Mood Disorders 2024-2 (PDF)

mood disorders Dr. Alvarez By the end of this lesson, you will be able to: Differentiate Between Sadness, depression and Bipolar Disorder Discuss Etiological Factors and Risk Elements Recognize Major depressive disorder with and without psychotic features. Recognize Major d...

mood disorders Dr. Alvarez By the end of this lesson, you will be able to: Differentiate Between Sadness, depression and Bipolar Disorder Discuss Etiological Factors and Risk Elements Recognize Major depressive disorder with and without psychotic features. Recognize Major depressive disorder: seasonal patterns, screening. Discuss Bipolar disorders: Manic, depressed, mixed episodes.  mood episode vs mood disorders Mood episodes are distinct periods of time in which some abnormal mood is present. They include depression, mania, and hypomania. Mood disorders are defined by their patterns of mood episodes. major depressive disorder (MDD), bipolar I disorder, bipolar II disorder, persistent depressive disorder, and cyclothymic disorder. Some may have psychotic features (delusions or hallucinations). Delusion: A false belief held with strong conviction, despite clear evidence to the contrary. Hallucination: A perceptual experience without an external stimulus, occurring in any sensory modality  bereavement AKA simple grief, is a normal reaction to a major loss, usually of a loved one, and it is not a mental illness. Symptoms are usually self-limited Normal bereavement should not include gross psychotic symptoms, disorganization, or active suicidality  depressive disorder Brief feelings of sadness or anger in response to challenges are part of everyday life experience. The clinical term ‘depression’ should be reserved for those with a pervasive change of mood, i.e. deterioration in mood that persists across different situations, that endures for a prolonged time with little or no variability, and with distinctive patterns of associated symptoms Dysphoria: depressive feelings  core features of depression Pervasive low mood: minimal variation in mood over the day; worst on wakening in the morning, improving as the day progresses, known as diurnal mood variation (DMV) (associated with moderate/ severe depression). Reduced capacity for pleasure (anhedonia— total inability to feel pleasure/enjoyment). A depressed mood and a loss of interest or pleasure are the key symptoms of depression. Patients may say that they feel blue, hopeless, in the dumps, or worthless. core features of depression Sleep disturbance (insomnia) - 80%: Initial or middle Early morning wakening: found in moderate/ severe depression, typically wakes at least 2 h before their usual waking time, unable to resume sleep, and feels ill- at- ease or distressed. Often associated with DMV. People may report a mix of the above sleep difficulties.  neurovegetative symptoms of depression anorexia (appetite loss) anergia poor concentration (often associated with memory difficulties) - hipoprosexia Reduced libido (under-reported). Feelings and thoughts of worthlessness or excessive guilt: ruminate on past events and perceived failings or mistakes.  neurovegetative symptoms of depression Self-critical thinking, catastrophizing minor problems. Can develop delusions of guilt This negative style of thinking can progress to feelings of hopelessness (an important predictor of risk of suicide), passive death wish, and suicidal ideas neurobiology of neurovegetative symptoms of depression Serotonin Dysfunction: Impairs sleep and appetite regulation, contributing to insomnia, hypersomnia, and disordered eating patterns. Norepinephrine Imbalance: Leads to decreased energy, fatigue, and reduced motivation—key neurovegetative signs. Circadian Disruptions: Misalignment in sleep-wake cycles intensifies depressive symptoms by impairing neuroplasticity and neurotransmitter systems. Role of Melatonin: Synthesized from serotonin, it helps regulate circadian rhythms; disruption exacerbates depressive states, especially in evening chronotypes prone to sleep disturbances and mood disorders. psychotic symptoms of depression MOOD disorders mood disorders Mood disorders are characterized by relapses with periods of normal functioning between episodes, distinctive from chronic psychiatric disorders like schizophrenia. Before diagnosing a primary mood disorder, it's essential to rule out medical or substance-induced causes, as mood episodes can result from underlying health conditions or drug use (prescribed or illicit). To diagnose any mental health disorder, there must be a negative impact on function.  major depressive episode (mde) MOOD EPISODES Must have at least five of core symptoms of depression (including depressed mood and anhedonia) for at least a 2-weeks. Symptoms must not be attributable to the effects of a substance (drug or medication) or another medical condition, and they must cause clinically significant distress or social/occupational impairment. MOOD EPISODES MANIC episode Period of persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week (or any duration if hospitalization is necessary), and including at least three of the following (four if the mood is only irritable): 1. Distractibility. 2. Inflated self-esteem or grandiosity. 3. in goal-directed activity (socially, at work, or sexually) or psychomotor agitation. 4. need for sleep. 5. Flight of ideas or racing thoughts. 6. More talkative than usual or pressured speech (rapid and uninterruptible). 7. Excessive involvement in pleasurable activities that have a high risk of negative consequences (e.g., shopping sprees, sexual indiscretions). MOOD EPISODES MANIC episode Symptoms must not be attributable to the effects of a substance (drug or medication) or another medical condition, and they must cause clinically significant distress or social/occupational impairment. Greater than 50% of patients with manic episodes have psychotic symptoms. MOOD EPISODES MIXED FEATURES Criteria are met for a manic or hypomanic episode and at least three symptoms of a MDE are present for the majority of the time. These criteria must be present nearly every day for at least 1 week  mood disorders due to other medical conditions Medical Causes of a Depressive Episode Cerebrovascular disease (stroke, Medical Causes of a manic Episode myocardial infarction), endocrinopathies (diabetes mellitus, Cushing syndrome, Addison disease, hypoglycemia, hyper/hypothyroidism, Metabolic (hyperthyroidism), hyper/hypocalcemia), Parkinson neurological disorders (temporal disease Viral illnesses (e.g., lobe seizures, multiple sclerosis) mononucleosis) Carcinoid syndrome Cancer (especially lymphoma and pancreatic carcinoma), collagen vascular disease (e.g., systemic lupus erythematosus)  MOOD disorders major depressive disorder (MDD) MDD is marked by episodes of depressed mood associated with loss of interest in daily activities. Patients may not acknowledge their depressed mood or may express vague, somatic complaints (fatigue, headache, abdominal pain, muscle tension, etc.) Lifetime prevalence: 12% worldwide. Onset at any age, but the age of onset peaks in the 20s. 1.5–2 times as prevalent in women than men during reproductive years. No ethnic or socioeconomic differences. Lifetime prevalence in the elderly: 2 months during those 2 years. No history of MDE, hypomania, or manic episode. Lifetime prevalence: