Transcript Mood Disorders - Psychology for you and me

Mood Disorders
Major Depression
And
Bipolar Disorder
Mood Disorders
• A wide range of behaviors are seen in mood
disorders. The three main types of mood
disorder are depressive disorders, bipolar
disorders, and other mood disorders which are
substance-induced or due to general medical
conditions.
• Facts about Mood Disorders Depressive
disorder is relatively common. Bipolar
disorders are much less common than
depressive disorder. The overall rates of both
depressive and bipolar disorders, but not their
typical symptoms, seem to be affected by a
variety of cultural, economic, and
environmental factors.
Types of mood disorder
Depressive Disorder
1.
Dysthymic disorder:
2.
Major depressive disorder: One or more major depressive
History of depressed mood a majority
of the time.
episodes.
Bipolar Disorders
1.
Bipolar I disorder: One or more manic episodes, and usually
one or more major depressive episodes.
2.
Bipolar II disorder: At least one hypomanic episode and one or
3.
Cyclothymic disorder: Numerous hypomanic episodes and
more major depressive episodes but no manic episode or
cyclothymia.
numerous periods of depressive symptoms that do not meet
criteria for major depressive episode.
Depression
• Depression can refer to a symptom or a disorder. The
symptom of depressed mood does not necessarily mean a
person has a depressive disorder. Although some symptoms of
depression occur frequently in people who “have the blues”
but are nor clinically depressed, those who do not meet DSM
IV criteria experience more symptoms and symptoms are
more sever. Depressive disorders are sometime referred to as
unipolar disorder to differentiate these types of depression
from that found in bipolar disorder. There are several
categories of depressive disorder. Patients often describe the
symptom of depression as one agonizing emotional pain and
sometimes complain about unable to cry, a symptom that
resolves as they improve. About two thirds of all depressed
patients contemplate suicide, and 10 to 15 percent commit
suicide.
Structures of mood disorders
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A. Unipolar disorder refers to the experience of either depression
or mania, and most individuals with this condition suffer from unipolar
depression. Bipolar disorder refers to alternations between
depression and mania. Feeling depression and manic at the same
time is referred to as a dysphoric manic or mixed episode.
B. An important feature of major depressive episodes is that they are
time limited, lasting 2 weeks to 9 months if left untreated.
C. Almost all major depressive episodes remit without treatment.
Manic episodes remit without treatment after six months. Thus, it is
important to determine the course or temporal patterning of the
depressive and manic episodes. Different patterns appear in the
DSM-IV-TR under the heading course modifiers for mood disorders.
D. Course modifiers characterize the past mood state and are
helpful to predict the future course of the disorder. Understanding the
course is related to predicting future occurrences of mood changes
and in helping to prevent them.
Dysthymic Disorder
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Dysthymic disorder shares many of the symptoms of major
depressive, but unlike major depression, the symptoms in dysthymia
tend to be milder and remain relatively unchanged over long periods
of time, as much as 20 or 30 years. Dysthymic disorder is defined by
persistently depressed mood that continues for at least 2 years.
During this time, the person cannot be symptom free for more than 2
months at a time. Many eventually experience a major depressive
episode at some point.
a.
The mean age of onset for dysthymia is typically in the early
20s (i.e., late onset). The onset of dysthymia before age 21 (i.e.,
early onset) is associated with (a) greater chronicity, (b) relatively
poor prognosis (i.e., response to treatment), and (c) stronger
likelihood of the disorder running in the family.
b.
The median duration of dysthymic disorder is approximately 5
years in adults and 4 years in children.
c.
Patients suffering from dysthymia have a higher likelihood of
attempting suicide than those suffering from major depressive
disorder.
DSM-IV-TR Diagnostic Criteria for
Dysthymic Disorder
A.depressed
mood for mood for most of the day, for more days than not,
as indicated either by subjective account or observation by other,
for at least 2 years. Note: In adolescents, mood can be irritable
and duration must be at least 1 year.
B. Presence, while depressed, of two (or more0 of the following:
(1) Poor appetite or over eating
(2) Insomnia or hypersomnia
(3) Low energy or fatigue
(4) Low self-esteem
(5) Poor concentration or difficulty making decisions
(6) Feelings of hopelessness
C. During the 2-year period (1 yr. For children or adolescents) of the
disturbance, the person has never been without symptoms in
criteria A and criteria B for more than 2 months at a time.
