Chapter 2 Mood Disorders
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First Episode Psychosis an Information Guide Revised Edition
First episode psychosis An information guide revised edition Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) i First episode psychosis An information guide Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) A Pan American Health Organization / World Health Organization Collaborating Centre ii Library and Archives Canada Cataloguing in Publication Bromley, Sarah, 1969-, author First episode psychosis : an information guide : a guide for people with psychosis and their families / Sarah Bromley, OT Reg (Ont), Monica Choi, MD, Sabiha Faruqui, MSc (OT). -- Revised edition. Revised edition of: First episode psychosis / Donna Czuchta, Kathryn Ryan. 1999. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-1-77052-595-5 (PRINT).--ISBN 978-1-77052-596-2 (PDF).-- ISBN 978-1-77052-597-9 (HTML).--ISBN 978-1-77052-598-6 (ePUB).-- ISBN 978-1-77114-224-3 (Kindle) 1. Psychoses--Popular works. I. Choi, Monica Arrina, 1978-, author II. Faruqui, Sabiha, 1983-, author III. Centre for Addiction and Mental Health, issuing body IV. Title. RC512.B76 2015 616.89 C2015-901241-4 C2015-901242-2 Printed in Canada Copyright © 1999, 2007, 2015 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. This publication may be available in other formats. For information about alterna- tive formats or other CAMH publications, or to place an order, please contact Sales and Distribution: Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.ca Website: www.camh.ca Disponible en français sous le titre : Le premier épisode psychotique : Guide pour les personnes atteintes de psychose et leur famille This guide was produced by CAMH Publications. -
Is Your Depressed Patient Bipolar?
J Am Board Fam Pract: first published as 10.3122/jabfm.18.4.271 on 29 June 2005. Downloaded from EVIDENCE-BASED CLINICAL MEDICINE Is Your Depressed Patient Bipolar? Neil S. Kaye, MD, DFAPA Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essen- tial, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treat- ment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdi- agnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive fea- tures and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifi- cally on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physi- cian can easily perform this assessment. Tools to assist the physician in daily practice with the evalua- tion and recognition of bipolar disorders and bipolar depression are presented and discussed. (J Am Board Fam Pract 2005;18:271–81.) Studies have demonstrated that a large proportion orders than in major depression, and the psychiat- of patients in primary care settings have both med- ric treatments of the 2 disorders are distinctly dif- ical and psychiatric diagnoses and require dual ferent.3–5 Whereas antidepressants are the treatment.1 It is thus the responsibility of the pri- treatment of choice for major depression, current mary care physician, in many instances, to correctly guidelines recommend that antidepressants not be diagnose mental illnesses and to treat or make ap- used in the absence of mood stabilizers in patients propriate referrals. -
Neuroticism, BIS, and Reactivity to Discrete Negative Mood Inductions ⇑ Jennifer Thake, John M
Personality and Individual Differences 54 (2013) 208–213 Contents lists available at SciVerse ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid Neuroticism, BIS, and reactivity to discrete negative mood inductions ⇑ Jennifer Thake, John M. Zelenski Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, Canada K1S 5B6 article info abstract Article history: Research has established relationships between the personality dimensions of neuroticism and BIS and Received 5 March 2012 broad negative emotional reactivity. However, few researchers have examined the relationships among Received in revised form 4 August 2012 neuroticism, BIS, and discrete negative emotional reactivities. The present study examined whether indi- Accepted 27 August 2012 viduals scoring high on neuroticism and BIS were more reactive across four discrete negative mood Available online 25 September 2012 inductions, relative to those scoring low on these traits. Participants (n = 166) completed personality questionnaires, measures of current mood, viewed a specific mood-inducing film clip (sadness, anger, Keywords: fear or disgust) and then reported their moods a second time. Results revealed that neuroticism/BIS Neuroticism was associated with high reactivity to the fear and sadness inductions. Neuroticism/BIS did not predict Behavioral inhibition system Mood anger or disgust reactivity, but neuroticism/BIS and extraversion/BAS interacted in predicting anger. Emotion Although further research is -
Specificity of Psychosis, Mania and Major Depression in A
