JADE R.

DINOLAN
BSN-III

MOOD DISORDERS
Disorders that have a disturbance in mood

 Major depressive episode

 Manic episode
 Mixed episode
 Hypomanic episode
 Major depressive disorder
 Dysthymic disorder
 Bipolar disorder

 Major depressive episode

Definition- Major depressive disorders are characterized by sadness severe enough or
persistent enough to interfere with function and often by decreased interest or pleasure in
activities.
Sign and Symptoms-

 You feel sad or irritable most of the day, nearly every day.
 You are less interested in most activities you once enjoyed.
 You suddenly lose or gain weight or have a change in appetite.
 You have trouble falling asleep or want to sleep more than usual.
 You experience feelings of restlessness.
 You feel unusually tired and have a lack of energy.
 You feel worthless or guilty, often about things that wouldn’t normally make you feel
that way.
 You have difficulty concentrating, thinking, or making decisions.
 You think about harming yourself or committing suicide.
Diagnostic Test-

 Transcanial magnetic stimulation ( TMS)- uses magnetic pulses to stimulate nerve cells
in the brain that are involved in regulation of mood.
 Electroconvulsive therapy ( ECT )- is used in depression to impact the function and
effect of neurotransmitters in the brain.
Therapies

 Psychotherapy or “ talk therapy”- is an effective treatment for MDD

Types of MDD Psychotherapy

 Cognitive behavioral therapy- Focus on how our own thoughts and behaviors
contribute to depression. The therapist will help us learn ways to react to things and
challenge our preconceptions.
 Interpersonal therapy- Mainly focuses on how our relationships with others and also
focus on practical issues. We have to learn how to spot unhealthy behaviors and change
them.
 Psychodynamic therapy- It is traditional. The therapist explores behavior patterns and
motivations that we may not be aware of which could contribute to depression.
 Individual Counseling- One-on -one session with MD ( psychotherapist/doctor)

Medical Management
The treatment for major depressive disorder is a combination of antidepressant medication
such as

 Selective serotonin reuptake inhibitors ( SSRIs )

Examples- Sertaline, Citalopram
 Serotonin- norepinephrine reuptake inhibitors ( SNRIs )
Examples- Duloxetine, Venlafaxine
 Tricyclic antidepressants
Examples- Doxepin, Desipramine
2. Seasonal affective disorder (SAD)
Definition

 This type of depression typically strikes during the short days of the year when the sun
isn't out as long.
Sign and Symptoms

 Feeling depressed most of the day, nearly every day

 Losing interest in activities you once enjoyed
 Having low energy
 Having problems with sleeping
 Experiencing changes in your appetite or weight
 Feeling sluggish or agitated
 Having difficulty concentrating
  Feeling hopeless, worthless or guilty
 Having frequent thoughts of death or suicide

Diagnostic Test

 Physical exam. Your doctor may do a physical exam and ask in-depth questions about
your health. In some cases, depression may be linked to an underlying physical health
problem.
 Lab tests. For example, your doctor may do a blood test called a complete blood count
(CBC) or test your thyroid to make sure it's functioning properly.
 Psychological evaluation. To check for signs of depression, your doctor or mental health
professional asks about your symptoms, thoughts, feelings and behavior patterns. You
may fill out a questionnaire to help answer these questions.
 DSM-5. Your mental health professional may use the criteria for seasonal depressive
episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
published by the American Psychiatric Association.
Therapies

 Light therapy
In light therapy, also called phototherapy, you sit a few feet from a special light box so
that you're exposed to bright light within the first hour of waking up each day. Light
therapy mimics natural outdoor light and appears to cause a change in brain chemicals
linked to mood.

