Chapter 7 Mood Disorder Notes

 Major Depressive Episode (MDE)

o Extremely depressed mood and or loss of pleasure (anhedonia)
 Most of the day, every day, 2+ weeks
o At least 4 additional physical or cognitive symptoms:
 Indecision, concentration
 Worthlessness, guilt
 Fatigue, loss of energy
 Appetite / weight change
 Restlessness / slowed
 Sleep
 Thoughts of death
 Unipolar Depressive Disorder
o Major Depressive Disorder
 1+ MDE
 No maniac episodes
 Specifiers
 Single episode / recurrent
 Severity (mild, moderate, severe)
 Anxious distress
 Mood congruent / incongruent psychotic symptoms
 Peripartum onset
 Seasonal pattern
 Other considerations
 Could not diagnose with grief in prior DSM versions
o Grief- feelings of loss; decreased intensity with time
 Waves / triggered by reminders, bouts of humor,
self-esteem intact
 Thought content- memories of deceased
o Depressed mood- persistent, inability to anticipate
happiness
 Self-esteem low
 Thought content- self-critical, pessimistic
o Persistent Depressive Disorder
 Depressed mood most of the day on more than 50% of days for 2 years
(irritable / 1 yr children)
 2+ of the following
 Poor appetite or overeating
 Insomnia or hypersomnia
 Concentration / decision difficulties
 Low energy / fatigue
  Low self-esteem
 Hopelessness
 Onset
o Rare in childhood, increase in adolescence, decrease in adulthood, increase in
older adulthood
 Course
o Untreated MDE may last for several months
o Episodic, chronic
 Prevalence
o Worldwide lifetime prevalence of MDD is 16%
o Similar worldwide
o Females are twice as likely to have major depression
 Life-span developmental
o Irritability accepted as symptoms from children
o 3-months-old can show depressive symptoms
o Mood disorders may be misdiagnosed as ADHD
o Depression in older adults between 14% and 42%; less gender imbalance
 Manic Episode
o Elevated, expansive or irritable mood for at least one week (hospitalization
exception)
o 3 or more of the following symptoms
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 More talkative / pressured speech
 Flight of ideas / racing thoughts
 Increased in goal-directed activity / psychomotor agitation
 Distractibility
 High risk activities with likely painful consequences
 Hypomanic episode
o Shorter, less severe version of manic episodes
o At least 4 days
o Less impairment
 Bipolar I Disorder
o People commonly think of this
o Full criteria for major depressive episodes and full criteria for manic episodes
 Bipolar II Disorder
o Full criteria for major depressive episodes
o Full criteria for hypomanic episodes
 Cyclothymic disorder
o Less severe depressive and hypomanic periods
o Specifiers for BP same as DDs; additional; rapid cycling
 Prevalence for Bipolar disorders:
o 1% lifetime (similar across all ages)
o 1:1 males and females
o Women: increased likelihood rapid cycling, depressive period
 Life Span Developmental Influences Bipolar Disorder:
o Young children less often classic mania symptoms; irritability
o Increasingly high diagnosis rates in children
 Integrative model
o Biological vulnerability psychologic vulnerability stressful life events
(depression: personal loss, social rejection, humiliation; mania: achievements,
new opportunities, perfectionistic striving)
o Genetics (increased risk for relatives, twin studies, higher heritability women)
o Inadequacies in coping
o Lower serotonin and depression
 Treatments
o Medications
 Antidepressants
 SSRIs, Tricyclics, Mixed reuptake inhibitors, MAOIs
 Equally effective; 50% of patients seem to benefit
 25%  approach normal function
 SSRIs
 Block Serotonin reuptake
 Some risk of suicide particularly in teens
 Potential birth complications if pregnant
 Tricyclics (Tofranil, elavil)
 Block reuptake norepinephrine and other neurotransmitters
o Negative side effects common (drowsiness, weight gain)
o Discontinuation common
o May be lethal in excessive doses
 Mechanisms not well understood
 Mixed reuptake inhibitors
 Serotonin-norepinephrine reuptake inhibitors (SNRI)
o Best known is venlafaxine (effexor)
 Monoamine oxidase (MAO) inhibitors
 Block monoamine oxidase (enzyme breaks down SE/NE)
 As effective as tricyclics, fewer side effects
 Dangerous with certain foods (beer, red wine, cheese) and cold
medicines
 Lithium
 Lithium carbonate = a common salt
 Treatment of choice for bipolar disorder
  Mood stabilizer  treats depression and manic symptoms
 Large amounts toxic (careful monitoring of doses)
 Effective for 50% of patients (mechanisms only partially
understood)
o Electroconvulsive Therapy (ECT)
 Effective for medication-resistant depression
 The nature of ECT
 Brief electrical current applied to the brain
 Results in temporary seizures
 Usually 6 to 10 outpatient treatments are required
 Side effects:
 Short term memory loss: usually restored
 Long term memory loss for some
o Psychosocial
 Cognitive-behavioral therapy
 Addresses cognitive errors
 Behavioral activation
 Interpersonal psychotherapy
 Focus: improving problematic relationships
 Longer-lasting effectiveness than meds
o Psychotherapy for BP
 Helpful in managing related problems (e.g., interpersonal, occupational)
 Family therapy may be helpful
 Lithium first line treatment
 Suicide
o Facts and stats
 10th-11th leading cause of death
 Risk highest: native American, NH White
 Teens: 3rd leading cause of death
o Demographic Risk Factors
 Risk highest: native American, NH White (lowest: African american)
 Males complete more often, Females attempt more often (chi)
o Risk factors
 Family history
 Lowe serotonin levels
 Psychological disorder
 Alcohol use/abuse
 SLE, especially humiliation
 History of SIB
 Plan and access to lethal methods
o Contagion effect
  Some research indicates that a person is more likely to commit suicide
after hearing about someone else committing suicide
 The nature and type of media portrayal may have an effect
 This does not mean that someone with no risk will be susceptible
o Protective factors
 Cognitive flexibility
 Strong social support
 Lack of precipitating life events
 No losses
 Hopefulness
 Treatment of psychiatric disorder
 Treatment of personality disorder
o Prevention / Treatment
 Mental health professionals- assess- thoughts, plan, intent, means
 Safety plan- coping, who to call…
 Remove lethal means
o NIMH Action Steps
 Ask
 Keep safe
 Be there
 Help connect
 Stay connected