Clinical Psychiatry Mood Disorders PDF

Clinical Psychiatry DPT415 Mood disorders  Mood Disorders activity Our emotions tell us how we are doing in life! Mood disorders: are a category of illnesses that describe a serious chan...

Clinical Psychiatry DPT415 Mood disorders  Mood Disorders activity Our emotions tell us how we are doing in life! Mood disorders: are a category of illnesses that describe a serious change in mood They are very common with a high level of morbidity and mortality The mood change is usually accompanied by a change in the overall level of activity. Most of these disorders tend to be recurrent, and the onset of individual episodes is often related to stressful events or situations.  Mood Episodes Mood episode simply refers to any period of time when a person feels abnormally happy or sad. Three types of Mood episodes: 1. Major Depressive Episode Ern 9 2. Manic Episode 3. Hypomanic episode  1-Major Depressive Episode (DSM-V Criteria) A. Major Depressive Episodes must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2-week period. B. This mood must represent a change from the person’s normal mood; social, occupational, educational, or other important functioning must also be negatively impaired by the change in mood. C. A Major Depressive Episode is also characterized by the presence of 5 or more of these symptoms: 1. Depressed mood most of the day, almost every day, indicated by your own subjective report or by the report of others. This mood might be characterized by sadness, emptiness, or hopelessness. 2. Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day. 3. Significant weight loss when not dieting or weight gain. 4. Inability to sleep or oversleeping nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. militants  1-Major Depressive Episode (DSM-V Criteria) mah fuel D. The episode is not due to the effects of a substance or to a medical condition E. The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophrenic form disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders to howeven says the s we lecterns  1-Major Depressive Episode Epidemiology Gender prevalence poor disond Higher in women than in men by about 2 to 1 bibs on Age tich Depression is more common in young women than in older women (greatest between ages 20-40) The opposite is true for men Etsy Marital status: 18T Single and divorced people are more likely to experience depression than married people  1-Major Depressive Episode Social class: 5TEur biblan barn Epidemiology There is an inverse relationship between social class and the report of depressive symptoms; the opposite is true with bipolar disorder. Seasonality: Affective disorders are more prevalent in the late fall or early winter  1-Major Depressive Episode Types The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies depressive disorders as the following: 1. Major depressive disorder 2. Persistent depressive disorder (PDD)/Dysthymic disorder 3. Disruptive mood dysregulation disorder (DMDD) 4. Premenstrual dysphoric disorder (PMDD) There are also specific forms of major depressive disorder, including: 5. Seasonal affective disorder (seasonal depression) 6. Postpartum depression  Major Depressive Disorder Major Depressive Disorder Loses interest or pleasure in usual activities Social and occupational functioning impaired for at least O 2 weeks  Major Depressive Disorder Diagnosis Criteria for major depression episode: 5 or more of the following for at least 2 weeks Esg  Major Depressive Disorder Diagnosis Criteria for major depression episode: 5 or more of the following for at least 2 weeks  Major Depressive Disorder Other symptoms Dysfunctional grieving Low self-esteem Powerlessness Social isolation/Impaired social interaction Disturbed thought processes Self-care deficit  Case study massive Michael, a 55-year-old accountant, presents to therapy feeling down, hopeless, and unmotivated. He reports experiencing these symptoms for the past six months and describes a significant decline in his overall well-being. Daily tasks feel overwhelming, and he has lost interest in activities he used to enjoy. Background Information: Michael has no prior history of mental health issues. He has a demanding job but has always managed stress effectively. Recently, however, he experienced a series of life stressors, including the death of a close friend and financial difficulties. He attributes the onset of his low mood to these events. Diagnostic Impression: Based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the therapist diagnoses Michael with Major Depressive Disorder (MDD). off  Persistent Depressive disorder (Dysthymia) offertories It is characterized by chronic low-level depression that is not as severe but may be longer lasting than, major depressive disorder. It involves a sad or dark mood most of the day, on most days, for two years or more in adults and at least one year in children and teens. During this time, symptoms can't be absent for more than two consecutive months to meet the criteria for PDD. Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” During periods of depressed mood, at least two of the following six symptoms from the list below: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness Trouble at work or school  Major Depressive Disorder Vs Persistent Depressive disorder Normal MDD PDD Fluctuations in mood Significantly sad, empty, Chronic low mood and irritable mood Enje Person adjusts to event or Occurs daily for most of Occurs consistently for circumstance and mood the day for more than 2 more than 1 year improves weeks Doesn’t significantly Interferes significantly with School and social interfere with daily school and social functioning likely to be activities functioning as indicated by impacted but is a change in interest or maintained pleasure May say, “ I wish I could May say, “This is hopeless”, May say, “I guess this is change what happened” “I am worthless” & “I don’t just the way I am”. want to be near anyone”.  