Mood Disorders Dr Joanna Bennett. Mood Disorders Pervasive alterations in emotions that are manifested by depression, mania, or both, and interfere with.

Mood Disorders

Dr Joanna Bennett

Mood Disorders

Pervasive alterations in emotions that are manifested by depression, mania, or both, and interfere with the person’s ability to function normally

Mood Disorders

Major depression: 2 or more weeks of sad mood, lack of interest in life activities, and other symptoms

Bipolar disorder (formerly called “manic-depressive illness”): mood cycles of mania and/or depression and normalcy and other symptoms

Some related disorders

Seasonal affective disorder (SAD)

Postpartum depression

Postpartum psychosis

Prevalence

International studies Major depression - 3-16% Bipolar disorder 0.3-1.5%

Caribbean 4.9% (PAHO 2005) Community prevalence and risk factors for

mood disorders are generally unknown

DSM Diagnostic criteria – Major depressive disorder

At least one of the following three abnormal moods

significantly interferes with the person's life: Depressed mood Loss of interest & pleasure Irritable mood (under 18 yrs)

Occurring most of the day, nearly every day, for at least 2 weeks

Diagnostic criteria: Depression

At least five of the following symptoms should have been present during the same 2 week depressed period: Depressed or irritable mood Loss of interest & pleasure Appetite/weight disturbance (gain/loss) Sleep disturbances Fatigue/loss of energy Guilt Poor concentration Morbid thoughts of death

Diagnostic criteria: Depression

The symptoms are not due to Physical illness, alcohol, medication, or

street drug use. Normal bereavement. Bipolar Disorder Delusional or Psychotic Disorders

Mania: Signs and symptoms

Grandiose delusions, inflated sense of self-importance

Racing speech, racing thoughts, flight of ideas

Impulsiveness, poor judgment, distractibility Reckless behavior In the most severe cases, delusions and

hallucinations

Mania: Signs and symptoms

Increased physical and mental activity and energy

Heightened mood, exaggerated optimism and self-confidence

Excessive irritability, aggressive behavior Decreased need for sleep without

experiencing fatigue

Types of Bipolar disorder

Diagnostic criteria: Mania

Persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

3 (or more) of the symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

Diagnostic criteria: Mania

inflated self-esteem or grandiosity decreased need for sleep more talkative than usual or pressure to keep

talking flight of ideas or subjective experience that

thoughts are racing distractibility excessive involvement in pleasurable activities

Nursing diagnosis

Psychiatrists have formulated clear guidelines for categorizing mental disorders (DSM-1V, ICD-10) – determines interventions

Nursing diagnosis provides basis for nursing intervention

Systematic collection & integration of data to formulate Nursing Diagnosis

The Nurse combines nursing diagnoses and DSM/ICD classifications to develop the treatment plan

Nursing Diagnosis

Assessment/psychiatric interview/MSE

Example nursing diagnosis

Risk for Suicide Ineffective Coping Hopelessness Self-Care Deficit

Aetiology

Depression often triggered by stressful life events Contributing factors:

Intensity and duration of these events individual’s genetic endowment coping skills social support network - depression and

many other mental disorders are broadly described as the product of a complex interaction between biological and psychosocial factors

Biological factors

Focus on alterations in brain function Abnormal concentrations of many

neurotransmitters and their metabolites in urine, plasma, and cerebrospinal fluid

Overactivity of the HPA (hypothalamus-pituitary-adrenal) axis - stress

dysfunction in serotonin (5-HT(1A) receptor activity could be due to a hypersecretion of cortisol

Monoamine Hypothesis

Prevailing hypothesis - depression is caused by an absolute or relative deficiency of monoamine transmitters in the brain Evidence that reserpine, a medication for

hypertension, caused depression by depleting the brain of both serotonin and the three principal catecholamines (dopamine, norepinephrine, and epinephrine).

Monoamine Hypothesis

monoamine hypothesis remains important for treatment purposes.

Many currently available pharmacotherapies that relieve depression or mania, or both, enhance monoamine activity.

One of the foremost classes of drugs for depression, SSRIs, increase the level of serotonin in the brain.

Psychosocial and Genetic Factors in Depression

Social, psychological, and genetic factors act together to predispose to, or protect against, depression. many episodes of depression are

associated with some sort of acute or chronic adversity

past parental neglect, physical and sexual abuse, and other forms of maltreatment impact on both adult emotional well-being and brain function

Psychosocial and Genetic Factors in Depression

early disruption of attachment bonds can lead to enduring problems in developing and maintaining interpersonal relationships and problems with depression and anxiety.

Cognitive factors

how individuals view and interpret stressful events contributes to whether or not they become depressed.

the impact of a stressor is moderated by the

personal meaning of the event or situation

Increased vulnerability to depression is linked to cognitive patterns that predispose to distorted interpretations of a stressful event

Genetic factors in depression & Bipolar

Susceptibility to a depressive disorder 2-4 times greater among the first-degree relatives of patients with mood disorder

The risk among first-degree relatives of people with bipolar disorder 6-8 times greater.

Genetic factors in depression & Bipolar

Does not prove a genetic connection.

First-degree relatives typically live in the same environment, share similar values and beliefs, and are subject to similar stressors, the vulnerability to depression could be due to nurture rather than nature

Treatment

50 to 70 % of depressed patients who complete treatment respond to either antidepressants or psychotherapies

Surveys consistently show that a majority of individuals with depression receive no treatment

Treatment

The acute phase - 6 to 8 weeks medication patients should be seen weekly or biweekly

for monitoring of symptoms, side effects, dosage adjustments, and support

Psychotherapies during the acute phase for depression typically consist of 6 to 20 weekly sessions

Treatment - ECT

60 to 70 % response rate seen with ECT Proposed to be useful with poor response

to medication depression is accompanied by potentially

uncontrollable suicidal ideas and actions

The most common adverse effects are

confusion and memory loss for events surrounding the period of ECT treatment.

Management- Maintenance

Medication acute phase treatment and at least 6

months of continued treatment

TCA’s, SSRI’s, NARIs, MAOIs,

St John Wort (Herbal) as effective as antidepressants

Psychosocial interventions : depression

NICE Guidelines (2009)

Mild depression – psychological

Moderate depression – Medication or Psychological

Severe depression – CBT & medication

Drug Treatment - Bipolar

Lithium – Long-term

Anticonvulsants – carbamazipine (not shown to be effective in acute treatment)

Antidepressants – SSRIs (inaequate evidence of effectiveness)

Antipsychotics – olanzapine, rispiridone (effective short-term)

Psychosocial interventions - Bipolar

CBT - group /individual

12-14 sessions < depressive episodes

Family therapy

psychoeducation, communication skills training, and problem-solving skills training.