Unipolar or Bipolar

Mood Disorders
Major Depressive Disorders
Bipolar Disorders
Dysthymic Disorder
Cyclothymic Disorder

Current Research NIMH Report

(July 2003)

Stress-sensitive version of serotonin

transporter gene
Noted as short version

Confers vulnerability to stresses (job loss, relationship

breaks, deaths of loved ones, prolonged illness)

at high risk for depression

43% versus 17% w different version of gene

Individuals abused as children also high risk

Found by study of stress histories
Not yet ready for diagnostic testing
Needs confirmation
May predispose

Necessary Clinical Information

History of:
financial
difficulties/failed
businesses
increased sexual activity
& sexual indiscretions
previous depression,
hypomania, or mania
rapid switches in mood
substance abuse
medical illness

Current mood
Guilty feelings, quality of
self-esteem
Current hallucinations or
delusions
Current & previous
suicide ideation/attempts
Change in energy level or
fatigue
Change in pattern of
sleep

Mood Disorders
Share a disturbance of mood
Mania/depression
not due to another physical or mental disorder

Mood may/may not affect social or

occupational functioning (clinical significance)
Prolonged emotion generally affects entire life
Distinguished by

intensity of abnormal mood

duration
impairment produced
behavioral, cognitive or physical symptoms

Major or Unipolar Depression

Profound sadness &
related problems, such
as sleep & appetite
disturbance, loss of
energy & self-esteem
issues
Meds Luvox, Prozac,
Zoloft, Paxil, others

Major Depressive Episode

Major depressive episode
core syndrome of severe depression

Some specific diagnoses

distinguished by # of major depressive
episodes
& presence/absence of manic or hypomanic
episodes

Child may present different symptoms

Mixed Episodes criteria from both
manic & depressive

Manic Episode
Mania must result
in marked dysfunction for Bipolar I

Unusually & persistently elevated,

expansive, & irritable mood
Individual usually unaware of problem
No clue that they make no sense
Appears to come on suddenly
Frequently resistant to treatment

Bipolar Disorders
Episodes of either mania alone or of both
mania & depression
Mania episode involved

Mania indicates:

Mood elevated or irritable

Extreme activity, talkativeness
Distractible
Frequently resists treatment

Meds Lithium, Zoloft, Wellbutrin, Prozac,

Depakote

Symptoms:
Major Depressive Disorder
Depressed mood; no
mania
Loss of pleasure in
activities
Weight loss or gain
Change inapposite
Change in sleep
pattern
Agitation
Loss of energy

Sense of
worthlessness
Difficulty
concentrating
High mortality
rate
Thoughts of death
Suicidal ideation

Chronic Mood Disorders

Cyclothymia
frequent periods of
depressed &
hypomania for at
least 2 years

Hypomania
episodes
disturbances of
mania not severe
enough to cause
major impairment

Dysthymia
chronic depression
Persistent
depression for 2
years or more
May or may not
significantly impair
activities
Determine whether
opposite behavior
ever present

Specifiers
Use specifiers with all mood disorders to
describe most recent episode
Code specifiers in 5th digit
If psychotic features specify whether
mood congruent or mood-incongruent
Use with course of recurrent episodes
also
Rapid cycling
Seasonal cycling etc

Ask yourself these questions

Is clients mood abnormal?
Could clients symptoms be produced by
drugs or a nonpsychiatric medical illness?
Does client have symptoms of psychosis?
Do these symptoms occur only in
presence of mood symptoms?
Has client ever had a manic, hypomanic,
or mixed episode?
Is the clients current mood depressed?

Depression in Children &

Adolescents
Increased risk for
illness, interpersonal
& psychosocial
difficulties
May persist long after
episode passes

Increased risk
for substance
for suicidal behavior

Often unrecognized

Symptoms often seen

as
normal mood swings
typical of development

Health care workers

reluctant
to prematurely label

Early diagnosis &

treatment
Critical to healthy
emotional, social, &
behavioral development
Can reduce duration &
severity

Scope of Problem with Youth

2.5 % of children
NIMH study of 9-17 yr
olds
8.3% of adolescents
Estimate prevalence
(other study 7-14% total)
6% in 6-mo period
Onset earlier today
With 4.9 major depression
Recovery rate
Often co-occurs
Single episode of MDD is high
Dysthymia

commonly anxiety, disruptive

behavior, or substance abuse

may lead to MDD

Symptoms expressed
MDD - likely family history
differently
acting out or irritable
Childhood Risk
Boys & girls equal risk

Adolescence Risk
Girls twice as likely

toward others
Talking with parents
important

Medications controversial

Signs Associated with children &

adolescents
Frequent, vague nonspecific complaints
School
Frequent absences
Poor performance

Talk of or efforts to
runaway
Outbursts of shouting,
unexplained
irritability,
complaining, or crying
Being bored

Alcohol or substance
abuse
Social isolation, poor
communication
Fear of death
Extreme sensitivity
to rejection or failure

Increased irritability,
anger, or hostility
Reckless behavior
Difficulty with relationships
Lack of interest in playing
with friends