Molecular Psychiatry (2014) 19, 209–213 & 2014 Macmillan Publishers Limited All rights reserved 1359-4184/14 www.nature.com/mp ORIGINAL ARTICLE Specificity of psychosis, mania and major depression in a contemporary family study CL Vandeleur1, KR Merikangas2, M-PF Strippoli1, E Castelao1 and M Preisig1 There has been increasing attention to the subgroups of mood disorders and their boundaries with other mental disorders, particularly psychoses. The goals of the present paper were (1) to assess the familial aggregation and co-aggregation patterns of the full spectrum of mood disorders (that is, bipolar, schizoaffective (SAF), major depression) based on contemporary diagnostic criteria; and (2) to evaluate the familial specificity of the major subgroups of mood disorders, including psychotic, manic and major depressive episodes (MDEs). The sample included 293 patients with a lifetime diagnosis of SAF disorder, bipolar disorder and major depressive disorder (MDD), 110 orthopedic controls, and 1734 adult first-degree relatives. The diagnostic assignment was based on all available information, including direct diagnostic interviews, family history reports and medical records. Our findings revealed specificity of the familial aggregation of psychosis (odds ratio (OR) ¼ 2.9, confidence interval (CI): 1.1–7.7), mania (OR ¼ 6.4, CI: 2.2–18.7) and MDEs (OR ¼ 2.0, CI: 1.5–2.7) but not hypomania (OR ¼ 1.3, CI: 0.5–3.6). There was no evidence for cross-transmission of mania and MDEs (OR ¼ .7, CI:.5–1.1), psychosis and mania (OR ¼ 1.0, CI:.4–2.7) or psychosis and MDEs (OR ¼ 1.0, CI:.7–1.4). -
Depression and Anxiety: a Review
DEPRESSION AND ANXIETY: A REVIEW Clifton Titcomb, MD OTR Medical Consultant Medical Director Hannover Life Reassurance Company of America Denver, CO [email protected] epression and anxiety are common problems Executive Summary This article reviews the in the population and are frequently encoun- overall spectrum of depressive and anxiety disor- tered in the underwriting environment. What D ders including major depressive disorder, chronic makes these conditions diffi cult to evaluate is the wide depression, minor depression, dysthymia and the range of fi ndings associated with the conditions and variety of anxiety disorders, with some special at- the signifi cant number of comorbid factors that come tention to post-traumatic stress disorder (PTSD). into play in assessing the mortality risk associated It includes a review of the epidemiology and risk with them. Thus, more than with many other medical factors for each condition. Some of the rating conditions, there is a true “art” to evaluating the risk scales that can be used to assess the severity of associated with anxiety and depression. Underwriters depression are discussed. The various forms of really need to understand and synthesize all of the therapy for depression are reviewed, including key elements contributing to outcomes and develop the overall therapeutic philosophy, rationale a composite picture for each individual to adequately for the choice of different medications, the usual assess the mortality risk. duration of treatment, causes for resistance to therapy, and the alternative approaches that The Spectrum of Depression may be employed in those situations where re- Depression represents a spectrum from dysthymia to sistance occurs. -
Chapter 7 Mood Disorders
An Overview of Mood Disorders • Gross Deviations in Mood • 2 Fundamental states: Depression & Mania Chapter 7 • Depression: “The Low” – Major Depressive Episode •The most commonly diagnosed & most severe Mood Disorders depression •Depressed (or in children, irritable) mood state that lasts at least 2 weeks –Cognitive symptoms •Feelings of worthlessness or inappropriate guilt •Diminished ability to concentrate or indecisiveness – Dysthymic Disorder –Disturbed physical functions (vegetative •Similar symptoms to Major Depressive Episode, symptoms) (central to the disorder) but milder •Insomnia or hypersomnia nearly every day –Also fewer symptoms: need only 2 of the •Significant weight loss or gain or change in symptoms, as opposed to 5 in Major Depressive appetite Episode •Fatigue or loss of energy nearly every day •A persistently depressed (or, in children & •Psychomotor agitation or retardation adolescents, irritable) mood that continues for at –Nearly always accompanied by markedly least 2 years diminished interest or ability to experience pleasure –During those 2 years, the individual has never been (anhedonia) from life without the symptoms for more than 2 months at a • Average duration if untreated: 9 months time •Most people with Dysthymia eventually experience a major depressive episode • Mania: “The High” –Abnormally exaggerated elation, joy, or euphoria OR irritability (common toward the –Behavioral symptoms end of the episode) lasting at least 1 week •More talkative / pressured speech –Cognitive symptoms •Psychomotor agitation -
What Is Bipolar Disorder?
