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SW724 Mood Disorder Presentation

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Jessica Bernardo

on 18 October 2012

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Transcript of SW724 Mood Disorder Presentation

MOOD DISORDERS Mood disorders are a group of mental disorders involving a disturbance of mood, along with either a full or partial excessively happy (manic) or extremely sad (depressive) syndrome. Depressive Disorders, Bipolar Disorders, Other Mood Disorders BIPOLAR DISORDERS DEPRESSIVE DISORDERS Mood Disorders are divided into three parts:
I. Mood Episodes
A. Major Depressive Episode
B. Manic Episode
C. Mixed Episode
D. Hypomanic Episode
II. Mood Disorders
III. Specifiers Major Depressive Disorder, also referred to as Clinical Depression, or Major Depression, is a serious medical illness that disrupts a persons mood, behavior, thought processes, and physical health.
It is characterized by one or more major depressive episodes. Major Depressive Disorder is associated with high mortality. According to the DSM-IV TR, up to 15% of individuals with severe Major Depressive Disorder commit suicide and evidence suggests that there is an increase in death amongst the 55 and older population. Symptoms: Causes: Bipolar Disorder consists of two mind sets
Manic stages and Depressive stages. Behavioral Mental Health Jessica Bernardo, Kori Napa`a, Mililani Keliihoomalu, Nichole Dye, Kalani Mills
SW 724/ Morelli
DSM-IV TR Axis Disorders: Seminar Presentation Ernest Hemingway,American Writer,
reportedly suffered from clinical depression
and committed suicide in 1961. Disney teen actress and singer, Demi Lovato, suffering from depression at 20 years old. SYMPTOMS 1. Sustained low or depressed mood.

2. Decreased interest or pleasure.

3. Sleep disturbances, increased or decreased.

4. Appetite disturbances, weight loss or gain.

5. Problems with memory and concentration.

6. Feelings of worthlessness or helplessness.

7. Psychomotor agitation or retardation.

8. Fatigue or loss of energy.

9. Thoughts of death, suicidal ideation. I. MAJOR DEPRESSIVE DISORDER
NOT OTHERWISE SPECIFIED "UNIPOLAR DEPRESSION" Causes of Mood Disorders: - Biological such as family/genetic influences. I.e., close relatives (increased risk)
- Low levels of serotonin in the brain (regulates our mood and emotions)
- Environmental factors such as stressful life events
- Experiencing Trauma ETIOLOGY:
- Familial
- Life Stress/ Events
- Genetic and Environmental causes
- Early Childhood Trauma DYSTHYMIC DISORDER (Chronic Depression)
is a chronically depressed mood for most of the day,
for more days than not, that persists for at least two

-Negative view of life and describes mood as "down in the dumps". Presence of two or more of the following:
1. Poor appetite or overeating.
2. Insomnia or hyper insomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making
6. Feelings of hopelessness. ECT (Electro- Convulsive Therapy) Depressive Disorder Not Otherwise Specified - Is a catchall term that is used when depression is serious enough to cause problems in an individuals life but, does not fulfill the criteria for any established disorder. A. Premenstrual Dysphoric Disorder
B. Minor Depression
C. Recurrent Brief Depression Risk Factors

Biological relatives with Depression
Being a woman
Childhood trauma
Having depressed family/ friends
Stressful life events
Few friends/ personal relationships
Serious Illness (Cancer, HIV/AIDS, etc.
Abusing alcohol or other drugs
low self-esteem, self-critical, pessimism TREATMENTS Resilience Factors

Building and maintaining positive support systems
Seeking purpose in life
Belief in ability of self to overcome adversity
Belief one can learn and grow from experience
Positive emotions
Self-enhancement MEDICATION ECT (Electro- Convulsive Therapy Cognitive
Therapy A Substance-Induced Mood Disorder is distinguished from a primary Mood Disorder by the fact that a substance is judged to be etiologically related to the symptoms. Alcohol: depression
Cocaine: hypomania, mania
Amphetamines: hypomania, mania
PCP: ketamine, hypomania, mania
Heroine: depression
Marijuana: depression
Mood symptoms present with intoxication or withdrawl
Normalization may take weeks or months
High instance of Comorbidity Substance Induced Mood Disorder With Depressive Features

If predominant mood is depressed but full criteria MDE not met

With Major Depressive –like episode
Meets full criteria except for Criteria D

With Mixed Features
Both manic and depression are present not dominant Subtypes The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder with Depressed Mood in response to the stress of having a general medical condition).

