mood disorders. the mood disorders major depressive disorder dysthymic disorder bipolar bipolar i...

34
Mood Disorders

Upload: candace-allen

Post on 27-Dec-2015

253 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorders

Page 2: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

The Mood DisordersMajor Depressive DisorderDysthymic DisorderBipolar

Bipolar I DisorderBipolar II Disorder

Cyclothymic Disorder

The mood disorders are built from the presence and combinations of mood episodes

Page 3: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood EpisodesMajor Depressive EpisodeManic EpisodeHypomanic EpisodeMixed Episode

Page 4: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood DisordersMajor Depressive DisorderDysthymic DisorderBipolar Disorder

Bipolar IBipolar II

Cyclothymic Disorder

Page 5: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Major Depressive Disorder

Lifetime risk:Women: 10% - 25%Men: 5% - 9%

Point prevalence:Women: 5% - 9%Men: 2% - 3%

Page 6: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Major Depressive Disorder: CourseCan begin at any age, but the average is in the

mid 20sThe average age of onset has been decreasing

At least 60% of people who have one Major Depressive Episode will have a second70% of people who have had 2 episodes will have a

third90% of people who have had 3 episodes will have a

fourth5% - 10% of people with MDD who have one Major

Depressive Episode develop a Manic Episode

Page 7: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Depression: TreatmentTherapy

Traditional “talk therapy”Cognitive behavioral therapy

MedicationMost effective in combination with therapy

Depression is thought to be caused by a shortage of serotonin and dopamine circulating in the brain

In severe cases, ECT may be used

Page 8: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

AntidepressantsMAOIs

Side effects can include:

•Dizziness •Headaches •Drowsiness

•Insomnia •Fatigue •Tremors

•Twitching •Convulsions •Constipation

•Dry mouth •Weight gain •Skin irritation

•Blurred vision •High blood pressure

•Eldepryl •Marplan

•Nardil •Parnate

Page 9: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

AntidepressantsSelective Serotonin Reuptake Inhibitors

(SSRIs)

Side effects include

These are among the most popular used

•Celexa •Luvox •Paxil

•Prozac •Zoloft

•Decrease in sex drive

•Fatigue

•agitation

Page 10: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

AntidepressantsOther commonly used antidepressants

include:WellbutrinLudiomilRemeroneEffexor

Page 11: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar I Disorder Variations:

Bipolar I Disorder, Single Manic EpisodeBipolar I Disorder, Most Recent Episode

Hypomanic There has been at least 1 Manic Episode or Mixed

Episode in the pastBipolar I Disorder, Most Recent Episode ManicBipolar I Disorder, Most Recent Episode MixedBipolar I Disorder, Most Recent Episode

Depressed

Page 12: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar II DisorderDefined by recurrent Major Depressive

Episodes with Hypomanic EpisodesThere are no Manic or Mixed Episodes

Page 13: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar II Disorder: NotesLifetime prevalence is approximately .5%60% - 70% of Hypomanic Episodes in Bipolar

II occur immediately before or after a Major Depressive EpisodeThe interval between episodes tends to

decrease with age10% - 15% have rapid cyclingOver 5 years, approximately 5% - 15% of

people with Bipolar II will develop a Manic Episode (hence new diagnosis of Bipolar I)

Page 14: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar Disorders Treatment

Bipolar disorder is thought to be caused by an imbalance of serotonin, dopamine, and norepinephrine

Bipolar Disorder is generally treated with a combination of medications and therapySome people with Bipolar Disorder may need

to take medications for all or most of their lives

Page 15: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar Disorders Treatment Mood StabilizersLithium based medications

EskalithLithobidLithonate

A downside of these medications is that lithium levels in the bloodstream need to be carefully monitored

Page 16: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar Disorders Treatment Mood Stabilizers•Tegretol •Neurontin •Lamictal

•Topamax •Depakote

Side effects include:

•Gastrointestinal distress

•Weight gain •Decrease in cognition/memory

•Nausea •Vomiting •Tremors

Page 17: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Bipolar Disorder Treatment

Antipsychotic medications may also be used, particularly to treat mania

Antidepressants are used sometimes, but may set off manic episodes

Page 18: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder SpecifiersMild, Moderate, Severe Without Psychotic

FeaturesBased on the severity of the symptoms, number

of symptoms, and impairmentSevere With Psychotic Features includes

delusions and/or hallucinations (typically auditory) during the episodeMood congruent: guilt, punishment, somatic

sensations of death, auditory hallucination of a voice berating the person

Mood incongruent

Page 19: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder SpecifiersFull Remission: at least 2 months in which there are

no significant symptoms of depressionPartial Remission

Some symptoms are still present, but full criteria are no longer met

There are no significant symptoms, but it has been less than two months

If the Major Depressive Episode was superimposed on Dysthymic Disorder, it is recorded as Major Depressive Disorder, Prior History

Chronic: in the most recent Major Depressive Episode full criteria have been met for at least 2 years

Page 20: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder Specifiers Catatonic FeaturesMelancholic FeaturesAtypical Features

Page 21: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder Specifiers – Catatonic FeaturesThe Clinical picture is dominated by at least

two of the following:1.Motoric immobility as evidenced by catalepsy

or stupor2.Excessive motor activity 3.Extreme negativism4.Peculiarities of voluntary movement as

evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing

5.Echolalia or echopraxia

Page 22: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder Specifiers – Melancholic Features

A. Either of the following, occurring during the most severe period of the current episode:

1. Loss of pleasure in all, or almost all, activities2. Lack of reactivity to usually pleasurable

stimuli (does not feel much better, even temporarily, when something good happens)

Page 23: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder Specifiers – Melancholic FeaturesB. Three (or more) of the following:

1. Distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)

2. Depression regularly worse in the morning3. Early morning awakening (at least 2 hours

before usual time of awakening)4. Marked psychomotor retardation or agitation5. Significant anorexia [loss of appetite] or

weight loss6. Excessive or inappropriate guilt

Page 24: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Mood Disorder Specifiers: Atypical FeaturesA. Mood reactivity (i.e., mood brightens in response to

actual or potential positive events)B. Two (or more) of the following features:

1. Significant weight gain or increase in appetite2. Hypersomnia3. Leaden paralysis (i.e., heavy, leaden feelings in arms or

legs)4. Long standing pattern of interpersonal rejection

sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

C. Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode

Page 25: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

SuicideA large percentage of people with mental

illness attempt or commit suicideParticularly common in:

Mood Disorders Schizophrenia Eating Disorders, especially anorexia Borderline Personality Disorder

Page 26: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Age group, Method, Fatality

Page 27: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

High School Students, Attempts by Gender

Page 28: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Additional Information About Suicide3rd leading cause of death among

adolescents/young adults (15-24)Fastest growing rates among youth

3 times as many women attempt, 3 times as many men “succeed”Men are more likely to use violent methods

Elderly people have the highest suicide ratesAlso higher rates in people with general

medical conditions

Page 29: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Additional Information About Suicide

Depression is the most common diagnosisHigher risk among people with bipolar

disorder Suicide or risky behavior with a high likelihood of

fatality may occur when the person is in a manic phase

Higher risk among people with substance abuse and other dual diagnoses

Page 30: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Additional Information About Suicide Particularly dangerous during the time a person

is, or seems to be, coming out of a depression Before they may have been too depressed to put in

the energy to act on suicidal impulses A person who has decided on committing suicide may

seem happier because he or she is anticipating an end to their pain

Page 31: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Additional Information About SuicideSuicidal ideation is not uncommon in the general

populationAffects all groups

highest rates among white peopleSocio-economic status/income has an ambiguous

role – mixed findingsUnemployed people have higher rates, but this is

correlation not causation A person may be depressed because they lost their job, or

the person may not have been able to perform at their job due to depression

Page 32: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Summary and NotesRisk factors/protective factorsNothing to suggest that there’s a seasonal

increase

Page 33: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Summary and Notes Risk Factors

Family history of suicide Family history of child maltreatment Previous suicide attempt(s) History of mental disorders, particularly depression History of alcohol and substance abuse Feelings of hopelessness Impulsive or aggressive tendencies Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal

dilemma) Local epidemics of suicide Isolation, a feeling of being cut off from other people Barriers to accessing mental health treatment Loss (relational, social, work, or financial) Physical illness Easy access to lethal methods Unwillingness to seek help because of the stigma attached to mental health and

substance abuse disorders or to suicidal thoughts

Page 34: Mood Disorders. The Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The

Summary and NotesProtective Factors:

Effective clinical care for mental, physical, and substance abuse disorders

Easy access to a variety of clinical interventions and support for help seeking

Family and community support (connectedness)Support from ongoing medical and mental health care

relationshipsSkills in problem solving, conflict resolution, and

nonviolent ways of handling disputesCultural and religious beliefs that discourage suicide

and support instincts for self-preservation (U.S. Public Health Service 1999)