1. Mood Disorders OT 460a

2. Diagnostic Criteria  Disturbance in mood not due to any other mental or physical dx  Emotion based problems (usually extreme cause dysfunction)  Dysthymia/ depressive disorder  Cyclothymia/ Bipolar disorder  Major Depression  Manic/ Hypomania 10/4/12OT 460A2

3. Causes occurrence and theories of mood disorders  Bipolar = in males vs. females  Depression 2x as common in females  Major depression 1.5-3x as common in families  Bipolar more common in first degree relatives  1.2% of adult population have bipolar  Causes: (See Table 7.1)  Chemical/ genetic; psychosocial; socio- environmental  Physical diseases: Hormones; Addisons; Thyroid; Diabetes; MS; Chronic Brain Syndromes; Anemia; malignancies; CHF; RA; Asthma; Medications 10/4/12OT 460A3

4. Clinical Picture  Mood alteration to the point of dysfunction (manic or depressed)  See Table 7.2 for signs / sx of each  Most dangerous period in depression is after initial tx 10/4/12OT 460A4

5. Common Evaluation and Management  Beck Depression Inventory; Hamilton Rating Scale for depression  Evaluate for co-morbid conditions (esp. substance abuse)  Medication:  Bipolar: lithium; anticonvulsants; neuroeleptics  Depression:  SSRI; MAOI; Tricyclic antidepressants  Therapy:  Interpersonal Therapy  Cognitive behavior therapy  Psychoanalysis  ECT 10/4/12OT 460A5

6. OT Tx  Interpersonal Approach  Understanding and empathy  Don’t expect too much too soon  Person-to-person interventions  Cognitive behavioral therapy / IPT  Role dx/ transitions; life planning; job coaching;  Activities  See Tables 8.3 and 8.4 for list of interventions for Depression and Mania  System Interventions  Acute to partial hospital to community ILF  Groups address skill development; problem solving and symptom management; Self advocacy and system negotiation 10/4/12OT 460A6