Scribd Logo
Upload

Welcome to Scribd!

  • 196 views

    Mood Disorder

    Uploaded by

    Shidev
    Major depressive disorder: - Recurrence rate of 50-85% over 10 years - Chronic course in 10-25% of cases • Bipolar disorder: - Lifelong illness with relapses common - Rapid cycling form has poorer prognosis • Factors associated with poorer prognosis: - Psychotic features - Comorbid substance abuse - Residual symptoms between episodes - Early age of onset - Frequent episodes - Lack of adherence to treatment

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Mood Disorder

    Uploaded by

    Shidev
    196 views32 pages
    Major depressive disorder: - Recurrence rate of 50-85% over 10 years - Chronic course in 10-25% of cases • Bipolar disorder: - Lifelong illness with relapses common - Rapid cycling form has poorer prognosis • Factors associated with poorer prognosis: - Psychotic features - Comorbid substance abuse - Residual symptoms between episodes - Early age of onset - Frequent episodes - Lack of adherence to treatment

    Original Description:

    k

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Major depressive disorder: - Recurrence rate of 50-85% over 10 years - Chronic course in 10-25% of cases • Bipolar disorder: - Lifelong illness with relapses common - Rapid cycling form has poorer prognosis • Factors associated with poorer prognosis: - Psychotic features - Comorbid substance abuse - Residual symptoms between episodes - Early age of onset - Frequent episodes - Lack of adherence to treatment

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    196 views32 pages

    Mood Disorder

    Uploaded by

    Shidev
    Major depressive disorder: - Recurrence rate of 50-85% over 10 years - Chronic course in 10-25% of cases • Bipolar disorder: - Lifelong illness with relapses common - Rapid cycling form has poorer prognosis • Factors associated with poorer prognosis: - Psychotic features - Comorbid substance abuse - Residual symptoms between episodes - Early age of onset - Frequent episodes - Lack of adherence to treatment

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 32
    At a glance
    Powered by AI
    The key takeaways are the different types of mood disorders, their epidemiology, etiology, clinical features, diagnosis and management approaches.

    The main types of mood disorders discussed are major depressive disorder, bipolar disorder, cyclothymia and dysthymia.

    Some of the biological factors implicated in the pathophysiology of mood disorders include neurotransmitters like norepinephrine and serotonin, neuroanatomy of structures like the prefrontal cortex and hippocampus, and genetic factors.

    Depressive Illness,

    Unipolar and Bipolar


    Affective Disorder
    AP HAITHAM
    PH.D (Psychiatry)
    ASSOCIATED PROFESSOR
    IMS, MSU

    Objectives
    To acquire knowledge about various Mood/ Affective
    Disorders
    To know conceptualization of Bipolar Disorders and
    Major Depressive Disorder
    To identify clinical features (signs/symptoms) of
    mood disorders
    To know management of mood disorders

    Introduction
    Mood is a pervasive and sustained feeling tone that is experienced
    internally and that influences a person's behavior and perception of the
    world
    Affect is the external expression of mood
    Mood can be normal, elevated, or depressed
    Healthy persons experience a wide range of moods and have an equally
    large repertoire of affective expressions; they feel in control of their
    moods and affects
    Mood disorders are a group of clinical conditions characterized by a
    loss of that sense of control and a subjective experience of great distress
    These disorders are associated with impaired interpersonal, social, and
    occupational functioning

    Contd.

    Patients afflicted with only major depressive episodes are said to


    have major depressive disorder or unipolar depression
    Patients with both manic and depressive episodes or patients with
    manic episodes alone are said to have bipolar disorder
    The terms unipolar mania and pure mania are sometimes
    used for patients who are bipolar, but who do not have depressive
    episodes
    Hypomania is an episode of manic symptoms that does not meet
    the full (DSM-IV-TR) criteria for manic episode.
    Cyclothymia and dysthymia are defined by DSM-IV-TR as
    disorders that represent less severe forms of bipolar disorder and
    major depression, respectively.

