Mood and Affective Disorders

Depression Bipolar affective disorders

Mood and Affective DisordersDr Aseni WickramatillakeWhat is a mood disorder?Mood:An individuals personal state of emotions

Affect : An individuals appearance of mood

Moods can be elevated or depressedMood Disorders

DepressionManiaintense sadness, feelings of futility and worthlessness, and withdrawal from othersten times greater than mania

elevated mood, expansiveness, or irritability, often resulting in hyperactivity.ten times less than depression

Emotional state characterized by3-Read Amandas story on page 354Causes of Mood DisordersChildhood loss, bereavementGenetic influencesThe depressed brainNegative moods feed negative thoughtsHelplessness/HopelessnessNegative attribution: negative reasons we give for why an event occurredPoor social networking

Causes of Mood DisordersNeurotransmittersCircadian Rhythms High levels of cortisol StressNeurotransmittersDepression is associated with low levels of serotonin or norepinephrineSerotonin regulate our emotional reactionsmore impulsive and wide moods swings are seen during low serotonin levels

Medications increase the availability of serotonin and/or norepinephrine in the synapse

6Neurotransmitters and Mood DisordersSymptoms of DepressionDepressed moodDejectionExcessive and prolonged mourningWorthlessness, lack of joy.PessimismDecreased energyDisinterest and loss of motivationSelf-accusations of being incompetent

Symptoms of DepressionSocial WithdrawalLowered Work ProductivityLack Of Personal CleanlinessSlow Speech And Bodily MovementsLoss Of Appetite/WeightConstipationSleep DisturbanceDisruption Of Menstrual Cycle And Aversion To Sexual Activity.

Types of Mood DisordersDepressive Disorders / Unipolar DisordersMajor depressive disorders Dysthymic disorder Depressive disorders not otherwise specifiedBipolar Disorders: Characterized by one or more manic or hypomanic episodes + one or more depressive episodesBipolar disorder IBipolar disorder IICyclothymic disorder

1111-Figure 11.2: Multipath Model for Unipolar Depression. The dimensions interact with one another and combine in different ways to result in unipolar depression.Major Depressive DisorderNo history of mania, hypomania, or mixed episodePrevalence : Female > MaleAverage age of onset in mid-20sIf untreated, average duration of first episode is 6-9 months; often recur Recurrent episodes(2 or more episodes)

Major Depressive Episode5 or more symptoms (1 must be either depressed mood or loss of interest) for 2 weeks

Symptoms:Depressed moodLoss of interest in activities (anhedonia)Significant weight loss or gain; decrease or increase in appetiteInsomnia or hypersomniaPsychomotor agitation or regardationFatigue or loss of energyFeelings of worthlessness or guiltPoor concentration or indecisivenessRecurrent thoughts of death or suicide or attempts of suicide

1414Dysthymic DisorderLess severeChronic low grade depressionDepressed mood nearly every day for > 2 yearsNo more than 2 months symptom freePrevalence equal in males and femalesAge on onset in the 20sSlow response to treatment may need higher doses, longer duration of treatment

Symptoms of Dysthymic DisorderDepressed mood most of day for most daysplus 2 of the following for >2 yearspoor appetite or overeatinginsomnia or hypersomnialow energy or fatiguelow self-esteempoor concentration or difficulty making decisionsfeelings of hopelessness

16Hypomania and ManiaHypomaniaManiaHigh MoodOveractive BehaviorPoor JudgmentDelusions (Rare),Attempts To Be DominatingGrandiose.

Pronounced overactivityGrandiosityIrritabilityincoherent speechLack of tolerance for criticism Lack of restraintDiagnosis of Manic Episodes Abnormally and persistently elevated, expansive, or irritable mood for at least 1 weekWith 3 additional symptoms

18Symptoms of Manic EpisodesInflated self-esteem/grandiosity (Belief that one has special talents, powers, and abilities)Decreased need for sleep (3 hrs.)Unusual talkativeness or rapid speechFlight of ideas/racing thoughtsIrritable19Symptoms of Manic EpisodesMarked distractibilityIncreased energy, enthusiasm, self-assertion at work, school, or in social situations IncreasedExcessive involvement in pleasurable activities with potential for painful consequences (spending money, excessive alcohol/drug use, reckless driving, and risky sex)

Hypomanic EpisodeElevated, expansive, or irritable mood for at least 4 days

Symptoms similar to manic episode, except no marked impairment/hospitalization21Mixed Episodecriteria for both major depressive episode and a manic episode at the same time

Symptoms persist for at least 1 weekBipolar Affective DisorderLifetime prevalence is 1%Average onset age is late teens-early 20Occurs equally often in men and womenStronger genetic relationship

Bipolar Disorder ISingle manic episodeno past major depressive episode Most recent episode hypomanicat least 1 past manic or mixed episode Most recent episode manicat least 1 past major depressive, manic, or mixed episode Most recent episode mixedat least 1 past major depressive, manic, or mixed episode Most recent episode depressedat least 1 past manic or mixed episodeBipolar Disorder IIAlternate between hypomanic and major depressive episodesAt least 1 or more Major Depressive Episode At least 1 Hypomanic Episode Never a Manic or Mixed Episode25Bipolar Affective DisorderBipolar IBipolar IIAt least one manic or mixed episodeNo need for a prior depressive episodeMore severe illness than Bipolar II and easier to diagnosePrevelance : men= women

At least one previous major depressive episodeAt least one hypomanic episodeLess severe than Bipolar I and more difficult to diagnosePrevelance: women>men

Cyclothymic DisorderAlternate between numerous episode of depressed and hypomanic symptoms which does not meet criteria for major depressive episode Present for at least 2 yrsNever free of symptoms for longer than 2 months.No major depressive, manic, or mixed episode

Rapid cyclingChange in four or more mood episodes within any 1 year periodCan be very difficult to treat

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3030-Table 11.2: Symptoms of Depression and Mania.ComparisonDepressive DisorderBipolar DisordersAge of onset : late 20sthan unipolar.ikely to exhibit anxietyPrevelance: 8-19% of adult population has major depressive disorder.

Age of onset : early 20sGreater psychomotor retardation and risk of suicide greater for bipolar Prevelance: 1%-2% of adult populationRespond to lithium

31Treatment of DepressionMedicalAntidepressantstricyclicsMAO inhibitorsSSRIsothersPsychosocialCognitive-behavioral therapyInterpersonal therapyOtherElectroconvulsive therapy (ECT)Light

32Treatment of Bipolar DisorderLithium is the best treatmentLithium blood levels should be monitoredLarge number respond well initiallySide effectsExcessive thirst and urinationDamage to kidneys and thyroid

Adjunctive treatmentsBenzodiazepinesSeclusion and restraintSleep aidsECTPsychosocial treatment33