MENTAL HEALTH

LESSON 2
 MOOD DISORDERS (DEPRESSION)

• Depression is likely the oldest and still one of the

most frequently diagnosed psychiatric illnesses.

• It is common among healthy people and

considered to be a normal response to everyday
disappointments in life
• These episodes are short-lived as the individual
adapts to the loss, change, or failure (real or
perceived) that has been experienced.
• Pathological depression occurs when adaptation is
ineffective.
 DEFINITIONS
Depression
• An alteration in mood that is expressed by feelings
of sadness, despair, and pessimism. There is a loss
of interest in usual activities, and somatic
symptoms may be evident.
Mood
• Also called affect, mood is a pervasive and
sustained emotion that may have a major
influence on a person’s perception of the world.
Examples of mood include depression, joy, elation,
anger, and anxiety
 DEPRESSIVE DISORDERS TYPES
Major Depressive Disorder
• Major depressive disorder (MDD) is
characterized by depressed mood or loss of
interest or pleasure in usual activities.
• impaired social and occupational functioning
that has existed for at least 2 weeks
• no history of manic behavior, and symptoms
that cannot be attributed to use of substances
or a general medical condition.
• Can be specified as single or recurrent
• degree of severity of symptoms can be termed
as ( Transient, mild, moderate, or severe)
• Symptoms for the degree of is described by
using four criteria,
- physiological.
- behavioral
- cognitive
- affective,
 Transient Depression

Symptoms at this level of the continuum are not

necessarily dysfunctional
• Physiological: Feeling tired and listless
• Affective: Sadness, dejection, feeling
downhearted
• Behavioral: Some crying possible
• Cognitive: Some difficulty getting mind off of
one’s disappointment
 Mild Depression
Symptoms at the mild level of depression are
identified by those associated with normal
grieving.
• Affective: Denial of feelings, anger, anxiety, guilt,
helplessness, hopelessness, sadness, despondency
• Behavioral: Tearfulness, regression, restlessness,
agitation, withdrawal
• Cognitive: Preoccupation with the loss, self-blame,
ambivalence, blaming others
• Physiological: Anorexia or overeating, insomnia or
hypersomnia, headache, backache, chest pain, or
other symptoms
 Moderate Depression

• decreased interest in personal hygiene and

grooming
• Affective: Feelings of sadness, dejection,
helplessness, powerlessness, hopelessness;
gloomy and pessimistic
• Behavioral: Slowed physical movements (i.e.,
psychomotor retardation); slumped posture;
slowed speech; limited verbalizations, possibly
consisting of ruminations about life’s failures or
regrets; social isolation with a focus on the self
increased use of substances possible;
• Physiological: Anorexia or overeating,
insomnia or hypersomnia, sleep disturbances,
amenorrhea, decreased libido,
• Cognitive: Retarded thinking processes;
difficulty concentrating and directing
attention; obsessive and repetitive thoughts,
generally portraying pessimism and
negativism
 Severe Depression

Severe depression is characterized by an intensification of

the symptoms described for moderate depression.
• Physiological: General slowdown of the entire body,
reflected in sluggish digestion, constipation, and urinary
retention; amenorrhea; impotence; diminished libido;
• Affective: Feelings of total despair, hopelessness, and
worthlessness; fl at (unchanging) affect,
• Behavioral: Psychomotor retardation so severe that
physical movement may literally come to a standstill
• Cognitive: Prevalent delusional thinking, with delusions
of persecution and somatic delusions being most
common
 Other forms
Postpartum Depression
• The severity of depression in the postpartum period
varies from a feeling of the “blues,” to moderate
depression, to psychotic depression.
Premenstrual Dysphoric Disorder
• The essential features include markedly depressed
mood, excessive anxiety, mood swings, and decreased
interest in activities during the week prior to menses
and subsiding shortly after the onset of menstruation
• Substance-Induced Mood Disorder (Depression)
• Mood Disorder (Depression) Due to a General
Medical Condition
 ETIOLOGY
• Genetics (adoption, twin studies)
Biochemical Influences
• It has been hypothesized that depressive
illness may be related to a deficiency of the
neurotransmitters norepinepherine,
serotonin, and dopamine at functionally
important receptor sites in the brain.
 Physiological Influences
Nutritional Deficiencies
• Deficiencies in vitamin B1 (thiamine), vitamin B6 (pyridoxine),
vitamin B12, niacin, vitamin C, iron, folic acid, zinc, calcium,
and potassium
Medication Side Effects
Neurological Disorders
• Brain tumors, particularly in the area of the temporal lobe,
Electrolyte Disturbances
• Excessive levels of sodium bicarbonate or calcium can
produce symptoms of depression, as can deficits in
magnesium and sodium.
Hormonal Disturbances
• Depression is associated with dysfunction of the adrenal
cortex and is commonly observed in both Addison’s disease
and Cushing’s syndrome.
 PSYCHOTHERAPY (INDIVIDUAL)
Phase I
• During the first phase, the client is assessed to determine the
extent of the illness. Complete information is then given to the
individual regarding the nature of depression, symptom pattern,
frequency, clinical course, and alternative treatments.
Phase II
• Treatment at this phase focuses on helping the client resolve
complicated grief reactions. This may include resolving the
ambivalence regarding a lost relationship, serving as a temporary
substitute for the lost relationship,
Phase III
• During the final phase of interpersonal psychotherapy, the
therapeutic alliance is terminated. With emphasis on
reassurance, clarification of emotional states, improvement of
interpersonal communication, and assistance with establishing
new relationships.
 Group Therapy

