Behavorial Sciences

• mood is defined as an internal emotional condition
• affect refers to how that emotional condition is expressed
• mood disorders are abnormalities of mood and affect
• fyi: mood disorders occur more frequently in single, divorced, and seperated ppl than in married ppl.

• some pt's seem unaware of or may deny depression (i.e. "masked" depression) even though symptoms are present
• cognitive impairment- pseudodementia
• symptoms of depression in both major depressive disorder and bipolar disorder and similar.

Rapid, excited speech, decreased need for sleep, and feelings of self-importance(grandiosity)

depression: decreased energy, difficulty in concentrating and in sleeping, guilt, reduction in appetite, and suicidal thoughts.

• altho pt's may be euphoric, excitable, and hyperactive, those experiencing a manic episode can also be irritable, angry, and hostile
• in mania, mood congruent delusions include those of strength, exceptional abilties, and financial power
• loosening of associations, flight of ideas, word salad, and neologisms
• as a manic episode proceeds, speech becomes difficult to follow and comprehend
• judgment is impaired during a manic episode laws are often broken

• Nuerotransmitters and mood disorders- the activity of NE and serotonin, is altered in pt's with mood disorders
• Dopamine activity may be decreased during depressive episode and increased during manic episodes
• MHPG, VMA, 5-HIAA, HVA occur in the urine, blood, and CSF of many pt's with mood disorders
• Ach levels may be abnormal in mood disorders

• Life stressor may be related to the development of depression
• the loss of a parent in the first decade of life and loss of spouse correlate with major depression.
• misinterpretation of life events, low self-esteem, and loss of hope are involved in cognitive theories about the development of depression
• cognitive therapy is particularly useful in treating these emotional problems

• mild: dysthymia
• severe: unipolar (major depression)

• mild: cyclothymia
• severe: bipolar (manic-depression)

• nonpsychotic depression-not severe enuff for hospitilzation
• MILD DEPRESSED MOOD
• loss of interest or pleasure
• CHRONIC
• not severe enough for hosp.
• note: pt. is functional, but at a suboptimal level

• chronic depressed mood for greater than/equal to 2 yrs. characterized by 2 or more of the following:
• poor app. or overeating
• insomnia/hypersomnia
• low energy or fatigue
• low self esteem
• poor conc. or diff making decisions
• hopelessness

• Nonpsychotic bipolar
• ALTERNATING STATES
• CHRONIC
• often not recognized by the person
• lifetime prevalence <1%

greater than or equal to 2 years with numerous periods of both : Dysthymic and hypomaniac symptoms

• Does not meet dx criteria for bi-polar!!
• Never symptom free for greater than or equal to 2 month period
• never a MDE or a maniac episode

• distinct period of elevated/irritable mood lasting > or = 4 days with: greater than or equal to 3 symptoms of mania, NO MARKED DYSFUNCTION, no psychotic features.
• chronic- may ultimatley have MDE or mania, which changes the diagnosis from cyclothymia to bipolar disorder (I or II)

• Mean age of onset= 40 years
• occurs twice as often in women than in men
• no correlation with social class
• some evidence of genetic etiology

• Mean age of onset = 30 years
• occurs equally in women and men
• higher incidence in upper socioeconomic groups
• strong evidence of genetic etiology

• > or equal to one MDE
• without the history of mania
• one-half to three-fourths of patients with major depression have a second depressive episode
• patients usually are mentally healthy b/w episodes of major depression
• amont patients w/ major depression, an average of five or six depressive episodes commonly occur over a twenty-year period

• greater than or equal to 2 weeks of depressed mood or anhedonia
• PLUS: greater than or equal to four-
• weight change
• sleep change
• psychomotor changes
• loss of energy
• guilt/worthless
• decrease in conc.
• suicidal ideation

• S: Sleep change
• I: Interest loss
• G: Guilt
• E: Energy problem
• C: Concentration poor
• A: Appetite change
• P: Psychomotor changes
• S: Suicidal ideation

• First manic episode often occurs after about three episodes of depression
• Manic episodes usually have a rapid onset and when untreated last about three months
• Period of time b/w manic episodes becomes shorter as bipolar progresses
• Period b/w episodes in bipolar illness is generally 6-9 months.
• Symptoms of major depression plus symptoms of mania-
• alternates b/w depression and mania
• subtypes:
• Bipolar I: mania more prominent
• Bipolar II: recurrent depressive episodes plus hypomaniac episodes
• Note: if alternates w/in 48/72 hours, called "rapid cycling bipolar disorder"

• Bipolar I: greater than or equal to 1 manic episode
• Bipolar II: at least one MDE and at least one hypomanic episode; NEVER a manic episode

• greater than or equal to 1 week of elevated mood or irritability with greater than or equal to 3 symptoms:
• inflated self-esteem (may be delusional)
• decreased need for sleep
• pressure of speech
• flight of ideas
• distractibility
• increased goal-directed avitivities or psychomotor acceleration
• excessive involvment in pleasurable but risky axn's

• "post-partum blues:" mild mood symptoms of short duration (<2 weeks)- this is NOT a psychiatric dx!
• MDD with post-partum onset: onset of MDE w/in 30 days after delivery.
• MDD with psychotic features and post-partum onset: onset of MDE with psychosis w/in 30 days after delivery. This is rare but serious condition associated with infanticide.

• depressive symptoms during the winter months
• winter has shortest days/least amt. of light
• "atypical" symptoms: increased sleep, increased appetite, decreased energy
• caused by abnormal melatonin metabolism; SAD related to seasonal depletion of light
• treat with bright light therapy(phototherapy); (1-2 hrs/day) to suppress release of melatonin. Symptoms respond in 3-4 days
• Note: not melatonin tablets