    History
    Hippocrates used the terms mania and melancholia to describe
    mental disturbances
    Emil Kraepelin, described manic-depressive psychosis using
    most of the criteria that psychiatrists now use to establish a
    diagnosis of bipolar I disorder

    Epidemiology
    Mood disorders are common
    Major depressive disorder has the highest lifetime prevalence
    (almost 17 percent) of any psychiatric disorder
    lifetime prevalence for bipolar disorder is 0 to 2.4%
    Major depressive disorder is two times more common in females
    bipolar I disorder has an equal prevalence among men and
    women
    Women have a higher rate of being rapid cyclers, defined as
    having four or more manic episodes in a 1-year period
    Mean age of onset for bipolar disorder 30 years
    Mean age of onset for major depressive disorder 40 years

    Etiology
    Biological Factors:
    Neurotransmitter: (Monoamine hypothesis)norepinephrine
    and serotonin are most implicated in the pathophysiology of
    mood disorders
    Neuroanatomy: the prefrontal cortex (PFC), the anterior
    cingulate, the hippocampus, and the amygdala
    Genetic factors: if one parent has a mood disorder, a child will
    have a risk of between 10 and 25 percent for mood disorder. If
    both parents are affected, this risk roughly doubles

    Etiology
    Psychosocial factors:
    Life Events and Environmental Stress
    Personality Factors: Persons with certain personality
    disorders histrionic, and borderline may be at greater risk for
    depression
    Psychodynamic Factors in Depression: disturbances in the
    infant mother relationship during the oral phase
    Psychodynamic Factors in Mania: Klein viewed mania as a
    defensive reaction to depression, using manic defenses such as
    omnipotence, in which the person develops delusions of
    grandeur

    Depressive Disorders in DSM-V


    Major depressive disorder
    --Prominent depressive symptoms meeting criteria for major depressive episode

    Dysthymic disorder
    --Prominent depressed mood lasting for 2 years

    Substance induced mood disorder with depressive features


    --Prominent depressive symptoms during/within 1 month of substance use

    Mood disorder due to a general medical condition with depressive


    features
    --Symptoms as direct physiologic consequence of GMC

    Adjustment disorder with depressed mood


    --Symptoms arise in response to identifiable stressor(s)

    Depressive disorder NOS


    Prominent depressive symptoms not meeting other criteria

    Contd.
    Major Depressive episode:
    A major depressive episode must last at least 2 weeks.
    At least one of the symptoms is either (1) depressed mood or (2) loss of
    interest or pleasure
    There should be least four symptoms from the following: changes in appetite
    and weight, changes in sleep and activity, psychomotor
    agitation/retardation,lack of energy, feelings of worthlessness/guilt, problems
    thinking/concentrating and making decisions, and recurring thoughts of death
    or suicide.
    Mild
    Moderate
    Severe without psychotic features
    Severe with psychotic features: mood congruent/ mood incongruent
    In Full remission

    Contd.

    Major Depressive Disorder:


    Presence of one or more major depressive episode(s).
    The major depressive episode(s) not better accounted for by schizoaffective
    disorder/ schizophrenia/ delusional disorder or other psychotic disorders.
    There has never been a manic episode/ hypomanic episode or mixed episode

    Chronic Major depressive Disorder: for past 2 years


    MDD with catatonic features specifier: atleast two of the following are
    present: motoric immobility/ stupor. Excessive motor activity. Extreme
    negativism. Peculiar movements. Echolalia/ echopraxia
    MDD with postpartum onset specifier: Onset within 4 weeks of postpartum
    MDD with seasonal pattern specifier

    Melancholic Depression
    Melancholia is one of the oldest terms used in psychiatry
    It is used to refer to a depression characterized by:
    -severe anhedonia
    -early morning awakening
    -weight loss
    -profound feelings of guilt (often over trivial events)

    It is not uncommon for patients who are melancholic to have


    suicidal ideation
    Also called as endogenous depression

    Atypical depression
    Mood reactivity (i.e., mood brightens in response to actual or
    potential positive events)
    Two (or more) of the following features:
    significant weight gain or increase in appetite
    hypersomnia
    leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
    long-standing pattern of interpersonal rejection sensitivity
    (not limited to episodes of mood disturbance) that results in
    significant social or occupational impairment
    Reversed vegetative symptoms
    Younger age of onset

    Contd.

