12.MOOD DISODERS power point presentation

Mood disorders

1. MOOD DISORDERS PAUL MWOVE FACULTY COLLAGE OF HEALTH SCIENCES School of Nursing Sciences (SONS) JKUAT

2. OUTLINE 1.Introduction 2.Definition 3. Types/Classifications of mood disorders. 4.Causes of mood disorders. 5.Presentation/signs & symptoms. 6.Management

3. Introduction

4. MOOD DISORDERS

5. DEFINITION/MEANING.

6. DEFINITION/MEANING MOOD: - Webster dictionary  Conscious state of mind or predominant emotion  :  - It is a Feeling e.g. He's been in a good  mood  all week. The way you  feel  at a  particular   time : What is a mood disorder? A mood disorder is a mental disturbance that primarily affects a person’s emotional state. It is a disorder in which a person experiences long periods of extreme happiness, extreme sadness, or both. OR Mood disorders also called affective disorders are pervasive alterations in emotions that are manifested by depression, mania, or both.

7. Changes in mood/emotions.

8. Types/Classifications of mood disorders Two broad types:- 1.Depressive disorders: Involves only depressive symptoms 2.Bipolar Disorders: Involves manic symptoms (bipolar disorders) 1.DEPRESSIVE DISORDERS:- DSM-5: Classified into 4 subtypes:- i ).Major depressive disorder (MDD) ii):-Persistent depressive disorder iii):-Premenstrual dysphoric disorder iv):-Disruptive mood dysregulation disorder 2.BIPOLAR DISORDERS: DSM-5: Classified into 3 subtypes:- i ):-Bipolar I disorder ii):-Bipolar II disorder iii):-Cyclothymia

9. Types/Classifications of mood disorders

10. DEPRESSIVE DISORDERS SIGNS & SYMPTOMS. DSM-5 Criteria for Diagnosis of depressive disorders:- 1.Major Depressive Disorder (MDD). Sad mood OR loss of interest or pleasure (anhedonia) Symptoms are present nearly every day, most of the day, for at least 2 weeks Symptoms are distinct and more severe than a normative response to significant loss PLUS four of the following symptoms: Sleeping too much or too little Psychomotor retardation or agitation Poor appetite and weight loss, or increased appetite and weight gain Loss of energy Feelings of worthlessness or excessive guilt Difficulty concentrating, thinking, or making decisions Recurrent thoughts of death or suicide

11. MAJOR DEPRESSIVE DISORDER SIGNS & SYMPTOMS CONT…. Episodic Symptoms tend to dissipate over time Recurrent Once depression occurs, future episodes likely

12. 2.PERSISTENT DEPRESSIVE DISORDER DSM-5 Criteria for diagnosis:- Depressed mood for at least 2 years; 1 year for children/adolescents PLUS 2 other symptoms: Poor appetite or overeating Sleeping too much or too little Poor self-esteem Trouble concentrating or making decisions Feelings of hopelessness Symptoms do not clear for more than 2 months at a time © 2015 John Wiley & Sons, Inc. All rights reserved.

13. 3.PREMENSTRUAL DYSPHORIC DISORDER. DSM-5 Criteria for diagnosis:- In most menstrual cycles, at least five of the following symptoms are present in the final week before menses and improve within a few days of menses onset: Affective lability Irritability Depressed mood, hopelessness, or self-deprecating thoughts Anxiety Diminished interest in usual activities

14. 3.PREMENSTRUAL DYSPHORIC DISORDER CONT… DSM-5 Criteria for diagnosis cont… Difficulty concentrating Lack of energy Changes in appetite, overeating, or food craving Sleeping too much or too little Subjective sense of being overwhelmed or out of control Physical symptoms such as breast tenderness or swelling, joint or muscle pain, or bloating

15. 4.DISRUPTIVE MOOD DYSREGULATION DisorderDSM-5 Criteria for diagnosis:- Severe recurrent temper outbursts, including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation. Temper outbursts are inconsistent with developmental level. The temper outbursts tend to occur at least three times per week. Negative mood between temper outbursts most days. These symptoms have been present for at least 12 months and do not clear for more than 3 months at a time. Temper outbursts and negative mood are present in at least two settings (at home, at school, or with peers) and are severe in at least one setting.

