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Mood Disorders April 6, 2010 1. Define the terms: a.

Mood: a sustained emotional tone perceived along a normal continuum from sad to happy  INTERNAL state b. Affect: an EXTERNAL expression of present emotional content c. Mood Disorder: a prolonged and abnormal disturbance of mood, generally of a depressed, elated, or irritable nature, with syndromal features that result in significant subjective distress 2. List DSM criteria for a major depressive episode and manic episode
Major Depressive Episode *Changes in feelings, thinking, behavior, body Must have one of the following: Depressed mood most of the day, almost every day Anhedonia: diminished interest or pleasure in activities Must have at least 4 of the following: weight loss or gain insomnia or hyposomnia psychomotor agitation or retardation fatigue lack of libido (not in DSM) feeling of worthlessness; guilt (almost delusional) diminished ability to think recurrent thoughts of death, SI, suicide attempt Manic Episode Duration: 2+ weeks Must have: 1+ week of abnormally elevated, expansive, or irritable mood Must have at least 3 of the following: Grandiosity, inflated self-esteem decreased need for sleep more talkative, pressure to keep talking flight of ideas distractibility increased goal-directed activity excessive involvement in pleasurable activities that have a high potential for bad consequences (sex, shopping, investments

3. Distinguish between Major Depression, Adjustment Disorder with Depressed Mood, and Bereavement in terms of symptoms and course Disorder
Major Depression Adjustment Disorder w/ Depression Bereavement

Symptoms
See #2 distress and impairment Depressed mood Body symptoms: insomnia,

Course
Effective treatment address bio, psycho, and social elements Symptoms must start w/in 3 mo of acute stressor and resolve w/in 6 mo Varies greatly depending on different factors,

decreased appetite, psychomotor retardation, decreased libido thoughts of death to be w/ loved one (not SI or suicide attempt) guilt/worthlessness, but around memories of deceased hallucinations of seeing/hearing/feeling the deceased

including cultural norms

4. Discuss Major Depression and Bipolar Disorder in terms of lifetime risk, typical age of onset, prognosis, and associated behavioral risks
Lifetime risk Major Depression People with childhood stressor have high risk of becoming clinically depressed Any time of life Good with effective treatment Often begin to manifest psychotic sxs: auditory hallucinations telling them they are bad/worthless; sometimes somatic delusions (organs rotting, foul smell) Bipolar Disorder Most heritable of any psychiatric illness Late adolescence Meds for the rest of patient’s life

Typical age of onset Prognosis Associated behavioral risks

5. Discuss the major etiologic theories for Mood Disorders
Major Depression Bio: low serotonin, NE, DA genetic differences in serotonin reuptake efficiency reduce activity of left frontal lobe Psycho: less flexible defense mechanisms pts tend to catastrophize; feel totally hopeless; exaggerate guilt/worthlessness stressors impacting one’s identity (e.g. jobs) or important relationships Social: childhood adversity poverty, lack of education, losing one’s job/house some ppl develop depression w/o ANY stressor  high degree of heritability DA hypothesis (too much DA) changes in signal transduction

Bipolar Disorder

6. List the treatment considerations for a patient with Major Depression with and without psychotic features and for a patient with a manic episode of Bipolar I Disorder

Major Depression Bipolar I Disorder

Bio: meds (e.g. SSRIs), exercise, early morning sunshine Psycho: psychotherapy, mindfulness Social: address stressors that may have started depression almost always requires meds (e.g. lithium, anti-epileptics, antipsychotics) *very important to ask depressed pts if they’ve ever had manic episode  unopposed antidepressants can provoke a “flip” into mania or hypomania avoid street drugs family support

7. Differentiate between primary mood disorders and mood disorders caused by medical conditions and legal and illegal substances in terms of etiology and presentation a. Because so many people w/ mood disorders also abuse substances, it’s often hard to tell which is the primary problem i. Psychiatrists are now more aggressive about treating both problems simultaneously because it is hard to see which is “true cause”