Bipolar Disorder Fact Sheet For more information about bipolar or other mental health disorders, call 513-563-HOPE or visit our website at www.lindnercenterofhope.com. What Is Bipolar Disorder? What does your mood Each year, nearly 6 million adults (or approximately 5% of the population) in the U.S. are affected by bipolar disorder, according to the Depression and Bipolar Support say about you? Alliance. While the condition is treatable, unfortunately bipolar disorder is frequently misdiagnosed and may be present an average of 10 years before it is correctly identified. Go to My Mood Monitor™, a three minute assessment Bipolar disorder (also known as bipolar depression or manic depression) is identified for anxiety, depression, PTSD by extreme shifts in mood, energy, and functioning that can be subtle or dramatic. The characteristics can vary greatly among individuals and even throughout the and bipolar disorder, at course of one individual’s life. www.mymoodmonitor.com to see if you may need a Bipolar disorder is usually a life-long condition that begins in adolescence or early professional evaluation. adulthood with recurring episodes of mania (highs) and depression (lows) that can continue for days, months or even years. My Mood Monitor™ Copyright © 2002-2010 by M3 Information™ Phases of Bipolar Disorder • Mania is the activated phase of bipolar disorder and is characterized by extreme moods, increased or impulsive mental and physical activities, and risk taking. • Hypomania describes a mild-to-moderate level of mania. Because it may feel good to the individual experiencing it, this condition can be difficult for someone with bipolar illness to recognize as a concern. -
Dysphoria As a Complex Emotional State and Its Role in Psychopathology
Dysphoria as a complex emotional state and its role in psychopathology Vladan Starcevic A/Professor, University of Sydney Faculty of Medicine and Health Sydney, Australia Objectives • Review conceptualisations of dysphoria • Present dysphoria as a transdiagnostic complex emotional state and assessment of dysphoria based on this conceptualisation What is dysphoria? • The term is derived from Greek (δύσφορος) and denotes distress that is hard to bear Dysphoria: associated with externalisation? • “Mixed affect” leading to an “affect of suspicion”1,2 1 Sandberg: Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtl Medizin 1896; 52:619-654 2 Specht G: Über den pathologischen Affekt in der chronischen Paranoia. Festschrift der Erlanger Universität, 1901 • A syndrome that always includes irritability and at least two of the following: internal tension, suspiciousness, hostility and aggressive or destructive behaviour3 3 Dayer et al: Bipolar Disord 2000; 2: 316-324 Dysphoria: associated with internalisation? • Six “dysphoric symptoms”: depressed mood, anhedonia, guilt, suicide, fatigue and anxiety1 1 Cassidy et al: Psychol Med 2000; 30:403-411 Dysphoria: a nonspecific state? • Dysphoria is a “nonspecific syndrome” and has “no particular place in a categorical diagnostic system”1; it is neglected and treated like an “orphan”1 1 Musalek et al: Psychopathol 2000; 33:209-214 • Dysphoria “can refer to many ways of feeling bad”2 2 Swann: Bipolar Disord 2000; 2:325-327 Textbook definitions: dysphoria nonspecific, mainly internalising? • “Feeling -
Which Is It: ADHD, Bipolar Disorder, Or PTSD?
