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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.
- 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.
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.
- 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
- 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
- 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
- mild: dysthymia
- severe: unipolar (major depression)
- mild: cyclothymia
- severe: bipolar (manic-depression)
- nonpsychotic depression-not severe enuff for hospitilzation
- MILD DEPRESSED MOOD
- loss of interest or pleasure
- not severe enough for hosp.
- note: pt. is functional, but at a suboptimal level
- chronic depressed mood for greater than/equal to 2 yrs. characterized by 2 or more of the following:
- poor app. or overeating
- low energy or fatigue
- low self esteem
- poor conc. or diff making decisions
- Nonpsychotic bipolar
- ALTERNATING STATES
- often not recognized by the person
- lifetime prevalence <1%
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
- 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)
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
- Mean age of onset = 30 years
- occurs equally in women and men
- higher incidence in upper socioeconomic groups
- strong evidence of genetic etiology
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
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
- 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
- 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
- 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"
- 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
- 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
- increased goal-directed avitivities or psychomotor acceleration
- excessive involvment in pleasurable but risky axn's
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.
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