Mood disorders - types, evaluation and occupational therapy

Occupational therapy treatment for mood disorders

1. MOOD DISORDERS Done by Grizelda Evangeline P MOT (Paediatric)

2. SYNOPSIS Mood disorders Classification of mood disorders Diagnostic features of each mood disorders Pathophysiology and Psychopathology Causes Medical management Scales OT assessment Problems Identified OT approaches/FOR OT treatment and activities

3. MOOD DISORDER Mood A patient's mood is their underlying feelings, which are more consistent and sustained over time. Affect A patient's affect is their immediate expression of emotion, which is more reactive and shorter in duration than mood. According to DSM-5, Mood disorders are mental health conditions that can be categorized as either bipolar or depressive. Mood disorders can cause intense and persistent changes in person’s mood, energy levels and behaviour. Mood disorders are described by marked disruptions in emotions.

4. CLASSIFICATION OF MOOD DISORDERS According to the Diagnostic and Statistical Manual of Mental disorders – 5 th edition DSM-5 Mood disorders are classified into two groups Bipolar and related disorders Depressive disorders

5. BIPOLAR AND RELATED DISORDERS Bipolar I disorder Bipolar II disorder Cyclothymic disorder substance/medication induced bipolar and related disorder Bipolar and related disorder due to medical condition Other specified Bipolar and related disorder. Unspecified bipolar and related disorder

6. DEPRESSIVE DISORDERS Disruptive mood dysregulation disorder Major depressive disorder Persistent depressive disorder – dysthymia Premenstrual dysphoric disorder Substance/medication induced depressive disorder Depressive disorder due to other medical condition Other specified depressive disorder Unspecified depressive disorder

7. DIAGNOSTIC FEATURES OF EACH MOOD DISORDERS BIPOLAR DISORDER It is characterised by mood swings from profound depression to extreme euphoria (mania), with interfering periods of normalcy. Delusions and hallucinations may or may not be present.

8. BIPOLAR TYPE I Mania Episode A Distinct period of abnormality and persistently elevated, expressive or irritable mood. Lasting for one week or more. Inflated self esteem or grandiosity Decreased need for sleep (3 hours of sleep) More talkative and pressure to keep on talking Flight of ideas Distractibility (attention easily withdrawn to unimportant or irrelevant external stimuli) Psychomotor agitation (increase in goal directed activity) Excessive involvement in pleasurable activities with painful consequences (foolish business investments or sexual indiscretion)

9. Hypomania Episode Milder degree of clinical symptoms of mania episodes. Diagnostic features: Same as mania episode but lasting at least 4 consecutive days. The disturbance in mood and the change in functioning are observable by others. It is not severe enough to cause marked impairment in social or occupational functioning.

10. Major Depressive Episode Five or more of the following symptoms have been present during two weeks or more. Diagnostic features: Depressed mood most of the day, nearly everyday. Markedly diminished interest or pleasure in all or almost all activities everyday. Significant weight loss or weight gain Insomnia or hypersomnia everyday Psychomotor agitation or retardation nearly everyday Fatigue or loss of energy nearly everyday Feelings of worthlessness or excessive or inappropriate guilt. Diminished ability to think or concentrate or indecisiveness nearly everyday. Recurrent thoughts of death, recurrent suicidal ideation

11. BIPOLAR TYPE II Criteria have been met for at least one hypomania episode and at least one major depressive episode There has never been a mania episode The occurrence of the hypomania episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

12. CYCLOTHYMIA For a diagnosis of cyclothymia, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. many periods of elevated mood (hypomania symptoms) and periods of depressive symptoms for at least two years (one year for children and teenagers) — with these highs and lows occurring during at least half that time. Periods of stable moods usually last less than two months. Your symptoms significantly affect you socially, at work, at school or in other important areas. Your symptoms don't meet the criteria for bipolar disorder, major depression or another mental disorder. Your symptoms aren't caused by substance use or a medical condition.

13. DEPRESSIVE DISORDERS Depression is an alteration in mood that is expressed by feelings of sadness, despair and pessimism. There is a loss of interest in usual activities and somatic symptoms may be evident. Changes in sleep and appetite pattern are evident. Diagnostic features: same as mentioned before (major depressive disorder)

14. DISRUPTIVE MOOD DYSREGULATION DISORDER Severe recurrent temper outbursts manifested verbally and or behaviourally. The temper outbursts are inconsistent with developmental level The temper outbursts occur three or more times per week. The mood between temper outbursts is persistently irritable or angry everyday. Present for 12 months or more.

15. DYSTHYMIA Dysthymia is also known persistent depressive disorder. It is a mental disorder that causes a chronic low level depression that lasts for years . Dysthymia is similar to major depressive disorder but the symptoms are less severe but last longer.