    Dysthymic disorder:
    A. Depressed mood for most of the day, for at least 2 years.
    B. Presence, while depressed, of two (or more) of the following:

    poor appetite or overeating


    insomnia or hypersomnia
    low energy or fatigue
    low self-esteem
    poor concentration or difficulty making decisions
    feelings of hopelessness

    C. The person has never been asymptomatic during this period


    D. No major depressive episode has been present during the first 2
    years of the disturbance
    E. There has never been a manic/hypomanic or mixed episode

    Bipolar Disorders in DSM-IV-TR

    Bipolar I disorder
    Bipolar II disorder
    Cyclothymia
    Substance induced mood disorder with manic/ mixed
    features
    Mood disorder due to a general medical condition
    with manic/ mixed features
    Bipolar disorder NOS

    Contd.

    A manic episode is a distinct period of an abnormally and persistently


    elevated, expansive, or irritable mood lasting for at least 1 week, or
    less if a patient must be hospitalized.
    During the period of mood disturbance, three (or more) of the
    following symptoms have persisted (four if the mood is only irritable)
    and have been present to a significant degree:

    inflated self-esteem or grandiosity


    decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
    more talkative than usual or pressure to keep talking
    flight of ideas or subjective experience that thoughts are racing
    distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    increase in goal-directed activity
    excessive involvement in pleasurable activities that may have painful consequences
    (sexual indiscretions, or foolish business investments)

    Contd.

    Psychotic symptoms in mania: in its most severe form, mania may be


    associated with psychotic symptoms

    A hypomanic episode lasts at least 4 days and is similar to a manic


    episode except that it is not sufficiently severe to cause
    impairment in social or occupational functioning, and no
    psychotic features are present.
    Both mania and hypomania are associated with inflated selfesteem, decreased need for sleep, distractibility, great physical and
    mental activity, and overinvolvement in pleasurable behavior
    A mixed episode is a period of at least 1 week in which both a
    manic episode and a major depressive episode occur almost daily.

    Contd.

    bipolar I disorder is defined as having a clinical course of one


    or more manic episodes and, sometimes, major depressive
    episodes.
    A variant of bipolar disorder characterized by episodes of
    major depression and hypomania rather than mania is known
    as bipolar II disorder.
    Cyclothymic disorder is characterized by at least 2 years of
    frequently occurring hypomanic symptoms that cannot fit the
    diagnosis of manic episode and of depressive symptoms that
    cannot fit the diagnosis of major depressive episode.

    Rapid cycling bipolar I/II disorder


    More common in females
    external factor such as stress or drug treatment may be
    involved in the pathogenesis
    At least four episodes of a mood disturbance in the previous
    12 months that meet criteria for a major depressive, manic,
    mixed, or hypomanic episode
    Episodes are demarcated either by partial or full remission for
    at least 2 months

    Differential Diagnosis
    Mood disorders due to general medical conditions

    Endocrine disorders
    Mania: Hyperthyroidism; Depression: Hypothyroidism, Cushing syndrome

    Substance induced Mood disorders


    Other Psychiatric Disorders

    Schizophrenia
    Schizoaffective disorders
    Acute/ transient psychotic disorders
    Adjustment disorders with depressed mood
    Generalized anxiety disorders/ Obsessive compulsive disorder

    Course and Prognosis


    Major depressive disorder is not a benign disorder
    It tends to be chronic, and patients tend to relapse
    Mild episodes, the absence of psychotic symptoms, short
    hospital stay, stable family functioning, and generally sound
    social functioning are good prognostic indicators
    Patients with bipolar I disorder have a poorer prognosis than
    do patients with major depressive disorder
    Bipolar I disorder with an early onset, premorbid poor
    occupational status, alcohol dependence, psychotic features,
    interepisode depressive features, and male gender is associated
    with a poor prognosis

