clinical mental health MOOD DISORDERS.pptx

clinical mental health

1. Mood disorders are characterized by marked disturbance in emotional state, which affect thinking, physical symptoms, social relationships and behavior. Depression and mania are central to these disorders Depression is characterized by intense feelings of sadness, feelings of futility and worthlessness and social withdrawal from others.

2. Mania is characterized by elevated mood, expansiveness, or irritability and often resulting in hyperactivity. Depression and mania, the two extremes of mood can be considered the opposite ends of a continuum that extends from deep sadness to wild elevation.

3. Mood disorders are of two basic types: Unipolar and bipolar disorder. People with unipolar disorder experience moods that are on the depressive end of the continuum. People with bipolar disorders experience moods that are at both ends of the continuum. Mood disorders are generally episodic, which means they tend to come and go. The duration of the disturbed emotional state and the pattern of its occurrence determine how a mood disorder is diagnosed.

4. Researchers believe that many different influences interact to produce mood disoders : Biological factors Genetic predisposition Neurotransmitters- low levels of serotonine Brain structure- researchers indicate that people with chronic depression tend to have smaller hippocampus and amygdala in brain, perhaps because of an excess of the stress hormone cortisal .

5. learned helplessness- the tendency to give up passively in the face of unavoidable stressors Self blame- depressed people tend to attribute negative events to internal, stable and global factors. They believe the problem is likely to be permanent, and overgeneralize from the problem to their whole lives. Low self esteem Rumination

6. Lack of social network Loss of an important relationship Emotional stress

7. Major depressive disorder is characterized by at least one major depressive episode. A depressive episode is a period of at least two weeks in which a person experiences some or all of the following symptoms consistent sadness or irritability Loss of interest in almost all activities Changed sleeping or eating patterns Low energy

8. Difficulty concentrating Feelings of worthlessness or guilt Recurrent thoughts about suicide It is important to note that major depression is more common in women than in men because women have a tendency to ruminate over issues.

9. Dysthymic disorder, or dysthymia, is a milder form of depression. It may not hinder a person’s ability to function in daily life. A person with dysthymic disorder experiences a depressed mood for a majority of days over at least two years. Unlike major depression, dysthymia may last at least four years although symptoms are not as severe as compared to major depressive disorder, though the symptoms are the same.

10. A. depressed mood for most of the day, for more days than not, as indicated by the subjective account or observation by others, for at least 2 years. B. presence, while depressed, of two or more of the following: Poor concentration Insomnia or hypersomnia Low energy or fatigue

11. Low self esteem Poor concentration or making decisions Feelings of haplessness c. During the two year period(1 for children or adolescents) of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2 months at a time. D. No major depressive episode has been present during the first 2 years of the disrurbance .

12. Double depression refers to a major depressive episode that is superimposed on dysthymic disorder.

13. Drug trials should last 4 to 8 weeks. No response within 4 weeks of treatment - the dose should be increased or the patient should be switched to another drug. Anti-depressants Selective serotonin reuptake inhibition(SSRIs) ( E.g.Fluoxetine ( prozac ),paroxine( paxil ), Sertraline (Zoloft) Serotonin and norepinephrine reuptake inhibition(SNRI) e.g. Duloxine , Venlafaxine

14. FLUOXETINE 40-60mg SERTRALINE 50-200mg PAROXETINE 20-60mg FLUVOXAMINE 50-200mg CITALOPRAM 10-40mg

15. Commonly used Imipramine Nortriptyline Amitriptyline 25mg OD

16. Overdose attempts with TCAs are serious and can often be fatal. Prescriptions for these drugs should be nonrefillable and for no longer than a week at a time for patients at risk for suicide. Symptoms of overdose include agitation, delirium, convulsions, hyperactive deep tendon reflexes, bowel and bladder paralysis, dysregulation of BP and temperature, and mydriasis. The patient then progresses to coma and perhaps respiratory depression. Cardiac arrhythmias may not respond to treatment. Because of the long half-lives of TCAs, the patients are at risk of cardiac arrhythmias for 3 to 4 days after the overdose, so they should be monitored in an intensive care medical setting.

17. Electroconvulsive therapy (ECT) is the treatment of choice for some patients with very severe depression, with high potential for suicide or other self destroying behavior and for pregnant women. Psycho-social therapy Counselling

18. Suicide is an act of killing oneself purposefully. Suicide is the 3 rd leading cause of death in people 15-25 via drug overdose The elderly are more likely to commit suicide than any other age group Up to 70% of all suicide result from mood disorder. Research shows that women are more likely to attempt suicide than men, but men are more likely to be successful at carrying out suicide.

19. Social withdrawal, decline in school functioning, loss of appetite, sleep problems.

20. Stressful life events Important losses that lead to hopelessness and negative expectations Three types of suicide (Emil Durkheim): Egoistic: people who are alienated and are unconcerned with societal norms Anomic: people who feel let down by society and or have experienced major change. Altruistic: believe it will benefit society

21. Medication Crisis intervention Hospitalization psychotherapy

22. Bipolar disorder, also called manic-depressive illness, is less common. In other words, the term bipolar is used because the disorders are usually accompanied by one or more depressive symptoms in addition to some manic symptoms. The condition is experienced equally by both men and women and generally manifests itself for the first time when the individual is between the ages of 15 and 25

23. There are three types of bipolar disorder: Bipolar disorder type I Bipolar disorder type II Cyclothymia

24. Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible. .

25. Inflated self-esteem or grandiosity Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility (i.e., attention too easily drawn to uniportant or irrelevat external stimuli).

26. Increased goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business involvement).

27. Bipolar 2 disorder, also known as hypomanic episode, is just the same as bipolar 1, except the symptoms are milder. No history of manic episode Alternates between periods of major depressive episode and hypomanic episodes( which have similar symptoms to mania, but may be shorter and less severe and impairing).

28. For cyclothymia persistent instability of mood, involving periods of mild depression and mild elation is typical. In other words, this disorder alternates between depressive symptoms(in the dysthymic range) and hypomanic episodes for at least two years. The mood swings are usually perceived by the individual as being unrelated to life events.

29. Patients with severe mania are best treated in the hospital where aggressive dosing is possible and an adequate response can be achieved within days or weeks. Adherence to treatment, however, is often a problem, because patients with mania frequently lack insight into their illness, and refuse to take medication. Because impaired judgment, impulsivity, and aggressiveness combine to put the patient or others at risk, many patients in the manic phase are medicated to protect themselves and others from harm.

30. Mood stabilizers: lithium (0.6—1.2 mEq /L) carbamazepine (6—12 mg/L) valproate (50—125 mg/L) Anticonvulsants: gabapentine topiramate lamotrigine Agitated or psychotic patient – coadministration of antipsychotics of second generation (olanzapine, risperidone) benzodiazepines (lorazepam, clonazepam)

31. Antidepressants psychotherapy