Mood Disorders

• Mood disorders (affective disorder)


  Pervasive alterations in emotions that are manifested by depression, mania, or both
• Mood disorders are the most common psychiatric diagnoses associated with suicide (with suicide the most risk factor)
• Mood disorders


  • They interfere with person's life plaguing the client with long term sadness, agitation, or elation
  • Accompanying self-doubt, guilt, and anger alter life activities especially those that involve self-esteem, occupation, and relationships
• Biblical personalities that suffered depression


  • King Saul
  • King Nebuchadnezzar
  • Moses
• Famous personalities with mood disorders

  • Queen Victoria
  • Abraham Lincoln
  • Artist Vincent Van Gogh
• Primary mood disorders


  • Major Depressive Disorder
  • Bipolar Disorder (formerly known as manic depressive illness)
• Major Depressive Illness


  Lasts at least 2 weeks during which a person experiences a depressed mood or loss of pleasure in nearly all activities
• Symptoms of major depressive illness

  • Changes in appetite, weight, sleep, or psychomotor activity
  • Decreased energy
  • Feelings of worthlessness or guilt
  • Difficulty thinking, concentrating, or making decisions or recurrent thoughts of death or suicidal ideation, plans or attempts
• Symptoms of major depressive illness must be present every day for 2 weeks and result in significant distress or impair social, occupational, or other important areas of functioning
• Psychotic depression


  Some people with a combination of hallucinations and delusions
• Bipolar disorder


  Diagnosed when person's mood cycles between extremes of mania and depression
• Mania


  Distinct period during which mood is abnormally and persistently elevated, expansive, or irritable
• Symptoms of manic episode (at least three)

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Pressured speech (unrelenting, rapid, often loud talking without pauses)
  • Flight of ideas (racing often unconnected thoughts)
  • Distractibility
  • Increased involvement in goal directed activity or psychomotor activity
  • Excessive involvement in pleasure seeking activities with high potential for painful consequences
• Hypomania


  Period of abnormally and persistently, elevated, expansive, or irritable mood lasting 4 days and including three or four of the additional symptoms mentioned earlier
• Hypomania vs mania


  Hypomanic episodes do not impair the person's ability to function (in fact, he or she may be quite productive) and there are no psychotic features (hallucination, delusions)
• Mixed episode


  When the person experiences both mania and depression nearly every day for at least 1 week
• Rapid cycling


  A mixed episode is called rapid cycling
• Bipolar disorders


  • Bipolar I disorder – one or more manic or mixed episodes usually accompanied by major depressive episodes
  • Bipolar II disorder – one or more major depressive episodes accompanied by at least one hypomanic episode
• Euthymic mood


  Normal mood and affect between extreme episodes
• Related disorders classified as mood disorders

  • Dysthymic Disorder
  • Cyclothymic Disorder
  • Substance-Induced Mood Disorder
  • Mood Disorder due to a General Medical Condition
• Dysthymic disorder


  Characterized by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode
• Cyclothymic disorder


  Characterized by 2 years of numerous periods of both hypomanic symptoms that do not met the criteria for bipolar disorder
• Substance-induced mood disorder


  Characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins
• Mood disorder due to a general medical condition


  Characterized by prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of a medical condition such as degenerative neurologic condition, cerebrovascular disease, metabolic or endocrine condition
• Other disorders involving changes in mood

  • Seasonal Affective Disorder (SAD)
  • Postpartum or Maternity Blues
  • Postpartum Depression
  • Postpartum Psychosis
• Seasonal Affective Disorder (SAD)

  Subtypes: Winter depression or fall onset (most common), Spring onset (less common)
• Symptoms of winter depression or fall onset SAD

  • Increased sleep
  • Increased appetite
  • Carbohydrate craving, weight gain
  • Interpersonal conflict, irritability
  • Heaviness in the extremities
• Symptoms of spring onset SAD

  • Insomnia
  • Weight loss
  • Poor appetite
• Postpartum or Maternity Blues

  Frequent normal experience after delivery of a baby, with symptoms beginning approximately 1 day after delivery, usually peaking in 7 days, and disappearing rapidly with no medical treatment
• Symptoms of Postpartum or Maternity Blues

  • Labile mood and affect
  • Crying spells
  • Sadness
  • Insomnia
  • Anxiety
• Postpartum Depression


  Meets all the criteria for a major depressive episode with onset within 4 weeks of delivery
• Postpartum Psychosis


  A psychotic episode developing within 3 weeks of delivery and beginning with fatigue, sadness, emotional lability, poor memory, and confusion and progressing to delusions, hallucinations poor insight, and judgment and loss of contact with reality
• Postpartum Psychosis is a medical emergency requiring immediate treatment
• Etiology of mood disorders

  • Recent research focuses on chemical biologic imbalances as the cause
  • Psychosocial stressors and interpersonal events appear to trigger certain physiologic and chemical changes in the brain which significantly alter the balance of neurotransmitters
  • Effective treatment addresses both the biologic and psychosocial components of mood disorders
• Genetic studies for depression


  Implicate transmission of major depression in the 1st degree relatives who have twice the risk of developing depression
• Genetic studies for bipolar disorder

  1st degree relatives of people with bipolar disorder have a 3% to 8% risk for developing bipolar disorder compared with 1% in general population
• Genetic studies for all mood disorders

  • Monozygotic (identical) twins have a concordance rate (both twins having the disorder) 2 to 4 times higher than that of dizygotic (fraternal) twins
  • Concordance rate for monozygotic twins is not 100%, so genetics alone do not account for all mood disorders
• Markowitz and Milrod (2005) discussed indications of a genetic overlap between early onset bipolar disorder and early onset alcoholism
• Clients with both early onset bipolar disorder and early onset alcoholism


  • Have a higher rate of mixed and rapid cycling, poorer response to lithium, slower rate of recovery and more hospital admissions
  • Mania displayed by these clients involves more agitation than elation, clients may respond better to anticonvulsants than to lithium
• Neurochemical theories


  Focus is on serotonin and norepinephrine, the two major biogenic amines implicated in mood disorders