Download Mood disorders Mood disorders: A category of mental disorders in

LP Psy Disorders BC:Psydisorder mood 1
03/23/09
Mood disorders
Mood disorders: A category of mental disorders in which
significant and chronic disruption in mood is the
predominant symptom, causing impaired cognitive,
behavioral and physical functioning. For more information,
(www.nimh.nih.gov)
Types of mood disorders:
• Major depression
o Dysthymic disorder (low-grade depression)
• Bipolar disorder
o Cyclothmyic disorder (low-grade bipolar)
• Season Affective Disorder (SAD)
LP Psy Disorders BC:Psydisorder mood 2
03/23/09
Major Depression
The diagnosis of major depression is when the person
displays most of the symptoms for 2 weeks or longer.
In many cases, there doesn’t appear to be any external
reason for the persistent feelings of depression. In other
cases, the downward emotional spiral can be triggered by
a stressful or negative event.
normal
depression
abnormal
depression
LP Psy Disorders BC:Psydisorder mood 3
03/23/09
Symptoms of Major Depression (see figure 14.3)
Emotional
• Feelings of sadness, hopelessness, helplessness,
guilt, emptiness or worthlessness.
• Feeling emotionally disconnected from others.
• Turning away from others.
• Loss in ability to experience pleasure
Behavioral
• Dejected facial expressions
• Smiles less often
• Slowed movements, speech and gestures
• Tearfulness or spontaneous episodes of crying
• Loss of interest or pleasure in usual activities
including eating and sex
• Withdrawal from social activities
Cognitive
• Difficulty thinking, concentrating or remembering
• Global negativity and pessimism
• Suicidal thoughts or preoccupation with death
Physical
• Changes in appetite resulting in significant weight loss
or gain
• Insomnia, early morning awakening or oversleeping
• Vague but chronic aches and pains
• Diminished sexual interest
• Global feelings of anxiety
• Restlessness, fidgety activity
LP Psy Disorders BC:Psydisorder mood 4
03/23/09
LP Psy Disorders BC:Psydisorder mood 5
03/23/09
LP Psy Disorders BC:Psydisorder mood 6
03/23/09
LP Psy Disorders BC:Psydisorder mood 7
03/23/09
How common/uncommon are mood disorders?
• According to the World Health Organization (WHO),
depression is the world's fourth most devastating
illness.
• 13-14 million Americans are affected by mood
disorders each year. (What is the population of
Oregon?)
• About 17.1% of Americans are likely to suffer at least
one episode of depression in their lifetime, and only
1/3 will receive treatment.
• For 20-35% of patients with major depression,
recurrence of episodes is chronic and may last 2
years or longer.
• According to the American Psychiatric Association, 1
year after a diagnosis of their initial depression,
o 40% of patients are without symptoms
o 20% are still depressed, but not enough to
warrant a diagnosis of major depression and
o 40% are still suffering from depression
LP Psy Disorders BC:Psydisorder mood 8
03/23/09
• Some people suffer only one major depressive
episode, but 50-60% will have recurrences of major
depression. Risk of recurrences is greatest for
females and individuals with an onset of depression
before age 15.
o Before the age of 11, girls and boys have the
same rates of depression.
o Between the ages 11-15, depression in girls
rises.
o By age 18, girls have twice the depression rate
as boys. Women are twice as likely as men to be
diagnosed with major depression.
If you are a woman, there is a 1 in 4 chance
that you will experience major depression in
your lifetime.
If you are a man, there is a 1 in 8 chance
you will experience major depression in your
lifetime.
o About 10% of those with major depression
attempt suicide.
o Up to 15% of people who suffer from depression
or bipolar disorder commit suicide each year.
LP Psy Disorders BC:Psydisorder mood 9
03/23/09
• Gender and major depression: Cross cultural studies
indicate that women are more likely to suffer from
major depression than men (across different cultures,
there are individual variations in this ratio) AND they
are more likely to be affected by negative
consequences of depression. Early onset of major
depression adversely affects educational attainment
and earning power of women, but not men. It is
suggested that this is because women serve more
roles than men in society—mother, wife, lover, friend,
daughter, etc., and put the needs of others ahead of
her own.
