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Surgeon General’s Report 1999
(Part 2)
Mood Disorders
and
Schizophrenia
MOOD DISORDERS
7 % of Americans suffer from mood
disorders
Rank among the top ten causes of
WORLDWIDE disability
The two that will be covered today:
~Major Depressive Disorder
~Bipolar Disorder
Comorbidities
(what Mood Disorders coexist with)
Anxiety Disorders
Substance Abuse Disorders
40% of people with mood disorders
also have substance abuse disorders
Clinical Depression
vs.
Normal Sadness
(what distinguishes Major Depressive Disorder?)
Anhedonia
Hopelessness
Loss of mood
reactivity
Suicidal thoughts
Delusions
Characteristics
of Major Depressive Disorder
One or more episodes lasting at least 2 weeks
Cardinal Symptoms:
Depressed mood
Loss of interest or pleasure
When untreated:
Lasts 9 months
50% will recur
Dysthymia
a CHRONIC form of depression
BIPOLAR DISORDER
Episodes of mania mixed with episodes of
depression
Recurrent
How is Bipolar Disorder
DIFFERENT from Major
Depressive Disorder?
Manic episodes
Earlier age at onset
Reversed vegetative symptoms
Oversleeping, overeating
Lithium salts are therapeutically effective
The MANIA Phase
Thought content is GRANDIOSE and
PARANOID
Speed of thought increases
Sleep deprivation contributes to delirious
mania
Equally common in both men and women
CYCLOTHYMIA
a MILDER form of Bipolar
Disorder
ETIOLOGY
of Mood Disorders
Biological factors
Monoamine Hypothesis
Deficiency of monoamine transmitters
SSRI’s boost serotonin levels
Depressed patients have too much activity in
the HPA axis
Depressed patients have higher levels of
CRH
ETIOLOGY, continued…
Psychosocial Factors
Stressful life events
The most stressful:
Death of a loved one
Cognitive factors
It’s all about perception
Temperament &
Personality
Neuroticism predisposes
Gender
All over the world,
Major Depressive
Disorder is more
common in women
Genetic
Tend to run in
families
TREATMENT
of Mood Disorders
Biggest problem= getting people into
treatment at all
More than 50% of depressed people don’t
get treatment
More than 40% of bipolar people don’t get
treatment
Reasons…
TREATMENT, continued…
Stages of Therapy
Acute phase
Usually requires 6-8 weeks
Electroconvulsive Therapy
Most common adverse effects: confusion and
memory loss
Continuation phase
At least 6 months of continued treatment
Maintenance phase
Purpose is to prevent future occurrences
TREATMENT
for specific episodes of
Depression and Mania
Four major classes of drugs
TCAs, HCAs, MAOIs, SSRIs
Newer therapies for Depression
Cognitive-Behavioral therapy
Interpersonal psychotherapy
Newer treatments for Mania
Verapamil is a calcium channel blocker
SCHIZOPHRENIA
…the BRIEFEST of
overviews…
CHARACTERISTICS
of Schizophrenia
Profound disruption in cognition and
emotion
Symptoms frequently include:
psychotic manifestations
Assigning unusual significance to normal
events
Having delusions
POSITIVE symptoms
(excess/distortion of normal functions)
Delusions
Hallucinations
Disorganized speech
Catatonic behaviors
Disorganized
thinking
Grossly distorted
behavior
NEGATIVE symptoms
(diminution or loss of normal functions)
Affective flattening
Alogia
Avolition
Recovery Factors
Family/Home atmosphere
Personal motivation
Availability of skill-building assistance
ETIOLOGY
of Schizophrenia
Immediate biological relatives have 10
times greater risk
Discordance among identical twins
indicates environmental factors also
important
Brain abnormalities include:
Enlarged cranial ventricles
Decreased cerebral size
PHYSIOLOGY
of Schizophrenia
Positive symptoms linked to
TEMPORAL LOBE dysfunction
Negative symptoms linked to
PREFRONTAL LOBE dysfunction
Pharmacotherapy Interventions
Chlorpromazine (older) and Clozapine (newer)
reduce the POSITIVE symptoms of
Schizophrenia
Newer meds also reduce the NEGATIVE
symptoms
Moderate levels of dosage are most effective
Problem: SIDE EFFECTS
40% of patients have side effects (parkinsonism and tardive
dyskinesia)
Clozapine is the prototype of the newer meds
THE END