Ch.3-Mood Disorders

Front 1

Mood episodes/disorders

Back 1

Has to be a period of time....periods of abnormally up/down

-On the rise

Episodes- is not a dx....it is what is based on

Manic

Hypomanic

Disorders: Bipolar1/2, MDD(Depressive), PMDD(depressive),PDD(depressive),DMDD(often in children)

Cyclothemia

*People show up when episodes are bad enough and interfering with life

- must evaluate episodes to determine d/o

- bipolar d/o will come to clinical attention first

*dx based on most recent episodes

*Bipolar d/o can have psychotic features

Front 2

Mood disorder

Back 2

-how we feel about life at a given point/sustained condition that colors the way we view life

-pattern of illness due to an abnormal mood

-common in at least 20% or 10% of men

- increasing in prevalence...more common in single people and those with a family hx

- used to be called affective d/o

Front 3

Duration of episodes

Back 3

Cannot diagnoses w/o it

Front 4

Major Depressive Episode

Back 4

Had to have depressive episodes for at least two weeks

-more commonly diagnosed

Front 5

Manic(excessive energy) episode

Back 5

Last at least a week

-tend to end up in the hospital or jail

Symptoms: heightened self-esteem(that is grandiose/delusional), require less sleep

Front 6

Hypomanic episode

Back 6

Last less than a week and doesn't require hospitalization

- a brief, less severe manic episode

-less driven

Front 7

Disorder: Bipolar 1

Back 7

A manic episode which may or may not be proceeded by a depressive or hypomanic episode

-mania brings you to my office

-onset around 18 years old

-common in men

Meds: lithium carbonate

Front 8

Disorder: Bipolar 2

Back 8

Have to have a hypomanic and at least one depressive episode

-depression brings you to my office

- can stay in depressive state longer

-watch out for suicide

*onset in mid 20s and more common in women

-tends to be high comorbidity with anxiety, substance abuse, and eating d/os

Tx.- support, family education, suicide evaluation

Front 9

Symptoms of episodes

Back 9

Manic-

1. elevated or irritable mood

2. grandiose behavior

3. very talkative (rapid pressured speech)

4. hyperactive

5. hard to talk to

6. bad judgement(excessive...often leads to legal trouble)

7. increase in pyschomotor activity

8. can't sleep

*looks like a person with flight of ideas

Hypomanic- shorter less severe

super happy but not driven

1. Elation or irritability

2. increased energy

3. require less sleep

4. poor judgement but not likely to get you in trouble

5. may be a bit more talkative

6. may be distractable

7. you just "feel good"

8. increased pyschomotor activity (pyschomotor agitation)

9. depressive/anhedonic

10. decrease or increase in eating/appetite

* will not experience psychosis

Front 10

Cyclothymic episode

Back 10

At least 2 years of hypomanic and depressive episode

Front 11

Symptoms of an episode (continued)

Back 11

Depressive

*These people will come to your office

1. depressive or anhedonic (not pleasure seeking)

2. increase or decrease in eating/appetite

3. increase or decrease in sleep

* always ask about manic/hypomanic

Front 12

Disorder: Major Depressive

Back 12

These patients have had one or more major depressive episodes....episodes can be recurrent or single

*85% get better w/o help

Front 13

Disorder: Persistent Depressive( dysthymia)

Back 13

-have to have symptoms for at least 2 years

-less severe and longer MDD

-struggle w/ concentration

-sleep/appetite is different but no weight gain

- no feelings of guilt or thoughts of suicide

- can worsen into depression

-doesn't have to be a catalyst

*ex. Charlie Brown and Eeyore

Front 14

Disorder: Disruptive mood dysregulation

Back 14

A child's mood is persistently negative between frequent, severe explosions of temper

Front 15

Disorder: Premenstrual dysphoric

Back 15

A few days before menses, a woman experiences symptoms of depression and anxiety

-usually starts in adolescence

Symptoms:

Mood swings

Depression

Anxiety/anger

Poor concentration

Anhedonia

Fatigue

Feeling out of control

Change in appetite

Change in sleep

Breast tenderness

Muscle pain

Weight gain

Bloating

-difference btw. PMS is physical and mood

*15% will attempt suicide

*often underdiagnosed; don't get diagnosed until 30

Risk factors

Excessive weight

Trauma

Family hx.

