c
- is defined as the persons state of mind exhibits through feelings and emotions

4 Categories

1. epressive isorders
2. Bipolar isorder
3. Mood disorder resulting from a general medical condition
4. Substance induced mood disorders


 


epression is the oldest and the most frequently described psychiatric illness.

Categories:

1. Major epressive isorder

2. ysthymic isorder
3. epressive disorder not otherwise specified

Major epressive isorder ʹ is a mood disorder characterized by symptoms that persists over a minimal
of 2 weeks.

- A person must have 5 of the 9 criteria

1. epressed Mood
2. Anhedonia (or Apathy)
3. Significant change in weight
4. Insomnia/hypersomnia
5. Increased/ecreased psychomotor activity
6. Fatigue/Energy Loss
7. Feelings of worthlessness or guilt
8. iminished concentration or indecisiveness
9. Recurrent death or suicidal thoughts

Specifiers

1. Atypical epression
2. Melancholic epression
3. Catatonic features
4. Postpartum epression
5. Psychotic epression
6. Seasonal Affective isorder (SA)

ATYPICAL EPRESSION

- Appear in younger population: women

 - Increased appetite, weight gain, hypersomnia, Leaden paralysis, extreme sensitivity to
interpersonal rejection
- MAOI first choice drugs

MELANCHOLIC EPRESSION

- Older adults
- Anhedonia, inability to cheer up

At least 3 of the depressive symptoms are found:

1. epression worse in AM, early AM awakening

2. Psychomotor retardation / Agitation
3. Anorexia
4. Wt. loss
5. Excessive inappropriate guilt
- Association with examethasone nonsuppression and increase cortisol
- Catatonic features
- Characterized by psychomotor alterations, including immobility, excessive motor activity,
mutism, echolalia, inappropriate posturing.

POSTPARTUM EPRESSION

- uring the first 30 days post partum

- 10% - 15%
- More severe than postpartum blues (50% - 80%)
- Anxious, irritable, tearful.

PSYCHOTIC EPRESSION

- Has delusions and hallucinations

- Antidepressants, antipsychotics

SEASONAL AFFECTIVE ISORER (SA)

- Association with seasonal change

- Women; most commonly affected
- The higher the latitude, the more likely SA will occur.

YSTHYMIC ISORER

- Is diagnosed when a person has a depressed mood for at least 2 years

Criteria:

A. epressed Mood for most of the day

B. Presence of 2 or more of the ff:
 1. Poor appetite/ overeating
2. Insomnia/hypersomnia
3. Fatigue/low energy
4. Low self esteem
5. Poor concentration / difficulty making decision
6. Feelings of hopelessness

OCCURRENCE IN SPECIFIC POPULATIONS

Adults

- Women 10% to 20%

- Men 5% to 10%
- Age of onset ʹ mid to late 20s

Children and adolescents

- Events that predispose children and adolescents to develop Major epressive isorder:
1. Loss of Parents ( ivorce, separation, death)
2. eath of other individual close to the child
3. eath of a pet
4. Move to another neighborhood / town
5. Academic problems / failure
6. Physical illness or Injury

Culture, Age and Gender

- Hispanic, Latino, Mediterranean groups

- Asian
- Native American & Asian American

Facts about bipolar disorder

1. onset is early 20s for both men and women

2. woman might have a higher rate of bipolar2 over 1.2% of the adult population suffers from
bipolar 1
3. over 2.6 % of the adult population suffers from all bipolar
4. about 15% of bipolar patient will die at their own hands
5. about 90% experience future episode
6. Untreated, a person might experience 10 or more episodes
7. It runs in families.
8. 50% experience chronic interpersonal / occupational difficulties
SYMPTOMS
Manic Episode

Elevated mood
Grandiosity
Irritability
Anger
Insomnia
Anorexia
Flamboyant gestures
Flight of ideas
istractibility, Hyperactivity
Loud, rapid speech, talkative
High energy
Increased interest in sex
High rate of suicide
Excessive make up
Labile elusion, Hallucination
epressed Mood
Low self esteem

 


Withdrawal
Passivity
Insomnia, daytime sleepiness
Anorexia, sluggish thinking
ifficulty concentrating
istractibility, inertia
iminished interest
ecrease in speech
Fatigue
ecrease interest in sex
High rate of suicide
Memory loss
Abnormal thoughts about death
Weight loss

c   

  

      
Gender Affected Equal Equal
Mean age of onset 20s 20s
Genetic Factors yes Yes
1 parent 25% 15%
BOTH 50% 35%
Identical Twins 40 ʹ 70% 50%
Course Chronic Chronic
Suicide 15% 10%
Cigarette Smoking Inc Inc
Substance abuse Inc Inc
Ventricular enlargement Yes Yes
Hypocampal volume Reduced Reduced
Very Sensitive to stress Yes Yes

 
 

À
 
 ʹ is the most significant of these disorders. The patient experiences swings between
manic episodes & major depression.
À
 
 ʹ similar to Bipolar I but the patient has never experienced a manic episode but only a
hypermanic
- Can also experienced a major depression
- Higher incidence among women
Cyclothymic isorder - is a swing between a hypomanic & depressive symptoms.
- Affects men & women
c

- Characterized by an elevated, expansive, or irritable mood.
- To meet the criteria, the 
   
  
- Manic episodes begin suddenly, escalate rapidly, and last for a few days to several months
- Judgment is impaired, social blunders occur, and involvement with alcohol & drugs is common
- Onset is usually in the early 20s
c
 
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Anoxia Hypercalcemia Hydrocephalus
Hyperthyroidism AIS
Hemodialysis Stroke
Lyme disease Brain Tumor

!" !c
Antidepressants Anticholinergics
Steroids Stimulants
# $

- is similar to manic episodes but denotes a less severe level of impairment
- for a hypermanic episode to be diagnosed, the length of episode must be at least 4 days in
duration
- Characterized by an abnormal period of persistent, elevated, expansive or irritable mood.
1. Increase self esteem or Grandiosity
2. ecrease need for sleep
 3. Subjective sense that thoughts are racing
4. istractability
5. Increase in goal-directed activity or motor agitation
6. Excessive involvement in pleasurable activities



- Symptoms are atypical (hypersomnia, hyperphagia, weight gain, absolute craving for CHO)
- evelop at younger age ( Paranoid, Irritable, Hallucination)
c!c"$
1. Safety
2. Consistent among staff
3. Reduction of environmental stimuli
4. ealing with Patients who are escalating
5. Reinforcement of hygiene & dress
6. Nutrition & sleep
´ Provide finger food, high CHON. High calorie
´ Weigh patient regularly
´ Provide a quiet place
´ Structure patients days so that there are fewer stimulating activities toward
bedtime
´ To not allow caffeinated drinks before bedtime
´ Assess the amount of rest that patients are receiving
B ʹ e firm & consistent
I ʹ ncrease calorie, CHON (Finger Food)
P ʹ rovide frequent rest periods
O ʹ ne on one interaction
L ʹ ithium 0.6-1.2 meq/L ʹ 900-1200 mg/day
A ʹ nticonvulsant drugs
R- educe environmental stimuli
S- afety, set limits, sublimation

  "#%
1. Genetic ʹ if one parent has bipolar disorder, 25% chance of transmission to child
2. Psychoanalytic ʹ Mania is a defense against an underlying depression
3. Biologic- Mania ʹincrease norephinephrine

Anxiety disorders
Generalized Anxiety isorder (GA)
- ͞free floating anxiety͟
- Problem with AL
- 6 mos
- Women and adolescence
-
Primary Symptoms
- Agitations
- iaphoresis
- Insomnia Irritability
- Nervousness
- Shortness of breath
- Tachycardia, tension
TNPR:
1. Reduce the level of anxiety
2. evelop / Teach coping strategies
3. evelop Trust and Rapport
4. Provide Safety, calm environment
Milleu:
SSRI (OC), TCA, Benzodiazepine

Phobic isorder
Tyoes:
Agoraphobia
Social Phobia
Simple / Specific P.
ù Natural ʹenvironmental
ù Blood Injection
ù Situational
ù Animal
Milieu:
- Systemic esensitization
- Exposure Therapy
- Flooding/Implosive
- CBT
OC: SSRI
3 For agora / social p.
Social Skills Training

Panic isorder
' ͞Panikos͟ (fear)
' Is a chronic condition characterized by appearance of panic attack.
Panic Attack ʹ sudden Period of intense fear and discomfort characterized by physical and cognitive
sysmptoms
' No precipitating factor
' 15 ʹ 30 mins; peak: 10 mins
' Late adolescence
Primary Symptoms:
yspnea, izziness, iaphoresis
Hyperventilation
Tachycardia
Uncontrollable fear

TNPR:

1. Teach relaxation techniques

2. 5s ʹ safety, stay, short, and simple sentences, suicide assessment
PHARMA: SSRI, TCA, MAOI, Benzodiazapines
Milieu: istraction, (+) Self Talk

OBSESSIVE COMPULSIVE ISORER (OC)

' Obsession ʹ are recurrent & persistent thoughts, ideas, impulses or images that are experience
as intrusive & senseless
' Compulsion ʹ repetitive behaviors that are performed in response to obsession
2 Forms: washer͛s
Checker͛s
Others: Counting, praying, touching, rubbing, ordering
TNPR:
1. Ensure that physiologic needs are met
2. Provide patient time to perform rituals
3. Structure simple activities
PHARMA: SSRI & TCA ʹ OC, ECT
Milieu:
- CBT (Cognitive Behavioral Theraphy)
- Relaxation Techniques
- Thought Sleeping
- Exposure Theraphy
Acute Stress isorder/post
Traumatic Stress isorder
AS: ONSET: 4 weeks after the event
URATION: 2 days ʹ 2 wks
PTS: Onset: 6 mos after the event
uration: 1 ʹ 3 mos or more
' Violence
' isaster
' Sexual Abuse
' War
' Illness
' Torture
' Child Abuse
PHARMA: SSRI, TCA, Benzodiazepine

AJUSTMENT ISORER
' ivorce
' isability
' Financial Problems
' Child bearing
' Moving
' Retirement
' Marriage
' w/in 3 mos to 6 mos

RELATE ISORERS
1. Anxiety isorder due to a general medical condition
2. Substance-induced anxiety disorder
3. Separation anxiety disorder