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Mood disordersHarsimrat BaggaWindsor University ofMedicine5/10/2013
‘’32 year old man was apprehended by the police 2 weeks agofor running across the freeway without regard for his personalsafety. The patient stated that he did this “ for the heck of it.”The patient appeared distracted during the initialinterview, spoke rapidly, and gave long drawn out answers.When asked about his mood, the patient said that he is feeling“okay, I’m under the weather, if you get my drift.” He wasadmitted to the inpatient unit for observation.Since his admission, he has been saying that he will soon replacethe president, that he is the next Alexander the Great, and thathe was told by the voices in his head. The patient’s admissionlaboratory values, including the drug screen for illicitsubstances, came back normal. Which of the following is themost likely diagnosis?”
• A) Bipolar disorder with psychotic features• B) Bipolar disorder without psychotic features• C) Depression with psychotic features• D) Schizophrenia , disorganized type• E) Schizophrenia, paranoid type
• Do you know many people are suffering from themood disorders that highly impair their dailyfunctioning and do not even get diagnosed• Do you know many well-known people have beendiagnosed with mood disorders but are well-treated to the point that they attain their normallevel of functioning• Example:• Catherine Zeta Jones- Bipolar IIMel Gibson- BipolarJim Carrey- Depression
• So lets study mooddisorders and seehow adequatediagnosis andtreatment can make adifference in people’slives!
Unipolar• Major Depressive Disorder• Dysthymic Disorder• Depressive DisorderUncategorizedBipolar Disorders• Bipolar I Disorder• Bipolar II Disorder• Cyclothymic Disorder
ETIOLOGY-Biological Factors:NOREPINEPHRINE FluctuationsSEROTONINDOPAMINE-Abnormalities of Sleep Neurophysiology-Genetics-Psychosocial Factors-Personality Factors
Unipolar DisordersMajor Depressive Disorder• Episodic Symptoms:Sad/depressed moodDecrease in interestPsychomotor changesSleep alternationsAppetite changesFatigue , low energyCognitive changes impacting attention and concentrationGuilt, feelings of worthlessness, hopelessnessSuicidal or homicidal ideation• For at least 2 weeks
Unipolar DisordersDysthymic Disorder-• Depressed mood for of most of the day for atleast 2 years. The disturbance does not occur dueto another disorder like schizophrenia ordelusional disorder or with other medicalcondition.
Unipolar DisordersAtypical depression• characterized by marked “anhedonia”, weightgain, increase inappetite, hypersomnia, ‘leaden paralysis’, andsignificant social impairment, hypersensitivityto perceived interpersonal rejection by others
Unipolar DisordersSeasonal affective disorder-• Seasonal pattern of depressiveepisodes occurring during fall orwinter with resolution by spring. Twoepisodes have to occur during thecolder months rather than any othertimes and over the course of two yearor more time period
Unipolar Disorders• Other forms of depression:-Post partum depression (within 1-3 monthsafter birth; may have negative feelings towardsbaby)-Postpartum blues ( immediately after birthupto 2 weeks, no negative feelings towardsbaby)-Premenstrual Dysphoric disorder
Bipolar Disorder• ManiaElevated MoodInflated Self-esteem or grandiosityDecreased need for sleepExcessive talkatingRacing thoughts, flight of ideasDistractibilityIncrease in goal directed activity(social, work, sex)Increase in libidoPsychomotor agitationPoor judgmentSymptoms lasting at least 1 week and are not due to any medicalcondition, treatment or substances. It impairs normal level offunctioning
Bipolar Disorder• Hypomaniaelevated, euphoric or irritable mood, lastingthroughout at least four days. The symptomsare not severe to cause any major impairmentin social or occupational functioning, or tomandate hospitalization. They are also notresult of any toxic substances or medicalconditions.
Rapidly cycling Bipolar:• 4 episodes of Mania in 1 year. It is due to useof anti-depressants
Bipolar Disorder• Cyclothymic Disorder –The occurrence of several periods of alternatinghypomanic symptoms with depressivesymptoms for at least 2 years. These symptomsnot due to the effects of substances, mediationsor medical conditions and they do causesignificant distress or impairment in functioning.
Goals• Patient’s safety primary concern• Complete and thorough diagnosticassessment• Treatment plan addressing not just immediatesymptoms but overall patient’s prospectivewell-being.• The need for hospitalization should beevaluated
Treatment• Pharmacotherapy:Major Depressive Disorder - MAOI’s, TCAC’s,SSRI’s, SNRI’s, mirtazipine, BupropianBipolar Disorders - Lithium, anticonvulsants,antipsychoticsAlternatives to drug therapy: Electroconvulsivetherapy (ECT)
References• Merino, L. (2009). Mood Disorders; Retrieved from:http://www.slideshare.net/Lucia_Merino/mood-disorders-presentation-3893405• Dr. Manood, H. (2010). Mood Disorders; Retrieved from:http://www.slideshare.net/specialclass/mood-disorders-psych-ii• Faraj, S. (2009). Mood Disorders; Retrieved from:http://www.slideshare.net/HusseinAliRamadhan/mood-disorder-drsaman• Khalife S, Singh V & Muzina D. (2009). Bipolar Disorders;Retrieved from:http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/bipolar-disorder/
References• Henry, P. (2010). Top 10 Antidepressant Medications Side Effects and Classification SARI SNRI; Retrieved from:http://paulahenry1.hubpages.com/hub/Antidepressant-medications• Narconon. (2009). Side Effects of Antidepressants; Retrieved from: http://www.narconon.org/drug-education/videos/effects-of-antidepressants-video.html• Harvard Medical School Publication. (2010). Seasonal affective disorder; Retrieved from:http://220.127.116.11/~abhccom/index.php?option=com_content&view=article&id=81%3Aseasonal-affective-disorder&catid=1%3Alatest-news&Itemid=1• Sandhar, N. (2009). Dysthymia Disorders; Retrieved from: http://www.glogster.com/navneet1109/dysthymia-by-nav-sandhar/g-6l3hr6d7c61glicoh4v3ha0• Terri D. (2007). PM-what? Retrieved from: http://pajamadiaries.com/pm-what/• My Healthy Feeling. (2013). Selective Serotonin Reuptake Inhibitors (SSRIs) Side Effects, Brand Names, Action; Retrievedfrom: http://www.myhealthyfeeling.com/selective-serotonin-reuptake-inhibitors-ssris-side-effects-brand-names-action/• Richeimer, S. (2000). The Assessment of the Patient with Pain; Retrieved from: http://www.helpforpain.com/articles/pain-assess/assessment.htm• UCCS. (2000). What is Bipolar Disorder? Retrieved from: http://www.uccs.edu/biology/mood-disorders/bipolar-disorder.html• Chen, J et al. (2011). Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: Alongitudinal, naturalistic study; Retrieved from: http://www.sciencedirect.com/science/article/pii/S0165032711007464
References• Dr. Fischer, C. (2013). Master The Boards (Second Edition); Kaplan Publishing Inc.: New York• Tao L & Vierregger K. (2010). First Aid Q &A for the Usmle Step 2 CK (Second Edition); McGraw Hillpublishing: New York• Stupid celebrities Gossip. (2012). Celebrities With Mental Disorders; Retrieved from:http://stupidcelebrities.net/2012/08/celebrities-with-mental-disorders/