Front 16

Disorder: Depression due to another medical condition

Back 16

A variety of medical and neurological conditions can produce depressive symptoms; they need not meet criteria for any of the conditions above

Front 17

Disorder: Substance/ medication induced depressive

Back 17

Alcohol or other substances( intoxication or withdrawal) can cause depressive symptoms; these need not meet criteria for any of the conditions above

Front 18

Disorder: Other specified, or unspecified, depressive

Back 18

Use one of these categories when a patient has depressive symptoms that do not meet the criteria for depressive diagnosis above or for any other diagnosis in which depression is a feature

Front 19

Disorder: Cyclothymic

Back 19

These patients have repeated mood swings but none that are severe enough to be called major depressive or manic

Front 20

Disorder: Substance/medication induced bipolar disorder

Back 20

Alcohol or other substances can cause manic or hypomanic symptoms

Front 21

Disorder: bipolar disorder due to another medical condition

Back 21

A variety of medical conditions can produce manic or hypomanic symptoms

Front 22

Disorder: Other specified or unspecified bipolar

Back 22

Use one of these categories when a patient has bipolar symptoms that do not meet the criteria for the bipolar diagnosis

Front 23

Causes of Depressive/Manic episodes

Back 23

1. Schizoaffective d/o- in these patients, symptoms suggestive of schizophrenia coexist w/ a major depressive or manic episode

2. Major and mild neurocognitive d/os with behavioral disturbance

3. Adjustment d/o with depressed mood

4. Personality d/os-can accompany borderline, avoidant,dependent, and histrionic

5. Uncomplicated bereavement- sadness at the death of a friend or relative; since Uncomplicated bereavement is a normal reaction, it is not recorder as a d/os but as a Z code(V code)

6. Other d/os-depression can accompany many other mental d/os like schizophrenia, the eating d/os, somatic symptom d/os, sexual dysfunctions, and gender dysphorias. Mood symptoms are likely in patients w/an anxiety d/o (especially the panic and phobia d/os), obsessive-compulsive, and posttraumatic stress d/o,

Front 24

Specifiers of single episodes

Back 24

1. With atypical features: these depressed patients, sleep excessively and have a feeling of being sluggish or paralyzed. They are often excessively sensitive to rejection

2. With melancholic features: this term applies to some of the "classic" symptoms of severe depression. These patients awaken early,feeling worse than they do later in the day. They lose appetite and weight, feel guilty, are either slowed down or agitated, and do not feel better when something happens that they would normally like

3. With anxious distress: patient has symptom of anxiety, tension, restlessness, worry, or fear that accompanies a mood episode

4. With catatonic features: there are features of either motor hyperactivity on inactivity. Catanic features can apply to major depressive and manic episodes

5. With mixed features: manic, hypomanic, and major depressive that may have mixtures of manic and depressive symptoms

6. With peripartium onset: a manic, hypomanic, or major depressive episode can occur in a women during pregnancy or within a month of having a baby

7. With psychotic features: manic and major depressive can be accompanied by delusions, which can be mood congruent or incongruent

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Specifiers of recurrent episodes

Back 25

1. With rapid cycling: within 1 year, the patient has had at least four episodes fulfilling criteria for major depressive, manic, or hypomanic episodes

2. With seasonal pattern: these patients regularly become ill at a certain time of the year, such as fall or winter

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Depressive d/o

Back 26

-most common problem for which people seek help

Why it is hard to diagnose:

1. hard to explain

2. some clients don't feel depressed they feel anhedonic

Clues:

1. Crying spells

2. Obsessive thinking

3. Feelings of helpless/hopeless

4. Suffer from anxiety

3. Excessive alcohol/drug use