    Management
    Hospitalization:
    Indications: risk of harm to self/others/ property, severe
    depressive/psychotic symptoms, history of rapidly progressing
    symptoms, patient's grossly reduced ability to get food and
    shelter, and the need for diagnostic procedures, rupture of a
    patient's usual support systems, initiation of ECT, treatment
    resistant depression
    Manic patients often have a complete lack of insight into their
    disorder that hospitalization seems absolutely absurd to them

    Pharmacological Treatment
    Treatment of Major Depressive Disorder:
    Antidepressants:

    Tricyclic antidepressants
    Selective serotonine reuptake inhibitors
    Serotonine norepinephrine reuptake inhibitors(venlafaxine)
    Dopamine reuptake inhibitor(bupropion,naltrexone,wellbutrin)

    Antidepressant treatment should be maintained for at least 6


    months or the length of a previous episode, whichever is
    greater.

    Contd.

    Treatment of Bipolar Mood Disorder:


    Treatment of Acute Manic Episode:
    Mood stabilizers: Sodium Valproate, Lithium Carbonate,
    Carbamazepine, Oxcarbazepine etc.
    Atypical Antipsychotics
    Benzodiazepines (Clonazepam and Lorazepam)

    Treatment of Acute Depressive Episode:


    Antidepressants are recommended to be used only in combination
    with mood stabilizers
    Lamotrigine
    Atypical antipsychotics

    Contd.

    Maintenance Treatment of Bipolar Disorder


    Aim: Prevention of recurrent episodes (mania or depression)
    Mood stabilizers (Sodium Valproate, Lithium, carbamazepine)
    alone or in combination, are the most widely used agents in
    the long-term treatment of patients who are bipolar.
    Lamotrigine has prophylactic antidepressant and, potentially,
    mood-stabilizing properties.
    Atypical antipsychotics

    Suicide prevention: Lithium

    Treatment Resistant Depression


    Failure to respond to adequate trials of two to four different
    antidepressants (plus or minus ECT)
    Seek answers to these questions:
    Is the diagnosis correct?
    Are the doses & duration appropriate?
    Is patient compliant to medications?
    Are there any maintaining factors?

    Treatment options:
    Continue monotherapy at maximum tolerable doses
    Add psychotherapy
    Change antidepressant
    Consider augmentation: lithium/atypical antipsychotic/thyroid hormone/lamotrigine
    Combine antidepressant from different classes
    Electro-convulsive therapy

    Non pharmacologic treatment


    Although most studies indicate and most clinicians and
    researchers believe that a combination of psychotherapy and
    pharmacotherapy is the most effective treatment for major
    depressive disorder
    Interpersonal therapy (Gerald Klerman)
    Cognitive therapy (Aaron Beck)
    Family therapy

    Non pharmacologic treatment: Bipolar Disorder


    Interpersonal & social rhythm therapy:
    To reduce mood lability maintain regular pattern of daily activities
    Evidence suggest improved long term outcome

    Cognitive behavior therapy:


    Educate about bipolar disorder & treatment
    Teach skills: cope with stressors
    Facilitate compliance with treatment

    Family therapy
    Psycho-education of patient & family members: accepting reality of illness, identifying
    precipitating stresses

    Support Groups
    Patient may benefit from hearing the experiences of others, struggling with similar issues

    Changes in DSM-V
    Among Bipolar Disorder the diagnosis of Mixed episode
    is replaced by a new specifier with mixed features.
    A new diagnosis of Disruptive Mood Dysregulation
    Disorder has been added in DSM-V to avoid
    overdiagnosis and overtreatment of bipolar disorder in
    children. These children present with persistent
    irritability.
    Major depressive episode presenting with additional
    manic symptoms (which dont fulfill the criteria of manic
    episode) is represented with a specifier with mixed
    features

    Take Home Message


    Types of Mood disorders
    Approach to a patient with mood disorders
    History/ MSE; signs/symptoms (Diagnosis)

    Differential diagnoses
    Management of Mood disorders
    Investigations
    Hospitalization
    Pharmacologic treatment
    Non pharmacologic treatment

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy