Unipolar or BipolarMood Disorders

Major Depressive DisordersBipolar Disorders

Dysthymic DisorderCyclothymic Disorder

Current Research – NIMH Report (July 2003)

• Stress-sensitive version of serotonin transporter gene– Noted as “short version”

• Confers vulnerability to stresses (job loss, relationship breaks, deaths of loved ones, prolonged illness)

– at high risk for depression– 43% versus 17% w different version of gene

• Individuals abused as children also high risk• Found by study of “stress histories”• Not yet ready for diagnostic testing

– Needs confirmation– May predispose

Necessary Clinical Information• History of:

– financial difficulties/failed businesses

– increased sexual activity & sexual indiscretions

– previous depression, hypomania, or mania

– rapid switches in mood– substance abuse– medical illness

• Current mood• Guilty feelings, quality of

self-esteem• Current hallucinations or

delusions• Current & previous

suicide ideation/attempts• Change in energy level or

fatigue• Change in pattern of

sleep

Mood Disorders• Share a disturbance of mood• Mania/depression

– not due to another physical or mental disorder

• Mood may/may not affect social or occupational functioning (clinical significance)

• Prolonged emotion generally affects entire life

• Distinguished by – intensity of abnormal mood– duration – impairment produced – behavioral, cognitive or physical symptoms

Major or Unipolar Depression

• Profound sadness & related problems, such as sleep & appetite disturbance, loss of energy & self-esteem issues

• Meds – Luvox, Prozac, Zoloft, Paxil, others

Major Depressive Episode• Major depressive episode

– core syndrome of severe depression

• Some specific diagnoses– distinguished by # of major depressive

episodes– & presence/absence of manic or hypomanic

episodes

• Child may present different symptoms

• Mixed Episodes – criteria from both manic & depressive

Manic Episode• Mania must result

– in marked dysfunction for Bipolar I• Unusually & persistently elevated,

expansive, & irritable mood• Individual usually unaware of

problem • No clue that they make no sense• Appears to come on suddenly• Frequently resistant to treatment

Bipolar Disorders• Episodes of either mania alone or of both

mania & depression– Mania episode involved

Mania indicates:– Mood elevated or irritable– Extreme activity, talkativeness– Distractible– Frequently resists treatment

• Meds – Lithium, Zoloft, Wellbutrin, Prozac, Depakote

Symptoms: Major Depressive Disorder• Depressed mood; no

mania• Loss of pleasure in

activities• Weight loss or gain• Change inapposite• Change in sleep

pattern• Agitation• Loss of energy

• Sense of worthlessness

• Difficulty concentrating

• High mortality rate– Thoughts of death– Suicidal ideation

Chronic Mood Disorders• Cyclothymia

– frequent periods of depressed & hypomania for at least 2 years

• Hypomania episodes– disturbances of

mania not severe enough to cause major impairment

• Dysthymia – chronic depression– Persistent

depression for 2 years or more

– May or may not significantly impair activities

– Determine whether opposite behavior ever present

Specifiers

• Use specifiers with all mood disorders to describe most recent episode

• Code specifiers in 5th digit• If psychotic features specify whether

mood congruent or mood-incongruent• Use with course of recurrent episodes

also– Rapid cycling– Seasonal cycling etc

Ask yourself these questions• Is client’s mood abnormal?• Could client’s symptoms be produced

by drugs or a nonpsychiatric medical illness?

• Does client have symptoms of psychosis? Do these symptoms occur only in presence of mood symptoms?

• Has client ever had a manic, hypomanic, or mixed episode?

• Is the client’s current mood depressed?

Depression in Children & Adolescents

• Increased risk for illness, interpersonal & psychosocial difficulties – May persist long after

episode passes

• Increased risk– for substance– for suicidal behavior

• Often unrecognized

• Symptoms often seen as – normal mood swings

typical of development

• Health care workers reluctant– to prematurely “label”

• Early diagnosis & treatment– Critical to healthy

emotional, social, & behavioral development

– Can reduce duration & severity

Scope of Problem with Youth• 2.5 % of children• 8.3% of adolescents

(other study 7-14% total)• Onset earlier today• Recovery rate

– Single episode of MDD is high

• Dysthymia– may lead to MDD

• MDD - likely family history

• Childhood Risk– Boys & girls equal risk

• Adolescence Risk– Girls twice as likely

• NIMH study of 9-17 yr olds– Estimate prevalence

• 6% in 6-mo period– With 4.9 major depression

• Often co-occurs – commonly anxiety, disruptive

behavior, or substance abuse

• Symptoms expressed differently – acting out or irritable

toward others– Talking with parents

important

• Medications controversial

Signs Associated with children & adolescents• Frequent, vague non-

specific complaints• School

– Frequent absences – Poor performance

• Talk of or efforts to runaway

• Outbursts of shouting, unexplained irritability, complaining, or crying

• Being bored

• Alcohol or substance abuse

• Social isolation, poor communication

• Fear of death• Extreme sensitivity

– to rejection or failure

• Increased irritability, anger, or hostility

• Reckless behavior• Difficulty with

relationships• Lack of interest in playing

with friends