Mood disorders


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Mood disorders

  1. 1. Andrea Gatto Senior Clinical Psychologist St. James’s Hospital
  2. 2.  Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) classification system where a disturbance in the person's mood is the main underlying feature. 2
  3. 3.  Two groups of mood disorders are broadly recognized:  Depressive disorders, of which the best known is Major Depressive Disorder (MDD) commonly called clinical depression or major depression; and Dysthymia.  Bipolar disorder (BD), formerly known as manic depression. 3
  4. 4.  ‘Depression is an affective state characterised by sad mood, anhedonia the inability to derive pleasure from activities such as eating or sex, and in psychomotor, sleeping, and eating patterns’ American Psychiatric Association (APA), 2000 4
  5. 5.    Depression ranks as the primary emotional problem for which help is sought which severe, complex problems, and rumination is a common feature. Depressed people often believe that their ruminations give them insight into their problems, but clinicians often view depressive rumination as pathological because it is difficult to disrupt and interferes with the ability to concentrate on other things. Abundant evidence indicates that depressive rumination involves the analysis of episode-related problems. Because analysis is time consuming and requires sustained processing, disruption would interfere with problem-solving. 5
  6. 6.  Symptoms:  constant feelings of sadness, irritability, or tension  decreased interest or pleasure in usual activities or hobbies  loss of energy, feeling tired despite lack of activity  a change in appetite, with significant weight loss or weight gain  a change in sleeping patterns, such as difficulty sleeping, early     morning awakening, or sleeping too much restlessness or feeling slowed down decreased ability to make decisions or concentrate feelings of worthlessness, hopelessness, or guilt thoughts of suicide or death 6
  7. 7.  Where a person has one or more major depressive episodes:  After a single episode, Major Depressive Disorder (Single Episode) would be diagnosed.  After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent).  Depression without periods of mania is sometimes referred to as unipolar depression because the mood remains at one emotional state or "pole". 7
  8. 8.  Diagnosticians recognize several subtypes or course specifiers:  Atypical depression  Melancholic depression  Psychotic major depression  Catatonic depression  Postpartum depression  Seasonal affective disorder 8
  9. 9.   Depression is commonly considered to be a neurochemical disorder, and it is often treated with antidepressant medications. Psychotherapy try to help people solve problems in their lives, and controlled experiments have shown that they work just as well as medications in the acute phase and have lasting posttreatment effects:  Cognitive behavioural therapy (CBT)  Enhanced behavioural activation therapy (EBA)  Interpersonal therapy (IPT) 9
  10. 10.  CBT has positive effects in the acute and post-treatment phases. In CBT, intervention is possible at a number of points, including:  helping depressed people solve the problems that cause their cognitions  helping depressed people stay engaged in their social environment so they can test the veracity of their cognitions  directly helping them change the way they think about their 10
  11. 11. The goal of EBA is to identify the punishing or non-rewarding aspects of the environment that the depressed person attempts to avoid and help the person find ways to make them more rewarding.  In the acute phase, EBA worked better than CBT and just as well as antidepressants, and just as well as CBT in the post-treatment phase.  Moreover, this study found that patients with severe, chronic depression did not respond well to CBT, whereas they responded better to EBA.  11
  12. 12.   Another effective psychotherapy is interpersonal therapy (IPT), and one of its primary goals is to assess the interpersonal problems that depressed people face and help them develop strategies and skills for solving them. Like EBA, there is some evidence that IPT may work better than CBT, and IPT appears to work just as well as medications in the acute phase 12
  13. 13.   Is a chronic, different mood disturbance where a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression). 13
  14. 14. Is a chronic and often devastating illness that may go diagnosed because of its complex and diverse presentation.  By the year 2020, bipolar disorder will be the sixth leading cause of disability worldwide among all medical illnesses.  Clinicians can provide psychological treatments, in conjunction with pharmacotherapy, that can reduce the frequency, severity, and duration of maniac and depressive episodes.  Persons with the disorder vary between the extremes of mania (a highly energized, elated, or irritable state) and depression (a deflated, withdrawn, morose, and often suicidal state).  14
  15. 15.     Bipolar I is distinguished by the presence or history of one or more manic episodes or mixed episodes with or without major depressive episodes. Bipolar II consisting of recurrent intermittent hypomanic and depressive episodes. Cyclothymia is a form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no full manic episodes or full major depressive episodes. Bipolar Disorder Not Otherwise Specified (BD-NOS) sometimes called "sub-threshold" bipolar, indicates that the patient suffers from some symptoms in the bipolar spectrum (e.g. manic and depressive symptoms). 15
  16. 16. The family environment is an important context for understanding the development and maintenance of severe psychopathology and mood disorders in particular.  Current thinking about the relapse–remission course of bipolar disorder emphasizes a biopsychosocial model that incorporates the interactive roles of genetic vulnerability, biological predispositions, family or life events stress, and psychological vulnerability.  The illness is clearly heritable, and there is substantial evidence for dysfunction of the neurotransmitter systems (notably dopamine and serotonin) and of the limbic–cortical system.  Specifically, elevated activity in the amygdala and diminished activity of the frontal-cortical regions may interfere with the capacity to regulate emotion.  16
  17. 17. Key Features of Family-Focused Treatment    Commences shortly after an acute episode of mania, depression, or mixed disorder Involves the patient and one or more relatives (spouse, parents, siblings) Consists of three consecutive modules:  Psychoeducation: didactic information and interactive discussion about the symptoms of bipolar disorder, early warning signs, relapse prevention plans, roles of risk and protective factors, and the importance of medication adherence.  Communication enhancement training: behavioural rehearsal of effective speaking, listening, and negotiating skills, with homework practice.  Problem-solving skills training: identify and define specific family problems, brainstorm solutions, evaluate the advantages and disadvantages of each solution, choose one or a combination of solutions, develop implementation plans; homework between sessions . 17
  18. 18. Andrews, P. W., & Thomson, J. A., Jr. (2009). The bright side of being blue: depression as an adaptation for analyzing complex problems. Psychological Review, 116(3), 620-654. Beynon, S., Soares-Weiser, K., Woolacott, N., Duffy, S., & Geddes, J. R. (2008). Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. The British Journal of Psychiatry: The Journal of Mental Science, 192(1), 5-11. Cuijpers, P., van Straten, A., van Schaik, A., & Andersson, G. (2009). Psychological treatment of depression in primary care: a meta-analysis. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 59(559), e51-60. Dumit, J. (2003). Is It Me or My Brain? Depression and Neuroscientific Facts. Journal of Medical Humanities, 24(1/2), 35-47. Hyde, J. S., Mezulis, A. H., & Abramson, L. Y. (2008). The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression. Psychological Review, 115(2), 291-313. Johnson, S. L., Cuellar, A. K., Cueller, A. K., Ruggero, C., Winett-Perlman, C., Goodnick, P., White, R., et al. (2008). Life events as predictors of mania and depression in bipolar I disorder. Journal of Abnormal Psychology, 117(2), 268-277. Leahy, R. L. (2007). Bipolar disorder: Causes, contexts, and treatments. Journal of Clinical Psychology, 63(5), 417-424. Miklowitz, D. J. (2007). The Role of the Family in the Course and Treatment of Bipolar Disorder. Current directions in psychological science, 16(4), 192-196. 18