The disturbance does not occur exclusively during the course of a delirium.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Diagnostic Criteria Cont. This category includes disorders with mood symptoms that do not meet the criteria for any specific Mood Disorders and in which it is difficult to choose between Depressive Disorder Not Otherwise Specified and Bi-Polar Disorder Not Otherwise Specified.(e.g.,acute agitation).
DSM IV 296.90 pg 410 Mood Disorder Not Otherwise Specified With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome

With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome Specifiers

A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:

(1) depressed mood or markedly diminished interest or pleasure in all, or almost all, activities

(2) elevated, expansive, or irritable mood

B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):

(1) the symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or Withdrawal
(2) medication use is etiologically related to the disturbance Substance –Induced Mood Disorder Diagnostic Features A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:

1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
2. elevated, expansive, or irritable mood

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. DSM IV Diagnostic criteria for 293.83 Mood Disorder Due to: DSM IV 293.83 Mood Disorders Due to a General Medical Condition Stroke
Huntington’s disease
Chronic infections
Certain medications:
Isotretinoin (Accutane)
Oral contraceptives
Antidepressants Thyroid abnormalities
Parkinson’s disease
Multiple sclerosis
Cancer (e.g., pancreatic)
Brain tumor
Traumatic brain injury
Autoimmune disorders Medical conditions Reconnection to local culture ( Best Practice) Other Mood Disorders Risks: - Chances of feeling better out of the blue is 10%

- Chances of being majorly depressed 10 years from now is 50%

- Interpersonal Therapy (SSRI) Highest rates of comorbid substance use disorders (SUD’s)
Co-occurring disorder presents:
severe clinical presentations
poor outcomes
earlier onset of mood symptoms
higher anxiety and suicide attempts
rapid cycling
lower treatment compliance Comorbidity Presence or history of one or more major depressive episode and the presence or history of at least one hypomanic episode.
The diagnosis of hypomania: 4-day duration of a persistently elevated, expansive, or irritable mood and change in functioning in the absence of marked impairment or psychosis that is observable. Diagnosing BP II Inflated self-esteem
Decreased sleep need
Talkativeness or pressure of speech
Flight ideas or racing thoughts
Increased goal directed activity
Excess pleasure seeking behavior
Psychomotor agitation
Excessive involvement in risky behavior Symptoms Medication is one key element that is successful
Psychosocial therapies
Interpersonal therapy
Family therapy
Electroconvulsive Therapy: used only when individual not respondent to medications.
Transcranial Magnetic Stimulation (TMS): target affected areas of brain (used after ECT) Evidence-based and/or Best Practice Treatments Lifetime prevalence in communities is .4% to 1.6%
BP I equally affects men and women
First episode for male is likely to be Manic
First episode for female is likely to be Depressive

Often begin in adolescence or early adulthood; occasionally in children
Average age of onset is 20 yrs. Old
Earlier onset linked to alcohol/substance abuse d/o

“Rapid Cycling” more common in women Prevalence across Populations Women with BP I have increased risk of ‘first episode’ during postpartum (within 4 weeks)
Misdiagnosing Schizophrenia instead of BP
In some ethnic, and age, groups Biopsychosocial Risk NO single cause; rather factor(s) of:
Genetic component linked to BP

Negative life event(s)
Sleep deprivation Etiology/Risk Factors Also known as manic depression, is a medical illness that causes extreme shifts in mood, energy and functioning. It’s a chronic lifelong condition with reoccurring episodes Bipolar Disorder Females more common than males
The mean age of onset is 18 years
50-66% of adult patients with bipolar report onset prior to 18 years
15-28% report onset before age 13
Childhood onset commonly associated with, or preceded, by:
conduct disorder
attention deficit disorder
oppositional defiant disorder Prevalence across populations Recurrent episodes of depression and hypomania
Hypomania, elevated euphoric, over activity and/or irritable mood
Depression can be syndromal and subsyndromal
Often mixed depression and non-euphoric usually subsyndromal, manic/ hypomanic symptoms) Bipolar II Disorder Characterized as by the occurrence of one or more:
Manic episodes
Mixed episodes
Major Depressive episodes

“Mixed State”
Rapid Cycling Bipolar I Disorder Schizophrenia
Schizoaffective d/o
Personality d/o Psychiatric Conditions/Disorders Thyroid disease
Tertiary syphilis Medical Conditions Comorbidity Cont. Extremely sad or hopeless
Feelings worried
Loss of interest in enjoyable activities
Tried or “slowed down”
Problems concentrating, remembering or making decisions
Change in eating, sleeping and other habits
Suicidal ideations/attempts Depressive Episode Overly joyful or overexcited
Extremely irritable, agitated, “jumpy” or “wired”
Easily distracted
Little sleep
An unrealistic belief in one’s abilities
Talking fast or racing thoughts Manic Episode Symptoms Anxiety Disorders (PTSD, obsessive compulsive disorder, Panic disorder)

Personality disorders

Somatoform disorders

Alcohol and other substance abuse/ dependence

Serious medical illnesses Commonly Co-existing Disorders
Major Depressive Disorder Children who develop depression continue to have episodes into adulthood

Prone to more severe illness in adulthood

May pretend to be sick, refuse to go to school, worry that a parent may die, get into trouble at school, feel misunderstood

Typical mood swings of a normal child make it difficult to accurately diagnose Major Depression/ Dysthymia
Children and Teens Loss of significant other/ spouse

May have more medical conditions that cause depressive sx’s

Medications that contribute to depression

Highest rates of suicide in U.S. (85 and older)

Antidepressant, psychotherapy, or both are effective tx’s in reducing depression Major Depression/ Dysthymia
Older Adults Early and gradual onset in childhood/adolescence, or early adulthood
75% develop Major Depressive Disorder within 5 years, without tx
Remmission rate approx 10%/yr, better with tx
Tx for dysthymic d/o is similar to other depressive disorders
With tx, intensity of sx often reduced or diminished completely
Maintenance tx helpful in relapse prevention Course
Dysthymic Disorder May begin at any age, average mid 20’s
Risk of having another episode:
≥ 60% if one previous episode
≥ 70% if two previous episodes
≥ 90% if three previous episode

5%- 10% develop a manic episode
(i.e. Bipolar I) Course
Major Depressive Disorder Major Depressive Disorder
Lifetime Risk: Women 10% to 25%
Men 5% to 9%
Point Prevalence: Women 5% to 9%
Men 2% to 3%
Dysthymic Disorder (general population)
Lifetime Risk: 6%
Point Prevalence: 3% Prevalence Adults
Major Depressive Disorder
Alcohol and other substance abuse and dependence

Conduct disorder
Anxiety disorders
Learning disorders Commonly Co-existing Disorders
Dysthymic Disorder Before puberty, depression develops equally between genders

By age 15, girls 2x likely for Major Depressive episode Major Depression/ Dysthymia
Children and Teens cont’d Major Depression/ Dysthymia More common
More likely to have feelings of sadness, worthlessness, and excessive guilt
More Suicide Attempts
More vulnerable due to hormonal factors:
Postpartum depression Women More likely to be tired irritable, difficulty sleeping
Alcohol or drugs
Consumed in work
Behave recklessly
Higher suicide rate Men
Family focused therapy and Multifamily Psychoeducation:
Alleviating mood symptoms, preventing recurrences, enhancing psychosocial functioning, reducing depression and hypomania symptoms and improvements in global functioning; augmenting individual and family coping skills and improving dimensions of family behavior among adults with mood disorders
Exert protective effect on conversion to bipolar spectrum disorder among children with depressive spectrum disorders

mood-stabilizing agents such as lithium and valproate, and second-generation antipsychotics
exert major effects on signaling pathways which regulate synaptic plasticity and cell survival
Acute BP-II depression: antidepressants

are taught to recognize early signs of relapse and seek treatment, reported fewer manic relapses, less hospitalization, better work and social function Treatment for BP-II 40-50% of patients initially diagnosed with MDD will eventually be diagnosed as BP-I or BP-II
Patients are twice more likely to have comorbid than non-comorbid BP-II disorder
Higher prevalence of anxiety disorders, in particular social and simple phobias with 45% lifetime prevalence.
Personality disorders occur in 33% of patients and OCD in 13.6% of BP-II patients
More borderline features with 66% of borderline personality diagnosis having comorbid affective diagnosis with BP-II being over-represented
Substance abuse occurs in up to 50% of people, with alcohol the most common agent
Eating disorders associated with BP-II
MDD and cyclothymic disorder also occur in children who later develop BP Comorbidity Pattern of illness:
Mild mood swings amplitude and frequency increase over time until the threshold reached
Often misdiagnosed as unipolar depression, an adjustment disorder, or personality disorder (especially borderline) \
Large percentage of patients outcomes quite poor, high rates of relapse, chronicity, lingering residual symptoms, subsyndromes, cognitive and functional impairment, and psychosocial disability
Impairments of structural plasticity and cellular resilience
Substantial morbidity; high rates of occupational, leisure, and relationship dysfunction; high rates of family dysfunction, divorce, or separation; and substantial suicide risk Clinical course and Prognosis Family History
High risk of bipolar II among relatives of probands with bipolar II disorder
History of generalized anxiety disorder and bipolar disorder are predictive for bipolar II disorder
Socioeconomic variables
gender, age of onset, marital status, and low parental financial status
Youth who meet criteria for BD not otherwise specified are at risk for converting to bipolar I disorder or bipolar II disorder
Adolescents and children who repeatedly run away from home and are physically fighting are 2.6-3.5X more likely to experience a bipolar II disorder in early adulthood Etiology/Risk Factors VETERAN'S AND MOOD DISORDERS Benazzi, F. (2007). Bipolar II Disorder: Epidemiology, Diagnosis, and Management. CNS Drugs, 21(9), 727-740. Retrieved October 1, 2012, from the Academic Search Premiere database.
Berck, M., & Dodd, S. (2005). Bipolar II Disorders:a review. Bipolar Disorders, 7(1), 11-21. Retrieved September 28, 2012, from the Academic Search Premiere database.
Coperland, L. A., Miller, A. L., Whelsh, D. E., Zeber, J. E., & Kilbourme, A. M. (2009). Clinical and Demographic Factors Associated With Homelessness and Incarceration Among VA Patients With Bipolar Disorder. American Journal of Public Health, 99(5), 871-877. Retrieved September 27, 2012, from the Academic Search Premiere database.
Endrass, J., Vetter, S., Gamma, A., Gallo, W., Rossgger, A., & Urbaniok, F. (2007). Are behavioral problems in childhood and adolescense associated with bipolar disorder in early adulthood?. Eur Arch Psychiatry Clin Neurosci, 25(7), 217-221. Retrieved September 28, 2012, from the Academic Search Premiere database.
Manji, H., & Young, T. (2002). Structural plasticity and neuronal resilience:are these targets for mood stabolizers and antidepressants in the treatment of bipolar disorder?. Bipolar Disorders, 4(1), 77-79. Retrieved September 27, 2012, from the Academic Search Premiere database.
Miklowitz, D., Taylor, D., Manpreet, G., Schneck, C., Meghan, D., & Garber, J. (2011). Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial. Bipolar Disorders, 13(1), 67-75. Retrieved September 28, 2012, from the Academic Search Premiere database. References Cont.: Bipolar I & II Ball, S., Egede, L., Mauldin, P., Moran, W., Nappi, J., & Robert, S. (2009, March). Evidence-based best practices for the treatment of bipolar disorder for primary care in south caroline. Retrieved from http://www.sccp.sc.edu/centers/SCORxE/protected/downloads/01942-EBBP BIPOLAR BOOKLET 6_3_09 corrected.pdf
Duckworth , K. (2007). Latest nimh study on bipolar disorder. Bipolar Disorder, 1-2. Retrieved from http://www.nami.org/Template.cfm?Section=press_release_archive&template=/contentmanagement/contentdisplay.cfm&ContentID=48119&title=Latest NIMH Study on Bipolar Disorder
National Alliance on Mental Illness. (2006). Bipolar disorder. Mental Illness, Retrieved from http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23037
Nery, F., & Soares, J. (2011). Comorbid bipolar disorder and substance abuse:evidence-based options. Current Psychiatry, 10(4), 57-66.
Rogge, T., bipolar affective disorder. In T. Rogge & D. Zieve (Eds.), A.D.A.M. Medical Encyclopedia. A.D.A.M. Inc. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/
Smith, M., Segal, J., & Segal, R. (2012, June). Treatment for bipolar disorder. Retrieved from http://www.helpguide.org/mental/bipolar_disorder_diagnosis_treatment.htm
The National Institute of Mental Health (2008). Bipolar disorder. NIH Publication. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder/nimh-bipolar-adults.pdf
Zeber, J., Copeland, L., McCarthy, J., Bauer, M., & Kilbourne, A. (2009). Perceived access to general medical and psychiatric care among veterans with bipolar disorder. American Journal of Public Health, 99(4), 720-727. References: Bipolar I & II Andrews, L. W. (2010). Encyclopedia of Depression. Santa Barbara: ABC-CLIO, LLC.
Belmaker, R., & Agam, G. (2008). Major Depressive Disorder. New England Journal of Medicine, 358(1), 55-68.
Deprssesion (Major Depression). (n.d.). Internet Mental Health. Retrieved October 2, 2012, from http:// mentalhealth.com
Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association.
Dysthymic Disorder. (n.d.). Internet Mental Health. Retrieved October 2, 2012, from http:// mentalhealth.com
Ikezu, T. (2008). Neuroimmune pharmacology. New York: Springer.
Mann, J. J. (2005). The Medical Management of Depression. New England Journalof Medicine, 353(17), 1819-1834.
Mayo Clinic. (n.d.). Depression (Major Depression). Retrieved October 2, 2012, from http:// mayoclinic.com
Thase, M. E., & Lang, S. S. (2004). Beating the blues new approaches to overcoming dysthymia and chronic mild depression. New York: Oxford University Press.
The Returning Veteran's Journey. (n.d.). Northwest Frontier ATTC Addiction Messenger. Retrieved September 28, 2012, from http://attcnetwork.org References: Depressive Disorders Family/ spouse first to know something is wrong (souses call wanting someone to see their spouse).