16. 4.DISRUPTIVE MOOD DYSREGULATION CONT... Disorder DSM-5 Criteria for diagnosis:- Age 6 or older (or equivalent developmental level). Onset before age 10. There has never been a distinct period lasting more than 1 day during which elevated mood and at least three other manic symptoms were present. The behaviors do not occur exclusively during the course of major depressive disorder and are not better accounted for by another mental disorder. This diagnosis cannot coexist with oppositional defiant disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder, or bipolar disorder.

17. EPIDEMIOLOGY OF DEPRESSION Depression is common Lifetime prevalence (Kessler et al., 2005): 16.2% MDD Twice as common in women as in men Three times as common among people in poverty Prevalence varies across cultures

18. EPIDEMIOLOGY OF DEPRESSION CONT… Symptom variation across cultures Latino cultures Complaints of nerves and headaches Asian cultures Complaints of weakness, fatigue, and poor concentration Symptom variation across life span Children Stomach and headaches Older adults Distractibility and forgetfulness Co-morbidity 2/3 of those with MDD will also meet criteria for anxiety disorder at some point

19. Median Age of MDD Onset by Generation

20. BIPOLAR DISORDERS

21. BIPOLAR DISORDERS

22. TYPES OF BIPOLAR DISORDERS Bipolar disorders exist in three forms:- i ):-Bipolar I ii):- Bipolar II iii):- Cyclothymia NB:- Mania defining feature of each of the three. Differentiated by severity and duration of mania Bipolar disorders usually involve episodes of depression alternating with mania Depressive episode required for Bipolar II, but not Bipolar I

23. BIPOLAR- 1 Bipolar I requires symptoms to meet the full criteria for what is known as a manic episode . NB: You do not have to experience depression to be diagnosed with bipolar 1, but many people with the diagnosis experience both kinds of mood episodes.

24. MANIC EPISODE- DSM 5 CRITERIA OF DIAGNOSIS. A manic episode must include at least three of the following symptoms:- Increased talkativeness Increased self-esteem or grandiosity Decreased need for sleep Increase in goal-directed activity, energy level, or irritability Racing thoughts Poor attention Increased risk-taking (spending money, risky sexual behaviors, etc.)

25. MANIA

26. MANIA-CLINICAL FEATURES

27. MANIA FEATURES-EXPANSIVE MOOD

28. CONT…MANIA CLINICAL FEATURES

29. BIPOLAR -2 To qualify for a diagnosis of bipolar II,: A person has to have experienced a depressive episode and a less severe form of mania known as  hypomania. A person experiencing mania will exhibit manic symptoms but is able to continue with day-to-day responsibilities and may even see an increase in job performance or other goal-directed activity. The elevated mood, however, is not so severe that the person requires hospitalization or experiences significant disruption at home or work.

30. HYPOMANIA

31. Manic and Hypomanic Episodes DSM-5 Criteria for diagnosis:- For a manic episode: Symptoms last for 1 week or require hospitalization or include psychosis Symptoms cause significant distress or functional impairment For a hypomanic episode: Symptoms last at least 4 days Clear changes in functioning that are observable to others, but impairment is not marked No psychotic symptoms are present

32. DSM-5 CRITERIA FOR DIAGOSING BIPOLAR DISORDERS BIPOLAR I At least one episode or mania (manic episode). BIPOLAR II At least one major depressive episode with at least one episode of hypomania CYCLOTHYMIC DISORDER (CYCLOTHYMIA) Milder, chronic form of bipolar disorder Lasts at least 2 years in adults, 1 year in children/adolescents Numerous periods with hypomanic and depressive symptoms Does not meet criteria for mania or major depressive episode Symptoms do not clear for more than 2 months at a time Symptoms cause significant distress or impairment

33. BIPOLAR EPIDEMIOLOGY AND CONSEQUENCES Prevalence rates lower than MDD 0.6% worldwide for Bipolar I – 2% for Bipolar II 4% for Cyclothymia Average age of onset in 20s No gender differences in rates of bipolar disorders Women experience more depressive episodes Suicide rates high in cases of bipolar (Angst et al., 2002)