• Support groups help members gain a sense of

perspective on their condition and tangibly
encourage them to link up with others who
have common problems
• The element of peer support provides a feeling
of security as troublesome or embarrassing
issues are discussed and resolved
• Group therapy forms an important dimension
of multimodal treatment for the depressed
client.
Cognitive Therapy
• In cognitive therapy, the individual is taught to
control thought distortions that are
considered to be a factor in the development
and maintenance of mood disorders.
Family Therapy
• The ultimate objectives in working with
families of clients with mood disorders are to
resolve the symptoms and initiate or restore
adaptive family functioning.
 Electroconvulsive Therapy

• the induction of a grand mal (generalized)

seizure through the application of electrical
current to the brain.

• ECT is effective with clients who are acutely

suicidal and in the treatment of severe
depression, particularly in those clients who
are also experiencing psychotic symptoms
 Mechanism of Action

• electric stimulation results in significant

increases in the circulating levels of several
neurotransmitters

• These neurotransmitters include serotonin,

norepinephrine, and dopamine, the same
biogenic amines that are affected by
antidepressant drugs.
 Side Effects

• The most common side effects of ECT are

temporary memory loss and confusion. Critics
of the therapy argue that these changes
represent irreversible brain damage.
 Psychopharmacology

• Antidepressant medications are used in the

treatment
• These drugs ultimately work to increase the
concentration of norepinephrine, serotonin,
and/or dopamine in the body.
• OR by blocking the reuptake SSRIs

• OR when an enzyme, monoamine oxidase is

inhibited at various sites in the nervous
system (MAOIs).
Tricyclics
• Amitriptyline
• Clomipramine (Anafranil)
• Desipramine (Norpramin)
• Imipramine (Tofranil)
Selective Serotonin Reuptake Inhibitors
• Citalopram (Celexa)
• Fluoxetine (Prozac, Sarafem)
Monoamine Oxidase Inhibitors
• Isocarboxazid (Marplan)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
 MOOD DISORDERS (BIPOLAR)

• A bipolar disorder is characterized by mood

swings from profound depression to extreme
euphoria (mania), with intervening periods of
normalcy.
• During a manic episode, the mood is elevated,
expansive, or irritable.
• Motor activity is excessive and frenzied
• Psychotic features may be present
• A somewhat milder degree of this clinical
symptom picture is called hypomania.

• Hypomania is not severe enough to cause

marked impairment in social or occupational
functioning or to require hospitalization, and it
does not include psychotic features.
 TYPES OF BIPOLAR
Bipolar I Disorder
• Bipolar I disorder is the diagnosis given to an
individual who is experiencing, or has experienced,
a full syndrome of manic symptoms. The client may
also have experienced episodes of depression.
Bipolar II Disorder
• The bipolar II disorder diagnostic category is
characterized by recurrent bouts of major
depression with episodic occurrence of hypomania.
• The client has never experienced an episode that
meets the full criteria for mania
• Substance-Induced Bipolar Disorder

