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MOOD

Mood

Persistent emotional state or tone

Affect (external display of feelings or observed


emotional response)

Primary disturbance in mood

Pervasive and sustained feeling or tone that is


experienced internally and that influences a
persons behaviour and perception of the world
(can be normal, elevated or depressed)

Disabling disturbances in emotional state

Continuum with normal mood

Poor appetite and weight loss, or less often


increased appetite and weight gain

Loss of energy, great fatigue

Negative self-concept, self-reproach and selfblame; feelings of worthlessness and guilt

Complaints or evidence of difficulty


concentrating, such as slowed thinking and
indecisiveness

Recurrent thoughts of death or suicide

Criteria for Manic Episode

Mood Disorder

Group of clinical conditions characterized by a loss of


that sense of control and a subjective experience of
reat distress; virtually always results in impaired
interpersonal, social and occupational functioning

Elevated or irritable mood for at least one week, plus


three of the following (four if mood is irritable)

Increase in activity level at work, socially, or


sexually

Unusual talkativeness; rapid speech

Flights of ideas or subjective impression that


thoughts are racing

Pervasive & significant change in mood

Beyond normal happiness during good times

Less than usual amounts of sleep needed

Beyond normal sadness during bad times

Onset often associated with stressful events or situation

Inflated self-esteem; belief that one has


special talents, powers, and abilities

Recurrence common

Distractibility; attention is easily diverted

DSM-IV

Excessive involvement in pleasurable activities


that are likely to have undesirable
consequences, such as reckless spending

Unipolar mood disorders

Additional notes:

Major depressive disorder

Dysthymic disorder

Bipolar mood disorders

BipoIar I disorder

Bipolar II disorder

Cyclothymic disorder

Known etiology

Substance-induced mood disorder

Mood disorder due to a general


medical condition

Criteria for Depressive Episode

Sad, depressed mood, most of the day, nearly everyday


for two weeks or loss of interest and pleasure in usual
activities, plus at least four of the following

Difficulties in sleeping (insomnia); not falling


asleep initially; not returning to sleep after
awakening in the middle of the night, and early
morning awakenings; or, in some patients, a
desire to sleep a great deal of the time
Shift in activity level, becoming either lethargic
(psychomotor retardation) or agitated

The symptoms do not meet criteria for a mixed


episode.

The mood disturbance is sufficiently severe to


cause marked impairment in occupational
functioning or in usual social activities or
relationships with others, ot to necessitate
hospitalization to prevent harm to self or others,
or there are psychotic features.

The symptoms are not due to direct


physiological effects of a substance or a
general medical condition.

** Mixed-like episodes that are clearly caused by somatic


antidepressant treatment should not count toward a diagnosis
of bipolar 1 disorder.

Hypomanic Episode

Same features as a manic episode but less severe


intensity lasting at least 4 days

Not severe enough to caused marked impairment in


social or occupational functioning, does not require
hospitalization and no psychotic symptoms
Additional notes:
DSM IV TR Criteria for Hypomanic Episode

A distinct period of persistently elevated, expansive


or irritable mood lasting throughout at least 4 days
that is clearly different from the usual nondepressed
mood.

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During the period of mood disturbance, 3 or


more of the ff symptoms have persisted (four if
the mood is only irritable) and have been
present to a significant degree:

Inflated self-esteem or grandiosity

Decreased need for help (e.g feels rested


after only 3hrs of sleep)

More talkative than usual or pressure to keep


talking

Flight of ideas or subjective experience that


thoughts are racing

Distractability (e.g attention too easily drawn to


unimportant or irrelevant external stimuli)

Increased in goal-directed activity (either


socially, at work or school, or sexually) or
psychomotor agitation

Major Depression, formerly called Unipolar


Depression, affects around 5.2% to 17.1% of the
population at any given time.

Prevalence rates suggest that it is increasing in


the 20th Century and that its age of onset is
deceasing.

Depression affects people differently across the


lifespan.

Excessive involvement in pleasurable activities


that have a high potential for painful
consequences (e.g the person engages in
unrestraining buying sprees, sexual
indiscretions or foolish business investments)

The episode is associated with an unequivocal


change in functioning that is uncharacteristic of
the person when not symptomatic

The disturbance in mood and the change in


functioning are observable by others

The episode is not severe enough to cause


marked impairment in social or occupational
functioning or to necessitate hospitalization
and there are no psychotic features

The symptoms are not due to the direct


physiological effects of a substance or a
general medical condition

** Hypomanic0like episodes that are clearly caused by


somatic antidepressant treatment should not count
toward a diagnosis of bipolar 2 disorder.

Mixed Episode

Meets criteria for both a manic and a major


depressive episode nearly every day during at
least a 1 week period
Additional notes:

The mood disturbance is sufficiently severe to


cause marked impairment in occupational
functioning or in usual social activities or
relationships with others, ot to necessitate
hospitalization to prevent harm to self or
others, or there are psychotic features.

The symptoms are not due to direct


physiological effects of a substance or a
general medical condition.

** Mixed-like episodes that are clearly caused by somatic


antidepressant treatment should not count toward a
diagnosis of bipolar 1 disorder.

Mood Disorders

Children typically have disturbances in


behavior, or somatic complaints and dont
necessarily admit to or recognize
changes in mood.

Elderly typically are distractible or have


memory loss.

Shift in activity level, becoming either


lethargic (psychomotor retardation) or
agitated. In rare instances, patients have
the opposite reaction, particularly
psychotic symptoms.

Poor appetite and weight loss or


increased appetite and weight gain

Loss of energy, great fatigue

Negative self concept, self-reproach and


self-blame; feelings of worthlessness and
having inappropriate feelings of guilt

Difficulty of concentrating such as slowed


thinking and indecisiveness which
impairs the ability of the patient to fulfil
certain responsibilities

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Recurrent thoughts of death or suicide


what you should always have to evaluate
for.

Additional notes:

The symptoms are not due to direct


physiological effects of a substance (e.g
drugs) or a general medical condition
(e.g. hypothyroidism)

The symptoms are not better accounted


for by bereavement (e.g death of a loved
one).

There are also cultural differences in depression.

Sometimes depression is mild and more acute


(short term) while at other times it can be very
intense reaching psychotic proportions. Other
times it is more chronic and last years.

Involves patients who may manifest both spectrum


of mood disturbances (extremes of the mood
spectrum)

bipolar I - History of at least one manic or mixed


episode.
-

Involves episodes of both mania and


depression

Episodes of mania tend to reoccur true


for all types of mood disturbances

bipolar II - History of at least one major


depressive episode and at least one hypomanic
episode.

Epidemiology
-

Incidence - 7 per 100,000


Prevalence - lifetime
Bipolar I 4 to 24 per 1000
Bipolar II 3 to 50 per 1000

There is great heterogeneity among the mood


disorder categories.

Patients with the same disorders can


vary tremendously

The length of time that symptoms persist


varies greatly, too.

Some patients experience mania


(symptoms last at least one week
and greatly impairs functioning)
while other patients experience
hypomania (symptoms last at least
four days and does not greatly
impair functioning).

Some patients experience melancholia which is a


specific pattern of symptoms and includes an
inability to feel pleasure in anything and usually
feel worse in the morning.

Both mania and depression can take on psychotic


symptoms as well including both mood congruent
and mood incongruent features.

This psychotic symptomatology can include


catatonia which includes both motoric immobility
or excessive, purposeless activity and agitation.

Episodes of depression tend to recur.

Bipolar I and II

The symptoms cause clinically significant


distress or impairment in social,
occupational or other areas of
functioning.

Hypomania 26 to 78 per 1000

Heterogeneity within Diagnoses

The symptoms do not meet criteria for a


mixed episode.

Depression

Chronic forms of Mood Disorders

Cyclothymic Disorder form of mania that


includes frequent periods of depression and
hypomania that can recur with asymptomatic
periods lasting no longer than two months. Often
the symptoms are not as severe as a full blown
episode of mania or depression

Dysthymic Disorder form of depression that


includes chronically present symptoms of
depression. The difference between major
depression and dysthymia is the duration of the
symptoms (longer in dysthymia) and that
dysthymia has fewer symptoms for a diagnosis (3
instead of 5). Dysthymic Disorder can last for
many years.

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Sometimes mood disorders can be brought on by


general medical conditions (i.e., cancer or arthritis)
or can be the result of substance abuse.

Sometimes substance abuse can mask the


presence of a mood disorder so when the
substance is not present the mood disorder is
present.

Seasonal Affective Disorder typically happens in


the Winter and may result from the loss of hours of
sunlight.