Disruptive Mood Dysregulation disorder The defining characteristic of disruptive mood dysregulation disorder (DMDD) is common among children already being treated for psychiatric illness. In children, it is chronic, severe, and with persistent irritability. This irritability is often displayed by the child as a temper tantrum, or temper outburst, that occurs frequently (3 or more times per week). The onset of symptoms must be before age 10, and a diagnosis should not be made for e the first time before age 6 or after age 18. m m  Specific Symptoms of Disruptive Mood Dysregulation Disorder 1. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or 6ft behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. 2. The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum). 3. The temper outbursts occur, on average, three or more times per week. 4. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends). 5. The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings. 6. The behaviors do not occur exclusively during an episode of major depressive disorder WENT and are not better explained by another mental disorder.  Case study Liam, an 8-year-old boy, is brought to therapy by his parents due to frequent and severe temper outbursts. These outbursts occur at home and school, often triggered by minor frustrations or disagreements. Liam throws tantrums, yells, and sometimes throws objects, causing significant distress to himself and those around him. Background Information: Liam's outbursts have been a problem for the past year. His parents describe him as a generally happy child but report a "short fuse" and difficulty managing his anger. These outbursts disrupt family life and have led to behavioral problems at school. Liam's parents are concerned about the impact on his social development and emotional well-being. Diagnostic Impression: Based on the criteria outlined in the DSM-5, the therapist diagnoses Liam with Disruptive Mood Dysregulation Disorder (DMDD). 0010 Egfr  Pre-menstrual Dysphoric Disorder Premenstrual Dysphoric Disorder aimwant Premenstrual dysphoric disorder (PMDD) is a health problem that is baitbut is more serious. similar to premenstrual syndrome (PMS) Essential Features Depressed mood Anxiety Mood swings Decreased interest in activities Symptoms occur during the week prior to menses and subside shortly after the onset of menstruation  Pre-menstrual Dysphoric Disorder The most common primary symptom of premenstrual dysphoric disorder (PMDD) is irritability. Criterion A is that in most menstrual cycles during the past year, at least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) were present: 1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts 2. Marked anxiety, tension, feelings of being “keyed up” or “on edge” 3. Marked affective liability (e.g., feeling suddenly sad or tearful or experiencing increased sensitivity to rejection) 4. Persistent and marked anger or irritability or increased interpersonal conflicts. 5. Decreased interest in usual activities (e.g., work, school, friends, and hobbies). GET 6. Subjective sense of difficulty in concentration. 7. Lethargy, easy fatigability, or marked lack of energy. 8. Marked change in appetite, overeating, or specific food cravings. 9. Hypersomnia or insomnia. 10. A subjective sense of being overwhelmed or out of control. 11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain  Pre-menstrual Dysphoric Entire Disorder CON…. realness Criterion B is that the symptoms must be severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning. For example, the patient may avoid social activities, or exhibit decreased productivity and efficiency at work or school. Criterion C is that the symptoms must be discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of any of these disorders). Criterion D is that criteria A, B, and C must be confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.  Case study Chloe, a 28-year-old graphic designer, seeks therapy due to severe mood swings, irritability, and anxiety that occur predictably in the week or two leading up to her menstrual period. These symptoms significantly disrupt her work, relationships, and overall well-being. Background Information: Chloe has experienced these premenstrual symptoms for several years. Initially, they were mild and manageable. However, in recent months, the intensity and duration of the symptoms have worsened. She describes feeling overwhelmed by sadness, anger, and anxiety during this time. She becomes easily frustrated, has difficulty concentrating, and withdraws from social interactions. These premenstrual symptoms significantly impact her work performance and strain her relationships with friends and family. Diagnostic Impression: Based on the cyclical nature of Chloe's symptoms, their severity, and their significant impact on her daily life, the therapist diagnoses Chloe with Premenstrual Dysphoric Disorder (PMDD). approprit DX nf clinches  Depressive disorder due to any medical Condition Symptoms of depressive disorder due to another medical condition are contingent on the medical complication that the individual has. Broadly speaking, however, the depression symptoms are similar to those found in other depressive disorders, such as bipolar and major depressive disorder. In seeking for symptoms of depressive disorder, the crucial step is to determine if the individual has a non- neuropsychiatric medical condition.  