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Mood Disorders

Mood Disorders

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Published by Jo Anne
this was my report for my psych rotation during my internship
this was my report for my psych rotation during my internship

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Categories:Types, Research
Published by: Jo Anne on Aug 01, 2010
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05/17/2012

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Presented by: PGI Ramos, Jo Anne N.

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Refers to a sustained emotional states, not merely to the external (affective) expression of a transitory emotional state. Cluster of signs and symptoms sustained over weeks to months, which represent a marked departure from a person s habitual functioning and tend to recur, often in periodic or cyclical fashion.

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Mood may be normal, elevated, or depressed. The sense of control is lost, and there is a subjective experience of great distress.

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Patients with an elevated mood demonstrates expansiveness, flight of ideas, decreased sleep, heightened self-esteem, and grandiose ideas. Patients with depressed mood show loss of energy and interest, feelings of guilt, difficulty concentrating, loss of appetite, and thoughts of death or suicide.

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These disorders always result in impairment of interpersonal, occupational, and social functioning.

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A major depressive disorder occurs without the history of a manic, mixed, or hypomanic episodes. 
Must last at least 2 weeks  Experiences at least 4 symptoms of:
Changes in appetite and weight Changes in sleep and activity Lack of energy Feelings of guilt Problems thinking and making decisions Recurring thoughts of death and suicide

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A manic episode is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood. 
Must last at least 1 week or less

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A hypomanic episode is similar to manic episode except that it is not severe enough to cause impairment in social or occupational functioning, and no psychotic features are present 
Must last at least 4 days

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Both mania and hypomania are associated with inflated self-esteem, decreased need for sleep, distractibility, great physical and mental activity, and overinvolvement in pleasurable behavior.

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Bipolar I Disorder: having a clinical course of one or more manic episodes and, sometimes, major depressive episodes. Mixed Episodes: a period of at least 1 week in which both a manic episode a major depressive episode occur almost daily. Bipolar II Disorder: episodes of major depression and hypomania rather than mania.

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Manic 3 Hypo- 2 manic 1
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Major Depression Bipolar I Bipolar II

De- -2 pressed -3
-4 1 2 3 4 5 6 7 8 9 10 11 12 Weeks Identify episodes: Manic Mixed Hypomanic Major Depressive

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Cyclothymic Disorder: characterized by at least 2 years of frequently occurring hypomanic symptoms that cannot fit the diagnosis of major depressive episode. Dysthymic Disorder: characterized by at least 2 years of depressed mood that is not severe enough to fit the diagnosis of major depressive episode.

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Specifiers (Most recent episode) 
Severity/psychotic/remission  Psychotic features: poor prognostic indicator  Melancholic features: severe anhedonia, early

morning awakening

Mood Disorder Depressive Disorders ‡Major Depressive Disorder

Lifetime Prevalence 10-25% for women 5-12% for men Approximately 3% of patients with MDD

‡Recurrent, with full interepisode recovery, superimposed on dysthymic disorder ‡Recurrent without full episode recovery , Approximately 20-25% of persons with MDD superimposed on dysthymic disorder (double depression) Approximately 6% ‡Dysthymic Disorder Bipolar Disorders ‡ Bipolar I ‡Bipolar II ‡Bipolar I or II ‡Cyclothymic disorder 0.4-1.6% Approximately 0.5% 5-15% of persons with Bipolar disorder 0.4-1.0%

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An almost universal observation, independent of country or culture, is the twofold greater prevalence of major depressive disorder in women than in men Reasons: (hypothesized) 
Hormonal differences  Effects of childbirth  Differing psychosocial pressures for women and

for men  Behavioral models of learned helplessness

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Bipolar I has an equal prevalence among men and women. Manic episodes are more common in men Depressive episodes are more common in women When manic episodes occur in women, they are more likely than men to present a mixed picture Women also have a higher of being rapid cyclers (4 or more manic episodes in a 1-year period)

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Bipolar I disorder is earlier than that of major depressive disorder. Age of onset ranges from childhood (as early as 5-6) to 50 years or even older Mean age: 30 years old For MDD, mean age is about 40 years Age of onset for MDD: 20-50 years old

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MDD occurs most often in persons without close interpersonal relationships or in those who are divorced or separated. Bipolar I disorder is more common in divorced and single persons than among married persons, but this difference may reflect the early onset and resulting marital discord characteristic of the disorder.

