Mood Disorders 

Epidemiology

Most Common mood disorders: Depression and Bipolar

 Lifetime prevalence - 2-25%
 Yearly rate
 Gender differences
 Ethnic differences

 PostPartum Depression
See Dr. Baker's article in Physician Assistant Journal.

 

Etiology

Biological – dysregulation of the biogenic amines; norepenephrine and sertonin most likely involved neurtransmitters.

Genetic – Strongly indicats that s significant genetic factor or involved.

Psychosocial

 

Symptoms of Depression

 Persistent sad, anxious, or "empty" mood
 Feelings of hopelessness, pessimism
 Feelings of guilt, worthlessness, helplessness
 Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
 Insomnia, early-morning awakening, or oversleeping
 Appetite and/or weight loss or overeating and weight gain
 Decreased energy, fatigue, being "slowed down"
 Thoughts of death or suicide; suicide attempts
 Restlessness, irritability
 Difficulty concentrating, remembering, making decisions
 Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

 

Treatment

 Psychotherapy
 Medication

Bipolar Disorder

Bipolar disorder involves cycles of depression and mania.
Bipolar II is characterized by the presence of major depressive episodes alternating with episodes of hypomania.  It does not meet full criteria for Major Depression in Bipolar I.

 

Symptoms of Mania

 Inflated sense of self-esteem
 Inappropriate elation
 Inappropriate irritability
 Severe insomnia
 Grandiose notions
 Increased talking
 Disconnected and racing thoughts
 Increased sexual desire
 Markedly increased energy
 Poor judgment
 Inappropriate social behavior

Dysthymia & Cyclothymia

At least 2 years in duration, occurs more often than not.

 

Anxiety Disorders

bulletAnxiety is normal

 Most Common form of anxiety:  Specific Phobias

Symptoms of Anxiety

 Diarrhea
 Dizziness, light-headedness
 Hypertension
 Palpitations
 Restlessness
 Tachycardia
 Tingling in the extremities
 Tremors
 Upset Stomach
 Urinary frequency

 
bulletWhether an event is stressful or not depends on 4 things:

 

Epidemiology

bulletLifetime prevalence is 30.5% for women and 19.2% for men.

 

Etiology

 Behavioral Theory of Anxiety
bulletClassical Conditioning
bulletSocial Learning
bulletBiology
bulletAutonomic nervous system
bulletNeurotransmitters
bulletGenetics

 

DSM-IV Anxiety Disorders

  1. Anxiety Disorder Due to a General Medical Condition
  2. Substance Induced Anxiety Disorder
  3. Anxiety Disorder NOS
 Mixed Anxiety-Depressive Disorder
  1. Panic Disorder and Agoraphobia

 

DSM-IV Criteria for Panic Attack

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Dizzy, unsteady, lightheaded or faint
  9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias (numbness of tingling sensations)
  13. Chills or hot flashes

Panic Disorder

  1. Recurrent unexpected panic attacks
  2. At least one of the attacks has been followed by at least 1 month of :
  1. Persistent concern about having another attack
  2. Worry about the implications of the attack (e.g., having a heart attack, loosing control, or am crazy)
  3. A significant change in behavior related to the attacks

Separated into With and Without Agoraphobia

Agoraphobia – anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the even a panic attack is experienced

Specific Phobia

Social Phobia

Obsessive-Compulsive Disorder
 Common obsessions and compulsions include:
bulletContamination
bulletPathological doubt
bulletIntrusive thoughts
bulletSymmetry
bulletOther

 

Posttraumatic Stress Disorder
bulletSymptoms are categorized into four categories: intrusive symptoms, avoidant symptoms, symptoms of hyperarousal, and associated features.

  1. Intrusive Symptoms
  2. Symptoms of Avoidance
  3. Symptoms of Hyperarousal
  4. Associated Features
  5. Discuss WTC Disaster & Anniversary Effect (9/11/2001)

 

Somatoform Disorders

Clinical features of somatoform disorders

 

 

Chronic Fatigue Syndrome

bulletChronic disorder of unknown cause characterized by fatigue, pain and cognitive disorders.
bulletNo evidence to date can prove a definite cause for CFS.
bulletSome doubt its existence.

 

Factitious Disorders

bulletDeliberate production or feigning of physical or psychological symptoms.
bulletMotivation is to assume the sick role.
bulletExternal incentives for the behavior.

 

 

Dissociative Disorders

bulletDisorder of the 1980’s.

 

Dissociative Identity Disorder (MPD)
 The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
 At least two of these identities or personality states recurrently take control of the person's behavior.
 Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.