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Surgeon General’s Report 1999
(Part 2)
Mood Disorders
and
Schizophrenia
MOOD DISORDERS
7 % of Americans suffer from mood
disorders
Rank among the top ten causes of
WORLDWIDE disability
The two that will be covered today:
~Major Depressive Disorder
~Bipolar Disorder
Comorbidities
(what Mood Disorders coexist with)
Anxiety Disorders
Substance Abuse Disorders
40% of people with mood disorders
also have substance abuse disorders
Clinical Depression
vs.
Normal Sadness
(what distinguishes Major Depressive Disorder?)
Anhedonia
Hopelessness
Loss of mood
reactivity
Suicidal thoughts
Delusions
Characteristics
of Major Depressive Disorder
One or more episodes lasting at least 2 weeks
Cardinal Symptoms:
Depressed mood
Loss of interest or pleasure
When untreated:
Lasts 9 months
50% will recur
Dysthymia
a CHRONIC form of depression
BIPOLAR DISORDER
Episodes of mania mixed with episodes of
depression
Recurrent
How is Bipolar Disorder
DIFFERENT from Major
Depressive Disorder?
Manic episodes
Earlier age at onset
Reversed vegetative symptoms
Oversleeping, overeating
Lithium salts are therapeutically effective
The MANIA Phase
Thought content is GRANDIOSE and
PARANOID
Speed of thought increases
Sleep deprivation contributes to delirious
mania
Equally common in both men and women
CYCLOTHYMIA
a MILDER form of Bipolar
Disorder
ETIOLOGY
of Mood Disorders
Biological factors
Monoamine Hypothesis
Deficiency of monoamine transmitters
SSRI’s boost serotonin levels
Depressed patients have too much activity in
the HPA axis
Depressed patients have higher levels of
CRH
ETIOLOGY, continued…
Psychosocial Factors
Stressful life events
The most stressful:
Death of a loved one
Cognitive factors
It’s all about perception
Temperament &
Personality
Neuroticism predisposes
Gender
All over the world,
Major Depressive
Disorder is more
common in women
Genetic
Tend to run in
families
TREATMENT
of Mood Disorders
Biggest problem= getting people into
treatment at all
More than 50% of depressed people don’t
get treatment
More than 40% of bipolar people don’t get
treatment
Reasons…
TREATMENT, continued…
Stages of Therapy
 Acute phase
Usually requires 6-8 weeks
 Electroconvulsive Therapy
Most common adverse effects: confusion and
memory loss
 Continuation phase
At least 6 months of continued treatment
 Maintenance phase
Purpose is to prevent future occurrences
TREATMENT
for specific episodes of
Depression and Mania
Four major classes of drugs
TCAs, HCAs, MAOIs, SSRIs
Newer therapies for Depression
Cognitive-Behavioral therapy
Interpersonal psychotherapy
Newer treatments for Mania
Verapamil is a calcium channel blocker
SCHIZOPHRENIA
…the BRIEFEST of
overviews…
CHARACTERISTICS
of Schizophrenia
Profound disruption in cognition and
emotion
Symptoms frequently include:
psychotic manifestations
Assigning unusual significance to normal
events
Having delusions
POSITIVE symptoms
(excess/distortion of normal functions)
Delusions
Hallucinations
Disorganized speech
Catatonic behaviors
Disorganized
thinking
Grossly distorted
behavior
NEGATIVE symptoms
(diminution or loss of normal functions)
Affective flattening
Alogia
Avolition
Recovery Factors
Family/Home atmosphere
Personal motivation
Availability of skill-building assistance
ETIOLOGY
of Schizophrenia
Immediate biological relatives have 10
times greater risk
Discordance among identical twins
indicates environmental factors also
important
Brain abnormalities include:
Enlarged cranial ventricles
Decreased cerebral size
PHYSIOLOGY
of Schizophrenia
Positive symptoms linked to
TEMPORAL LOBE dysfunction
Negative symptoms linked to
PREFRONTAL LOBE dysfunction
Pharmacotherapy Interventions
Chlorpromazine (older) and Clozapine (newer)
reduce the POSITIVE symptoms of
Schizophrenia
Newer meds also reduce the NEGATIVE
symptoms
Moderate levels of dosage are most effective
Problem: SIDE EFFECTS
 40% of patients have side effects (parkinsonism and tardive
dyskinesia)
Clozapine is the prototype of the newer meds
THE END