Mood Disorders

Mood Disorders

1. Unipolar

   • Major Depressive Disorder
     •  15% die suicide
     • Diagnostic Criteria
       • Single episode of Major Depression Alteration in sleep, appetite, energy
       • 5 symptoms for 2 weeks 1 must be depressed mood or loss of interest and pleasure Sleep/Guilt/Energy/Concentration/appetite/Psychomotor/suicidality
       • Untreated Episodes: 6-12 months
     • Epidemiology
       • PR 5-20% Female-Male 2:1 IR 20-40  Decreases above 65
     • Etiology
       • Genetic/Personal Experience Deficiency in: NE - Alertness and enegry Serotonin - mood and imulse Dopamine - drive and motivation
       • Neuro-endocrine link Hypothalamic-Pituitary-Adrenal axis
       • Anti-hypertensives Cortisone Analgesics Hormones
       • Brain Tumors CVA High Potassium, Sodium Bicarb Calcium Low Vitamines B1,B6, C, D, Folic Acid
       • Beck
         • Pessimistic Views
       • Hopelessness Theory
   • Persistent Depressive Disorder
   • Dysthymic Disorder
     • Mild/Chronic MDD PR: 6% 2 years of chronically depressed mood
     • Diagnostic Criteria
       • Sleep Appetite Energy Concentration and Hopelessness Major Depressive Episodes may co-occur --> Double Depression

2. Bipolar

   • Bipolar 1
     • Most serious At least 1 episode of mania and MD EPISODES
     • Diagnostic Criteria
       • Mania
         • 3 to 4 of the below: esteem/sleep/speech/thoughts/attenntion/activity/Hedonism A week of elevated mood for one time
         • PR 0.4-1.6% Male=Female Early 20s Sleep/wake cycle
   • Bipolar 2
     • PR 0.5% Women Cyclic  Suicide 15%
     • Diagnostic Criteria
       • Hypomania 3 days with 3 or 4 of the following symptoms: Grandiose-Decreased sleep-Pressured speech- Racing thoughts-Flight of ideas-easily distractible-psychomotor agitation
   • Cyclothymic
     • Diagnostic Criteria
       • Recurrent, Chronic, Mild  Hypomania and dysthymia Adolescents to early adulthood
       • PR 0.1-1% MEN=WOMEN Steroids, high dose anti-convulsants, amphetamines, narcotics
       • 1 episode of hypomania

3. Mood Disorder with a known etiology

   • Substance Induced
   • Due to a medical condition
   • Melancholic Depression
     • Depression Guilt Remorse Loss of pleasure Vegetative Symptoms
   • Postpartum Depression
     • 4 weeks of delivery
   • Seasonal Mood Disorders
     • Depression worsen in the fall and improve in the spring and vice versa
   • Atypical
     • Pattern of hyperinsomia, increased appetite and weight gain
   • Rapid Cycling
     • 4 mood disturbances per year
   • Catatonic

4. Disruptive Mood Dysregulation Disorder

   • Childhood Bipolar Disorder Children up to 18 years

5. Premenstrual Dysphoric Disorder

   • The final week before the onset of menses, few weeks after its onset
   • first 4 must be present Affective liability (swings) Irratibility Depression Anxiety

6. Suicide

   • Tunnel vision Constriction in their common cognitive state