Mood Disorders

Yüklə 123 Kb.
ölçüsü123 Kb.

Mood Disorders


  • Mood – pervasive emotional state of patient

  • Depression - #1 burden of disease for ages 15-45

  • Bipolar - #6 burden of disease ages 15-45

Mood Disorder Neurobiology

  • Depression – associated with low levels of NE & serotonin in body

  • Mania – associated with high levels of NE & serotonin in body

  • Antidepressants – aim to increase the synaptic transmission of NE/serotonin, or both

  • Hypothalamic-Pituitary-Adrenal (HPA) axis – depression causes hyperactivation

    • Excess cortisol secretion – as a result of whole HPA axis screwed up

    • Dexamethasone Suppression Test (DST) – in depression, cortisol unsuppressed in DST

  • Hypothalamic-pituitary-thyroid axis – depression associated w/ hypoactivationhypothyroidism


  • Sleep cycle – altered for the worse  decreased sleep time, more frequent REM, less slow wave sleep

  • Neuroimaging – decreased volume/metabolism in frontal lobes, amygdala, hippocampus

  • Learned Helplessness” – fatalist mentality of chronically depressed, believe life events out of control

The Major Depressive Episode

  • Major Depressive Episode – defined as 2 weeks of consistently depressed mood with some symptoms:

    • Decreased appetite/weight loss – in most cases; but can be increased in atypical

    • Insomnia – usually early waking; but can be increased in atypical

    • Psychomotor – retardation & slow movement; but can be increased in atypical

    • Fatigue – loss of energy

    • Learned Helplessness” – fatalist mentality of chronically depressed; often inappropriate guilt

    • Death/Suicide Ideation – recurrent thoughts of death/suicide

  • Impaired Function – to qualify as major depressive, must impair function or cause significant distress

  • Substance Abuse/Medical Illnessdon’t qualify as major depressive episodes

  • Bereavement – normal in many circumstances, also doesn’t qualify

Depressive Episode Subtypes

  • Atypical – can have increased appetite, hypersomnia, preserved affect; sensitive to rejection

  • Melancholia – prominent anhedonia (no pleasure or interest in anything), along w/ depressive symptoms

  • Postpartum – depressive episodes within 4 weeks of delivery of child

  • Catatonic – depressive episode with characteristic motor signs (similar to Schizophrenia)

  • Psychotic Features – accompany 10% of depressive episodes  1% population psychotic!

  • Seasonal – depressive episodes occur most commonly in fall/winter

The Manic Episode

  • QUIZ: Manic Episode – defined as 1 week of continuous elevated/expansive/irritable mood with some symptoms:

    • Inflated self-esteem – takes on grandiose ideas, increased involvement in goal-directed activity

    • Decreased sleep need – manic episode requires little to no sleep each day

    • Loud, rapid, intrusive speech – can talk for hours without breaking/prompting

    • Flight of ideas – constantly racing thoughts, very distractible

    • High-risk behavior – fast driving, indiscriminate sex, spending sprees, bad investments, etc.

  • Impaired Function - to qualify as manic episode, must impair function or have active psychosis

  • Subtypes – include mixed, psychotic features, rapid cycling:

    • Mixed – episode meets criteria for both depressive episode and manic episode “crash and burn”

    • Psychotic Features – present in 80% manic episodes, has grandiose delusions and poor insight

    • Rapid Cycling – episodes occur 4 or more times per year

The Hypomanic Episode

  • Hypomanic Episode – defined as 4-7 days of symptoms same as manic episode

  • QUIZ: Unimpaired Function – unlike a manic episode, patient stays unimpaired and can be very productive

  • No Psychosis/Hospital Admission – patient stays away from threshold of manic episode

Major Depressive Disorder

  • Major Depressive Disorder – having one or more depressive episodes, without manic/hypomanic episode

  • QUIZ: Prevalence – twice as common in women as men:

    • Lifetime risk – 10-25% for women; men half

    • Point Prevalence – 5-10% of women; men half

  • Onset – very wide age range, can be sudden or gradual, strong genetic component

  • Recurrence – 50% of patients experience recurrence

  • Recovery – 50% recover after 6 months

  • Treatment – include medications, psychotherapy, and electroconvulsive therapy (ECT)

    • Antidepressant RxSSRIs, tricyclic antidepressants = 1st line; MAOIs = 2nd line; 6-month Tx

    • Psychotherapy – cognitive behavioral therapy (stopping spirals), good for mild Tx, good with Rx

    • Electroconvulsive Therapy – used w/ severe depression, 80% effective, great Tx but $$$

      • Indications – non-response to other therapies, psychotic features, high sucide risk, starvation/dehydration, pt. request, prior response

      • CI: intracranial mass, dementia, severe personality disorder, anesthesia risk

Major Depressive Disorder + Pyschotic Features

  • Prevalence – about 10% of depressed patients  1% population!

  • Mood – psychotic symptoms usually congruent with mood

  • Treatment – can give combination drugs or ECT:

    • Combination drugsunlike other depressive disorders, need antidepressant and antipsychotic

    • ECT – electroconvulsive therapy also highly effective treatment (80%)

Dysthymic Disorder

  • Dysthymic Disorder – at least 2 years of mildly depressed mood, with a couple depressive symptoms

  • Prevalence – lifetime risk 6%, point prevalence 3%

  • Double Depression” – can be co-morbid w/ major dep.  slightly depressed always + depressive bursts

  • Treatment – antidepressants, psychotherapy (cognitive behavioral Tx CBT, interpersonal Tx IPT)

Bipolar I Disorder

  • Bipolar I Disorder – have one or more manic episodes, regardless of depressive

  • Prevalence – 1% lifetime prevalence, 1:1 M:F, strong genetic component

  • Onset – range teens-60s, peaks 20s, rapid onset: elevated mood  euphoria  irritability  pyschosis

  • Triggers – often triggered by stress, lack of sleep; can be followed/proceeded by depressive episode

  • QUIZ: Recurrence – 90% of patients have recurrent episodes, prophylaxis essential

  • Recovery – 70-80% recover to full function between episodes, rest are persistently unstable

  • Complications – high suicide risk; can also ruin life (relationships, reputation, etc)

  • Treatment – involves antipsychotics & mood stabilizers:

    • Antipsychotics – 1st line treatment

    • Mood Stabilizers – lithium, Valproic acid, anticonvulsants – 1st line Tx and prophylaxis!

    • No Antidepressants – bad idea, can help trigger manic episodes

Bipolar II Disorder

  • Bipolar II Disorder – have one or more hypomanic episodes (no manic), at least one depressive

  • Prevalence, Onset, Course, Complications, Treatment – same as Bipolar I

Cyclothymic Disorder

  • Cyclothymic Disorder – chronic fluctuating mood not qualifying for manic/major depressive episodes

  • Onset – very gradual, unlike Bipolar I & II disorders

  • Prevalence, Treatment – same as Bipolar I & II  1%, give antipsychotics & mood stabilizers

Substance Induced Mood Disorder

  • Substance-Induced Mood Disorder – persistent mood disturbance related to intoxication/withdrawal

  • Common Drugs – alcohol = depressant, amphetamine, cocaine, steroids = mood elevators

  • Treatment – can resolve spontaneously after de-tox, or may need antidepressants

Mood Disorder Due to General Medical Condition

  • Definition - persistent mood disturbance related to direct physiological effects of illness

  • Illnesses – huge range, can be neurologic, endocrine, infectious…

Adjustment Disorder with Depressed Mood

  • Definition – depressed mood within 3 months of stressor, symptoms resolve by 6 months after removal

  • Depression Criteria – not met during adjustment disorder, although obvious stressor exists

Yüklə 123 Kb.

Dostları ilə paylaş:

Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur © 2024
rəhbərliyinə müraciət

    Ana səhifə