• Bipolar Disorder Due to a General Medical

Condition
 ETIOLOGICAL IMPLICATIONS

Genetics
• Twin Studies
• Family Studies
Biochemical Influences
• Early studies have associated symptoms of
depression with a functional deficiency of
norepinephrine and dopamine and mania with
a functional excess of these amines.
• serotonin appears to remain low in both states
Physiological Influences
Neuroanatomical Factors
• Right-sided lesions in the limbic system, temporo
basal areas, basal ganglia, and thalamus have
been shown to induce secondary mania.
• Medication Side Effects
Certain medications used to treat somatic
illnesseshave been known to trigger a manic
response. Steroids, amphetamines, high doses of
narcotics and anticonvulsants
 symptomatology
manic states can be described according to
three stages:
• hypomania, acute mania, and delirious mania.
• Symptoms of mood, cognition and
perception, and activity and behavior are
presented for each stage.
 Hypomania
• disturbance is not sufficiently severe to cause marked impairment
in social or occupational
Mood
• The mood is cheerful and expansive.
Cognition and Perception
• Perceptions of the self are exalted—ideas of great worth and
ability. Thinking is flighty, with a rapid flow of ideas.
Activity and Behavior
• increased motor activity.
• very extroverted and sociable, and they attract numerous
acquaintances. They lack the depth of personality and warmth to
formulate close friendships
• They talk and laugh a great deal, usually very loudly and often
inappropriately
• Increased libido is common. Some individuals experience anorexia
and weight loss.
Acute Mania
Mood
• Acute mania is characterized by euphoria and
elation.
• frequent variation, easily changing to irritability
and anger or even to sadness and crying.
• Hallucinations and delusions (usually paranoid and
grandiose)
Cognition and Perception
• Cognition and perception become fragmented and
often psychotic in acute mania.
• disjointed thinking (flight of ideas
• pressured speech (loquaciousness)
Activity and Behavior
• the use of excessive make-up or jewelry is
common.
• Excessive spending is common
• have the ability to manipulate others to carry
out their wishes
• the need for sleep is diminished.
• Hygiene and grooming may be neglected
• Dress may be disorganized
• Psychomotor activity is excessive. Sexual
interest is increased
Delirious Mania
Activity and Behavior
• Psychomotor activity is frenzied and
characterized by agitated, purposeless
movements.
• Mood
• The mood of the delirious person is very labile.
Cognition and Perception
• Cognition and perception are characterized by a
clouding of consciousness, with accompanying
confusion, disorientation, and sometimes stupor.
 Treatment for bipolar
• Psychopharmacology with Mood-Stabilizing
Agents
• Group Therapy
• Family Therapy
• Cognitive Therapy
• Electroconvulsive Therapy
• Individual Psychotherapy
 Psycho pharmacology
Antimanic
Lithium carbonate
Anticonvulsants
• Carbamazepine (Tegretol)
• Valproic acid (Depakene;
Antipsychotics
• Olanzapine (Zyprexa
• Chlorpromazine (Thorazine)
• Risperidone (Risperdal
 individual Psychotherapy
• Manic clients traditionally have been difficult
candidates for psychotherapy.
• They form a therapeutic relationship easily
because they are eager to please and grateful
for the therapist’s interest.
• However, the relationship often tends to
remain shallow and rigid.
 Group Therapy
• Once an acute phase of the illness is passed,
groups can provide an atmosphere in which
individuals may discuss issues in their lives
that cause, maintain, or arise out of having a
serious affective disorder.
• The element of peer support may provide a
feeling of security as troublesome or
embarrassing issues are discussed and
resolved.
 Group Therapy
• Support groups help members gain a sense of
perspective on their condition and tangibly
encourage them to link up with others who
have common problems.
• Self-help groups offer another avenue of
support for the individual with bipolar
disorder.
 Family Therapy
• The ultimate objectives in working with
families of clients with mood disorders are to
resolve the symptoms
• initiate or restore adaptive family functioning.
• As with group therapy, the most effective
approach appears to be with a combination of
psychotherapeutic and pharmaco therapeutic
treatments.
 Cognitive Therapy
• In cognitive therapy, the individual is taught to control
thought distortions that are considered to be a factor in
the development and maintenance of mood disorders.
• The general goals in cognitive therapy are to obtain
symptom relief as quickly as possible, to assist the
client in identifying dysfunctional patterns of thinking
and behaving, and to guide the client to evidence and
logic that effectively tests the validity of the
dysfunctional thinking.

Electroconvulsive therapy
 ANXIETY DISORDERS
• An emotional response (e.g., apprehension,
tension, uneasiness) to anticipation of danger, the
source of which is largely unknown or
unrecognized. Anxiety may be regarded as
pathological when it interferes with effectiveness
in living, achievement of desired goals or
satisfaction, or reasonable emotional comfort
• Anxiety may be distinguished from fear in that the
former is an emotional process, whereas fear is a
cognitive one. Fear involves the intellectual
appraisal of a threatening stimulus; anxiety
involves the emotional response to that appraisal.
• Anxiety is usually considered a normal
reaction to a realistic danger or threat to
biological integrity or self concept.
• Normal anxiety dissipates when the danger or
threat is no longer present.
• It is difficult to draw a precise line between
normal and abnormal anxiety.
• Anxiety can be considered abnormal or
pathological if:
1. It is out of proportion to the situation that is
creating it.
2. The anxiety interferes with social,
occupational, or other important areas of
functioning.
 Panic attack
• This disorder is characterized by recurrent panic attacks,
the onset of which is unpredictable and manifested by
intense apprehension, fear, or terror, often associated with
feelings of impending doom and accompanied by intense
physical discomfort.
• The symptoms come on unexpectedly; that is, they do not
occur immediately before or on exposure to a situation that
usually causes anxiety
• The attacks usually last minutes, or more rarely,
hours. The individual often experiences varying degrees of
nervousness and apprehension between attacks. Symptoms
of depression are common
 Generalized Anxiety Disorder
• Generalized anxiety disorder is characterized by
chronic, unrealistic, and excessive anxiety and worry.
• The symptoms have existed for 6 months or longer
and cannot be attributed to specific organic factors,
such as caffeine intoxication or hyperthyroidism.
• The symptoms must have occurred more days than
not for at least 6 months and must cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 Post-Traumatic Stress Disorder
• Post-traumatic stress disorder (PTSD) is
described as the development of
characteristic symptoms following exposure to
an extreme traumatic stressor involving a
personal threat to physical integrity or to the
physical integrity of others.
• The symptoms may occur after learning about
unexpected or violent death, serious harm, or
threat of death or injury of a family member
or other close associate
• Characteristic symptoms include re-experiencing the traumatic
event, a sustained high level of anxiety or arousal, or a general
numbing of responsiveness.

• Intrusive recollections or nightmares of the event are common.

Some individuals may be unable to remember certain aspects of
the trauma

• Examples of some experiences that may produce this type of

response include participation in military combat, experiencing
violent personal assault, being kidnapped or taken hostage,
being tortured, being incarcerated as a prisoner of war,
• experiencing natural or man-made disasters, surviving
severe automobile accidents, or being diagnosed with
a life-threatening illness
 Phobias

• Phobia:-Fear cued by the presence or anticipation of a

specific object or situation, exposure to which almost
invariably provokes an immediate anxiety response or
panic attack, even though the subject recognizes that the
fear is excessive or unreasonable.
Specific phobia
• Was formerly called simple phobia. The essential feature of
this disorder is a marked, persistent, and excessive or
unreasonable fear when in the presence of, or when
anticipating an encounter with, a specific object or
situation
Social phobia
• is an excessive fear of situations in which a person might do
something embarrassing or be evaluated negatively by
others.
 Obsessive-Compulsive Disorder

• Obsessive-compulsive disorder is described (OCD)

as recurrent obsessions or compulsions
• that are severe enough to be time consuming or
to cause marked distress or significant impairment
Compulsions
• Unwanted repetitive behavior patterns
Obsessions
• Unwanted, intrusive, persistent ideas, thoughts,
impulses, or images that cause marked anxiety or
distress.
 Individual Psychotherapy
• Most clients experience a marked lessening of
anxiety when given the opportunity to discuss
their difficulties with a concerned and
sympathetic therapist.
 Cognitive therapy
• Cognitive therapy strives to assist the individual to reduce
anxiety responses by altering cognitive distortions.
Anxiety is described as being the result of exaggerated,
automatic thinking.
• Rather than offering suggestions and explanations, the
therapist uses questions to encourage the client to
correct his or her anxiety-producing thoughts.
• The focus is on solving current problems. Together, the
client and therapist work to identify and correct
maladaptive thoughts and behaviors that maintain a
problem and block its solution.
Behavior Therapy
• Two common forms of behavior therapy include
systematic desensitization and implosion therapy
(flooding).
Implosion Therapy (Flooding)
• Implosion therapy, or flooding, is a therapeutic
process in which the client must imagine situations or
participate in real-life situations that he or she finds
extremely frightening for a prolonged period of time.
Systematic Desensitization
• In systematic desensitization, the client is gradually
exposed to the phobic stimulus, either in a real or
imagined situation.
Psychopharmacology
• anxiolytics and minor tranquilizers
Action
• Antianxiety drugs depress subcortical levels of
the central nervous system (CNS), particularly
the limbic system and reticular formation.
• Indications
• Antianxiety agents are used in the treatment
of anxiety disorders, anxiety symptoms, acute
alcohol withdrawal,
Antihistamines
• Hydroxyzine (Vistaril)
Benzodiazepines
• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)