Unipolar or Bipolar Mood Disorders Major Depressive Disorders Bipolar Disorders Dysthymic Disorder...
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Transcript of Unipolar or Bipolar Mood Disorders Major Depressive Disorders Bipolar Disorders Dysthymic Disorder...
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