24/7 hotlines for individuals feeling suicidal and need to talk (one source that all branches of the military can access 24/7).

Within the unit, there is an immediate supervisor the service members can go to for assistance.

Counselor center on the majority of military bases. Social network, family, and community in times of crisis or when veterans are experiencing mental illness Understanding military culture
-Rank structure

Military Occupational Structure

-Assessing trauma
-Asking appropriate questions Cultural Competency Mental Disorders, particularly Mood Disorders and Anxiety Disorders such as Depression and PTSD
Mentality of “Sucking it up”
- Fear of being labeled
- Come into treatment by way of an incident General Perspective on Mental Health and Well-Being http://www.fda.gov/ohrms/dockets/ac/00/slides/3590s1c/tsld003.htm
DSM IV pg 401-410
DSM IV pg 181 References: Other Mood Disorders Life
Personally & professionally Affects Depression
Episodic panic attacks
Suicidal ideations
Memory impairment
Difficulty concentrating
Mood disturbances
Social & Occupational impairment With Depressive Features: Inability to cope with life
Chemical imbalance
Hereditary Manifestations: Outcomes Culture can influence the experience and communication of symptoms of depression and may be expressed in somatic terms in contrast to the emotional sadness or guilt that is commonly expressed.

- "Nerves" and Headaches- Latino and Mediterranean Cultures

- Weakness, Tiredness, or "Imbalance"- Chinese and Asian Cultures

- "Heart" Problems- Middle Eastern Cultures Cross Cultural ISsues
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