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Mood Disorders

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Mood Disorders Dr Joanna Bennett * Abnormal depressed mood: Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal ... – PowerPoint PPT presentation

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Title: Mood Disorders


1
Mood Disorders
  • Dr Joanna Bennett

2
Mood Disorders
  • Pervasive alterations in emotions that are
    manifested by depression, mania, or both, and
    interfere with the persons ability to function
    normally

3
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

4
Some related disorders
  • Seasonal affective disorder (SAD)
  • Postpartum depression
  • Postpartum psychosis

5
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

6
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

7
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

8
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

9
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

10
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

11
Types of Bipolar disorder
12
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

13
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

14
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

15
Nursing Diagnosis
  • Assessment/psychiatric interview/MSE
  • Example nursing diagnosis
  • Risk for Suicide
  • Ineffective Coping
  • Hopelessness
  • Self-Care Deficit

16
Aetiology
  • Depression often triggered by stressful life
    events
  • Contributing factors
  • Intensity and duration of these events
  • individuals 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

17
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-ad
    renal) axis - stress
  • dysfunction in serotonin (5-HT(1A) receptor
    activity could be due to a hypersecretion of
    cortisol

18
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).

19
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.

20
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

21
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.

22
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

23
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.

24
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

25
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

26
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

27
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.

28
Management- Maintenance
  • Medication
  • acute phase treatment and at least 6 months of
    continued treatment
  • TCAs, SSRIs, NARIs, MAOIs,
  • St John Wort (Herbal) as effective as
    antidepressants

29
Psychosocial interventions depression
  • NICE Guidelines (2009)
  • Mild depression psychological
  • Moderate depression Medication or Psychological
  • Severe depression CBT medication

30
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)

31
Psychosocial interventions - Bipolar
  • CBT - group /individual
  • 12-14 sessions lt depressive episodes
  • Family therapy
  • psychoeducation, communication skills training,
    and problem-solving skills training.
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