1. MOOD DISORDERS INTRODUCTION DR. HASSAN SARSAK, PHD, OT

2. Mood disorders Dysfunctional grieving…..Mood disorders or affective disorders Mood: is the individual’s emotional tone, which significantly influences behavior, personality, and perception. Individuals experience an extreme in the continuum of typical moods-From the low, sad, unpleasant mood of unipolar depression to the elevated, elated, energized mood of mania. And those who experience both ends of the continuum are known to have bipolar Mood disorders frequently occur in conjunction of other mental conditions, such as anxiety and personality disorders, general medical condition and substance-induced mood disorder Epidemiology of mood disorders: gender, age, social class, race, marital status, seasonality. According to DSM-IV, there are two major categories: Depressive disorders, and bipolar disorders.

3. Mood disorders -Etiology  In industrialized countries major depression is twice as common in female as in male  Bipolar: equally common among male and female  Major depression is 1.5-3 times more common among relatives  4.5-9.3 % of the female (12% of adult women) and half of that of the male population (7 % of adult men) have major depressive disorder  More common among individuals who are younger than 45 years old with the average onset is mid 20s  1.2 percent of the adult population have bipolar disorder

4. Mood disorders - E tiology (continued) 1. Biological theories: Genetics  Genetic link has been suggested through studies, but no definite mode of genetic transmission has been demonstrated.  Twin studies: 50% of monozygotic and 10-25 % in dizygotic twins.  Family studies: 1.5-3 times more among first degree biological relatives.  Adoption studies: increase risk in biological children of affected parents  At least 50% of those with bipolar & depressive illness have a parent with mood disorder

5. Mood disorders - Etiology (continued) 2. Physiological A. functional performance of neuro-hormonal activities  Studies of waking and sleeping cycles suggest that mood disorders involve problems with the limbic system, basal ganglia and hypothalamus  Hypothalamic pituitary adrenocortical axis (see discussion on.  Hypothalamic pituitary thyroid axis.  Speculation that affective disturbance (seasonal affective disorder) is associated with daylight.

6. Mood disorders - Etiology (continued) B. Physiological influences (secondary depression)  Medication side effect: Antihypertensive medications (e.g., propranolol), Cortisone, Antiparkinsonian agents and hormones  Neurological disorders: CVA, brain tumor, Alzheimer  Electrolyte disturbances: ↑ sodium bicarbonate and calcium,  Hormonal disturbances: hypo and hyperthyroidism.  Other diseases associated with mood disorders include diabetes, syphilis, multiple sclerosis, chronic brain syndrome, mononucleosis, anemia, malignancies, colitis, heart failure, RA, and asthma.  Nutritional deficiencies: deficiencies in vitamin B12, B6, niacin,…,

7. Mood disorders - Etiology (continued) 3. Biochemical influences:  The firing & interactions of brain neurons and their transmitters (e.g., norepinephrine & serotonin)  Endocrine disorders & misfiring of neurohormones (e.g., vasopressin, peptides, endorphines)  Biogenic amines (neurotransmitters, such as dopamine)

8. Mood disorders - Etiology (continued) 4. Psychosocial theories  Psychoanalytical theories: intra psychic or internal make up of the mind, dealing with the loss of libidinal or pleasurable internal representation, and an ambivalence love relationship of oneself (symbolic self),  Learning theory: experiencing numerous failures  Object loss theory: postulate that mood disorders result from separation from mother in the first 6 months..  Cognitive theory: depression is the product of negative feelings (destructive)

9. Mood disorders - Etiology (continued) 5. Behavioral theory:  A)- learned helplessness theory: connects depression to a continual failure to control one’s environment, which leads to passivity & helplessness.  B)- Reinforcement theories: depression is related to receiving few positive reinforcement and many negative reinforcement and punishments throughout life.  Other hypothesis postulate that constitutional factors & environmental variables may lead to both symptoms of personality disorders and depressive disorders.

10. Mood disorders - Diagnosis Mood disorders are diagnosed based on the incidence of manic, hypomanic, major depressive, and mixed episodes. DSM IV specify three criteria for diagnosis of mood disorders  Episode  Disorder  Specifiers

11. Mood disorders - Episode Episode is distinct periods and features of mood disturbance, for example:  A depressed mood and loss of interest or pleasure in life activities (anhedonia) for at least two weeks are the main characteristic of depressive episode  An abnormally expansive, or irritable mood for at least 1 week, in conjunction with other criteria, such as inflated self-esteem or grandiosity, etc…. Are characteristics of manic episode  Other episodes include hypomanic episode, mixed episode,

12. Mood disorders - Disorder Depression Dysthymic Mania Hypomania Bipolar

13. Mood disorders - Specifiers Specifiers: are descriptors that help qualify disorder or episode  Melancholic: classic features of depression, which include loss of pleasure in nearly all activities and or lack of pleasure even when something good happens, early morning awakening with a depressed mood that improves during the day, loss of appetite, marked weight loss, excessive guilt, psychomotor retardation, feeling slowed down or agitated with loss of interest and pleasure in those events and experiences that usually bring pleasure  Atypical features: describe depressive episode in which the individuals have mood brightening with positive events and neurovegitative functions that are reversed from melancholic. The S&S include eating and sleeping a lot, feel weighed down, and almost immobile, are extremely sensitive to rejection.

14. Mood disorders - Specifiers Specifiers (continued)  Catatonia: describe features of either extreme motor hypoactivity or extreme inactivity/random-seeming activity  Postpartum onset: describes either manic or depressive episode experienced by a woman within a month of giving birth  Rapid cycling: describes a person who has had at least four episodes within a year  Seasonal pattern: describes those who become ill with regularity at the same time

15. Group Symptoms Vegetative signs : Problems with sleep, appetite, weight, and libido. Cognitive features: Distorted attention, memory, and thinking. Impulse control problems: suicide, and/or homicide Behavioral features: Withdrawal lack of pleasure, fatigability. Somatic features: Headache, stomachache, and muscle tension.