 Light therapy is one of the first line treatments for fall-onset SAD. It generally starts
working in a few days to a few weeks and causes few side effects. Research on light
therapy is limited, but it appears to be effective for most people in relieving SAD
symptoms.
 Psychotherapy
 Psychotherapy, also called talk therapy, is another option to treat SAD. A type of
psychotherapy known as cognitive behavioral therapy can help you:
 Identify and change negative thoughts and behaviors that may be making you feel
worse
 Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and
scheduling activities
 Learn how to manage stress

Medical Management
  Antidepressants
 SSRI ( increase serotonin levels )
 Paxil, Prozac, Zoloft
3. Bipolar I disorder
Definition
 A chronic, treatable mood disorder with a relapsing and remitting course marked by
manic episodes, with most patients also experiencing major depressive episodes
 Manic episodes are periods of elevated mood, elevated self attitude (e.g. self esteem or
self confidence), and increased vital sense (physical and mental energy).
 Depressive episodes are characterized by the triad of low mood, self-attitude and vital
sense.
 Previously known as manic-depressive illness
Sign and Symptoms
 Feeling unusually “high” and optimistic OR extremely irritable
 Unrealistic, grandiose beliefs about one’s abilities or powers
 Sleeping very little, but feeling extremely energetic
 Talking so rapidly that others can’t keep up
 Racing thoughts; jumping quickly from one idea to the next
 Highly distractible, unable to concentrate
 Impaired judgment and impulsiveness
 Acting recklessly without thinking about the consequences
 Delusions and hallucinations (in severe cases)
Diagnostic Test
 Physical exam. Your doctor may do a physical exam and lab tests to identify any medical
problems that could be causing your symptoms.
 Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you
about your thoughts, feelings and behavior patterns. You may also fill out a
psychological self-assessment or questionnaire. With your permission, family members
or close friends may be asked to provide information about your symptoms.
 Mood charting. You may be asked to keep a daily record of your moods, sleep patterns
or other factors that could help with diagnosis and finding the right treatment.
 Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the
criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), published by the American Psychiatric Association.

Therapies
Psychotherapy
 In addition to medication, psychotherapy, or ‘talk’ therapy, can be an effective
treatment for bipolar disorder. It can provide support, education, and guidance to
people with bipolar disorder and their families.
 Cogitive behavioral therapy ( CBT )
 Family focused therapy
 Psychoeducation therarpy
Electroconvlsive Therapy ( ECT )
 For cases in which medication and /or psychotherapy does not work,
electroconvulsive therapy ( ECT ) may be useful.
Medical Management
 Mood stabilizing medications are usually the first choice to treat bipolar disorder.
- Lithium, Depakote
 Atypical antipsychotic medications are called “ atypical” to set them apart from earlier
medications, which are called “conventional” or first-generation” antipsychotics.
-Zyprexa, Abilify, Seroquel, Risperdal, Geodon
 Antidepressant mediactions
- Prozac, Paxil, Zoloft, Wellbutrin
4. Bipolar II disorder:
Definition
Bipolar II disorder (pronounced "bipolar two") is a form of mental illness. Bipolar II is similar to
bipolar I disorder, with moods cycling between high and low over time. However, in bipolar II
disorder, the "up" moods never reach full-blown mania. The less-intense elevated moods in
bipolar II disorder are called hypomanic episodes, or hypomania. A person affected by bipolar II
disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II
disorder suffer more often from episodes of depression.

Sign and Symptoms

During a hypomanic episode, elevated mood can manifest itself as either euphoria (feeling
"high") or as irritability.
Symptoms during hypomanic episodes include:

 Flying suddenly from one idea to the next

  Having exaggerated self confidence
 Rapid, "pressured" (uninterruptible) and loud speech
 Increased energy, with hyperactivity and a decreased need for sleep
Diagnostic Test
 Physical exam. Your doctor may do a physical exam and lab tests to identify any medical
problems that could be causing your symptoms.
 Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you
about your thoughts, feelings and behavior patterns. You may also fill out a
psychological self-assessment or questionnaire. With your permission, family members
or close friends may be asked to provide information about your symptoms.
 Mood charting. You may be asked to keep a daily record of your moods, sleep patterns
or other factors that could help with diagnosis and finding the right treatment.
 Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the
criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), published by the American Psychiatric Association.
Therapies
Psychotherapy
Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual,
family or group settings. Several types of therapy may be helpful. These include:

 Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of
daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for
better mood management. People with bipolar disorder may benefit from establishing a
daily routine for sleep, diet and exercise.
 Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs
and behaviors and replacing them with healthy, positive ones. CBT can help identify
what triggers your bipolar episodes. You also learn effective strategies to manage stress
and to cope with upsetting situations.
 Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and
your loved ones understand the condition. Knowing what's going on can help you get
the best support, identify issues, make a plan to prevent relapse and stick with
treatment.
 Family-focused therapy. Family support and communication can help you stick with
your treatment plan and help you and your loved ones recognize and manage warning
signs of mood swings
Medical Management
Mood Stabilizers

 Lithium: This simple metal in pill form is highly effective at controlling mood swings
(particularly highs) in bipolar disorder. Lithium has been used for more than 60 years to
treat bipolar disorder. Lithium can take weeks to work fully, making it better for long-
term treatment than for acute hypomanic episodes. Blood levels of lithium and other
laboratory tests (such as kidney and thyroid functioning) must be monitored periodically
to avoid side effects.
 Carbamazepine (Tegretol): This antiseizure drug has been used to treat mania since the
1970s. Its possible value for treating bipolar depression, or preventing future highs and
lows, is less well-established. Blood tests to monitor liver functioning and white blood
cell counts also are periodically necessary.
 Lamotrigine (Lamictal): This drug is approved by the FDA for the maintenance
treatment of adults with bipolar disorder. It has been found to help delay bouts of mood
episodes of depression, mania, hypomania (a milder form of mania), and mixed
episodes in people being treated with standard therapy. It is especially helpful in
preventing lows.
5. Cyclothymic disorders:
Definition
Cyclothymia is a rare mood disorder which has similar characteristics of bipolar disorder, just in
a milder and more chronic form. If you are suffering from cyclothymia, you experience cyclic
highs and lows that are persistent for at least two years or more. With cyclothymic disorder,
your lows are a mild depression – not characteristic of full major depression.
Sign and Symptoms

 Feelings of sadness, emptiness, and hopelessness

 Irritability
 Feeling tearful
 Sleep disturbances – sleeping much more or much less than usual
 Restlessness
 Feelings of worthlessness and guilt
 Fatigue
 Concentration problems
 Suicidal thoughts
 Loss of interest in activities once considered pleasurable
 Weight changes – due to eating much more or much less than usual
 Lack of motivation
 Impaired judgment, planning, or problem-solving abilities
  Low self-esteem
Diagnostic Test

 Physical exam. A physical exam and lab tests may be done to help identify any medical
problems that could be causing your symptoms.
 Psychological evaluation. A doctor or mental health provider will talk with you about
your thoughts, feelings and behavior patterns. You may also fill out a psychological self-
assessment or questionnaire. With your permission, family members or close friends
may be asked to provide information about your symptoms, such as possible hypomanic
or depressive symptoms.
 Mood charting. To identify what's going on, your doctor may have you keep a daily
record of your moods, sleep patterns or other factors that could help with diagnosis and
finding the right treatment.
Therapies

 Cognitive Behavioral Therapy (CBT) – a focus on changing negative thoughts and beliefs
into positive ones; stress management techniques; identification of trigger points
 Dialectical Behavioral Therapy (DBT) – teaches awareness, distress tolerance, and
emotional regulation
 Interpersonal and Social Rhythm Therapy (IPSRT) – a focus on the stabilization of daily
rhythms – especially related to sleep, wake, and mealtimes; routines being indicative of
helping stabilize moods
Medical Management
The main types of medications used to treat cyclothymia include:

 mood stabilizers such as lithium

 anti-seizure medications (also known as anticonvulsants) include divalproex sodium
(Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
 atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel)
and risperidone (Risperdal) may help patients who don't respond to anti-seizure
medications
 anti-anxiety medications such as benzodiazepine
 antidepressants should only be used in conjunction with a mood stabilizer as they may
cause potentially harmful manic episodes when taken on their own