Seasonal/ Postpartum Depression Seasonal affective disorder (seasonal depression) This is a form of major depressive disorder that typically arises during the fall and winter and goes away during the spring and summer. Postpartum Depression May last for a few weeks to several months Usually associated with hormonal changes Treatments: antidepressants and psychosocial therapies Symptoms include: Fatigue Irritability Loss of appetite Sleep disturbances Loss of libido Concern about the inability to care for the infant  Substance/medication Induced Depressive Disorder Substance/medication-induced mood disorder is a mental health condition characterized by significant and persistent disturbances in mood, emotions, or behavior, such as those seen in depression and bipolar disorders resulting from the use, abuse, or withdrawal of substances or medications. These substances can include alcohol, drugs, prescription medications, or toxins that directly affect the brain's neurotransmitters and lead to mood alterations. Each case may show different complicated symptoms  Depressive Disorders Etiology Biological theories Genetics: Hereditary factors may be involved (twins) Biochemical influences: Deficiency of norepinephrine, serotonin, and dopamine has been implicated  Depressive Disorders Etiology Physiological influences Medication side effects Neurological disorders washider Electrolyte disturbances (hyponatremia & hypokalemia) Hormonal disorders Nutritional deficiencies Secondary depression related to: i Cardiovascular disease Infections (e.g., hepatitis, pneumonia) Metabolic disorders (e.g., diabetes mellitus) Is it  etc Depressive Disorders Etiology Psychological factors Major life events Distorted thinking Lose hopefulness  G errerenpe.tr Depressive Disorders Candi vital Cheach BR Intervention Management of the illness Medication management Electroconvulsive therapy Exeter Stress management techniques Ways to increase self-esteem Psychosocial Treatments Psychotherapy Psychoeducation Biofeedback Physical activity EYELET will Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., & Theodorakis, Y. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: A ftp.e.g.ee ffniiy systematic review and meta-analysis. Depression and anxiety, 36(1), 39- 53. renren.int  Depressive Disorders vii Intervention Support services Suicide/mental health hotline (920033360) Support groups Legal/financial assistance https://www.moh.gov.sa/Ministry/Information-and- services/Pages/psychiatry.aspx#:~:text=%D9%85%D9%86%20%D9%86%D8%A7%D8%AD %D9%8A%D8%AA%D9%87%D8%8C%20%D9%8A%D8%B3%D8%AA%D9%82%D8%A8%D 9%84%20%D9%85%D8%B1%D9%83%D8%B2%20%D8%A7%D9%84%D8%A7%D8%AA%D 8%B5%D8%A7%D9%84,%D9%85%D9%86%D8%A7%D8%B7%D9%82%20%D8%A7%D9% 84%D9%85%D9%85%D9%84%D9%83%D8%A9%20%D9%88%D9%84%D8%AC%D9%85% D9%8A%D8%B9%20%D9%81%D8%A6%D8%A7%D8%AA%20%D8%A7%D9%84%D9%85 %D8%AC%D8%AA%D9%85%D8%B9  2- Manic Episode (Bipolar Disorder ) Is A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period of abnormal mood must last at least 1 week (or less if hospitalization is required). The mood disturbance must be accompanied by at least three additional symptoms from the list below: Inflated self-esteem or grandiosity Decreased need for sleep Pressure of speech Flight of ideas overtiffon Distractibility Increased involvement in goal-directed activities or psychomotor agitation Excessive involvement in pleasurable activities with a high potential for painful consequences. don't think abut safety  Bipolar disorders Etiological implications Biological theories: Strong hereditary implications Biochemical influences: Possible excess of norepinephrine, serotonin, and/or dopamine Physiological influences Alterations in electrolyte transfer Brain lesions Medication side effects Steroids Amphetamines Antidepressants  Bipolar disorders Types of Bipolar disorder Bipolar I disorder Bipolar II disorder Cyclothymia  Bipolar disorders Bipolar I Disorder One or more manic usually accompanied by major depressive episodes A full syndrome of manic The depression that lasts at least 7 days Having at least one episode of mania in their lifetime Male: female is equal The 1st episode of mania usually occurs in the early 20 Manic episodes often begin abruptly over hours to days & escalate in 1-4 weeks 15-20% of bipolar commit suicide  Bipolar disorders Bipolar II Disorder One or more major depressive episodes accompanied by at least one hypomanic episode Has not experienced an episode that meets the full criteria for mania or mixed symptomatology Bipolar disorders  Bipolar disorders Symptoms of manic episode Feel very “up or high” A lot of energy Increase activity levels Trouble sleeping Talk really fast about a lot of different things Be agitated & irritable Feel like their thoughts are going very fast Think they can do a lot of things at once Do risky things, like spending a lot of money  Bipolar disorders Symptoms of depressive episode Feel very sad, down, and empty Decrease activity levels Trouble sleeping, they may sleep too little or too much Feel like they can’t enjoy anything Feel worried & empty Trouble concentrating Forget things a lot Eat too much or too little Feel tired Think about death or suicide  Case study Sarah, a 32-year-old marketing manager, presents to the emergency room experiencing a manic episode. She reports feeling overly energetic, having racing