Cont.DSM-IV-TR Diagnostic Criteria
for Dysthymic d/o
D. No major depressive episode has been present during the first
2 years of the disturbance (1 year for children and
adolescent_ I.e. the disturbance is not better accounted for by
chronic major depressive disorder, in partial remission. Note:
there may have been previous major depressive episode
provided there was full remission (no significant signs or
symptoms for 2 months) before development of the dysthymic
disorder.
E. There has never been a manic episode, a mixed episode, or a
hypomanic episode, and criteria have never been met for
cyclothymic disorder.
F. The disturbance does not occur exclusively during the course
of a chronic psychotic disorder, such as schizophrenia or
delusional disorder.
Cont. Diagnostic criteria for
Dysthymic Disorder
G. The symptoms are not due to the direct physiological effects
of a substance (e.g. drug of abuse, a medication) or general
medical condition (e.g. hypothyroidism)
H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Specify if:
Early Onset: if onset is before age 21 years
Late onset: if onset is age 21 years or older
Specify (for most recent 2 years of dysthymic disorder):
With atypical features
Cont. Depression
• Almost all depressed patients (97 percent0 complain
about reduced energy; they have difficulty finishing
tasks, are impaired at school and work, and have less
motivation to undertake new projects. About 80 percent
of patients complain of trouble sleeping, especially,
especially early awakening (I.e. terminal insomnia) and
multiple awakenings at night, during which they
ruminate about their problems. Many patients have
decrease appetite and weight gain and sleep longer
than usual. These pt.’s are classified in DSM-IV-TR as
having atypical features. Other vegetative symptoms
include abnormal menses and decrease interest and
performance in sexual activities.
Depressed Mood
• In every language, we often use the term
depression to refer to normal feelings
experiences after significant loss, such as the
breakup of a relationship or the failure to
attain a significant goal. Theses feelings are
not classified as a depressive disorder by
DSM-VI. Symptoms of grief over the death of
a loved one also are not classified as a
depression unless they continue for an
unusually long period.
Vulnerability factors for
depression
• Genetic makeup, or heredity, is an important risk factor
for both major depression and bipolar disorder. Age is
also a risk factor. Women are particularly a risk during
young adulthood, while for men the risk is highest in
early middle age. Gender is also a related risk. Twice as
many women as men in the general population report a
depressive disorder. Other risk factor are experiencing
negative life events and lack of social support,
particularly from close relationships. This support may
be especially valuable if stressful life events have
recently occurred.
Major depressive disorder
• A major depressive episode is marked by
either depressed mood or a loss of interest or
pleasure in almost all activities and at least
four additional symptoms from the following
group: marked weight loss or gain when not
dieting; constant sleeping problems; agitated
or greatly slowed-down behavior; fatigue;
inability to think clearly feelings of
worthlessness, and frequent thoughts about
death or suicide. These symptoms must last at
least 2 weeks and represent a change from
the persons usual functioning.
Diagnostic criteria for 296.2x Major
Depressive Disorder, Single Episode
A.
B.
C.
presence of a single Major Depressive Episode
The major Depressive Episode is not better accounted
for by Schizaoaffective Disorder and is not
superimposed on schizoaffective, Schizophreniform
Disorder, Delusional Disorder, or Psychotic Disorder
Not Otherwise Specified.
There has never been a manic episode, a mixed
episode, or a hypomanic episode. Note: this exclusion
does not apply if all of the manic-like, or hypomaniclike episode are substance or treatment induced or
are due to the direct physiological effects of a general
medical condition.
Cont. diagnostic criteria for major
depressive disorder, single episode
•
If the full criteria are currently met for a Major Depressive Episode, specify its
current clinical status and/or features:
• Mild, Moderate, Severe Without Psychotic Features/Severe With
Psychotic Features
• Chronic
• With Catatonic Features
• With Melancholic Features
• With atypical Features
• With Postpartum Features
If the full criteria are not currently met for a Major Depressive Episode, specify the
current clinical status of the Major Depressive Disorder;
In Partial Remission, In Full Remission
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum onset
Criteria for Major Depressive Episode
A.