16. PREMENSTRUAL DYSPHORIC DISORDER At least five symptoms must be present in the final week before the onset of menses but starts to improve within few days after the onset of menses Marked affective lability (mood swing) Marked irritability or anger increased interpersonal conflict Marked depressed mood, feelings of hopelessness or self deprecating thoughts. Marked anxiety, tension and or feelings of being keyed up or on edge. Diagnostic features same as depressive disorders

17. PATHOPHYSIOLOGY Constant stress results from overactivation of the hypothalamic-pituitary-adrenal (HPA) axis , which results in glucocorticoid cortisol level increase. Neuronal plasticity also plays a significant role in the pathophysiology of mood disorder. Patients with poor social support show signs of impaired neuronal plasticity, predisposing them to mood disorders. Mild to moderate impairment of neuronal plasticity causes depression, while severe impairment results in mania.

18. PSYCHOPATHOLOGY Genetic factors Bipolar Disorder is among the most heritable of disorders.  The risk of Bipolar Disorder among children of Bipolar Disorder parents is four times greater than the risk among children of healthy parents.  Neurotransmitters dysregualtion Three neurotransmitters have received the most attention in studies of mood disorders: norepinephrine, dopamine, and serotonin. The original neurotransmitter models suggested depression was tied to low levels of norepinephrine and dopamine, whereas mania was tied to high levels of norepinephrine and dopamine.

19. CAUSES OF MOOD DISORDERS Life events: Stressful life events, such as the death of a loved one, chronic stress, or traumatic events, can increase the risk of developing a mood disorder. Genetics: Mood disorders can run in families, and people with a strong family history are more likely to develop them. Brain chemicals: An imbalance of brain chemicals can contribute to mood disorders. Medications: Some prescription drugs and street drugs can cause mood disorders. Withdrawal: Withdrawing from benzodiazepines can cause depression, which usually improves after a few months

20. MEDICAL MANAGEMENT Antidepressants – Amoxapine, Imipramine Lithium for mania Antipsychotics – Risperidone, Olanzapine, Haloperidol Mood stabilisers – Sodium valproate, carbamazepine, Benzodiazepines ECT Psychosocial treatment

21. SCALES Depression Hamilton Rating Scale for Depression (HAM-D) Montgomery- Asberg Depression Rating Scale (MADRS) Depression, Anxiety, stress scale Mania Young Mania Rating Scale (YMRS) Manic State Rating Scale (MSRS) Bech-Rafaelsen Mania Rating Scale (MAS) Mood disorder Questionnaire (MDQ)

22. OT ASSESSMENT Demographic data Medical history Personal history Educational history Premorbid personality General appearance Psychomotor activity Sensory perceptual evaluation Thought disorder Cognition evaluation Emotions Mood Affect Insight Interpersonal behaviour Intrapersonal behaviour Roles and routines ADL IADL

23. PROMBLEMS IDENTIFIED ADL are affected Self care Work Leisure Poor cognition Attention Concentration Problem solving Decision making Changes in Mood and affect Maladaptive behaviour Thought disorders – flight of ideas, preoccupation, suicidal thoughts Poor or absent of Insight Changes in sleep pattern Loss of appetite Poor interpersonal skills Poor intrapersonal skills

24. OT APPROACHES / FOR Psychoanalytical approach Cognitive behavioural FOR Behavioural FOR Acquisitional FOR

25. Psychoanalytical approach Free flowing conversation Interpretation Cognitive behavioural approach Replacing depressive negative cognition with new cognitive and behavioural responses Self monitoring Cognitive restructuring Bibliotherapy Communication skills Behavioural FOR Modeling shaping Chaining Token economy system Fading Acquisitional FOR Activity based goals Natural progression Client awareness Imitation.

26. OT TREATMENT AND ACTIVITIES Psychoeducation Reality orientation therapy Social skills training Group therapy Guided imagery Stress management Assertiveness training Sleep hygiene techniques Relaxation techniques Projective techniques Family and marital therapy Sensory modulation techniques

27. Psychoeducation Provide info and support to better understand and cope with illness for patient and caregiver Reality orientation therapy To help them maintain a sense of reality and reduce disorientation and preoccupation Social skills training Motivation Demonstration Practice Feedback Sensory modulation techniques Calming sensory input Self regulation techniques Self soothing activities Relaxation techniques Deep breathing exercises Meditation Yoga Music and art therapy Sleep hygiene techniques Regular physical exercises Minimize daytime napping Sleep in a dark, quiet comfortable environment. Avoid food intake one to two hours before sleeping. Projective techniques - Arts and crafts activities

28. RECENT ADVANCEMENTS Evidence based group therapy for mood disorders: Treatment for depression and bipolar disorders. - 2024 - Cognitive behavioural group therapy and group cognitive therapy Group behavioural activation, group interpersonal therapy, group functional remediation and group psychoeducation. Effectiveness and changes in brain function by an occupational therapy program incorporating mindfulness in outpatients with anxiety and depression – 2023 - Occupational therapy incorporating mindfulness (MOT) improves well being and global function for those who struggles with social and occupational functioning.

29. REFERENCE A short textbook of psychiatry – Niraj Ahuja Mental health concepts and techniques – Mary Beth Early Diagnostic and statistical manual of mental disorders – fifth edition DSM – 5 th.

30. THANK YOU