Behavioral Therapy
    • Help person identify and challenge negative, distorted thinking and maladaptive beliefs
    • Help the person learn more adaptive ways of thinking
    • Help clients learn new behavioral skills
  • 51. Psychodynamic Theory
    • Early childhood experiences 
      • unhealthy relationship patterns
      • dependence on the approval of others
      • anxiety about separation and abandonment
    • Introjected hostility – person perceives rejection or abandonment and turns anger in on self, e.g. by blaming or punishing him/herself
  • 52. Psychodynamic Therapy
    • Insight Oriented Approach:
    • Help the person gain insight into “old wounds” and unconscious conflicts and themes, such as introjected hostility and fears of abandonment stemming from childhood, in order to facilitate change
  • 53. Interpersonal Theory of Depression
    • (Klerman, Weissman, Rounsaville, & Chevron)
    • Depression is precipitated or maintained by problematic childhood relationships and current interpersonal difficulties or patterns.
    • Depression occurs in the interpersonal context of:
      • Grief over loss of significant relationships
      • Interpersonal role disputes & conflict
      • Role transitions
      • Interpersonal deficits – e.g. lack of social support or intimacy
  • 54. Interpersonal Therapy
    • Focuses on four types of interpersonal problems:
    • Grief & loss
    • Role disputes & conflict
    • Role transitions
    • Deficits in interpersonal skills
    • Helps the person to establish more social support and more positive, healthy relationships
  • 55. Treatments for Bipolar Disorder
    • Psychotherapy: supportive, psychoeducational, self-care, family involvement
    • Drug Treatments:
      • Lithium Carbonate
      • Anticonvulsants – Depakote, Lamictal
      • Calcium Channel Blockers
      • Antipsychotics