#14080 - Mood Disorders - Psychology

Mood disorders

Depression / unipolar- most burdosome neuropsychiatric disorder

The two most commonly used criteria for diagnosis are the

• -DSM-5 – American psychiatric association diagnostic and statistical manual

• -ICD-10 : World Helath organisation’s international classification of diseases version 10

Major depressive disorder is characterised by a history of one or more major depressive episodes and no history of mania

• Primary feature: low mood, reduced energy, reduced enjoyment (3 cardinal symptoms)

• Secondary features: physical/ psychological/social

• Must have 5 or more symptoms persisting for at least 2 consecutive weeks

• Impairment in functioning

• Exclusions: not due to substance misuse (alcohol/drugs) or physical disorder (brain tumour, hypothyroidism) or other disorder that should feature in differential diagnosis

-Low mood + psychological symptoms

• Hopelessness, helplessness – future

• Low self esteem- present

• Guilt of past

• Reduced motivation

• Reduced interest

• Reduced enjoyment- anhedonia

• Diurnal variation in mood-in the morning it is the worst

• Early morning wakening = terminal insomnia

• Mood congruent delusions + hallucinations

• Recurrent thoughts of death or suicidal ideation, or a suicide attempt

• Decreased ability to concentrate, think, or make decisions, nearly every day

-Low mood and physical symptoms

• Reduced appetite

• Reduced weight

• Constipation

• Reduced libido

• Reduced energy

• Amenorrhoea

• Psychomotor retardation or agitation nearly every day that is observable by others

• Fatigue or low energy, nearly every day

-Low mood and social symptoms

• Social withdrawal

• Absence from work

• Reduced performance at work

• Reduced interest in hobbies or other interests

-In addition symptoms cause significant distress or psychosocial impairment

Prevalence

• 10-20% lifetime prevalence

• Major cause of mortality >40% of suicides have a depressive disorder

Aetiology

• Due to emotional weakness -71%

• Caused by bad parenting – 65%

• Result of sinful behaviour -35%

• Involves the brain- 10%

Risk factors

• Genetic

• Gender- female x2 more likely

• Childhood disadvantage

• Life events- especially loss

• Life difficulties

• Neurotic temperament

• Dysfunctional attitudes

• Chronic or severe illness

• Substance misuse

• Previous history of depression

Pathophysiology of depression

• Genetic

• Neurochemical

• Cortisol hypersecretion

• Abnormalities in neural circuitry involved in experience and mood

• Abnormal cognitions (negative emotional bias)

Treatment

• Cognitive therapy

  • Give a card with list of instructions- this is targeted at patient’s belief of treatment and illness and increases compliance and decreases helplessness. The card gives an impression of caring. RCT showing that giving a card makes more people take the drug

  • Suggest a book to read- recommend a chapter to read and come back and talk about it- encourages the participant to engage

• Cognitive behavioural therapy

  • Focused on heare, now

  • Scientific empiricism- patient goes and tests it out and patient learns through trying different behavioural experiments

  • Activity diary

    • Plan activities that are enjoyable/ satisfying

  • Identify and challenge negative automatic thoughts

    • Use a dysfunctional thogt record to indentify negative automatic thoughts and their triggers and challenge them systematically

• Problems with CBT

  • Lengthy treatment

  • Lack of therapists

  • Long waiting lists

• Overcome problems- stepped care

  • Level 3: individual CBT

  • Level 2: Group CBT/ assisted self help CBT

  • Level 1: self help by book/ computerised

Manic episode

Diagnosis

• Primary feature: elated/ irritable mood

• Secondary feature

  • Inflated self esteem

  • Reduced need for sleep

  • More talkative

  • Flight of ideas/ subjective racing thoughts

  • Subjective racing thoughts

  • Distractability

  • Increased goal directed activity

  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

    • Unrestrained bying

    • Sexual indiscretions

    • Foolish investments

• Duration: > 1 week

• Exclusions: not due to substance misuse/ physical disorder or schizophrenia

Bipolar disorder

• Bipolar 1: mania and depression- at least one manic episode

• Bipolar 2: no manic episodes but at least one episode of depression

The main burden of the illness is depression; substance misuse is a common morbidity

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