Mood Disorders
Dr Joanna Bennett
Mood Disorders
Pervasive alterations in emotions that are manifested by depression, mania, or both, and interfere with the person’s ability to function normally
Mood Disorders
Major depression: 2 or more weeks of sad mood, lack of interest in life activities, and other symptoms
Bipolar disorder (formerly called “manic-depressive illness”): mood cycles of mania and/or depression and normalcy and other symptoms
Some related disorders
Seasonal affective disorder (SAD)
Postpartum depression
Postpartum psychosis
Prevalence
International studies Major depression - 3-16% Bipolar disorder 0.3-1.5%
Caribbean 4.9% (PAHO 2005) Community prevalence and risk factors for
mood disorders are generally unknown
DSM Diagnostic criteria – Major depressive disorder
At least one of the following three abnormal moods
significantly interferes with the person's life: Depressed mood Loss of interest & pleasure Irritable mood (under 18 yrs)
Occurring most of the day, nearly every day, for at least 2 weeks
Diagnostic criteria: Depression
At least five of the following symptoms should have been present during the same 2 week depressed period: Depressed or irritable mood Loss of interest & pleasure Appetite/weight disturbance (gain/loss) Sleep disturbances Fatigue/loss of energy Guilt Poor concentration Morbid thoughts of death
Diagnostic criteria: Depression
The symptoms are not due to Physical illness, alcohol, medication, or
street drug use. Normal bereavement. Bipolar Disorder Delusional or Psychotic Disorders
Mania: Signs and symptoms
Grandiose delusions, inflated sense of self-importance
Racing speech, racing thoughts, flight of ideas
Impulsiveness, poor judgment, distractibility Reckless behavior In the most severe cases, delusions and
hallucinations
Mania: Signs and symptoms
Increased physical and mental activity and energy
Heightened mood, exaggerated optimism and self-confidence
Excessive irritability, aggressive behavior Decreased need for sleep without
experiencing fatigue
Types of Bipolar disorder
Diagnostic criteria: Mania
Persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
3 (or more) of the symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:
Diagnostic criteria: Mania
inflated self-esteem or grandiosity decreased need for sleep more talkative than usual or pressure to keep
talking flight of ideas or subjective experience that
thoughts are racing distractibility excessive involvement in pleasurable activities
Nursing diagnosis
Psychiatrists have formulated clear guidelines for categorizing mental disorders (DSM-1V, ICD-10) – determines interventions
Nursing diagnosis provides basis for nursing intervention
Systematic collection & integration of data to formulate Nursing Diagnosis
The Nurse combines nursing diagnoses and DSM/ICD classifications to develop the treatment plan
Nursing Diagnosis
Assessment/psychiatric interview/MSE
Example nursing diagnosis
Risk for Suicide Ineffective Coping Hopelessness Self-Care Deficit
Aetiology
Depression often triggered by stressful life events Contributing factors:
Intensity and duration of these events individual’s genetic endowment coping skills social support network - depression and
many other mental disorders are broadly described as the product of a complex interaction between biological and psychosocial factors
Biological factors
Focus on alterations in brain function Abnormal concentrations of many
neurotransmitters and their metabolites in urine, plasma, and cerebrospinal fluid
Overactivity of the HPA (hypothalamus-pituitary-adrenal) axis - stress
dysfunction in serotonin (5-HT(1A) receptor activity could be due to a hypersecretion of cortisol
Monoamine Hypothesis
Prevailing hypothesis - depression is caused by an absolute or relative deficiency of monoamine transmitters in the brain Evidence that reserpine, a medication for
hypertension, caused depression by depleting the brain of both serotonin and the three principal catecholamines (dopamine, norepinephrine, and epinephrine).
Monoamine Hypothesis
monoamine hypothesis remains important for treatment purposes.
Many currently available pharmacotherapies that relieve depression or mania, or both, enhance monoamine activity.
One of the foremost classes of drugs for depression, SSRIs, increase the level of serotonin in the brain.
Psychosocial and Genetic Factors in Depression
Social, psychological, and genetic factors act together to predispose to, or protect against, depression. many episodes of depression are
associated with some sort of acute or chronic adversity
past parental neglect, physical and sexual abuse, and other forms of maltreatment impact on both adult emotional well-being and brain function
Psychosocial and Genetic Factors in Depression
early disruption of attachment bonds can lead to enduring problems in developing and maintaining interpersonal relationships and problems with depression and anxiety.
Cognitive factors
how individuals view and interpret stressful events contributes to whether or not they become depressed.
the impact of a stressor is moderated by the
personal meaning of the event or situation
Increased vulnerability to depression is linked to cognitive patterns that predispose to distorted interpretations of a stressful event
Genetic factors in depression & Bipolar
Susceptibility to a depressive disorder 2-4 times greater among the first-degree relatives of patients with mood disorder
The risk among first-degree relatives of people with bipolar disorder 6-8 times greater.
Genetic factors in depression & Bipolar
Does not prove a genetic connection.
First-degree relatives typically live in the same environment, share similar values and beliefs, and are subject to similar stressors, the vulnerability to depression could be due to nurture rather than nature
Treatment
50 to 70 % of depressed patients who complete treatment respond to either antidepressants or psychotherapies
Surveys consistently show that a majority of individuals with depression receive no treatment
Treatment
The acute phase - 6 to 8 weeks medication patients should be seen weekly or biweekly
for monitoring of symptoms, side effects, dosage adjustments, and support
Psychotherapies during the acute phase for depression typically consist of 6 to 20 weekly sessions
Treatment - ECT
60 to 70 % response rate seen with ECT Proposed to be useful with poor response
to medication depression is accompanied by potentially
uncontrollable suicidal ideas and actions
The most common adverse effects are
confusion and memory loss for events surrounding the period of ECT treatment.
Management- Maintenance
Medication acute phase treatment and at least 6
months of continued treatment
TCA’s, SSRI’s, NARIs, MAOIs,
St John Wort (Herbal) as effective as antidepressants
Psychosocial interventions : depression
NICE Guidelines (2009)
Mild depression – psychological
Moderate depression – Medication or Psychological
Severe depression – CBT & medication
Drug Treatment - Bipolar
Lithium – Long-term
Anticonvulsants – carbamazipine (not shown to be effective in acute treatment)
Antidepressants – SSRIs (inaequate evidence of effectiveness)
Antipsychotics – olanzapine, rispiridone (effective short-term)
Psychosocial interventions - Bipolar
CBT - group /individual
12-14 sessions < depressive episodes
Family therapy
psychoeducation, communication skills training, and problem-solving skills training.