• When you combine the cost of treating depression,
worker absenteeism, reduced productivity at work,
and loss of lifetime earning from depression, the cost
is estimated at $44 billion dollars a year in the United
States.
Risk factors for major depression:
• People in the 15-24 and 35-44 age brackets are at a
higher risk
• If you have little education or income, a homemaker,
divorced, widowed or separated.
LP Psy Disorders BC:Psydisorder mood 10
03/23/09
Example of a mood disorder
A writer has periods where she produces so much work
that her friends are amazed. She’s on an emotional high
during her productive periods, and can get by with only a
couple of hours of sleep each day. But she has other
periods when she can’t seem to write anything; she can’t
concentrate; in fact, she often can’t even get out of bed for
days at a time. During these times, nothing interests her,
even things she usually loves to do.
Likely disorder: bipolar disorder (mood disorder)
Characteristics of bipolar disorder:
• One or more manic episodes characterized by
euphoria, high energy, grandiose ideas, flight of
ideas, inappropriate self-confidence, and decreased
need for sleep.
• Usually, one or more episodes of major depression
• May alternate rapidly between symptoms of mania or
major depression.
Prevalence of bipolar disorder:
• About 2 million Americans suffer from bipolar
disorder.
• Unlike major depression, there is no gender disparity.
LP Psy Disorders BC:Psydisorder mood 11
03/23/09
Bipolar Disorder
(formerly known as manic depression)
Bipolar disorder is a mood disorder in which manic
episodes alternate with periods of depression, usually with
relatively normal periods in between.
Manic episode: A period of excessive euphoria,
inflated self-esteem, wild optimism, and hyperactivity.
It is often accompanied by delusions of grandeur,
drug abuse, and sexual promiscuity. Hostility can
occur when the bipolar’s behavior is blocked by
others.
It is believed that Vincent Van Gogh had a bipolar
disorder. In one two month period, he produced 60
paintings—some were his best works. Between these
periods of mania of almost non-stop work, he
experienced deep despair in which he did no work at
all.
• Bipolar is less common than major depression, affecting
about 2 million Americans per year.
• There are no gender differences in likelihood of being
afflicted by bipolar disorder. The lifetime risk of
developing bipolar disorder is about 1%.
• Bipolar tends to appear in late adolescence or early
childhood. The average person with bipolar disorder has
four episodes of mania or depression during the first 10
years of their illness.
LP Psy Disorders BC:Psydisorder mood 12
03/23/09
• Manic and depressive episodes can range from a few
days to a couple of months.
• About 90% of those with the disorder have recurrences,
and about 50% experience another episode within a
year of recovering from the previous episode.
• 70-80% of the patients return to a state of emotional
stability, but mild cognitive deficits such as difficulties in
planning, persist in many patients following a manic
episode.
• More than 50% of people with bipolar disorder abuse
drugs or alcohol during their illness (though not all that
abuse alcohol are bipolar)
• On the average, people with bipolar disorder see 3 to 4
doctors and spend more than eight years seeking
treatment before a correct diagnosis.
• On average, without treatment, manic episodes last a
few months, while depression lasts more than six
months.
• The more mood episodes a person experiences, the
harder it is to treat subsequent episodes
• Treatment: Drugs such as lithium and divalproex and
psychotherapy has been helpful in treating bipolar.
LP Psy Disorders BC:Psydisorder mood 13
03/23/09
Explaining mood disorders
• A small thimble-size patch of brain tissue in the lower
prefontal cortex (about 2-3 inches behind the bridge
of the nose) is 40-50% smaller in people with major
depression. In addition, the people high in the
personality trait neuroticism may be predisposed to
depression and suicidal thoughts
• Genetics: If one twin has major depression, there is a
50% chance the other twin will have major depression
where as fraternal twins have a 7% chance. If a
person’s has a mood disorder, the immediate
relatives are three times as likely as the general
population to have a mood disorder.
• Neurotransmitters: Increasing the availability of
norepinephrine and serotonin helps lifts the symptoms
of depression. Lithium appears to help regulate the
glutamate neurotransmitter.
Psychological
disorder
Obsessivecompulsive
Depression
Serotonin norepinephrine
Deficit
Deficit
Deficit
• Stress: Major depression is often triggered by
traumatic and stressful events, especially those who
have a family history of mood disorders.