Five (or more) of the following symptoms have been
present during the same 2-week period and represent a
change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are clearly due to a general
medical condition, or mood-incongruent delusions or
hallucinations.
(1)
Depressed mood most of the day, nearly every day, as indicated
by either subjective report (e.g. feels sad or empty) or
observation made by other (e.g. appears tearful) Note: in
children and adolescent can irritable mood.
(2) Markedly dimishid interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by
either subjective account or observation made by others).
Cont.
criteria for major depressive episode
(3) Significant weight loss when not dieting or weight gain (e.g. a change
of more than 5% of body weight in a month), or decrease or increase
appetite nearly everyday. Note: in children, consider failure to make
expected weight gains.
(4) Insomnia or hypersomnia nearly every day.
(5) Psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down)
(6) Fatigue or loss of energy nearly everyday
(7) Feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-approach or
guilt about being sick)
(8) Diminished ability to think or concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others)
((9) recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide
Cont. criteria for depressive episode
B. The symptoms do not meet criteria for a Mixed Episode
c. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
D. The symptoms are not due to the direct physiological effects
of a substance (e.g., a drug of Abuse, a medication) or a
general medical condition (e.g. hypothyroidism).
E. The symptoms are not better account for by bereavement,I.e.
after the loss of loved one, the symptoms persist for longer
than 2 months or are characterized by a marked functional
impairment, morbid preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or psychomotor
retardation.
Recurrent Major depressive disorder
• When a person who has experience one
major depressive episode develops the
symptoms again at a later time, the
diagnosis is changed to recurrent major
depressive disorder.
• DSM-IV-TR-Diagnostic criteria, p.
376
Causes and Treatment of
Depression
• Biological factors in Depression- the mechanism for depressed
or manic behavior may be the activity of the neurotransmitter
systems. An early theory, the monoamine hypothesis focused
on the neurotransmitters serotonin and the catecholamines,
but other neurotransmitters including GABA and
acetylcholine also seem to be involved in depression. The
study of the effects of various antidepressant drugs- including
MAO inhibitors, tricyclics, and selective serotonin
reuptake (SSRIs)-has led to hypothesis about the role of the
neurotransmitters in producing behaviors associated with
depression. The search for for markers of depression has been
an important research strategy. The markers investigated
include specific receptor sites in the brain, studied by various
scanning devices, and the role of biological rhythms,
especially in seasonal affective disorder (SAD).
The bipolar disorders
• DSM-IV list four bipolar disorders; Bipolar I disorder,
Bipolar II disorder, cyclothymic disorder, and a
miscellaneous group.
• Is an illness involving episodes of mania and
depression.
• Bipolar I – will experience episodes of mania and
usually major depressive episodes as well. bipolar d/o
has been found to occur with a higher frequency of
creative people such as artist and poets than in the
general population. Episodes of bipolar d/o tend to
recur. The number of recurrence is greater in those who
have a family history that include bipolar disorder.
Bipolar disorder I
Bipolar disorder
• Bipolar II Disorder is variant of bipolar disorder in
which there has been no manic episode but at least one
hypomanic period as well as a major depressive
episode. A hypomanic episode refers to a period of
manic behavior that is not extreme enough to greatly
impair function. People who experience a hypomanic
episode may not see it as pathological, although those
around them may be concerned about the erratic
behavior they see. For the person affected, the feelings
of elation and creativity and the driving energy
characteristic of the hypomanic state can be positive
forces.
• DSM-IV-TR Diagnostic criteria, p.397
Manic/hypomanic& mixed
episodes
A manic episode is a distinct period of abnormality and
persistently elevated, expansive, o irritable mood
lasting for at least 1 week, or less if a patient must be
hospitalized. A hypomanic episode lasts at least 4 days
and is similar to a manic episode except that is not
severe enough to cause impairment in social or
occupational functioning, and no psychotic features are
present. Both mania and hypomania are associated with
inflated self-esteem, decrease need for sleep,
distractibility, great physical and mental activity, and
over involvement in pleasurable behavior