Transcript Unipolar or Bipolar

Unipolar or Bipolar
Mood Disorders
Major Depressive Disorders
Bipolar Disorders
Dysthymic Disorder
Cyclothymic Disorder
Current Research – NIMH Report
(July 2003)
• Stress-sensitive version of serotonin transporter
gene
– Noted as “short version”
• Confers vulnerability to stresses (job loss, relationship
breaks, deaths of loved ones, prolonged illness)
– at high risk for depression
– 43% versus 17% w different version of gene
• Individuals abused as children also high risk
• Found by study of “stress histories”
• Not yet ready for diagnostic testing
– Needs confirmation
– May predispose
Necessary Clinical Information
• History of:
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• Current mood
financial difficulties/failed • Guilty feelings, quality of
self-esteem
businesses
increased sexual activity & • Current hallucinations or
delusions
sexual indiscretions
• Current & previous suicide
previous depression,
ideation/attempts
hypomania, or mania
• Change in energy level or
rapid switches in mood
fatigue
substance abuse
• Change in pattern of sleep
medical illness
Mood Disorders
• Share a disturbance of mood
• Mania/depression
– not due to another physical or mental disorder
• Mood may/may not affect social or occupational
functioning (clinical significance)
• Prolonged emotion generally affects entire life
• Distinguished by
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intensity of abnormal mood
duration
impairment produced
behavioral, cognitive or physical symptoms
Major or Unipolar Depression
• Profound sadness & related
problems, such as sleep &
appetite disturbance, loss
of energy & self-esteem
issues
• Meds – Luvox, Prozac,
Zoloft, Paxil, others
Major Depressive Episode
• Major depressive episode
– core syndrome of severe depression
• Some specific diagnoses
– distinguished by # of major depressive episodes
– & presence/absence of manic or hypomanic
episodes
• Child may present different symptoms
• Mixed Episodes – criteria from both
manic & depressive
Manic Episode
• Mania must result
– in marked dysfunction for Bipolar I
• Unusually & persistently elevated,
expansive, & irritable mood
• Individual usually unaware of problem
• No clue that they make no sense
• Appears to come on suddenly
• Frequently resistant to treatment
Bipolar Disorders
• Episodes of either mania alone or of both mania &
depression
– Mania episode involved
Mania indicates:
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Mood elevated or irritable
Extreme activity, talkativeness
Distractible
Frequently resists treatment
• Meds – Lithium, Zoloft, Wellbutrin, Prozac,
Depakote
Symptoms:
Major Depressive Disorder
• Depressed mood; no
mania
• Loss of pleasure in
activities
• Weight loss or gain
• Change inapposite
• Change in sleep pattern
• Agitation
• Loss of energy
• Sense of
worthlessness
• Difficulty
concentrating
• High mortality rate
– Thoughts of death
– Suicidal ideation
Chronic Mood Disorders
• Cyclothymia
– frequent periods of
depressed &
hypomania for at
least 2 years
• Hypomania episodes
– disturbances of
mania not severe
enough to cause
major impairment
• Dysthymia
– chronic depression
– Persistent depression
for 2 years or more
– May or may not
significantly impair
activities
– Determine whether
opposite behavior
ever present
Specifiers
• Use specifiers with all mood disorders to
describe most recent episode
• Code specifiers in 5th digit
• If psychotic features specify whether mood
congruent or mood-incongruent
• Use with course of recurrent episodes also
– Rapid cycling
– Seasonal cycling etc
Ask yourself these questions
• Is client’s mood abnormal?
• Could client’s symptoms be produced by
drugs or a nonpsychiatric medical illness?
• Does client have symptoms of psychosis? Do
these symptoms occur only in presence of
mood symptoms?
• Has client ever had a manic, hypomanic, or
mixed episode?
• Is the client’s current mood depressed?
Depression in Children & Adolescents
• Increased risk for illness,
interpersonal &
psychosocial difficulties
– May persist long after
episode passes
• Increased risk
– for substance
– for suicidal behavior
• Often unrecognized
• Symptoms often seen as
– normal mood swings
typical of development
• Health care workers
reluctant
– to prematurely “label”
• Early diagnosis &
treatment
– Critical to healthy
emotional, social, &
behavioral development
– Can reduce duration &
severity
Scope of Problem with Youth
• 2.5 % of children
• NIMH study of 9-17 yr olds
– Estimate prevalence
• 8.3% of adolescents (other
• 6% in 6-mo period
study 7-14% total)
– With 4.9 major depression
• Onset earlier today
• Often co-occurs
• Recovery rate
– Single episode of MDD is high
• Dysthymia
– may lead to MDD
• MDD - likely family history
• Childhood Risk
– Boys & girls equal risk
• Adolescence Risk
– Girls twice as likely
– commonly anxiety, disruptive
behavior, or substance abuse
• Symptoms expressed
differently
– acting out or irritable toward
others
– Talking with parents
important
• Medications controversial
Signs Associated with children &
adolescents
• Frequent, vague nonspecific complaints
• School
– Frequent absences
– Poor performance
• Talk of or efforts to
runaway
• Outbursts of shouting,
unexplained irritability,
complaining, or crying
• Being bored
• Alcohol or substance abuse
• Social isolation, poor
communication
• Fear of death
• Extreme sensitivity
– to rejection or failure
• Increased irritability, anger,
or hostility
• Reckless behavior
• Difficulty with relationships
• Lack of interest in playing
with friends