Mood Disorders

Mood: Relatively long lasting, sustained emotional state Affective states: Brief emotional feelings (e.g euphoria, joy, surprise, fear, sadness, etc.) When emotional states become predominant and uncontrollable, individuals may be diagnosed with a mood disorder

Unipolar (major or clinical) depression Bipolar disorder (manic-depressive)

Unknown

The causative factors can be divided into: Genetic predisposition: - Environmental influences - Neuroanatomic and functional abnormalities - Neurochemical dysregulation - Endocrine factors - Neuroendocrine dysregulation

A state of intense sadness and despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living

Most common mood disorder 25-44 Y.O at high risk 10-25% of women 5-12% of men Suicide rate ~ 15%

Sadness, or "empty" feelings Loss of interest or pleasure in activities once enjoyed Decreased energy (fatigue), or increased energy (agitation) Insomnia or oversleeping Decreased appetite, or increase appetite Unintentional weight loss or weight gain Difficulty concentrating or remembering Feelings of hopelessness and pessimism Feelings of helplessness, guilt, and worthlessness Thoughts of death or suicide, or suicide attempts

American Psychiatric Association's 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) World Health Organization's International statistical Classification of Diseases and related health problems (ICD-10)

Depression is related to deficiency in the amount of 5-HT, NE, and DA in the cortex and limbic system Amine levels increase immediately with antidepressant use, but maximum beneficial effects are not seen for many weeks Monoamaine function is important but not exclusive factor in the pathophysiology of depression

Serotonin (5-HT) neurons project extensively to all regions of the cortex, basal ganglia, limbic system, hypothalamus, cerebellum and brain stem The serotonin neuron cell bodies are located in dorsal and median raphe nuclei in the brainstem

Depression is related to deficiency in Brain-Derived Neurotrophic Factor (BDNF) which is important for neuronal survival and growth

Depression is related to hormonal abnormalities - HPA dysregulation- increase in cortisol level - HPT dysregulation-hyper/hypothyroidism - Estrogen/testosterone deficiency

Monoamaine, neuroendorine, and neurotrophic systems are interrelated in important ways. The chronic activation of monoamine receptors increase BDNF transcription Activation of monoamine receptors appears to down-regulates HPA axis

Can be triggered by/associated with medical, neurologic disorders or drug therapy Diabetes, Addison's disease MI, CHF Cancer Stroke, Parkinson's disease, Alzheimer's disease, MS Antihypertensives, interferon α-2b

Bipolar disorders are characterized by episodes of mania or mania and depression, which usually alternate

~ 1-3% of the adult population has either bipolar I or II disorder Bipolar I disorder occurs equally in males and females Bipolar II is more common in females

DSM-IV criteria Requires that the episode of abnormal mood lasts at least 1 week

1 week period of continuously elevated or irritable mood. In addition, patient should experience at least 3 of the following symptoms

Elevated self-esteem or grandiose ideation Reduced need for sleep Pressured speech Racing thoughts or flight of ideas Easily distracted Agitation Excessive involvement in high risk activities

Similar symptoms to that of mania, however symptoms are not as severe. Hypomania is diagnosed as an elevated mood present for at least 4 days with at least 3 of the symptoms described for mania. The symptoms should not interfere with social or occupational functioning and should not cause hospitalization.

When the criteria for both mania and major depressive disorder episodes are met every day for nearly 1 weak. Affect social and occupational functioning.

at least 1 week of episode of abnormal mood

One manic or mixed episode + one major depressive episode

One hypomania + one major depressive episode. No mania or mixed episode

2 year history of multiple episodes of hypomania and depressive symptoms. Never met full criteria for major depressive disorder, or mania.

Patients experience at least 4 depressive, manic, hypomanic, or mixed episodes within 12 month period

Bipolar I disorder Rapid cycling Bipolar II disorder Cyclothymic disorder

Genetic factors: A positive family history is present in 80%-90% of patients with bipolar disorder

A manic episode is believed to result from elevation in NE, DA A depression episode is believed to result from a decrease in NE, DA 5-HT pathways in the brain plays a critical role in the stabilization of catecholamines A deficiency in GABA (an inhibitory neurotransmitter) may lead to mania caused by unopposed excitatory neurotransmitters, such as NE, DA.

