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Sowk2008 Mood Disorder Presentation

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Ku Yu

on 18 October 2012

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Transcript of Sowk2008 Mood Disorder Presentation

Mood Disorder What is it? Types Causal factors Treatment Prevalence Indicates that experiences of depression and mania, either singly or together.
Depression:
feelings of extraordinary sadness and dejection

Mania:
intense and unrealistic feelings of excitement and euphoria.

Gender difference:
Women are much more likely than men to be diagnosed with depression Mood Disorder DSM Classification of Mood Disorders Episodic patterns in mood disorders.
emotional disturbance come and go unpredictably in mood disorders.
Unipolar disorders :suffer from depression only
Bipolar disorders experience both manic and depressive episodes. 1. grieving process
 four phrases of normal response to the loss of spouse/close family members
 not absolutely suffer from mood disorder All Depression = Unipolar disorder??? 2. Postpartum Blues
exist after the birth of baby
Not a mood disorder, but it has great likelihood to develop major depression after postpartum blues persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure Major depressive disorder The most common form of mood episode.

Criteria:
1. > 5 of the following symptoms have been present during the same 2-week period including
i) Cognitive
ii) Behavioral
iii) Physical symptoms

2.represent a change from previous functioning; at least one of the symptoms is either: 
   (a) depressed mood, or
   (b) loss of interest or pleasure

3.Symptoms do not meet criteria for a Mixed Episode. Major depressive episode (DSM-IV-TR) Have persistently depressed mood most of the day for at least 2 years

Have at least 6 additional symptoms

Mild to moderate intensity but Chronic

Intermittently normal
mood Dysthymic Disorder Cognitive, behavioral & physical symptoms Major depressive episode (DSM-IV-TR) During the period of mood disturbance, three (or more) of the following symptoms have persisted and have been present to a significant degree
i) Behavioral
ii) Mental
iii) Physical Symptoms Mania Episode (DSM-IV-TR) A distinct period of persistently elevated, expansive or irritable mood,
lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
Less severe and less disruptive version of manic episode.
Doesn’t cause marked impairment in social or occupational functioning. Hypomanic Episode (輕度狂躁) Level of neurotransmitters






Cortical activities
Caudal ventral prefrontal cortex(cVPFC) depend on the mood




Genetic predisposition
twin studies
Greater genetic contribution to bipolar I disorder than to unipolar disorder 1. Biological factors Presence of manic or hypomanic episodes, preceded or followed by periods of depression
(video) Bipolar Disorders Cyclothymic Disorder mood disturbances with alternate manic and depressive episodes
lacks certain extreme symptoms and psychotic features, such as delusions
less serious version of full-blown bipolar disorder 2 Recurrent disorders

Bipolar I Disorder: Manic or mixed episode and major depressive episodes

Bipolar II Disorder: Hypomanic episodes and major depressive episodes. May evolve into bipolar I disorder Bipolar Disorders (I and II) Maybe misdiagnosed as unipolar disorder

Duration of manic and hypomanic episodes tends to be shorter than the duration of depressive episodes

More severe symptoms and more role impairment than unipolar disorders Bipolar Disorders Independent life event:
independent to a person's behavior and personality
e.g. job losing

dependent life events :
related to a person's behavior and personality
e.g. conflict with spouse

causal factors of depression:
dependent > independent Unipolar V.S. Bipolar disorder

Subcortical brain regions, including the basal ganglia and amygdala

Bipolar disorder: Enlarged
Unipolar disorder:reduced
Bipolar patients: Increased activation 1.Biological factors Stressful life events 4. Stress Adult in Hong Kong
The morbidity of depression: 8.8%
(Female: 9.7%, Male: 6.8%)

The morbidity of bipolar I disorder: 3.9%
(Female: 4.9%, Male: 2.7%)

For every 100 Hong Kong adults,
8% may suffer from depression.
3% may suffer from Bipolar I disorder.

Hong Kong Mood Disorder Centre (2005, 2007) Children and Adolescents 18% to 20% of nursing home residents may experience major depressive episodes
==>likely to be chronic if they first appear after the age of 60.

Anxiety disorder accompany depression in about 1/3 of elderly patients, particularly generalized anxiety disorder and panic disorder. Elderly in Hong Kong Antidepressant, mood-stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders.

Lithium therapy has now become widely used as a mood stabilizer in the treatment of both depressive and manic episodes of bipolar disorder. 1.Pharmacotherapy 2.Alternative Biological Treatments a. Cognitive-Behavioral and Behavioral Activation Therapy

b. Interpersonal Therapy
Focus on current relationship issues
Help the person understand and change maladaptive interaction patterns
Useful in long-term follow-up for individuals with severe recurrent unipolar depression

c. Family and Marital Therapy
Deal with unusual stressors in a patient’s life 3.Psychotherapy Depressive disorders: Children < adults
==> but rise dramatically in adolescence.

For young children:
dysthymic disorder> major depressive disorders
For adolescence:
major depressive disorder> dysthymic disorder Bipolar disorder emerges most frequently during the 20s decade. These results suggest that there must be a genetic predisposition to mood disorders.
The disparity in concordance between the two types of twins is greater for mood disorders than for either anxiety disorders or schizophrenic disorders
genetic factors may be particularly important in mood disorders.
(Data from Gershon, Berrettini, & Goldin, 1989) Freud :
Underline psychic conflicts or fears

Self-reproach (guilt & self-criticism) of depressed people originated from anger directed at someone else 2.Psychodynamic Perspective suggested that We unconsciously have some negative feelings toward those we love 3. Behavioral perspective Interpersonal factors in depression. Behavioral theories about the etiology of depression emphasize how inadequate social skills may contribute to the development of the disorder. Poor social skills

Decrease in positive reinforcement

Increase in negative reinforcement

Deterioration in interpersonal relationships

Negativity resulting from major life event

Increased vulnerability to depression Beck:
1.Pessimistic explanatory style 3. Cognitive factors Negative thinking and prediction of depression:

Alloy and colleagues (1999) measured the explanatory style of first-year college students and characterized them as high risk or low risk for depression 2. learned helplessness
when people find they have no control over aversive events, they may learn that they are helpless. The Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) examines the prevalence of mood disorders among children who are slightly younger than those in the NCS-A. A distinct period of persistently elevated, expansive or irritable mood,

lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

Less severe and less disruptive version of manic episode.

Doesn’t cause marked impairment in social or occupational functioning. Hypomanic Episode Alloy,L. B., Abramson, L. Y., Whitehouse, W. G., Rose, D. T., redictive
validity, information processing and personality characters, and developmental origins.
Bipolar disorder among adults (2005). Retrieved from National
Institute of Mental Health, Web site:http://www.nimh.nih.gov/statistics/1BIPOLAR_ADULT.shtml
Butcher, Mineka & Hooley(2012). Abnormal Psychology, 15th,
Pearson international edition
Durand, V. M., & Barlow, D. H. (2006). Essentials of abnormal
psychology. Belmont, CA: Thomson/Wadsworth.
Goodwin FK, Jamison KR (1990). Manic-Depressive Illness. Oxford
University Press, New York.
Hong Kong Mood Disorders Center. (April 24, 2005). Retrieved
from http://www.hmdc.med.cuhk.edu.hk/report/report20.html
Hong Kong Mood Disorders Center. (April 1, 2007). Retrieved from
http://www.hmdc.med.cuhk.edu.hk/report/report24.html References
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