Psychiatry: Mood Disorders

• Major Depressive Disorder (MDD)
• Dysthymic Disorder

• Bipolar I and II
• Cyclothymic Disorders

5/9 symptoms, 2+ weeks

• *Depressed mood (or irritable mood: <18)
• *Anhedonia
• Appetite
• Sleep disturbance, too much/too little
• Agitation or retardation
• Fatigue
• Feelings of worthlessness or guilt
• Difficulty concentrating or deciding
• Recurrent thoughts of death

• SPACE DRAGS
• Sleep Disturbance
• Pleasure/interest (lack of); anhedonia
• Agitation+\???
• Concentration
• Energy (lack of)/fatigue
• Depressed mood
• Retardation movement+\???
• Appetite Disturbance
• Guilt, worthless, useless
• Suicidal thought

• Single= 1 episode
• Recurrent= 2+ episodes separated by > 2 month period

60%

• 2 years (or 1 year for someone under 18)
• Can't be w/o symptoms > 2 months
• 3/7 symptoms

• *Depressed (or irritable mood: <18)
• Concentrating or deciding
• Appetite
• Sleep disturbance, too much/too little
• Energy (lack of)/fatigue
• Low self esteem (MDE:  worthlessness)
• Hopelessness (MDE:  suicidal thought)

Alternating btw Depression and Mani/hypomania

(The two ends of the emotional spectrum.  This is not a personality disorder!)

• 1 week
• 4/8 symptoms (5/8 if mood is irritable)

I DIG FAST

• *Intense elated mood or irritable mood
• Distracted- can't dismiss ireelevant stimuli
• Indiscretion/disinhibition (pleasure acts)
• Grandiosity or inflated self-esteem
• Flight of ideas/racing thoughts
• Activity increase (goals; very productive)
• Sleep deficit/ decrease need for sleep
• Talkative; pressure to keep talking

90%

65%

4 days

• 4 days in duration
• Functioning= different
• Not impaired (socially, or occupationally)
• 3/8 symptoms (4/7 if mood= irritable)

• 7 days, nearly every day
• Meet criteria for Manic Episode
• meet criteria for MDE (except for duration)

• 1+ manic/ mixed episode
• Do not have an MDE

• 0 manic/mixed episode
• 1+ hypomanic episode
• 1+ MDE

• 0 manic/mixed episode; 0 MDE
• Many periods: hypomanic and depressed symptoms
• Chronic (2 years) w/o any remission for 2 months

• Bipolar affects men and women equally.
• Women are more heavily affected by all the others.

• MDE: 4-9 mo
• DYST: 5 yrs
• BP1: Wks-mo
• BP2: Wks-mo
• CYC: Chronic

Hormone theories have been disproved!!!

• General Response to depressed mood:
• Women:  Ruminating/brooding (not reflection; causes, meaning, and consequences)
• Men: Distraction

Multiple genes likely at play

Relatives:  8-9% of BP relative have BP (compared to 1% of population)

Twins:  MZ (60%), DZ (19%)

• Serotonin= decreased (instability, impulsivity, aggression, suicide)
• Dopamine= decreased (Low exploratory, outgoing, pleasure-seeking)
• Norepinephrine= decreased (low alertness)

• Serotonin:  decreased (instability, impulsivity, aggression, suicide)
• Dopamine:  increased (exploratory, outgoing, pleasure seeking; not cocaine stimulates dopamine production - produces manic-like behavior)
• Norepinephrine:  increased (regulates tendencies, alertness)

• Diathesis= biology (serotonin transporter [s/l]; controls ability of an axon to reabsorb serotonin after its release)
• Stress= environment (# of stressful life events)

4

s/s

Drawing a negative conclusion that lacks supports (ie. Company goes out of business and you lose your job.  You're convined its due to your inabilities)

• Arbitrary Inference
• Overgeneralization

Sweeping generlizations from 1 neg incident (ie. if lecturer gives numerous lectures on mood disorders and loses her train of though.  Then she's convinced she can never give a lecture again.)

manic episodes

Bipolar disorder

40%

BP

(Pts. seek help when depressed)

35%

Primary care doctor (45% of the time)

• PHQ-9 (Patient Health Questionnaire)
•        9 Q's, +=10
• MDQ (Mood Disorder Questionnaire)
•        13 Q's, +=7

Remember:  screening does NOT equal diagnosis

• Screening
• Monitoring
• Treating

• SSRIs (Serotonin Reuptake Inhibitors)
• Antidepressants

• Prevents the presynaptic neuron from reabsorbing serotonin
• Neurotransmitter remains longer in the synaptic cleft
• Can be recognized again and again by the receptors of the recipient cell

• Change brain levels of neurotransmitters
• Effective for 60% of pts.
• Take 3-4 wks to produce effects
• Placebo effect:  Improvement because expects effect

Zoloft, Luvox, Celexa, Paxil, or Seroxat

• Mood Stabilizers: Lithium
• Anticonvulsants:  Depakote, Tegretol

Giving a bipolar person antidepressant will throw them into a manic episode

• Decreases duration/frequency, severity of both manic and depressed episodes
• 70% have an initial response
• Many ultimately relapse

Tremors, thirst, weight gain, cognitive impairment

*Must be monitored closely because it can be toxic

• Pt. is anesthetized and given muscle-relaxing drugs to prevent bone breakage
• Electric shock (less than 1 second) administered to the brain to produce seizures (last several minutes)
• usually done every other day for 6-12 sessions
• Can significantly reduce depression in pts. who don't respond to medication

Controversial b/c:  We don't know why it works.  Produces memory loss/confusion (disappears after a week or two)

Goal:  Stabilize rhythms (sleep-wake cycle)

• Cognitive-Behavioral Therapy (CBT)- Cognitive erors and distorted thoughts
• Interpersonal Therapy-resolve problems in relationships; skills to form new relationships

• CBT is as effective as medication (60%)
• Actually changes neurotransmitter levels

CBT is more effective at:  1) maintaining gains; 2) preventing further relapse