Study Notes Assessing, Diagnosing, and Treating Adults With Mood Disorders
1. Introduction
Mood disorders are psychiatric conditions that primarily affect emotional state, leading to persistent sadness, elation, irritability, or mood instability.
Common examples: Major Depressive Disorder (MDD), Bipolar Disorder (BD), Persistent Depressive Disorder (Dysthymia), Cyclothymic Disorder.
They significantly impair functioning in work, relationships, and daily life.
Effective management requires comprehensive assessment, accurate diagnosis, and individualized treatment planning.
2. Epidemiology and Impact
Mood disorders are among the most prevalent mental health conditions worldwide.
Lifetime prevalence:
Major Depressive Disorder: ~15–20% of adults.
Bipolar Disorder: ~1–3% of adults.
Associated with high morbidity, suicide risk, and economic burden.
Early identification improves prognosis and reduces relapse.
3. Assessment
Goal: Gather detailed information to understand symptom patterns, severity, and functional impact.
Key Components:
Clinical Interview:
Chief complaint, history of present illness, symptom onset, duration, triggers.
Psychiatric History:
Past diagnoses, hospitalizations, therapy, medication trials.
Medical History:
Chronic illnesses, neurological conditions, substance use.
Family History:
Genetic predisposition to mood disorders.
Social History:
Employment, relationships, stressors, lifestyle.
Mental Status Examination (MSE):
Appearance, behavior, speech, mood, affect, thought process/content, cognition, insight, judgment.
Screening Tools:
PHQ‑9 (depression), GAD‑7 (anxiety comorbidity), Mood Disorder Questionnaire (MDQ), Beck Depression Inventory.
Risk Assessment:
Suicide ideation, self‑harm, violence risk.
4. Diagnosis
DSM‑5 Criteria:
Major Depressive Disorder (MDD): ≥5 symptoms for ≥2 weeks (depressed mood, anhedonia, sleep/appetite changes, guilt, poor concentration, suicidality).
Persistent Depressive Disorder (Dysthymia): Depressed mood most of the day, more days than not, for ≥2 years.
Bipolar I Disorder: At least one manic episode (elevated mood, increased energy, decreased need for sleep, risky behavior).
Bipolar II Disorder: Hypomanic episodes + major depressive episodes.
Cyclothymic Disorder: ≥2 years of hypomanic and depressive symptoms not meeting full criteria.
Differential Diagnosis:
Anxiety disorders, ADHD, substance‑induced mood disorder, medical conditions (thyroid disease, neurological illness).
5. Treatment Approaches
Multimodal treatment is most effective.
A. Pharmacological Interventions
Antidepressants: SSRIs (fluoxetine, sertraline), SNRIs (venlafaxine, duloxetine), atypical antidepressants (bupropion, mirtazapine).
Mood Stabilizers: Lithium, valproate, carbamazepine, lamotrigine.
Antipsychotics: Atypical agents (quetiapine, olanzapine, lurasidone) for bipolar depression or mania.
Combination Therapy: Often required for complex cases.
Monitoring: Side effects, adherence, drug interactions.
B. Psychotherapy
Cognitive Behavioral Therapy (CBT): Targets negative thought patterns.
Interpersonal Therapy (IPT): Focuses on relationships and social functioning.
Dialectical Behavior Therapy (DBT): Useful for mood instability and self‑harm.
Family Therapy: Enhances support and reduces relapse.
C. Lifestyle and Supportive Interventions
Regular exercise, sleep hygiene, balanced diet.
Stress management, mindfulness, relaxation techniques.
Support groups, psychoeducation.
D. Advanced Treatments
Electroconvulsive Therapy (ECT): For severe, treatment‑resistant depression.
Transcranial Magnetic Stimulation (TMS): Non‑invasive option for refractory depression.
Ketamine/Esketamine: Emerging treatment for resistant depression.
6. Monitoring and Follow‑Up
Regular evaluation of symptom severity, side effects, functional improvement.
Adjust treatment based on response and tolerability.
Long‑term management to prevent relapse.
Collaborative care with primary care providers, psychiatrists, therapists.
7. Challenges in Treatment
Comorbidity: Anxiety, substance use, medical illnesses complicate treatment.
Adherence Issues: Side effects, stigma, cost.
Diagnostic Complexity: Overlap between depression and bipolar disorder.
Risk Management: Suicide prevention, crisis intervention.
8. Case Example (Abbreviated)
Patient: 35‑year‑old female, reports persistent sadness, fatigue, poor sleep.
Assessment: PHQ‑9 score = 20, flat affect, impaired concentration.
Diagnosis: Major Depressive Disorder, severe.
Treatment Plan: Initiate SSRI, weekly CBT, lifestyle modification, suicide safety plan, follow‑up in 2 weeks.
9. Summary
Mood disorders are common, disabling, and treatable.
Effective care requires thorough assessment, accurate diagnosis, and individualized treatment.
Combining medication, psychotherapy, and lifestyle interventions yields best outcomes.
Continuous monitoring and patient engagement are essential for long‑term recovery.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
Which of the following is NOT a mood disorder? a) Major Depressive Disorder b) Bipolar Disorder c) Generalized Anxiety Disorder d) Cyclothymic Disorder
The PHQ‑9 is primarily used to assess: a) Anxiety b) Depression c) Mania d) Psychosis
A manic episode is required for the diagnosis of: a) Bipolar I Disorder b) Bipolar II Disorder c) Cyclothymic Disorder d) Persistent Depressive Disorder
Which symptom is NOT part of DSM‑5 criteria for Major Depressive Disorder? a) Anhedonia b) Decreased need for sleep c) Suicidal ideation d) Poor concentration
Persistent Depressive Disorder requires symptoms lasting at least: a) 6 months b) 1 year c) 2 years d) 5 years
Which medication is considered a mood stabilizer? a) Fluoxetine b) Lithium c) Sertraline d) Bupropion
Cognitive Behavioral Therapy focuses on: a) Family dynamics b) Negative thought patterns c) Medication adherence d) Sleep hygiene
Which treatment is most effective for treatment‑resistant depression? a) CBT b) ECT c) Lifestyle changes d) SSRIs
Which of the following is a common pitfall in treating mood disorders? a) Combining medication and therapy b) Ignoring comorbid conditions c) Monitoring side effects d) Psychoeducation
The Mood Disorder Questionnaire (MDQ) screens for: a) Depression b) Bipolar Disorder c) Anxiety d) Psychosis
Which therapy is especially useful for mood instability and self‑harm? a) CBT b) DBT c) IPT d) Family Therapy
Which lifestyle intervention is recommended for mood disorders? a) Sleep hygiene b) Excessive caffeine c) Social isolation d) Irregular exercise
Which of the following is an atypical antipsychotic used in bipolar disorder? a) Quetiapine b) Fluoxetine c) Venlafaxine d) Bupropion
Which factor increases risk of relapse in mood disorders? a) Strong family support b) Poor adherence to treatment c) Regular follow‑up d) Psychoeducation
Why is accurate diagnosis critical in mood disorders? a) It eliminates need for treatment b) It guides appropriate therapy and prevents mismanagement c) It reduces stigma automatically d) It ensures immediate cure
Answer Key:
1‑c, 2‑b, 3‑a, 4‑b, 5‑c, 6‑b, 7‑b, 8‑b, 9
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