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    Mood Disorders: Dr. Amjad Hakro MBBS, FCPS (Psych) Consultant Psychiatrist, Senior Registrar ATMCH, Karachi

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    Muhammad Makki
    The document discusses mood disorders such as depressive disorder and bipolar disorder. It provides information on: 1) Depressive disorder is characterized by low mood, loss of interest, and reduced energy for over two weeks, with a lifetime prevalence of 10-20% and one year prevalence of 2-5%. 2) Bipolar disorder involves discrete periods of mania and depression separated by remission, and is more common than schizophrenia. 3) Treatment involves psychotherapy, medication including mood stabilizers, and management of substance abuse and stressors. Lithium, anticonvulsants, atypical antipsychotics are commonly used pharmacological treatments.

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    Mood Disorders: Dr. Amjad Hakro MBBS, FCPS (Psych) Consultant Psychiatrist, Senior Registrar ATMCH, Karachi

    Uploaded by

    Muhammad Makki
    85 views17 pages
    The document discusses mood disorders such as depressive disorder and bipolar disorder. It provides information on: 1) Depressive disorder is characterized by low mood, loss of interest, and reduced energy for over two weeks, with a lifetime prevalence of 10-20% and one year prevalence of 2-5%. 2) Bipolar disorder involves discrete periods of mania and depression separated by remission, and is more common than schizophrenia. 3) Treatment involves psychotherapy, medication including mood stabilizers, and management of substance abuse and stressors. Lithium, anticonvulsants, atypical antipsychotics are commonly used pharmacological treatments.

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    Mood Disorder

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    The document discusses mood disorders such as depressive disorder and bipolar disorder. It provides information on: 1) Depressive disorder is characterized by low mood, loss of interest, and reduced energy for over two weeks, with a lifetime prevalence of 10-20% and one year prevalence of 2-5%. 2) Bipolar disorder involves discrete periods of mania and depression separated by remission, and is more common than schizophrenia. 3) Treatment involves psychotherapy, medication including mood stabilizers, and management of substance abuse and stressors. Lithium, anticonvulsants, atypical antipsychotics are commonly used pharmacological treatments.

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    85 views17 pages

    Mood Disorders: Dr. Amjad Hakro MBBS, FCPS (Psych) Consultant Psychiatrist, Senior Registrar ATMCH, Karachi

    Uploaded by

    Muhammad Makki
    The document discusses mood disorders such as depressive disorder and bipolar disorder. It provides information on: 1) Depressive disorder is characterized by low mood, loss of interest, and reduced energy for over two weeks, with a lifetime prevalence of 10-20% and one year prevalence of 2-5%. 2) Bipolar disorder involves discrete periods of mania and depression separated by remission, and is more common than schizophrenia. 3) Treatment involves psychotherapy, medication including mood stabilizers, and management of substance abuse and stressors. Lithium, anticonvulsants, atypical antipsychotics are commonly used pharmacological treatments.

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    of 17

    MOOD DISORDERS

    Dr. AMJAD HAKRO


    MBBS, FCPS (Psych)
    Consultant Psychiatrist,
    Senior Registrar
    ATMCH, Karachi
    DEPRESSIVE DISORDER
    • Depressive disorder is a common psychiatric disorder
    characterized by the symptoms of low mood, loss of interest
    and enjoyment, and reduced energy leading to increased
    fatigability lasting for 2 weeks or more.

    • Life time prevalence is 10-20%.


    • One year prevalence is 2-5%.
    Screening Depression in Suspected cases
    Use following 2 screening questions in suspected cases:

    • 1. Over the past 2 weeks, have you felt down, depressed, or hopeless?

    • 2. Over the past 2 weeks, have you felt little interest or pleasure in doing
    things?

    If either of these is present , then ask additional questions

    Ref: David Goldberg , Prescribing anti-depressants in primary care and hospital practice ;
    Depression in medical secularities ; WPA Bulletin on Depression “ Facing, understanding and managing
    Depression Vol.7 No 26 ,2003
    Criteria for Depressive Disorder
    Common symptoms / Typical symptoms
    1. Depressed mood: most of the day, nearly every day
    2. Anhedonia: diminished interest/ lack of pleasure
    3. Fatigue: loss of energy
    4. Weight change: more than 5% per month
    5. Disturbed sleep: insomnia, hypersomnia (atypical depression
    6. Agitation: psychomotor
    7. Reduced libido
    8. Inappropriate guilt
    9. Indecisiveness: diminished ability to think
    10. Suicide: thoughts of death
    What are the defining symptoms of anxiety
    and depression? The tables below show the
    differences and the similarities.
    Anxiety & Anxiety Disorder Depression
    Feeling of fear, apprehension and excessive anxiety Feeling of emptiness, deep sadness or misery, loss of
    energy hope
    Physical feelings of agitation, muscle tension and Slowing down of physical movement and lack of physical
    symptoms of anxiety eg. heart symptoms, nausea, energy
    dissociation, diarrhoea, breathing difficulties etc

    General sense of being tense and rigid Physical body slumped


    May be a perfectionist and is concerned about the results Loss of interest and ambition (can lead to poor
    of activities (can lead to poor performance) performance)

    May fear death but not focused on suicide (Suicide Suicidal thoughts present in severe depression
    thoughts come only when Depression is a secondary
    effect of anxiety disorder)
    THE BIPOLAR ILLNESSES

    Wide range of syndromes with manic features,


    Mania
    associated with episodes of depression

    Hypomania

    Normal

    Depression

    Severe
    depression
    Normal Cyclothymic Cyclothymic Bipolar II Unipolar Bipolar I
    mood personality disorder disorder mania disorder
    variation

    Goodwin FK and Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990
    BIPOLAR DISORDER:
    A common disorder of mood or affect, characterized by
    discrete periods of mania and depression separated by an
    interval of remission (euthymia)
    • More common than schizophrenia
    • Men and women equally affected regardless of race, education,
    occupation or income
    • Most common first presenting episode
    • women: depression
    • men: mania
    MANIA:
    PRESISTENT ELATION OR IRRITABILITY
    OF MOOD FOR AT LEAST ONE WEEK
    (MOST OF THE DAY EVERYDAY)

    Just opposite to the depressive disorder

    HYPOMANIA:
    LESSER DEGREE OF MANIA

    HIGH MENTAL & PHYSICAL EFFICIENCY


    MILD ELATION OF MOOD
    BIPOLAR DISORDER: AGE OF ONSET
    1,2
    • Peak age of onset: 15–19 and 20–24 years
    • Earlier onset and more
    3 severe course in
    substance abusers
    • In early-onset patients, typical time-lag is
    3–10 years between first presentation 4 and
    initiation of treatment/hospitalization
    • Later onset in association with other conditions
    e.g., endocrinopathy

    1
    Burke KC et al. Arch Gen Psychiatry 1990;47(6):511–18;
    2
    Weismann MM et al. Psychol Med 1998;18:14–53;
    3
    Brady KT et al. J Clin Psychiatry 1995;56(Suppl. 3):19–24;
    4
    Egeland JA. Compr Psychiatry 1983;24(4):337–44
    ETIOLOGY
    BIOLOGICAL
    GENETIC
    TWIN – MONOZYGOTIC (IDENTICAL)
    – DIZYGOTIC FRATERNAL

    NEUROTRANSMITTERS
    5HT
    NORADRENALINE
    DOPAMINE

    ENVIROMENTAL
    PSYCHOLOGICAL FACTORS (STRESS)

    SOCIAL FACTORS (RECENT LIFE EVENTS)


    Bipolar Disorder:
    • Abnormally and persistently elevated, expansive,
    or irritable mood > 1 week
    • 3* or more activation symptoms:
    • Distractibility, Increased risk-taking, Grandiosity,
    Fast/racing thoughts, Activity increased, Sleep
    decreased, Talkativeness (“DIG FAST”)
    • Marked social/occupational impairment
    • Not due to drugs or medical condition
    Bipolar Disorder:
    • 5 or more of following present > 2 weeks:
    • depressed mood most of day, nearly every day
    • decreased interest or pleasure in activities most of day, nearly every day
    • increased/decreased appetite & weight
    • increased/decreased sleep
    • psychomotor agitation/retardation
    • decreased energy
    • guilt/worthlessness
    • poor concentration
    • recurrent thoughts of death/suicide
    Psychotherapeutic Interventions
    • Education
    • Challenging irrational beliefs
    • Self-monitoring (mood, sleep, stress
    charts) and social rhythms
    • Manage interpersonal relationships and
    family coping
    • Medication adherence
    • Manage alcohol and substances
    Pharmacotherapy in Bipolar Disorder

    MOOD
    STABILZERS

    ATYPICAL
    ANTI-
    LITHIUM ANTI-
    CONVULSANTS
    PSYCHOTICS
    Pharmacotherapy for Bipolar illness
    mnemonic
    Mood Stabilizer – lithium, divalproex sodium,
    M Carbamazepine, topiramate,
    Anxiolytic – clonazepam, lorazepam
    A Antidepressant – bupropion, SSRI, other
    Neuroleptic – olanzapine, risperidone (clozapine,
    N ziprasidone)
    Indications for Inpatient treatment – suicide, severe
    I psychosis, substance abuse
    Consultation – Compliance
    C Counseling – depression, family therapy
    Thank you

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