Etiology and Treatment of Mood Disorders

Psychoanalytic

Etiology loss, dependent on external


approval, anger directed inward. Mania a
defense against depression.

Treatment Theory of depression:


depression was introjected anger the
treatment involves learning how to not
hold your anger in.

Free association

Hypnosis

Catharsis
Behavioral learned helplessness
Etiology Maladaptive learning
May involve the loss of and/or lack of
reinforcers in the environment
Treatment Relearn
appropriate/effective behaviors
Social skills training
Assertiveness training
Relaxation training
Humanistic
Etiology Thwarted human growth and
potential
Treatment Unleash or unblock growth
and nurture the healthy potential in the
individual
Basic empathy
Unconditional positive regard
Genuineness
Relationship is especially
important
Frank discussion of these can concerns
can be very useful
Other - Existential Therapy

All of the difficulties of human existence


can result in anxiety and depression
Cognitive
Etiology Maladaptive thoughts
Becks

The Negative view of


self

The Negative
interpretation of
experiences

The Negative
expectation of the
future
Treatment Alter distortions and
maladaptive thoughts
Confrontation
Skills training
Problems solving approach
Biological -The Genetic/Family Data
Bipolar disorder
10-25% of 1st degree relatives
have experienced an episode of
mood disorder
70% identical twins
25% fraternal twins
Dominant gene on 11th
chromosome
Unipolar depression
Less risk as compared to bipolar
disorder
Monozygotic twins>dizygotic
twins concordances
Women>men concordances
Biological biochemical data
This area of mood disorders has
advanced perhaps more than any area in
the treatment of mood disorders
Etiology Underlying biological issues
Based on the assumption that
there is an imbalance of
neurotransmitters in the nervous
system
Treatment Provide symptomatic relief
of mood symptomatology
Re-establish the proper level of
neurotransmitters in the brain

The wide use of antidepressant medications is


evidence of the trend in
the field of psychiatry

MAO-I

Tricyclic

SSRI

ECT
Encourage lifestyle changes

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Systematically provide
education to support life
changes
Suicide Assessment and Prevention

Giving direct verbal cues, such as "I wish I were


dead" and "I'm going to end it all" (suicidal threats)

Giving less direct verbal cues, such as "What's the


point of living?," "Soon you won't have to worry
about me," and "Who cares if I'm dead, anyway?"

Risk Factors for Suicide

Previous suicide attempt(s)

History of mental disorders, particularly depression


and alcohol or other substance abuse

Looking for ways to kill him- or herself: seeking


access to pills, weapons or other means.

Increasing alcohol or other drug abuse

Family history of suicide

Acute or chronic losses (relational, social, work,


financial or physical)

Global insomnia Isolating him- or herself from


friends and family

Chronic physical illness, particularly if associated


with chronic pain

Exhibiting a sudden and unexplained improvement


in mood after being depressed or withdrawn

Neglecting his or her appearance and hygiene.

Easy access to lethal methods

Impulsive or aggressive tendencies

Take it seriously

Feelings of hopelessness or isolation

Remember: suicidal behavior is a cry for help.

Be willing to give and get help sooner rather than


later.

Listen.

Ask questions

If the person is acutely suicidal, do not leave him


alone.

Urge professional help.

No secrets.

Crisis to Recovery

Protective Factors

An individual's genetic or neurobiological make-up

Attitudinal or behavioral characteristics

Family and community support

Effective and appropriate clinical care for mental,


physical and substance abuse disorder

Easy access to effective clinical interventions and


support for help-seeking.

What can we do to help?

Restricted access to highly lethal methods of


suicide

Cultural and religious beliefs that discourage


suicide and support self-preservation instincts

Do you ever wish you could go to sleep and never


wake up?

Support from ongoing medical and mental health


care relationships

Acquisition of learned skills for problem solving,


conflict resolution and non-violent management of
disputes

Sometimes when people feel sad, they have


thoughts of harming or killing themselves, Have
you had such thoughts?

Are you thinking about killing yourself?

When was the last time that you thought about


suicide?

Questions to Ask

Warning Signs

Talking or writing about suicide, death or dying

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Factors to Warrant Intermediate Intervention

The patient's expressed wish to die


Any evidence of a current psychiatric disorder

Past incidents of suicidal behavior or self-harm

A family history of suicide

Sources: lectures ppt and some notes

A history of psychiatric disorders or the abuse of


alcohol and other drugs

The patient's admission that he or she has


considered suicide

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