34. Rapid Cycling Subtype of Bipolar Disorder

35. ETIOLOGY/CAUSES OF MOOD DISORDERS 1.Genetic factors Research to identify specific genes involved ongoing. 2.Biochemical/Neurobiological factors Neurotransmitters (NTs): norepinephrine, dopamine, and serotonin MDD Low levels of norepinephrine, dopamine, and serotonin Mania High levels of norepinephrine and dopamine, low levels of serotonin 3.Psychosocial factors 4.Psychological factors

36. Social and Psychological Factors in Bipolar Disorder Triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes Negative life events, neuroticism, negative cognitions, expressed emotion, and lack of social support Predictors of mania Reward sensitivity-(striving towards multiple rewards/fixation to rewards). Sleep disruption

37. TREATMENT OF MOOD DISORDERS Psychological Treatment of Mood Disorders 1.Interpersonal psychotherapy (IPT) Short-term psychodynamic therapy Focus on current relationships 2.Cognitive behavior therapy Monitor and identify automatic thoughts Replace negative thoughts with more neutral or positive thoughts 3.Mindfulness-based cognitive therapy (MBCT) Strategies, including meditation, to prevent relapse 4.Behavioral activation (BA) therapy Increase participation in positively reinforcing activities to disrupt spiral of depression, withdrawal, and avoidance 5.Psycho education approaches Provide information about symptoms, course, triggers, and treatments 6.Family therapy: Education about the disorder,enhanced family communication.

38. BIOLOGICAL TREATMENT OF MOOD DISORDERS 1.Electroconvulsive therapy (ECT) Reserved for treatment non-responders Induce brain seizure and momentary unconsciousness Side effects Memory loss ECT more effective than medications Unclear how ECT works

39. ECT

40. MEDICATIONS FOR BIPOLAR DISORDER Lithium Up to 80% receive at least some relief with this mood stabilizer Potentially serious side effect Lithium toxicity Mood stabilizers i ).Anticonvulsants Depakote,tegretal ii).Antipsychotics Eg olanzepine © 2015 John Wiley & Sons, Inc. All rights reserved.

41. SUICIDE. Key Terms in Suicide. 1.Suicide ideation: thoughts of killing oneself 2.Suicide attempt: behavior intended to kill oneself 3.Suicide: death from deliberate self-injury 4.Non-suicidal self-injury: behaviors intended to injure oneself without intent to kill oneself © 2015 John Wiley & Sons, Inc. All rights reserved.

42. Annual Deaths Due to Suicides per 100,000 People

43. RISK FACTORS FOR SUICIDE 1.Psychological Disorders Half of suicide attempts are depressed at the time of the act 2.Neurobiological factors Heritability of 48% for suicide attempts Low levels of serotonin 3.Social Factors Economic recessions Media reports of suicide Social isolation and a lack of social belonging 4.Psychological factors Problem-solving deficit Hopelessness Life satisfaction Impulsivity

44. Preventing Suicide Talk about suicide openly and matter-of-factly Most people are ambivalent about their suicidal intentions. Treat the associated mental disorder Treat suicidality factors directly Suicide prevention centers

45. Suicidality factors- These personal factors contribute to increased risk of suicide: Previous suicide attempt. History of depression and other mental illnesses. Serious illness leading to chronic pain e.g.cancer etc. Criminal/legal problems. Job/financial problems or loss. Impulsive or aggressive tendencies. Substance use - misuse and abuse of alcohol or other drugs/substances. Current or prior history of adverse childhood experiences.

46. Suicide safety plan. Steps involved in the development of a Safety Plan. Step 1: Warning Signs – -observe and monitor patient closely. (Suicide plan, suicidal ideation, method). Step 2: Internal Coping Strategies. Step 3: Social Contacts Who May Distract from the Crisis…. Step 4: Family Members or Friends Who May Offer Help. ... Step 5: Professionals and Agencies to Contact for Help. ... Step 6: Making the Environment Safe.

47. Priority intervention. For a client threatening self-harm/suicide: Ensure immediate safety Provide emotional support, Refer to a specialist, and formulate a safety plan.