Mood Disorder

MOOD DISORDER

Mood Disorder (Affective Disorder) 

-are pervasive alteration in emotion that are manifested by depression mania or both 

-during mid 1950�s, there was no treatment for mood disorders

Categories Of Mood Disorder

A. Unipolar Disorder 

1.Major Depressive Disorder 

2.Dysthymic Behavior

B.Bipolar Disorder 

1..Bipolar I 

2..Bipolar II

A. UNIPOLAR DISORDER

1. MAJOR DEPRESSIVE DISORDER

2. Dysthymic Disorder is similar however, they are not as severe and do not include delusions, hallucinations, impaired communication and incoherence

Characterized by at least 2 years of depressed mood for more days than not, with some additional less severe symptoms that do not meet the criteria for a major depressive disorder

Diagnostic Criteria:

Typically involve >2 weeks of sad motor or lack of interest in life activities with at least 4 other symptoms of depression resulting to a significant distress or impaired social, occupational function

� Depressed mood everyday with marked feeling of sadness (dysphoria) 

� Markedly diminished interest or pleasure in activities of the day (anhedonia) 

� Significant weight loss or weight gain, or decrease or increase in appetite or eating (hyperphagia) 

� Insomnia or hyperinsomnia 

� Psychomotor agitation or retardation 

� Fatigue or loss of energy (anergia) 

� Feeling of worthlessness or inappropriate guilt 

� Diminished ability to think or concentrate, indecisiveness 

� Recurrent thought of death (suicidal ideation); or specific suicidal plan; or attempt

� to diagnose, the above symptoms must be present everyday for 2 wks which result in significant distress or impaired social, occupational function

Psychotic Depression � Major depression plus hallucination or delusion  

MAJOR DEPRESSION 

- persistent sad or depressed mood, loss of interest in things that were once pleasurable with disturbance in sleep, appetite (and weight), energy and concentration 

- twice more common in females with poorer prognosis in older adults 

Neurobiological Theories 

� With high familial and genetic patterns 

� Dysregulation of norepinephrine and serotonin (biogenic amine hypothesis) 

� Low levels of tryptophan (precursor of serotonin) 

� Neuroendocrine: elevated glucocorticoid activity can lead to increase cortisol secretion which causes depression 

Psychoanalytical Theories 

� Disturbance in interpersonal relations in early childhood 

� came from withdrawal of maternal love and support during the oral phase and later experiences of loss. (Freud); anger turned inward 

� Bibling believes that one�s ego (self) aspires to be ideal, to be loved and to be worthy; not meeting this high standard will result to depression 

� Jacobson theories compare the state of depression to a situation in which the ego is powerless 

� Meyer viewed depression as a reaction to a distressing life 

� Beck saw depression as a resulting from specific cognitive distortion in susceptible people 

Cognitive Behavioral Theories 

� Depression associated with significant loss of important sources of positive reinforcement or high rate of aversive experience 

(reinforcement theory) 

� Learned helplessness 

� Cognitive triad: negative view of self; of the world; and of the future. (Aaron BecK)

Treatment and Prognosis 

1) Psychopharmacology 

Anti-Depressants: 

1. MAOI�S 

Monoamine oxidase inhibitors 

Increase concentration of neurotransmitter

Isocarboxazid (Marplan) 

Tranylcypromine sulfate (Parnate) 

Phenelzine sulfate (Nardil) 

Moclobemide ( Manerix)  

If foods with tyramine are ingested, client can have hypertensive crisis: -headache, sweating, palpitations, stiff neck, intracranial hemorrhage

Postural hypotension

Potentiates alcohol and other medications  

� Avoid foods with tyramine-aged cheese, liver, yogurt, herring, yeast, beer, wine, sour cream, pickled products 

� Avoid alcohol, caffeine, antihistamines, amphetamines 

� Takes 3-4 weeks to work 

� Avoid tricyclics until 3 weeks after Stopping MAO inhibitors 

� Monitor vital signs 

� Sunblock required 

2. TCA (Tricyclic Antidepressants) 

Tricyclics- 

Increase brain amine levels 

(block serotonin and NE at nerve endings and synapses)

Amitriptyline hydrochloride (Elavil) 

Imipramine (Tofranil) 

Desipramine hydrochloride (Pertofrane, Norpramin) 

Clomipramine (Anafrani) 

Nortriptyline (Pamelr) 

Doxepine (Sinequan) 

Amoxapine (Ascendin) 

Trazodone (Desyrel)