thoughts, sleeping very little, and engaging in reckless spending sprees. These symptoms started abruptly a week ago and are significantly impacting her work, finances, and relationships. Background Information: Sarah has no prior history of mental health issues. However, family members have mentioned periods of unusual talkativeness and hyperactivity in the past, followed by periods of low mood and withdrawal. Sarah denies experiencing any significant depressive episodes before this manic episode. I tyn  Case study there Michael, a 40-year-old teacher, seeks therapy due to recurring episodes of depression and hypomania. He describes periods of feeling down, hopeless, and unmotivated that last for several weeks, followed by periods of increased energy, talkativeness, and impulsivity that are less severe than a full-blown manic episode. These mood swings significantly disrupt his relationships and work life. Background Information: Michael has experienced these mood swings for several years. Initially, the episodes were infrequent and relatively mild. However, in recent months, the frequency and severity of his mood swings have increased. He is concerned about the impact on his mental and emotional well-being.  Bipolar disorders Cyclothymia Numerous periods of hypomanic symptoms, periods of depressive symptoms lasting for at least 2 years The patients have had mood swings but none of them are severe enough to be called manic or major depressive episodes.  Case study Emily, a 22-year-old college student, comes to therapy due to feeling emotionally unstable. She describes experiencing frequent mood swings, ranging from periods of feeling mildly euphoric, energetic, and productive to periods of feeling down, irritable, and unmotivated. These mood swings are disruptive to her studies and social life. Background Information: Emily reports experiencing these mood swings for as long as she can remember. While the highs are not as extreme as full-blown mania, they can lead to impulsive decisions and difficulty focusing on long-term goals. The lows, while not as severe as major depression, make it difficult for her to maintain motivation and social connections. Diagnostic Impression: Based on the presence of numerous hypomanic and depressive symptoms that don't meet the criteria for a major depressive or manic episode, and the chronic nature of these mood swings lasting for at least two years, the therapist diagnoses Emily with Cyclothymia. Cyclothymia is a mood disorder characterized by frequent but less severe mood swings compared to bipolar disorder.  Bipolar disorders Diagnosis Risk for Injury related to: Extreme hyperactivity Disturbed thought processes related to: Biochemical alterations in the brain Disturbed sleep pattern related to: Excessive hyperactivity and agitation  Bipolar disorders Diagnosis Imbalanced Nutrition less than body requirements related to: Refusal or inability to sit still long enough to eat Disturbed sensory perception related to: Biochemical alterations in the brain and possible sleep deprivation Impaired Social Interaction  Bipolar disorders Client/Family Education Management of illness Medication management Electroconvulsive Therapy Support services Crisis hotline Support groups Legal/financial assistance  Bipolar disorders Treatment Modalities for Mood Disorders Psychopharmacology For Depression Mechanism of action: increase levels * Maprotiline of norepinephrine, serotonin, and * Amoxapine dopamine * Trazodone Side effects: temporary memory loss For mania: and confusion Lithium carbonate Anticonvulsants Risks: mortality; permanent memory loss; brain damage Verapamil Olanzapine  Bipolar disorders Treatment Modalities Psychological treatment Individual psychotherapy Group therapy Family focus therapy Cognitive therapy Psychoeducation Supplement  Bipolar disorders Recommendation Ensure the client’s physical safety and the safety of those around the client. Set limits on the client’s behavior when needed. Remind the client to respect distances between self and others. Use short, simple sentences to communicate. Promote rest. Protect the client’s dignity when inappropriate behavior occurs. Channel the client’s need for movement into socially acceptable motor activities.  Bipolar disorders Suicide Assessment Epidemiological factors Marital status: The suicide rate for single people is twice that of married people Single, divorced, and widowed people have rates four to five times greater than those who are married Gender: Women attempt suicide more often; more men succeed Age: Suicide highest in persons older than 50 years; adolescents are also at high risk  Bipolar disorders Suicide Assessment Epidemiological factors (cont.) or a ñ Socioeconomic status: People in the highest and lowest social classes have higher suicide rates than those in the middle classes. Professionals: Professional healthcare personnel and business executives are at the highest risk. Religion  Bipolar disorders Suicide Assessment Presenting symptoms/Medical-psychiatric diagnosis Mood disorders (major depression and bipolar disorders) are the most common disorders that precede suicide. Other disorders include Anxiety disorders Schizophrenia  Bipolar disorders Suicide Assessment Suicidal ideas or acts Assess: previous attempts Verbal clues: Direct statements: “I want to die.” Indirect statements: “I don’t have anything to live for anymore.”  3- Hypomanic Episode It is similar to Manic episode but it is less severe and its duration is also less than the one of manic episode usually four days, and hospitalization is not required Thank you!