Mood Disorders

1
Mood Disorders

• Affect vs. mood
• Cause disturbances in mood or emotion
• Not due to medical condition or substance abuse
• Not due to grief reaction
• Excessive for amount of actual environmental
  stress (or inappropriate response to environment)

2
Normal Grief

• Response to loss or emotional stressor
• Death, failure, loss of relationship, illness
• Often mixture of depressed/anxious mood
• Feelings of despair/sadness/loss
• Physiological sx tightness in chest, weakness,
  insomnia
  
• Grief reaction diminishes with time
• Approx 6 months moratorium
• Adjustment dx

3
Health Psychology

• Study of emotional reactions to health problems
• Psychoneuroimmunology
• Tx of secondary depression/anxiety
• Diagnosis of mental illness in medical
  populations
  
• Somatic symptoms

4
Depressed mood

• Normal reaction to loss, life stress
• Sadness, hopelessness (temporary), despair,
  feeling overwhelmed
  
• Diminishes with adjustment
• Factors influencing
• Weather
• Mood of others
• Diet
• Exercise
• Sleep
• Medications
• Nostalgic reactions

5
Depressive disorder Risk Factors

• Female gender
• Age teens, low to mid 20s, again among elderly
• Separation/Divorce/Marital Discord
• Although happily married people are happier
  than single (particularly men)
  
• Chronic stress (e.g. low SES)
• Family hx.
• Baby Boomer generation
• 25 female, 10 male lifetime prevalence

6
Depressive Episode

• At least 2 week period
• Persistent sadness (almost all day, almost every
  day)/Irritability
  
• Anhedonia
• Sleep/eating disturbances
• Psychomotor agitation/retardation
• Fatigue/energy loss
• Poor attention/concentration
• Guilt/worthlessness/hopelessness/isolation
• Poor self-esteem
• Suicidal ideation
• Delusions/hallucinations possible

7
Major Depression

• History of at least 1 depressive episode
• With psychotic features
• With postpartum onset
• With seasonal pattern
• Situational vs. Biological

8
Dysthymia

• Enduring pattern or mild depressive symptoms
• Lasting at least 2 years (1 under age 18)
• Less than 2 months w/o
• Double Depression

9
Biological Theories of Depression

• Genetics mild relation (compared to other
  disorders)
  
• Hormonal thyroid, pituitary, hypothalamus,
  overproduction of cortisol
  
• Neurochemical norepinephrine, serotonin get
  most attention. Melatonin as well

10
Common medications

• MAO Inhibitors prevent breakdown of NE,
  effective.
  
• If mixed with cheese, chocolate, beer, red wine,
  can cause fatal BP increase
  
• Weight gain, liver damage, interactions with
  other meds
  
• Parnate and Nardil most common
• Tricyclics, prevent reuptake of NE (and Serotonin
  to lesser extent), effective
  
• Dry mouth, constipation, vision problems, sexual
  dysfunction, fatal overdose
  
• Tofranil (imipramine), Elavil most common
• SSRIs prevent S reuptake, effective
• Agitation, nausea, sexual dysfunction, suicide
  risk in children
  
• Prozac, Paxil, Zoloft, Luvox
• Atypicals Work either on both serotonin and NE
  (Serzone, Effexor, Remeron) or remain rather
  mysterious (Wellbutrin) in their effects

11
CBT for Depression

• Behavioral Activation (Exposure)
• Cognitive Restructuring
• Thought Stopping
• Problem Solving

12
Manic Episode

• Expansive, euphoric or irritated mood (1 week)
• nonresponsive
• Decreased need for sleep
• Psychomotor agitation
• Pressure of speech
• Flight of ideas
• Poor concentration, distractibility
• Impulsive
• Poor reality contact

13
Bipolar Disorder

• Formerly manic-depression
• At least 1 manic episode (and typically at least
  1 depressive episode)
  
• Tends to be lifelong, repetitive, debilitating
  illness
  
• Legal problems are common
• Bipolar II
• Hypomania
• Cyclothymia
• Rapid Cycling 4 or more episodes in 1 year
• 1 prevalence (possibly lower) male and female

14
Etiology

• Cause largely unknown
• Serotonin, NE, Glutamate, protein kinase
• Genetics
• Larger component for Bipolar disorder
• Probably largely biological etiology although
  environmental stress may worsen risk

15
Treatment

• Almost exclusively medical
• Lithium, very effective in treating mania
• Highly toxic, abdominal pain, weight gain,
  gastrointestinal problems, dry mouth, liver
  problems
  
• Anti-Seizure meds Carbamazepine, Depakote
  (Valproic Acid), Neurontin, Topamax
  
• Anti-Psychotics Seroquel, Abilify, Zyprexa
  commonly used

16
Suicide

• Response to psychological pain
• Often occurs with lift in symptoms
• Relatively rare event
• 13 out of every 100,000 deaths
• But11th (2002) leading cause of death
• 15 of major depression cases attempt suicide
• Females 2-3x more likely to attempt
• Males 3-4X more likely to succeed

17
Suicide Continued

• Risk factors
• Social isolation
• Response to other suicides
• Religion, having children protective factors
• Parasuicide
• Suicide w/o depression
• Cultural expectations (e.g. Imperial Japan)
• Terminal illness