Surgeon General’s Report 1999 (Part 2) Mood Disorders and Schizophrenia

MOOD DISORDERS 7 % of Americans suffer from mood disorders Rank among the top ten causes of WORLDWIDE disability The two that will be covered today: ~Major Depressive Disorder ~Bipolar Disorder

Comorbidities (what Mood Disorders coexist with) Anxiety Disorders Substance Abuse Disorders 40% of people with mood disorders also have substance abuse disorders

Clinical Depression vs. Normal Sadness (what distinguishes Major Depressive Disorder?) Anhedonia Hopelessness Loss of mood reactivity Suicidal thoughts Delusions

Characteristics of Major Depressive Disorder One or more episodes lasting at least 2 weeks Cardinal Symptoms: Depressed mood Loss of interest or pleasure When untreated: Lasts 9 months 50% will recur

Dysthymia a CHRONIC form of depression

BIPOLAR DISORDER Episodes of mania mixed with episodes of depression Recurrent

How is Bipolar Disorder DIFFERENT from Major Depressive Disorder? Manic episodes Earlier age at onset Reversed vegetative symptoms Oversleeping, overeating Lithium salts are therapeutically effective

The MANIA Phase Thought content is GRANDIOSE and PARANOID Speed of thought increases Sleep deprivation contributes to delirious mania Equally common in both men and women

CYCLOTHYMIA a MILDER form of Bipolar Disorder

ETIOLOGY of Mood Disorders Biological factors Monoamine Hypothesis Deficiency of monoamine transmitters SSRI’s boost serotonin levels Depressed patients have too much activity in the HPA axis Depressed patients have higher levels of CRH

ETIOLOGY, continued… Psychosocial Factors Stressful life events The most stressful: Death of a loved one Cognitive factors It’s all about perception Temperament & Personality Neuroticism predisposes Gender All over the world, Major Depressive Disorder is more common in women Genetic Tend to run in families

TREATMENT of Mood Disorders Biggest problem= getting people into treatment at all More than 50% of depressed people don’t get treatment More than 40% of bipolar people don’t get treatment Reasons…

TREATMENT, continued… Stages of Therapy Acute phase Usually requires 6-8 weeks Electroconvulsive Therapy Most common adverse effects: confusion and memory loss Continuation phase At least 6 months of continued treatment Maintenance phase Purpose is to prevent future occurrences

TREATMENT for specific episodes of Depression and Mania Four major classes of drugs TCAs, HCAs, MAOIs, SSRIs Newer therapies for Depression Cognitive-Behavioral therapy Interpersonal psychotherapy Newer treatments for Mania Verapamil is a calcium channel blocker

SCHIZOPHRENIA …the BRIEFEST of overviews…

CHARACTERISTICS of Schizophrenia Profound disruption in cognition and emotion Symptoms frequently include: psychotic manifestations Assigning unusual significance to normal events Having delusions

POSITIVE symptoms (excess/distortion of normal functions) Delusions Hallucinations Disorganized speech Catatonic behaviors Disorganized thinking Grossly distorted behavior

NEGATIVE symptoms (diminution or loss of normal functions) A ffective flattening A logia A volition

Recovery Factors Family/Home atmosphere Personal motivation Availability of skill-building assistance

ETIOLOGY of Schizophrenia Immediate biological relatives have 10 times greater risk Discordance among identical twins indicates environmental factors also important Brain abnormalities include: Enlarged cranial ventricles Decreased cerebral size

PHYSIOLOGY of Schizophrenia Positive symptoms linked to TEMPORAL LOBE dysfunction Negative symptoms linked to PREFRONTAL LOBE dysfunction

Pharmacotherapy Interventions Chlorpromazine (older) and Clozapine (newer) reduce the POSITIVE symptoms of Schizophrenia Newer meds also reduce the NEGATIVE symptoms Moderate levels of dosage are most effective Problem: SIDE EFFECTS 40% of patients have side effects (parkinsonism and tardive dyskinesia) Clozapine is the prototype of the newer meds

THE END