HEALINGHEALINGA PUBLICATION OF THE HCH CLINICIANS’ HANDSHANDS NETWORK Vol. 10, No. 3 I August 2006 Which Is It: ADHD, Bipolar Disorder, or PTSD? Across the spectrum of mental health care, Anxiety Disorders, Attention Deficit Hyperactivity Disorders, and Mood Disorders often appear to overlap, as well as co-occur with substance abuse. Learning to differentiate between ADHD, bipolar disorder, and PTSD is crucial for HCH clinicians as they move toward integrated primary and behavioral health care models to serve homeless clients. The primary focus of this issue is differential diagnosis. Readers interested in more detailed clinical information about etiology, treatment, and other interventions are referred to a number of helpful resources listed on page 6. HOMELESS PEOPLE & BEHAVIORAL HEALTH Close to a symptoms exhibited by clients with ADHD, bipolar disorder, or quarter of the estimated 200,000 people who experience long-term, PTSD that make definitive diagnosis formidable. The second chronic homelessness each year in the U.S. suffer from serious mental causative issue is how clients’ illnesses affect their homelessness. illness and as many as 40 percent have substance use disorders, often Understanding that clinical and research scientists and social workers with other co-occurring health problems. Although the majority of continually try to tease out the impact of living circumstances and people experiencing homelessness are able to access resources comorbidities, we recognize the importance of causal issues but set through their extended family and community allowing them to them aside to concentrate primarily on how to achieve accurate rebound more quickly, those who are chronically homeless have few diagnoses in a challenging care environment. -
Reward and Emotion: an Affective Neuroscience Approach
Reward and emotion: An affective neuroscience approach David Sander1 & Lauri Nummenmaa2 1Swiss Center for Affective Sciences (CISA), Campus Biotech, and Laboratory for the Study of Emotion Elicitation and Expression, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland 2TurKu PET Centre, TurKu University Hospital, and Department of Psychology, University of TurKu, Finland Address Correspondence to: Lauri Nummenmaa Turku PET Centre c/o Turku University Hospital FI-20520 Turku, Finland Email: [email protected] Tel: +358 50 574 7933 Acknowlegements This study was supported by the Academy oF Finland (grants #294897 and #332225), Sigrid Juselius stiftelse and Signe och Anet Gyllenberg’s stiftelse, and by the Swiss National Science Foundation (grant 100019_188966). DS and LN thank Brian Knutson For in-depth discussions concerning several aspects of this paper. Conflicts of interest None Abstract Pleasure and reward are central for motivation, learning, feeling and allostasis. Although reward is without any doubt an affective phenomenon, there is no consensus concerning its relationship with emotion. In this mini-review we discuss this conceptual issue both from the perspective of theories of reward and emotion as well as human systems neuroimaging. We first describe how the reward process can be understood and dissected as intertwined with the emotion process, in particular in light of the appraisal theories, and then discuss how different facets of the reward process can be studied using neuroimaging and neurostimulation techniques. We conclude that future worK needs to focus on mapping the similarities and differences across stimuli and mechanisms that are involved in reward processing and in emotional processing, and propose that an integrative affective sciences approach would provide means for studying the emotional nature of reward. -
Generalized Anxiety Disorder: Practical Assessment and Management MICHAEL G
Generalized Anxiety Disorder: Practical Assessment and Management MICHAEL G. KAVAN, PhD; GARY N. ELSASSER, PharmD; and EUGENE J. BARONE, MD Creighton University School of Medicine, Omaha, Nebraska Generalized anxiety disorder is common among patients in primary care. Affected patients experience excessive chronic anxiety and worry about events and activities, such as their health, family, work, and finances. The anxiety and worry are difficult to control and often lead to physiologic symptoms, including fatigue, muscle tension, restless- ness, and other somatic complaints. Other psychiatric problems (e.g., depression) and nonpsychiatric factors (e.g., endocrine disorders, medication adverse effects, withdrawal) must be considered in patients with possible generalized anxiety disorder. Cognitive behavior therapy and the first-line pharmacologic agents, selective serotonin reuptake inhibitors, are effective treatments. However, evidence suggests that the effects of cognitive behavior therapy may be more durable. Although complementary and alternative medicine therapies have been used, their effectiveness has not been proven in generalized anxiety disorder. Selection of the most appropriate treatment should be based on patient preference, treatment success history, and other factors that could affect adherence and subsequent effective- ness. (Am Fam Physician. 2009;79(9):785-791. Copyright © 2009 American Academy of Family Physicians.) ▲ Patient information: nxiety disorders, such as generalized GAD is 3.1 percent in population-based sur- -
Empirical Redefinition of Delusional Disorder and Its Phenomenology: the DELIREMP Study ⁎ Enrique De Portugala, , Nieves Gonzálezb, Victoria Del Amoc, Josep M
Available online at www.sciencedirect.com Comprehensive Psychiatry 54 (2013) 243–255 www.elsevier.com/locate/comppsych Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study ⁎ Enrique de Portugala, , Nieves Gonzálezb, Victoria del Amoc, Josep M. Harod, Covadonga M. Díaz-Caneja e, Juan de Dios Luna del Castillof, Jorge A. Cervillag aDepartment of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital General Universitario Gregorio Marañón, Madrid, Spain bResearch and Development Unit, Sant-Joan de Déu-SSM, Barcelona, Spain cDepartment of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain dParc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain eChild and Adolescent Psychiatry Department. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain fDepartment of Psychiatry & Institute of Neurosciences, University of Granada, Spain gCentro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitario San Cecilio, Granada, Spain Abstract Aims: Since Kraepelin, the controversy has persisted surrounding the nature of delusional disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD. Methods: A cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques.