Mood disorders

Harsimrat BaggaWindsor University of Medicine

5/10/2013

‘’32 year old man was apprehended by the police 2 weeks ago for running across the freeway without regard for his personal safety. The patient stated that he did this “ for the heck of it.” The patient appeared distracted during the initial interview, spoke rapidly, and gave long drawn out answers. When asked about his mood, the patient said that he is feeling “okay, I’m under the weather, if you get my drift.” He was admitted to the inpatient unit for observation.

Since his admission, he has been saying that he will soon replace the president, that he is the next Alexander the Great, and that he was told by the voices in his head. The patient’s admission laboratory values, including the drug screen for illicit substances, came back normal. Which of the following is the most likely diagnosis?”

• A) Bipolar disorder with psychotic features• B) Bipolar disorder without psychotic features• C) Depression with psychotic features• D) Schizophrenia , disorganized type• E) Schizophrenia, paranoid type

• Do you know many people are suffering from the mood disorders that highly impair their daily functioning and do not even get diagnosed

• Do you know many well-known people have been diagnosed with mood disorders but are well-treated to the point that they attain their normal level of functioning

• Example:• Catherine Zeta Jones- Bipolar II

Mel Gibson- BipolarJim Carrey- Depression

• So lets study mood disorders and see how adequate diagnosis and treatment can make a difference in people’s lives!

Unipolar

• Major Depressive Disorder• Dysthymic Disorder• Depressive Disorder

Uncategorized

Bipolar Disorders

• Bipolar I Disorder• Bipolar II Disorder• Cyclothymic Disorder

MOOD DISORDERS LIFETIME PREVALENCESMajor Depressive Disorder Female = 10 – 25%

Male = 5 – 12%

Bipolar I disorder 0.4 – 1.6%

Bipolar II disorder 0.5 %

Dysthymia 6%

Cyclothymia 0.4 – 1.0%

ETIOLOGY -Biological Factors:

NOREPINEPHRINE FluctuationsSEROTONINDOPAMINE

-Abnormalities of Sleep Neurophysiology

-Genetics

-Psychosocial Factors -Personality Factors

Unipolar Disorders

Major Depressive Disorder • Episodic Symptoms:

Sad/depressed mood Decrease in interestPsychomotor changesSleep alternationsAppetite changesFatigue , low energyCognitive changes impacting attention and concentration Guilt, feelings of worthlessness, hopelessness Suicidal or homicidal ideation

• For at least 2 weeks

Unipolar Disorders

Dysthymic Disorder-• Depressed mood for of most of the day for at

least 2 years. The disturbance does not occur due to another disorder like schizophrenia or delusional disorder or with other medical condition.

Unipolar Disorders

Atypical depression• characterized by marked “anhedonia”, weight

gain, increase in appetite, hypersomnia, ‘leaden paralysis’, and significant social impairment, hypersensitivity to perceived interpersonal rejection by others

Unipolar Disorders

Seasonal affective disorder-• Seasonal pattern of depressive

episodes occurring during fall or winter with resolution by spring. Two episodes have to occur during the colder months rather than any other times and over the course of two year or more time period

Unipolar Disorders

• Other forms of depression:-Post partum depression (within 1-3 months after birth; may have negative feelings towards baby)-Postpartum blues ( immediately after birth upto 2 weeks, no negative feelings towards baby) -Premenstrual Dysphoric disorder

Bipolar Disorder• ManiaElevated MoodInflated Self-esteem or grandiosityDecreased need for sleep Excessive talkatingRacing thoughts, flight of ideasDistractibilityIncrease in goal directed activity(social, work, sex) Increase in libidoPsychomotor agitation Poor judgment

Symptoms lasting at least 1 week and are not due to any medical condition, treatment or substances. It impairs normal level of functioning

Bipolar Disorder

• Hypomaniaelevated, euphoric or irritable mood, lasting throughout at least four days. The symptoms are not severe to cause any major impairment in social or occupational functioning, or to mandate hospitalization. They are also not result of any toxic substances or medical conditions.

Rapidly cycling Bipolar:• 4 episodes of Mania in 1 year. It is due to use

of anti-depressants

Bipolar Disorder

• Cyclothymic Disorder –The occurrence of several periods of alternating hypomanic symptoms with depressive symptoms for at least 2 years. These symptoms not due to the effects of substances, mediations or medical conditions and they do cause significant distress or impairment in functioning.

TREATMENT

Goals• Patient’s safety primary concern• Complete and thorough diagnostic

assessment • Treatment plan addressing not just immediate

symptoms but overall patient’s prospective well-being.

• The need for hospitalization should be evaluated

Treatment

• Hospitalization: • Psychosocial Therapy• Cognitive Therapy • Interpersonal Therapy• Behavior Therapy• Psychoanatically-oriented Therapy• Family Therapy• Pharmacotherapy:

Treatment

• Pharmacotherapy: Major Depressive Disorder - MAOI’s, TCAC’s, SSRI’s, SNRI’s, mirtazipine, Bupropian

Bipolar Disorders - Lithium, anticonvulsants, antipsychotics

Alternatives to drug therapy: Electroconvulsive therapy (ECT)

References

• Merino, L. (2009). Mood Disorders; Retrieved from: http://www.slideshare.net/Lucia_Merino/mood-disorders-presentation-3893405

• Dr. Manood, H. (2010). Mood Disorders; Retrieved from: http://www.slideshare.net/specialclass/mood-disorders-psych-ii

• Faraj, S. (2009). Mood Disorders; Retrieved from: http://www.slideshare.net/HusseinAliRamadhan/mood-disorder-drsaman

• Khalife S, Singh V & Muzina D. (2009). Bipolar Disorders; Retrieved from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/bipolar-disorder/

References• Henry, P. (2010). Top 10 Antidepressant Medications Side Effects and Classification SARI SNRI; Retrieved from: http://

paulahenry1.hubpages.com/hub/Antidepressant-medications

• Narconon. (2009). Side Effects of Antidepressants; Retrieved from: http://www.narconon.org/drug-education/videos/effects-of-antidepressants-video.html

• Harvard Medical School Publication. (2010). Seasonal affective disorder; Retrieved from: http://174.120.190.8/~abhccom/index.php?option=com_content&view=article&id=81%3Aseasonal-affective-disorder&catid=1%3Alatest-news&Itemid=1

• Sandhar, N. (2009). Dysthymia Disorders; Retrieved from: http://www.glogster.com/navneet1109/dysthymia-by-nav-sandhar/g-6l3hr6d7c61glicoh4v3ha0

• Terri D. (2007). PM-what? Retrieved from: http://pajamadiaries.com/pm-what/

• My Healthy Feeling. (2013). Selective Serotonin Reuptake Inhibitors (SSRIs) Side Effects, Brand Names, Action; Retrieved from: http://www.myhealthyfeeling.com/selective-serotonin-reuptake-inhibitors-ssris-side-effects-brand-names-action/

• Richeimer, S. (2000). The Assessment of the Patient with Pain; Retrieved from: http://www.helpforpain.com/articles/pain-assess/assessment.htm

• UCCS. (2000). What is Bipolar Disorder? Retrieved from: http://www.uccs.edu/biology/mood-disorders/bipolar-disorder.html

• Chen, J et al. (2011). Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: A longitudinal, naturalistic study; Retrieved from: http://www.sciencedirect.com/science/article/pii/S0165032711007464

References• Dr. Fischer, C. (2013). Master The Boards (Second Edition); Kaplan Publishing Inc.: New York • Tao L & Vierregger K. (2010). First Aid Q &A for the Usmle Step 2 CK (Second Edition); McGraw Hill

publishing: New York • Stupid celebrities Gossip. (2012). Celebrities With Mental Disorders; Retrieved from:

http://stupidcelebrities.net/2012/08/celebrities-with-mental-disorders/