Normal feelings expressed in threatening or harmful situations Both are alerting signals that warn us of impeding danger Fear is a response to a known, external, definite threat Anxiety is a response to a threat that is unknown, internal and vague

a diffuse sense of apprehension, often accompanied by autonomic symptoms (headache, sweating, increased heart rate, palpitations, and mild stomach discomfort)

When fear and anxiety become too intense and undermine the ability to function on daily basis, the individual may develop an anxiety disorder A patient with an anxiety disorder often exhibits symptoms of clinical depression and vice-versa

The most common psychiatric disorder 1 in 4 people meet the diagnostic criteria for at least one anxiety disorder Lifetime prevalence: women 30.5%; men 17.7%

Poorly understood Functional changes in brain activity

Neurotransmitters associated with anxiety are 5-HT, NE and GABA NE system: Abnormal firing of locus coeruleus neurons may contribute to onset of panic attacks 5-HT system: 5-HT1A receptors play a role in anxiety disorder GABA receptors: some patients with anxiety disorder have reduction/abnormal functioning of their GABA receptors

Panic disorder Generalized anxiety disorder Posttraumatic stress disorder Obsessive-compulsive disorder

Consists of multiple, disabling panic attack Brief attacks (usually ~10 min) of extreme anxiety, intense terror and apprehension Between panic attacks the individual spends an excessive amount of time worrying about future panic attacks Panic disorder is often accompanied by agoraphobia (caused by the fear of having a panic attack in a public place from which there is no easy means of escape; sufferers of agoraphobia may avoid public and/or unfamiliar places)

Racing or pounding heartbeat (palpitations) Chest pains Stomach upset Dizziness, lightheadedness, nausea Difficulty breathing, a sense of feeling smothered Tingling or numbness in the hands Hot flashes or chills Dreamlike sensations or perceptual distortions Terror: a sense that something unimaginably horrible is about to occur and one is powerless to prevent it A need to escape Fear of losing control and doing something embarrassing and fear of dying.

Women are 2-3 times more likely to be affected than men Comorbidity: 90% of patients with panic disorder have at least one more psychiatric disorder Most commonly major depressive disorder, other anxiety disorders, personality disorders and substance abuse

DSM-IV lists a set of diagnostic criteria

Long-lasting anxiety that is not focused on any particular object or situation Characterized by excessive, persistent, uncontrollable and often irrational worry about everyday things Unable to articulate the specific fear

Because of persistent muscle tension and autonomic fear reactions, they may develop fatigue, irritability, headaches, muscle aches, heart palpitations, dizziness, and insomnia These symptoms must be consistent and on-going, persisting at least 6 months for GAD to be established

Approximately 6.8 million American adults experience GAD, affecting about twice as many women as men

DSM-IV diagnostic criteria help differentiate between GAD, normal anxiety and other mental disorders

A set of typical symptoms that develops after an exposure to a terrifying or life-threatening trauma that involves intense fear, threat of death or helplessness

Lifetime prevalence is 1-3%

The individual re-experiences the traumatic event as intrusive recollections or flashbacks during the day and during persistent nightmares, resulting in insomnia, irritability and avoidance of stimuli that can trigger flashbacks Associated symptoms can include aggression, violence, poor impulse control and substance abuse Cognitive testing may reveal impairments of memory and attention DSM-IV diagnostic criteria

Primarily characterized by obsessions and/or compulsions Obsessions : Are distressing, repetitive, intrusive thoughts Compulsions : are repetitive behaviors that the person feels forced or compelled into doing, in order to relieve anxiety

People with OCD recognize that their reactions are irrational and disproportionate OCD can be disabling; obsessions are often time consuming and interfere with people's normal routine and work

Lifetime prevalence: 2-3% DSM-IV diagnostic criteria