Mood Disorders
• Affect: Observed expression of emotion ( happy you smile, etc.) response to an emotion
• Mood: A pervasive and sustained emotion, subjectively experienced and/or reported by the patient and/or reported by others; PROLONGED
* Anxiety is a mood
• The mood disorders ….
1. Include disorders that have a disturbance in mood as the predominent features
2. Are characterized by depression, mania, and/or hypomania
I. Manic Episodes
• DSM-IV Criteria for a manic episode
- Persistently elevated, or expansive irritable mood lasting at least one week or any duration if hospitalization is necessary
- During the period of mood disturbance three or more of the following manifestations must exist:
1. Inflated self-esteem or grandiosity- in addition to feeling happy, you may show grandiosity and irritability, and labile mood
2. Decreased need for sleep
3. More talkative than usual- pressure of speech, clang
4. Flight of ideas of subjective feeling than the thoughts are racing Loosening of associations
5. Distractability
6. Increased goal directed activity or agitation- don’t accomplish much even though they are always doing something
7. Excessive involvement in pleasurable activities that have high potential for painful consequences; i.e. hypersexual- people use poor judgement and do not protect themselves; get VD’s, HIV, etc.; also true for gamblers, etc.
- 2 Parameters that distinguish Mania from Hypomania:
- Mood disturbance is sufficiently severe to cause impairment in social or occupational functioning; poor judgement
- Symptoms are not due to the direct effect of a substance or a general medical condition
• Characteristics
- Sex – ↑ sexual drive, fantasy, and behavior are present
- Social life – ↑ sociability; they are amusing but you cannot cope with them for more than an hour or two
- Sleep – ↓ sleep
- Functioning – Marked impairment in functioning
- Judgement- usually poor judgement
- Thinking – the pt is often preoccupied by religious, political, financial, sexual, or persecutory ideas that can evolve into complex delusional symptoms; frequenty; they do not recognize that they are ill (denial), or anosognosia and distractability; often believe that they can change the world; marked distractibility;
- Perceptive disorder – Some individuals describe a much sharper sense of smell, hearing, or vision; hallucinations are not frequent manifestations;
Vell’s mania- rare- person so happy that they start having visual hallucinations; unusual because most of the time if a manic pt has hallucinations they are auditory
- Manic episodes in adolescence – more likely to include psychotic features and may be associated with school truancy, antisocial behavior, school failure, or substance abuse
• Coexisting Disorders
- Alcohol dependence and other substance-related disorders are commonly associated with mood disorders;
- Anxiety disorders, mood disorders, somatoform disorders, and drug abuse all go together
II. Hypomaniac Disorders
• DSM-IV Criteria
- A distinct period of persistently elevated, expansive or irritable mood lasting throughout at least 4 days that is clearly different from the usual non-depressed mood; hyperfunctional people (work more and produce more)
- During the period of mood disturbance, 3 or more of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractability
6. Increased goal directed activity or agitation that have a high potential for painful consequences
- Episode is associated with unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
- The disturbance in mood change and functioning are observed by others
- The episode is not severe enough to cause marked impairment in social or occupational functioning, or necessitate hospitalization, and there are NOT PSYCHOTIC features; if you see these, you must switch your diagnosis from hypomania to mania ***TQ***
- Use good judgement
- The symptoms are not due to direct psychological effects of substance abuse or a general medical condition (ie hyperthyroidism)
III. Bipolar Disorders-
Classification of Bipolar Disorders
• Bipolar I Disorder – mood disorder in which the main manifestations are mania or hypomania with or without depression
• Bipolar I Disorder Subtypes
- Single manic episode- after this you are bipolar I the rest of your life
- Most recent episode…
Hypomanic- were manic at one pt, then became hypomanic
Manic- were depressed at 1 pt, then became manic
Mixed – ONE WEEK very rapid changes (dep-mania or hypomania)- Mon pt Dep, Tues pt Manic, Wednesday pt Dep, Thurs pt Manic in am and Dep in pm, Fri pt Dep in am and Manic in pm, Sat pt Manic- SUPER RAPID CHANGES (HRS/DAYS= changes in 1 week- minimum 2 changes/wk) ****TQ****
Depressed
Unspecified- you don’t know where to place the patient
• Bipolar I Disorder Specifiers (subtypes of subtypes)- most based on depression
- Mild episodes – characterized by the presence or only 3 or 4 manic symptoms; pt is there, not functioning BUT DOES NOT NEED SUPERVISION
- Severe without psychotic symptoms – characterized by the need of almost continual supervision
- Severe with psychotic symptoms- as above, but pt shows delusions or hallucinations- if psychotic features are present ever, ALWAYS treat with anti-psychotics
• CONGRUENT (I am the best psychiatrist in the world no one can compare to me)
• INCONGRUENT DELUSIONS/HALLUCINATIONS (martians are putting electrodes into my brain; I am so happy but I know that I am going to hell- I have committed so many mistakes in my life that I am going to hell.)
- Moderate- extreme increase in activity or impairment of judgement
- In partial remission – full criteria for the symptoms of mania are not met
- Catatonic features- marked by psychomotor disturbances (motor immobility or excessive motor activity, or in a stupor)
- Post-partum onset- onset of the episode within 4 wks post-partum; respond best to MAOI’s & SSRI’s
♣ Mood reactivity to environment – something good happens and they get happy for a few hours
♣ Irritability- if you tell them that they are eating/sleeping too much, etc.
♣ Anxiety -
♣ Increased appetite and weight gain
♣ Hypersomnia
- With melancholic features-
- Characterized by:
Lack of reactivity to pleasurable activities
Anhedonia – not reactive to the environment- get good news, they are sad
Depression worse in the morning
Early morning awakening – at least 2 hours before the usual time
Patient usually feels better at night; 9-10 in the am they are miserable
Marked psychomotor retardation or agitation- retardation of speech
Anorexia or weight loss
Excessive or inappropriate guilt- I feel miserable because I am ignoring my husband, wife, and children
killer condition – use ECT or other anti-depressents
Common among hispanics
- With atypical features – characterized by:
1. Mood reactivity- something good happens and they get happy for a few hours
2. Increased appetite and weight gain
3. Hypersomnia
4. Heavy laden feelings in arms and legs
5. Sensitivity to rejection
- Chronic – characterized by a duration of 2 yrs or longer
- With seasonal pattern- the features of the onset and resmission of the episodes (mania, hypomania, or depression) occur at a characteristic time of year; increased depression in the winter months (low sunlight)- light therapy; Use sunlight (fake or real) as therapy
- With rapid cycling – there must be 4 or more episodes in one year; may occur in any combination or order; the episodes must meet both the duration and symptoms criteria for major depression, amnia, hypomania, or mixed and must be demarcated by either period of full resmission or a switch to an episode of the opposite polarity- 1 year period you must have 4 fully developed episodes (depression for 2 months, then manic, then depressed, then manic-no specific order )- poor response to lithium
Tags: anxiety disorder, bipolar disorder, depression, Dopamine Mania, eating disorder, hypomania, mania, Neuroanatomical considerations, Neuroendocrine regulation, Neuronal Hyperexcitability, schizophrenia, Vasopressin opiates