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No correlation has been found between socioeconomic status and major depressive disorder. A higher than average incidence of bipolar I disorder is found among the upper socioeconomic groups. Depression is more common in rural areas than in urban areas. Bipolar I disorder is more common in persons who did not graduate from college The prevalence of mood disorder does not differ among races.

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BIOGENIC AMINES: Abnormalities in biogenic amine metabolites are reported have been documented in CSF, urine, and blood in patients with mood disorders. NEUROENDOCRINE REGULATION: The adrenal, thyroid, and growth hormone axes are the major neuroendocrine axes reported in mood disorders.

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SLEEP ABNORMALITIES: Problems with sleeping initial and terminal insomnia, multiple awakenings, hypersomnia are common and classic symptoms of depression and a perceived decreased need for sleep is a classic symptom of mania. CIRCADIAN RHYTHM: Sleep deprivation have led to theories that depression reflects abnormal regulation of the internal biological clock.

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NEUROANATOMICAL CONSIDERATIONS: Involve the pathology of the limbic system, basal ganglia, and the hypothalamus. 
Altered sleep, appetite, sexual behavior

dysfunction of the hypothalamus  Stooped posture, motor slowness, minor cognitive impairment (similar to Parkinson s disease and subcortical dementia) signs of disorder of basal ganglia.

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A genetic factor plays a significant role in transmitting bipolar I disorder than major depressive disorder. 1st degree relatives 8-18x more likely to develop bipolar I disorder and 2-10x to develop MDD The likelihood of having a mood disorder decreases as the degree of relationship widens. 50% of all bipolar I disorder patient have at least one parent with a mood disorder, most often MDD. If one parent has bipolar I disorder there is a 25% chance that any child will have a mood disorder.

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Bipolar I disorder in monozygotic twins has a concordance of 33-90% MDD in monozygotic twins has a 50% concordance rate The concordance rates in dizygotic twins are about 5-25% for bipolar I disorder and 10-25% for MDD.

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Stressful life events more often precede first, rather than subsequent, episodes of mood disorder. Stress accompanying the first episode, results to long lasting changes in brain s biology. Obsessive-compulsive disorder, histirionic, and borderline disorders may be a greater risk for depression

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Recent stressful events are the most powerful predictors of the onset of depressive episode. Stressors that the patient experiences as reflecting more negatively to his or her selfesteem are more likely to produce depression.

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Classical View of Depression (Sigmund Freud and Karl Abraham): 
Disturbance in infant-mother relationship during the

oral phase (0-18 months)  Depression can be linked to real or imagined object loss  Introjection of the departed objects is a defense mechanism to deal with the distress with the object s loss  The lost object is regarded with a mixture of love and hate, feelings of anger are directed inward at the self.

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Karl Abraham believed that manic episodes may reflect an inability to tolerate a developmental tragedy. The manic state may also result from a tyrannically superego, which produces intolerable self-criticism that is then replaced by euphoric self-satisfaction. Mania is a defensive reaction to depression, using manic defenses such as omnipotence (delusion of grandeur).

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Learned Helplessness: internal causal explanations are thought to produce a loss of self-esteem after adverse external events. 
Outcomes were independent of responses

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Therapeutic Goals: 
Patient s safety must be guaranteed.  A complete diagnostic evaluation of the patient

must be carried out.  Treatment plan that addresses not only the immediate symptoms but also the patient s perspective well-being must be initiated.

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Hospitalization 
Risk for homicide or suicide  Grossly reduced ability to get food or shelter  Rapidly progressing symptoms  Rupture of a patient s usual support system

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Psychotherapy Pharmacotherapy 
MDD: Tricyclic antidepressants, SSRIs

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Bipolar I Disorder: Lithium, Divalproex, and Olanzapine (standard treatments)

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