disorders 1 What is a mood disorder Mood is a persons subjective emotional state Affect pattern of the observable o bjective behaviours eg ID: 749979
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Slide1
Mood Disorders(affective disorders)
1Slide2
What is a mood disorder?
Mood is a person’s
subjective
emotional stateAffect – pattern of the observable (objective) behaviours e.g. facial expressions that are associated with subjective feelings, like moodMood disorders involve a depression or elevation of mood as the primary disturbance
2Slide3
Types of mood disorders
Depressive
Disorders
Bipolar Disorders3Slide4
4
Depressed Mood – Depression
Unipolar
Depression
Slide5
5
Elevated Mood – Mania (Manic Phase)
Depressed Mood – Depression
Bipolar
DisorderSlide6
Types of mood disorders 6
Depressive
Bipolar
Mood Disorder Due to General Medical ConditionSubstance
-
Induced
Mood
Disorder
Adjustment
Mood
Disorder
PRIMARY
SECONDARY
:Slide7
Types of Mood Disorders
7
Depressive
DisordersMajor Depressive Disorder MDD(Unipolar Depression) Major Depressive EpisodeReccurent
Dysthymic
Disorder
(
Dysthymia
)
Depressive
Disorder
NOS (Not
Other
Specified
)Slide8
Major Depressive Episode
Depressed mood
or
Anhedonia (loss of interest and pleasure)8Slide9
Major Depressive Episode
Depressed mood
or
Anhedonia (loss of interest and pleasure)Persistently decreased sleep (early, middle, late insomnia) or increased sleep (atypical symptom) if
only
sleep
problems
CONSIDER „
masked
depression
”
9Slide10
Major Depressive Episode
Depressed mood
or
Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep
if
only
sleep
problems
consider
„
masked
depression
”
Feelings of worthlessness or inappropriate
guilt (severe depression delusions of guilt)
Low
energy or fatigue
(↓
hygene
, ↓
grooming
)
(
severe
cases
- „
leaden
paralysis
”)
Decreased
concentration
or indecisiveness
,
memory
complaints
greatly
impair
work
function
(
eldery
patients
-
false
diagnosis
of dementia)Decrease or increase (atypical) in appetite OR significant weight loss or gainPsychomotor changes (retardation or agitation)
10Slide11
Major Depressive Episode
Depressed mood
or
Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep if only sleep
problems
„
masked
depression
”
Feelings of worthlessness or inappropriate
guilt
(
severe
depression
delusions
of guilt) Low energy or fatigue
(↓ hygene, ↓ grooming) ( severe
cases- „leaden paralysis”)
Decreased
concentration
or indecisiveness
, memory complaints
greatly impair work function
(eldery patients- false diagnosis of dementia)
Decrease or increase
(atypical)
in
appetite
OR
significant weight loss or gain
Psychomotor
changes (r
etardation
or
agitation
)
Re
current thoughts of death, suicidal ideation
s
(2/3 poeple with depression)
, or
suicide
attempt
11Slide12
Major Depressive Episode
Depressed mood
or
Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep if only sleep
problems
„
masked
depression
”
Feelings of worthlessness or inappropriate
guilt
(
severe
depression
delusions
of guilt) Low energy or fatigue
(↓ hygene, ↓ grooming) ( severe
cases- „leaden paralysis”)
Decreased
concentration
or indecisiveness
,
memory
complaints
greatly
impair
work
function
(
eldery
patients
-
false
diagnosis
of
dementia
)
Decrease or increase
(
atypical
)
in
appetite
OR
significant weight loss or gain
Psychomotor
changes (retardation or agitation)Recurrent thoughts of death, suicidal ideations (2/3 people with depression) , or
suicide
attempt
Other
symptoms
:
anxiety
, morning worsening of symptoms, chronic pain (if only chronic pain- „masked depression”)
12
≥
5
symptoms present for ≥ 2 weeksSlide13
Diagnosis of depression: (AD) SIG E CAPS (
medical mneumonic commonly
used
in the real world to diagnose depression)131 or 2 major symptoms: Anhedonia and/or Depressed mood + ≥ 4 minor symptoms ≥ 2 weeks (SIG E CAPS)
S
leep
↑ ↓
(
changes
in
sleep
pattern
)
I
nterest
↓
(
loss of interest in activities)Guilt ↑ (feelings of worthlessness)Energy ↓ (fatique
)Concentation
/Cognition/Decisiveness ↓ (
difficulty
concentrating
/
decline
in
cognition
/
Indecisiveness
A
ppetite
↑ ↓
(
changes
in
appetite
)
P
sychomotor
↑ ↓
(
retardation
or
agitation
)
S
uicide
/
Death
↑
(preoccupation)Slide14
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
Depressed mood
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide15
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
Depressed mood
S
leep- changes
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide16
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
Depressed mood
S
leep- changes
I
nterest- loss
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide17
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
Depressed mood
S
leep- changes
G
uilt/worthlessness
I
nterest- loss
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide18
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
D
epressed mood
S
leep- changes
E
nergy loss- fatique
G
uilt/worthlessness
I
nterest- loss
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide19
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
D
epressed mood
S
leep- changes
E
nergy loss- fatique
G
uilt/worthlessness
C
oncentration- difficulties /Indecisiveness
I
nterest- loss
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide20
Depression clip arts mnemonics (AD) SIG E CAPS
A
nhedonia/
D
epressed mood
S
leep- changes
E
nergy loss- fatique
G
uilt/worthlessness
C
oncentration- difficulties /Indecisiveness
I
nterest- loss
A
ppetite- changes
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide21
Depression clip arts mnemonics (AD) SIG E CAPS
21
A
nhedonia/
D
epressed mood
S
leep- changes
E
nergy loss- fatique
G
uilt/worthlessness
C
oncentration- difficulties /Indecisiveness
I
nterest- loss
A
ppetite- changes
P
sychomotor-retardation or agitation
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide22
Depression clip arts mnemonics (AD) SIG E CAPS
22
A
nhedonia/
D
epressed mood
S
leep- changes
E
nergy loss- fatique
G
uilt/worthlessness
C
oncentration- difficulties /Indecisiveness
I
nterest- loss
A
ppetite- changes
S
uicide/Death-preocupattion
P
sychomotor-retardation or agitation
Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide23Slide24
Major Depressive Disorder
specifiers
24Slide25
Major Depressive Episode
specifiers
25Slide26
Major Depressive Disorder- diagnostic criteria
26Slide27
The Reccurent Course of Major Depressive
Disorder
27
School
Friends
Job
Marriage
Out of
job
Finances
Physical health
Depression
DepressionSlide28
Major Depressive Disorder (outside psychiatric
setting)
Up to
1/4
of patients with major medical comorbidity (cerebrovascular accidences, diabetes, cancer) will develop MDD, what has the huge effect on worsening their health.Less than half of primary care patients with mental illness receive ANY treatment.50-70% MDD is NOT accurately diagnosed or treated in primary setting.Roughly 80% of all antidepressants are prescribed by non psychiatrists (Mark at all. 2009)28Slide29
Major Depressive Disorder- prognosis
For
many
patiens MDD can be a chronic relapsing illnessRelapse within 6 months of recovery – 1/4 patientsRisk of having another episode:≥ 60% if one previous episode≥ 90% if three previous episodes severity of next episodes is greater5%-10% will go on to develop Bipolar DisorderChronically ill – 1/3 of patients
The
overall
mortality
risk
↑ 2
times
(
suicides
,
medical
illnesses
)
The
risk
of death by suicide ↑ 26 times in untreated patients29Slide30
Major Depressive Disorder-Course
Approx. 50%
people
with
first-episode depression experience a prodromal period (mild depressive symptoms and anxiety)Untreated mild/moderate episodes can last 1-6 months severe 6-8 months and even >12 months Treated depressive episode lasts on average 3 months
30Slide31
Major Depressive Disorder- epidemiology
Lifetime risk:10%-25% for women
5%-12% for men
Lifetime risk for developing depression is increasing
(for people born after The II World War)Average age of onset in mid-20’s (trend of increasingly younger age of depression onset)31Slide32
Etiology of Mood Disorders
32Slide33
SEROTONINERGIC ACTIVITY: PET STUDY
HEALTHY CONTROL
PATIENT DURING DEPRESSIONSlide34
SPECTSlide35
Types of mood disorders
35
Depressive
disordersMajor Depressive Disorder(Unipolar Depression)Single EpisodeReccurentDysthymic Disorder
1
1
2Slide36
Dysthymic Disorder
36
Associated with ≥ 2 of the following:
decreased or increased appetite
decreased or increased sleeplow energy or fatiguelow self-esteempoor concentration or indecisivenesshopelessnessDepressed mood nearly every day
for > 2 years
Milder
but
chronic
depression
.Slide37
Who was dysthymic in „Winnie the
Pooh”?
37Slide38
Eeyore
38Slide39
Types of Mood Disorders
39
Depressive
DisordersMajor Depressive Disorder Single EpisodeReccurentDysthymic Disorder
Adjustment
Mood
DisorderSlide40
Adjustment Disorder
with Depressed M
ood
40
stress related disturbanceSlide41
Adjustment Disorder with
Depressed Mood
Depressive symptoms that develop within 3 months of a
stressor
(negative and positive events)Symptoms do not meet criteria for another mood episodeSymptoms are clinically significant because of:Marked distress is in excess of what would be expected ORSignificant social or occupational impairment41Slide42
Bereavement (mourning, grief)
“Normal” reaction to the loss of a loved one
May have several depressive symptoms
Consider diagnosis of major depressive episode if:
Symptoms persist > 2 months after lossPresence of any of the following:Guilt (except for actions taken or not taken at time of death)Profound and persistent anhedoniaMarked psychomotor retardationDecreased self-esteemSuicidal ideationHallucinations other than hearing voice or seeing image of deceased person42Slide43
A well-known man who
suffered from depression…
43Slide44
Famous people suffering from
depression
44
Hugh Laurie
J.K.Rowling
Gwyneth
PaltrowSlide45
BIPOLAR DISORDERSSlide46
Aretaeus
of
Cappadocia
150 AD, mania and melancholy are the same illnessJules Francois Baillarger1853 The illness was separated from schizophrenia
Extreme
mood
changes
are
different
phases
of
the
same
illness
Emil
Kraepelin 1899 Name: manic-depressive illness
Karl Kleist
1953
separated out unipolar depression,
The term: Bipolar DisorderSlide47
Types of Mood Disorders
Bipolar
Disorders
Bipolar I DisorderBipolar II DisorderCyclothymic Disorder
47
Bipolar
NOS (Not
Other
Specified
)Slide48
Bipolar I and Bipolar II
48Slide49
Manic EpisodeElevated (or irritable) mood for >1 week
(or less if must be hospitalized)
49Slide50
Manic Episode
Elevated (or irritable) mood for >1 week (or less if
must
be hospitalized)≥ 3 of following (4 if mood irritable):50Decreased need for sleepSlide51
Manic Episode
Elevated (or irritable) mood for >1 week week (or less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):51Decreased need for sleepIncreased goal-directed activitySlide52
Manic Episode
Elevated (or irritable) mood for >1 week week (or less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):52Decreased need for sleepIncreased goal-directed activityDistractibilitySlide53
Manic Episode
Elevated (or irritable) mood for >1 week week (or less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):53Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughtsSlide54
Manic Episode
Elevated (or irritable) mood for >1 week week (or
less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):54Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts
Excessive involvement in pleasurable activities with high riskSlide55
Manic Episode
Elevated (or irritable) mood for >1 week week (or less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):55Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts
Excessive involvement in pleasurable activities with high risk
Pressured speechSlide56
Manic Episode
Elevated (or irritable) mood for >1 week week (or less
if
must be hospitalized)≥ 3 of following (4 if mood irritable):56Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts
Excessive involvement in pleasurable activities with high risk
Pressured speech
GrandiositySlide57
Diagnosis of mania: (DIG FAST) (medical
mneumonic commonly
used
in the real world to remember symptoms of mania)57
D
istractibility (and easy frustration)
I
rresponsibility (and erratic uninhibited behaviour)
G
randiosity
F
light of ideas (and racing thoughts)
A
ctivity increased (with weight loss and increased libido)
