Chapter Five Introduction What is sadness and how does it differ from a Mood Disorder DSMIV Classifications Axis OneClinical Disorder Axis TwoPersonality DisorderMental Retardation Axis ThreeGeneral Medical Condition ID: 337551
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Slide1
Mood Disorders
Chapter FiveSlide2
Introduction
What is sadness and how does it differ from a Mood Disorder?Slide3
DSM-IV Classifications
Axis One-Clinical Disorder
Axis Two-Personality Disorder/Mental Retardation
Axis Three-General Medical Condition
Axis Four-Psychosocial and Environment
Axis Five- Educational ProblemsSlide4
Terms used in Psychopathology of Depression
Emotion-
state of arousal defined by subjective states of feeling such as sadness, anger and disgust
.
Affect-
pattern of observable behavior associated with subjective feelings such as facial expression, tone of voice and gestures.
Mood-
pervasive and sustained emotional response that can color the person’s perception of the world
Slide5
Additional Terms
Mood Disorders-
discrete periods of time when a person’s behavior is dominated by either a depressive or a manic mood.
Mania-
flip side of depression that involves a disturbance in mood characterized by elation including inflated self-esteem, euphoria, decreased need for sleep and pressure to keep talking and racing thoughts.
Unipolar Mood Disorder-
behavior is dominated by either a depressed or manic mood
Bipolar disorder (aka manic depressive disorder)-
person experiences episodes of mania as well as depression.
Relapse-
return of active symptoms in a person who has recovered from a previous episode.
Remission-
when a person’s symptoms diminish or improveSlide6
Symptoms and Considerations when diagnosing clinical depression
Differential symptoms between Clinical Depression and Normal Sadness.
Four General types of symptoms.
Emotional
Cognitive
Behavioral
Somatic
Slide7
Emotional
Symptoms
Dysphoric (unpleasant) mood
Diagnostic distinction made between normal sadness and clinical depression Severity, quality and pervasive impact of the depressed mood.
Anxiety-often a co-morbid diagnosis with depression
Manic symptoms-euphoric and energetic at the beginning of the cycle, changing to irritable, angry, out of control, self-destructive.Slide8
Cognitive Symptoms
Slowed thinking, trouble concentrating and easily distracted
Pre-occupied with guilt and worthlessness
Focus attention on the depressive triad:
Self
Environment
Future
Manic symptoms
easily distracted by random stimuli and often respond inappropriately
Grandiose ideas and inflated self-esteem
Quick to anger, argumentative and abusiveSlide9
Somatic Symptoms
Sleeping Problems-trouble falling asleep, fatigue, early morning waking, spend more or less time sleeping than usual
Appetite-changes—eating more or less than usual
Libido-loss of sexual desire
Manic-
drastic reduction in need for sleep, extremely energeticSlide10
Behavioral Symptoms
Psychomotor retardation-slowed movements, may walk or talk as if they are in slow motion
Manic-
gregarious, energetic, provocative, flirtatious and often sexually inappropriate.Slide11
Classification of Mood Disorders
Unipolar Disorders
Major Depressive Disorder-
One or more depressive episodes
No manic or hypomanic episode ( hypomanic episode is an episode of increased energy that are not sufficiently severe to classify as full blown mania)
Major Depressive Disorder most often follows a course of repeated episodes through life
Dsythymic Disorder
Depressed mood for at least two years, without cessation or remission of symptoms for longer than 2 months during this period.
No major depressive episodes during the first two years.Slide12
Bipolar Disorders
Bipolar I disorder
One or more manic episodes
Usually accompanied by major depressive episodes in between manic episodes
Bipolar II disorder
One or more major depressive episodes
At least one hypomanic episode
No manic episodes
Cyclothymic Disorder
Numerous periods with hypomanic symptoms as well as periods of depressed mood for at least 2 years.
No remission of symptoms for longer than 2 months during the 2 year period.
No major depressive episodes
No manic episodes.Slide13
Further Descriptions: Subtypes
Episode Specifier-
specific descriptions of symptoms that were present during the most recent episode of depression.
melancholia-episode specifier used to describe a particularly severe type of depression, the presence of which indicates the person is likely to be responsive to antidepressant therapy or ECT.
psychotic features- an episodic feature that indicates the presence of hallucinations or delusions during the most recent episode of mania or depression, the presence of which usually requires hospitilization.
Course Specifier
-extensive descriptions of the pattern that the disorder follows over time, as well as adjustment between episodes.
rapid cycling-if the person experiences at least four episodes of major depression, mania, or hypomania within a 12-month period.
Seasonal affective disorder-onset of episodes is regularly associated with a change in seasons.Slide14
Unipolar Disorder: Outcome, Incidence and Prevalence & Etiology
Incidence and Prevalence:
One of the most common forms of psychopathology, the lifetime risk of suffering from this disorder for the general population is 5%.
Gender
Cross Cultural-Universal
Incidence increasing at earlier ages (M=45 years)Slide15
Unipolar
Disorder: Course, Episodes and
Outcome
Duration
Episodes
RecoverySlide16
Bi-Polar Disorders: Course and Outcome
Onset-usually occurs between the ages of 18-22 years which is younger than the average age of onset for
unipolar
Course and Duration-intermittent. Most patients tend to have more than one episode, however the length of time between episodes is difficult to predict.
Incidence and Prevalence- Slide17
Etiology and Theories
Unipolar
Mood Disorder
Social
Interpersonal loss or separation
Major disappointments dealing with acceptance such as getting fired
Stressful events
Psychological
Cognitive Vulnerability:
Beck-Depressive Triad
Theory of Hopelessness
Interpersonal Perspective
Biological-Genetic contribution appears to be highest for bipolar disorder then major depressive disorder and relatively minor for
dysthymia
. Slide18
Etiology and Theories
BiPolar
Disorder
Social Factors
Increased frequency of stressful life events the weeks preceding a manic episode.
Schedule disrupting events such as loss of sleep, holidays
Goal attainment events, such as a major job promotion, acceptance to medical school and graduate school or a new romance.
Social Environments
Aversive emotional stress in the family.
Biological-Genetic contribution appears to be highest for bipolar
disorder. Men and women are equally likely to develop bipolar disorder. Slide19
Biological
Endocrine system
Hypothalamic Pituitary Adrenal Axis (HPA)
Neurotransmitter Levels
Serotonin
Current Neurotransmitter theories
Bidirectional effects
Slide20
Treatment
- Unipolar
Cognitive
-focus on helping patients replace self-defeating thoughts with more rational self statements
Interpersonal Therapy
-attempts to improve the patient’s relationships with other people by building communication and problem solving skills.
Antidepressant Medications
–Selective Serotonin re-uptake inhibitors developed in the 1980’s. They are the most frequently prescribed treatment, however medication with other mechanisms of action are also used.Slide21
Antidepressant Therapy
Selective Serotonin Re-uptake Inhibitors
Mechanism of action-reuptake pump
Side Effects
Tricyclics (Tofranil)
Mechanisms of action ( Considered 5 drugs in one)
SRI- reuptake pump
NRI-reuptake pump
Anti-Cholinergic
Alpha 1 antagonists (blocks)
Histaminergic
Side Effects
Onset of Effectiveness
Comparisons of TCA & SSRI
Monoamine Oxidase Inhibitors-Inhibits the breakdown of NE into its by-products. Not used as often due to its interaction with tyrosine which is found in many foods such as cheese, chocolate and wine which must be completely avoided.
Serotonin Norepinephrine Reuptake inhibitorSlide22Slide23Slide24Slide25
Two Very Cute BabiesSlide26
Treatment
-Bipolar Disorders
Antidepressants-sometimes used in combination with a mood stabilizer.
Lithium Carbonate-first line treatment-eliminates manic episodes. Large number of non-responders ( up to 40%)
Anti-
convulsants
-more effective in treating rapid cyclers.
Anti-psychotics-sometimes used to alleviate symptoms of psychosis—not always present.
PsychotherapySlide27
Psychotherapy as a treatment of
BiPolar
Disorder
Used as a supplement to medication.
Cognitive Therapy-
Interpersonal Therapy-emphasis on monitoring the interaction between symptoms and social interaction. Help patients lead more orderly lives, especially with regard to sleep wake cycles and work patterns ( aka-social rhythm therapy). Slide28
Suicide
DSM IV-TR-Classification of Suicide
Four types of Suicide (Durkheim)
Egoistic suicide-(diminished integration)
Altruistic suicide-(excessive integration)
Anomic suicide-(diminished regulation)
Fatalistic suicide-(excessive regulation) Slide29
Etiology of Suicide
Psychological Factors
Biological Factors
Social FactorsSlide30
Treatment
Crisis Hotlines
Psychotherapy
Medication
Serotonin Dysregulation
Involuntary Hospitalization