Lecture 1
Psychiatry
Mood Disorders
Depressive disorders Bipolar disorder
Mood Disorders or
Affective Disorders
Depressive disorders
Depressive disorders
Introduction
Epidemiology
Types
Etiological Implications
Developmental Implications
Introduction
Depression or depressive disorders (depression) are
mental illnesses characterized by a profound and
persistent feeling of sadness or hopeless
and/or a loss of interest in things that once were
pleasurable. Changes in sleep, appetite, decreased
energy, feeling of worthlessness or guilt and hopeless.
Introduction (cont.)
Depression is the oldest and most frequently
described psychiatric illness.
Transient symptoms are normal, healthy
responses to everyday disappointments in life.
Pathological depression occurs when
adaptation is ineffective.
Epidemiology
Gender prevalence
Higher in women than in men by about 2 to 1
Age
Depression more common in young women than in older women
Opposite is true for men
Marital status: Single and divorced people more likely to experience depression
than married people
Epidemiology (cont.)
Social class: There is an inverse relationship between social class and
report of depressive symptoms; the opposite is true with bipolar
disorder.
Seasonality: Affective disorders are more prevalent in the spring and
in the fall.
Types of Depressive disorders
Major depressive disorder
Dysthymic disorder
Premenstrual dysphoric disorder
Major Depressive Disorder
Characterized by depressed mood or loss of
interest in pleasure usual activities
Social and occupational functioning impaired
for at least 2 weeks
Dysthymic Disorder
Chronic sadness or “feeling very down”
No evidence of psychotic symptoms
Essential feature is a chronically depressed
mood for
Most of the day
More days than not
For at least 2 years
Premenstrual Dysphoric
Disorder
Essential Features include
Depressed mood
Anxiety
Mood swings
Decreased interest in activities
Symptoms occur during the week prior to menses
and subside shortly after onset of menstruation
Etiology-Depressive Disorders
Biological
Genetics: Hereditary factor may be involved
Biochemical:
Deficiency of norepinephrine, serotonin, and dopamine has been implicated
Possible diminished release of thyroid- stimulating hormone
Etiology-Depressive Disorders (cont.)
Physiological influences
Medication side effects
Neurological disorders
Electrolyte disturbances
Hormonal disorders
Nutritional deficiencies
Secondary depression related to:
Cardiovascular disease
Infections (e.g., hepatitis, pneumonia)
Metabolic disorders (e.g., diabetes mellitus)
Developmental Implications
Adolescence
Symptoms include:
Anger, aggressiveness
Social withdrawal
Substance abuse
Restlessness; lack of interest
Developmental Implications (cont.)
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 inability to care for infant
Client/Family Education
Management of the illness
Medication management (Pharmacotherapy)
Stress management techniques
Ways to increase self-esteem
(Psychotherapy)
Support services
Suicide hotline
Support groups
Legal/financial assistance
Mood Disorders
Part II
Bipolar disorders
Bipolar disorders
Introduction
Etiological Implications
Types
Diagnosis Management
Introduction
Bipolar disorder
also known as manic depression
Characterized by mood swings from profound depression to extreme euphoria (mania),
with intervening periods of normalcy
At least three of the following symptoms are present:
• Grandiosity
• Decreased sleep
• Pressured speech
• Flight of ideas
• Distractibility
• Talkative
Delusions or hallucinations may or may not be part of clinical picture
Bipolar Disorder (Mania)
Etiology
Biological theories: Strong hereditary implications
Biochemical influences: Possible excess of norepinephrine, serotonin, and/or
dopamine
Bipolar Disorder (Mania) (cont.)
Physiological influences
Alterations in electrolyte transfer
Brain problems
Medication side effects
Steroids
Amphetamines
Antidepressants
Types of Bipolar disorder
Bipolar I disorder
Bipolar II disorder
Cyclothymia
Bipolar I Disorder
Individual is experiencing, or has experienced,
a full syndrome of manic or mixed symptoms
May also have experienced episodes of
depression
Bipolar II Disorder
Recurrent episodes of major depression
Episodic occurrences of hypomania
Has not experienced an episode that meets the
full criteria for mania or mixed
symptomatology
Client/Family Education
Management of illness
Medication management
Support services
Crisis hotline
Support groups
Individual psychotherapy
Legal/financial assistance
Treatment Modalities for Mood Disorders
Psychological treatment
Individual psychotherapy
Group therapy
Family therapy
Cognitive therapy
Organic Treatments
Treatment Modalities for Mood Disorders (cont.)
Psychopharmacology
For Depression
* Maprotiline * Mirtazapine
* Amoxapine * Serzone
* Trazodone * Effexor
• Bupropion
For mania:
Lithium carbonate
Anticonvulsants
Verapamil
Olanzapine
Treatment Modalities for Mood Disorders (cont.)
Electroconvulsive Therapy
For depression and mania
Mechanism of action: increase levels of biogenic amines
(norepinephrine, serotonin, and dopamine)
Side effects: temporary memory loss and confusion
Risks: mortality; permanent memory loss; brain damage
Medications: pretreatment medication; muscle relaxant;
short-acting anesthetic
