Behavorial Sciences

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Behavorial Sciences
2011-02-08 14:46:25

Mood Disorders
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  1. Mood vs. Affect
    • mood is defined as an internal emotional condition
    • affect refers to how that emotional condition is expressed
    • mood disorders are abnormalities of mood and affect
    • fyi: mood disorders occur more frequently in single, divorced, and seperated ppl than in married ppl.
  2. Depression
    • some pt's seem unaware of or may deny depression (i.e. "masked" depression) even though symptoms are present
    • cognitive impairment- pseudodementia
    • symptoms of depression in both major depressive disorder and bipolar disorder and similar.
  3. Mania vs. Depression
    Rapid, excited speech, decreased need for sleep, and feelings of self-importance(grandiosity)

    depression: decreased energy, difficulty in concentrating and in sleeping, guilt, reduction in appetite, and suicidal thoughts.
  4. Mania cont'd
    • altho pt's may be euphoric, excitable, and hyperactive, those experiencing a manic episode can also be irritable, angry, and hostile
    • in mania, mood congruent delusions include those of strength, exceptional abilties, and financial power
    • loosening of associations, flight of ideas, word salad, and neologisms
    • as a manic episode proceeds, speech becomes difficult to follow and comprehend
    • judgment is impaired during a manic episode laws are often broken
  5. Biologic factors
    • Nuerotransmitters and mood disorders- the activity of NE and serotonin, is altered in pt's with mood disorders
    • Dopamine activity may be decreased during depressive episode and increased during manic episodes
    • MHPG, VMA, 5-HIAA, HVA occur in the urine, blood, and CSF of many pt's with mood disorders
    • Ach levels may be abnormal in mood disorders
  6. Psychosocial factors
    • Life stressor may be related to the development of depression
    • the loss of a parent in the first decade of life and loss of spouse correlate with major depression.
    • misinterpretation of life events, low self-esteem, and loss of hope are involved in cognitive theories about the development of depression
    • cognitive therapy is particularly useful in treating these emotional problems
  7. Stable
    • mild: dysthymia
    • severe: unipolar (major depression)
  8. alternating
    • mild: cyclothymia
    • severe: bipolar (manic-depression)
  9. Dysthymia
    • nonpsychotic depression-not severe enuff for hospitilzation
    • loss of interest or pleasure
    • not severe enough for hosp.
    • note: pt. is functional, but at a suboptimal level
  10. Diagnostic criteria
    • chronic depressed mood for greater than/equal to 2 yrs. characterized by 2 or more of the following:
    • poor app. or overeating
    • insomnia/hypersomnia
    • low energy or fatigue
    • low self esteem
    • poor conc. or diff making decisions
    • hopelessness
  11. Cyclothymia
    • Nonpsychotic bipolar
    • often not recognized by the person
    • lifetime prevalence <1%
  12. Diag criteria
    greater than or equal to 2 years with numerous periods of both : Dysthymic and hypomaniac symptoms

    • Does not meet dx criteria for bi-polar!!
    • Never symptom free for greater than or equal to 2 month period
    • never a MDE or a maniac episode
  13. Hypomaniac Episode
    • distinct period of elevated/irritable mood lasting > or = 4 days with: greater than or equal to 3 symptoms of mania, NO MARKED DYSFUNCTION, no psychotic features.
    • chronic- may ultimatley have MDE or mania, which changes the diagnosis from cyclothymia to bipolar disorder (I or II)
  14. Major Depressive Disorder
    • Mean age of onset= 40 years
    • occurs twice as often in women than in men
    • no correlation with social class
    • some evidence of genetic etiology
  15. Bipolar Disorder
    • Mean age of onset = 30 years
    • occurs equally in women and men
    • higher incidence in upper socioeconomic groups
    • strong evidence of genetic etiology
  16. Major Depressive Disorder (cont'd)
    • > or equal to one MDE
    • without the history of mania
    • one-half to three-fourths of patients with major depression have a second depressive episode
    • patients usually are mentally healthy b/w episodes of major depression
    • amont patients w/ major depression, an average of five or six depressive episodes commonly occur over a twenty-year period
  17. Diagnositc criteria for an MDE
    • greater than or equal to 2 weeks of depressed mood or anhedonia
    • PLUS: greater than or equal to four-
    • weight change
    • sleep change
    • psychomotor changes
    • loss of energy
    • guilt/worthless
    • decrease in conc.
    • suicidal ideation
    • S: Sleep change
    • I: Interest loss
    • G: Guilt
    • E: Energy problem
    • C: Concentration poor
    • A: Appetite change
    • P: Psychomotor changes
    • S: Suicidal ideation
  19. Bipolar Disorder
    • First manic episode often occurs after about three episodes of depression
    • Manic episodes usually have a rapid onset and when untreated last about three months
    • Period of time b/w manic episodes becomes shorter as bipolar progresses
    • Period b/w episodes in bipolar illness is generally 6-9 months.
    • Symptoms of major depression plus symptoms of mania-
    • alternates b/w depression and mania
    • subtypes:
    • Bipolar I: mania more prominent
    • Bipolar II: recurrent depressive episodes plus hypomaniac episodes
    • Note: if alternates w/in 48/72 hours, called "rapid cycling bipolar disorder"
  20. Diagnositc criteria
    • Bipolar I: greater than or equal to 1 manic episode
    • Bipolar II: at least one MDE and at least one hypomanic episode; NEVER a manic episode
  21. Manic Episode
    • greater than or equal to 1 week of elevated mood or irritability with greater than or equal to 3 symptoms:
    • inflated self-esteem (may be delusional)
    • decreased need for sleep
    • pressure of speech
    • flight of ideas
    • distractibility
    • increased goal-directed avitivities or psychomotor acceleration
    • excessive involvment in pleasurable but risky axn's
  22. Mood changes post-partum
    • "post-partum blues:" mild mood symptoms of short duration (<2 weeks)- this is NOT a psychiatric dx!
    • MDD with post-partum onset: onset of MDE w/in 30 days after delivery.
    • MDD with psychotic features and post-partum onset: onset of MDE with psychosis w/in 30 days after delivery. This is rare but serious condition associated with infanticide.
  23. Seasonal Affective Disorder
    • depressive symptoms during the winter months
    • winter has shortest days/least amt. of light
    • "atypical" symptoms: increased sleep, increased appetite, decreased energy
    • caused by abnormal melatonin metabolism; SAD related to seasonal depletion of light
    • treat with bright light therapy(phototherapy); (1-2 hrs/day) to suppress release of melatonin. Symptoms respond in 3-4 days
    • Note: not melatonin tablets