S
leep decreased
T
alkativenessSlide58
Mania (clip arts mnemonics) DIG FAST
58
Elevated expansive mood
or
Irritable moodSlide59
Mania (clip arts mnemonics) DIG FAST
59
Elevated expansive mood
or
Irritable mood
D
istractibility
Slide60
Mania (clip arts mnemonics) DIG FAST
60
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour Slide61
Mania (clip arts mnemonics) DIG FAST
61
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour
G
randiositySlide62
Mania (clip arts mnemonics) DIG FAST
62
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour
G
randiosity
F
light of ideas/Racing thoughtsSlide63
Mania (clip arts mnemonics) DIG FAST
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour
G
randiosity
F
light of ideas/Racing thoughts
A
ctivity increased/ Psychomotor agitation Slide64
Mania (clip arts mnemonics) DIG FAST
64
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour
G
randiosity
F
light of ideas/Racing thoughts
A
ctivity increased/ Psychomotor agitation
S
leep decreasedSlide65
Mania (clip arts mnemonics) DIG FAST
65
Elevated expansive mood
or
Irritable mood
D
istractibility
I
rresponsibility and erratic uninhibited behaviour
G
randiosity
F
light of ideas/Racing thoughts
A
ctivity increased/ Psychomotor agitation
S
leep decreased
T
alkativenessSlide66
The Course of Bipolar I
66
Mania
Depression
Mixed state
Mania
Depression
School
Friends
Job
Marriage
Finances
Physical healthSlide67
Bipolar Disorder specifiersSlide68
Bipolar Disorder specifiersSlide69
The Course of Bipolar -Rapid cycling
69
Qualifier for Bipolar I
and
Bipolar II Disorder≥ 4 mood episodes (any type) within any 1 year period difficult to treatSlide70
Rapid cyclingSlide71
Bipolar I
- diagnosis
At least
one manic
or mixed episodeNo need for a prior depressive episodeSymptoms cause significant impairment in social and/or occupational functioning Symptoms do not result from a drug of abuse, medication, other treatment, or general medical conditionCould be delusions what need additional treatment71Slide72
Bipolar I- frequency of symptoms
Paul E. Keck, Jr, MD, Roger S. McIntyre, MD, FRCPC, and Richard C. Shelton,
Bipolar Depression: Best Practices for the Outpatient
MDCNS Spectr. 2007;12:12(Suppl 20):1-16Slide73
Bipolar II Disorder
73Slide74
Hypomanic Episode
Elevated, expansive, or irritable mood lasting > 4 days –
clearly different
from baselineThree or more of the following (four if mood irritable):Little need for sleepIncreased goal-directed activityFlight of ideas, racing thoughtsDistractibilityExcessive involvement in pleasurable activities with high riskRapid speechOverconfidenceClear change in functioning but no marked impairment in social or occupational functioning74Slide75
Bipolar II
Disorder- diagnosis
At least
one
previous major depressive episodeAt least one hypomanic episodeLess severe than Bipolar I and more difficult to diagnose75Slide76
Bipolar II- frequency of symptoms
Paul E. Keck, Jr, MD, Roger S. McIntyre, MD, FRCPC, and Richard C. Shelton,
Bipolar Depression: Best Practices for the Outpatient
MDCNS Spectr. 2007;12:12(Suppl 20):1-16Slide77
Bipolar Disorders- Epidemiology
Lifetime risk:Bipolar I Disorder: 1% (men = women)Bipolar II Disorder: 0,4% (
adults
)
* 3-4% (adolescens) *Age of onset late teens to early 20’s * Merikangas KR, Lamers F. Curr Opin Psychiatry. 2012 Jan;25(1):19-2377Slide78
Famous bipolar people
Mel Gibson
Curt Cobain
Robert Downey jr.Slide79
Types of mood disorders
Bipolar
Disorders
Bipolar I Bipolar II Cyclothymic Disorder
79
Bipolar
NOSSlide80
Cyclothymic Disorder80
Hypomanic episodes and depressive symptoms alternate
over at least 2 years
Several distinct
periods of hypomanic and depressive symptoms (not MDD)Symptom-free periods are < 2 months ≥ 2 years