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IzBen C. Williams, MD, MPH Instructor
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Lecture - 11 MOOD DISORDERS
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MOOD DISORDERS
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DEFINITIONS: The essential feature of mood disorders is a disturbance of one’s emotional state along the happy-sad axis causing subjective distress and problems in functioning.
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MOOD DISORDERS DEFINITIONS: Subjectively, the person may feel: Somewhat worse than would be expected (dysthymia) Very much worse than would be expected (depression) Somewhat better than would be expected (hypomania) Very much better than would be expected (mania)
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MOOD DISORDERS DIAGNOSIS: The diagnosis of mood disorder requires the identification of mood episodes, which are building blocks for making a diagnosis of mood disorder. Mood episodes: A. Major depressive episode (MDE) B. Manic episode C. Mixed episode D. Hypomanic episode
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MOOD DISORDERS EPIDEMIOLOGY: There are no differences in the occurrence of mood disorders associated with ethnicity, education, marital status, or income. The lifetime prevalence of mood disorders is: A. Major depressive disorder: M 5-12% and F 10-20% B. Bipolar disorder: 1% overall, no sex difference C. Dysthymic disorder: 6% overall; M : F = 1 : 3 D. Cyclothymic disorder: < 1% overall; no sex difference
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MOOD DISORDERS Major Depressive Disorder Characteristics: Recurrent episodes of depression, each continuing for at least two weeks Symptoms of depression (qv) Masked depression: being unaware of or in denial of depression; (50% of depressed patients) Usually complain to 1° care doctor of vague physical symptoms These complaints may be mistaken for hypochondriasis Seasonal affective disorder (light Tx) Suicide risk (see table of risk factors for suicide)
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MOOD DISORDERS Major Depressive Disorder Associated clinical features: Psychotic features (mood congruent) Melancholia (profound anhedonia and neurovegetative symptoms. Significant wt. loss) Mortality and morbidity (additional risk of illness or death due to medical causes) Psychiatric comorbidity
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MOOD DISORDERS Dysthymic Disorder Diagnosis: chronic depression (at least two years duration) but not severe enough to meet the criteria for MDE. Requires only 2 rather than 5 MDE symptoms. Associated clinical features: social impairment, health problems, abuse of alcohol and other drugs, major depression (double depression)
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MOOD DISORDERS Bipolar I Disorder Bipolar I Disorder (misnomer) Diagnosis: at least one manic or mixed episode Associated clinical features: Psychotic features (mood congruent) Morbidity and Mortality Psychiatric comorbidity Epidemiology: Mean age of occurrence 21 yrs; Likelihood of recurrence 90%
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MOOD DISORDERS Bipolar II Disorder Diagnosis: at least one MDE and one hypomanic episode in the absence of manic or mixed episodes. Associated clinical features: suicide risk particularly during depressive episodes
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MOOD DISORDERS Cyclothymic Disorder Dysthymia with intermittent hypomanic episodes. Like dysthymia it is chronic rather than episodic Diagnosis: experienced over at least two years at least one MDE and one hypomanic episode in the absence of manic or mixed episodes. Associated features: substance abuse and social and occupational dysfunction are commonly seen Epidemiology: up to 50% may ultimately develop bipolar disorder
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MOOD DISORDERS
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Etiology: Etiology: The etiology is multifactorial Biologic Genetic factors (family studies, adoption studies) Neurochemical factors (NE, 5-HT and less solidly Dopamine); and other neurotransmitters such as GABA and neuropeptides also implicated Other biologic factors (neuroendocrine regulation, sleep and circadian rhythm, kindling
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Bipolar disorder The Genetics of Bipolar Disorder GROUP% Occurrence The general population1% Person with one bipolar parent or sibling (or dizygotic twin)20% Person with two bipolar parents60% Monozygotic twin of a person with bipolar disorder75%
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MOOD DISORDERS Etiology: Psychosocial: Stress Loss of a parent before age 11, linked to depression in adulthood Anger turned inward, intrapsychic processing of loss ….depression and self hatred Learned helplessness, (animal model) Negative cognitions
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MOOD DISORDERS Treatment: Overall treatment planning: Mood disorders vary in symptoms and severity, but some overall guidelines exist Treatment setting Diagnostic evaluation Assessment of safety
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MOOD DISORDERS Treatment: Treatment of major depressive disorder: Hospitalization: may become necessary for safety, treatment (including ECT), or support Outpatient treatment: combination of ψTx and medication, there are several models of ψTx for depression, support in its various forms Somatic therapies (medication and ECT)
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MOOD DISORDERS Treatment: Treatment for bipolar I and Bipolar II disorders: Hospitalization: containment of manic behavior, initial or reinstituted treatment, compliance Outpatient treatment: combination of ψTx and medication, Somatic therapies: Lithium, Valproate, Carbamazepine, et al Other drugs: antipsychotics, benzodiazepines, antidepressants
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Mood Disorder Vignettes 1.Major Depression https://www.youtube.com/watch?v=4YhpWZCdiZc 2.Manic Depressive Disorder: commentary https://www.youtube.com/watch?v=cqMcAeLWO9c 3.Manic episode https://www.youtube.com/watch?v=zA-fqvC02oM
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