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MOOD DISORDERS :
are characterised by a
disturbance of mood,
accompanied by a full or
partial manic or depressive
syndrome, which is not due
to any other physical and
Oxford textbook of psychiatry (1997)
defines depressive disorders as
syndromes of depressed mood,
pessimistic thinking , lack of enjoyment,
reduced energy and slowness.
• F30-39- mood ( affective disorder)
• F 32 -Depressive episode
• F 32.0 -Mild depressive episode
• F 32.1 - Moderate depressive episode
• F 32.2 - Severe depressive episode without psychotic
• F 32.3 - Severe depressive episode with psychotic
• F 32.8 - Other depressive episode – atypical depression
• F 32.9 - Depressive episode , unspecified
• F 33 - Recurrent depressive disorder.
lifetime prevalence of about 15%
perhaps as high as 25% for women.
• Sex: more in women.
• Age: The mean age of onset is about
40 years, 50% of all the patients have
an onset between 20-50 years of age.
• Marital status
• Socioeconomic and cultural
considerations: rural areas than in
• Biological Theories
• twin studies,
• family studies and
• Adoption studies.
• PSYCHOSOCIAL THEORIES
– Psychoanalytic theory: loss of loved
– Behavioral theory: conditioned by
repeated losses in past.
– Cognitive theory: depression is due to
– Sociological theory: Stressful life
• DEPRESSED MOOD: Sadness of mood,
loss of interest and loss of pleasure in
almost all activities.
– Pervasive and persistent pattern of
• DEPRESSIVE COGNITIONS
– Hopelessness: no hope in future due to
– Helplessness: no help is possible
– Worthlessness: feeling of inadequacy and
– Unreasonable guilt
– Self blame
• SUICIDAL THOUGHTS:
• PSYCHOMOTOR ACTIVITY:
– Psychomotor retardation
– Thinks, walks and acts slowly
– Delay in answering questions
• PSYCHOTIC FEATURES
– Delusions and hallucinations
• Somatic symptoms
– Significant decrease in appetite or weight
– Early morning awakening
– Pervasive lack of interest and lack of reactivity to
– Posture is stooped
– Reddened eyes from crying
– Persons look 10 years older than their
– Constipation and anorexia
– dry mouth, headache, sleep disturbance, fatigue
and lowered libido
MAJOR DEPRESSIVE DISORDERS
• SINGLE EPISODE OR RECURRENT
• MILD/MODERATE/ SEVERE
• WITH PSYCHOTIC FEATURES
• WITH CATATONIC FEATURES
• WITH MELANCHOLIC FEATURES
• WITH SEASONAL PATTERN
• WITH POSTPARTUM ONSET
• DYSTHYMIC DISORDER
• PREMENSTRUAL DYSPHORIC DISORDER
• ICD 10 diagnostic criteria
• Psychological tests- Beck depression
inventory, Hamilton rating scale
• Dexamethazone suppression test
• Based on signs and symptoms
• High risk for self directed violence
related to depressed mood, feelings of
worthlessness and anger turned inward
on the self
• Dysfunctional grieving related to real or
perceived loss as evidenced by denial of
loss, inappropriate expression of anger.
• Powerlessness related to dysfunctional
grieving process as evidenced by feeling of
lack of control over life situations.
• Self esteem disturbance related to learned
helplessness , negative view of self as
evidenced by expression of worthlessness
and sensitivity to criticism
• Altered sleep and rest related to depressed
mood as evidenced by difficulty in falling
asleep and early morning awakening.