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Presented by
 RASYIDAH
 SHARIFAH NAHIDHAH
 SITI HAJAR
 Mood : prevailing internal emotional state
 Affect: external display of feelings
 Mood disorders are a category of ill...
 Classification of mood disorders:
• Major Depressive Disorder
• Dysthymic Disorder
Depressive
(unipolar)
• Bipolar I
• B...
 Among 5 most common disorder.
 Lifetime prevalence 5-20%.
 Female to male ratio is 2:1
 The incidence rate is greates...
ETIOLOGY:
1. Biological Factors
 More common in monozygotic twins.
 Unipolar depressions in a parent
 Abnormalities in ...
Criteria For Major Depressive Episode : 5 Or More
Of The Following For At Least 2 Weeks
DEPRESSED MOOD1
ANHEDONIA
2
GUILT SLEEP DISTURBANCE
3 4
APPETITE
ENERGY
5
6
CONCENTRATION
SUICIDALITY
PSYCHOMOTOR
7
8
9
Mood Sleep Interest
Guilt Energy Concentration
Appetite Psychomotor Suicidality
Criteria For Major Depressive Episode : 5 ...
1. Other psychiatric disordes, sleep disorders and neurological
disorders.
2. Endocrine disorders: Addison’s disease, Cush...
 There are NO specific tests.
Investigations focus on exclusion of treatable causes
or other secondary problems.
 Standa...
 Focused investigations :only if indicated by history
and/or physical signs:
1. Urine or blood toxicology
2. Breathe or b...
 Hospitalization
If there is:
 Serious risk of suicide
 Serious risk of harm to
others
 Significant self -neglect
 Se...
First line of treatment: Anti-depressant
 effective in 65-75% of patients.
 The decision of choosing anti-depressant dep...
TRICYCLIC ANTIDEPRESSANTS (TCA)
 Action: reuptake inhibition of norepinephrine(NE) and serotonin (5-HT), increasing both ...
Second line of treatment:
 When the first line
treatment fail.
 Unacceptable side effects
from 1st line drug.
 Change o...
 Mild, chronic depression for at least 2 years.
 Common psychiatric comorbidities: major depression
(up to 75%), “ Doubl...
DEFINITION
- known as manic-depressive illness
- a brain disorder
- causes unusual shifts in mood, energy,
activity levels...
BIPOLAR I
-manic episodes that last at least 7
days
BIPOLAR II
-a pattern of depressive episodes
and hypomanic episodes
CY...
MANIC EPISODE:
 Feel very “up,” “high,” or elated
 A lot of energy
 Increased activity levels
 Trouble sleeping
 Talk...
DEPRESSIVE EPISODE:
 Feel very sad, down, empty, or hopeless
 decreased activity levels
 trouble sleeping, they may sle...
 The lifetime prevalence is 0.4-1.6%
 Male : female is equal.
 The 1st episode of mania usually occurs in the early 20
...
 A distinct period of elevated, expansive or irritable mood at least 1
week
 3 of the following, if mood is only irritab...
 Substance induce mood disorder and mood disorder 2ry
to medical condition are the essential differential
diagnosis:
-End...
1. Brain Structure and Functioning
2. Genetics
3. Family History
4. Substance abuse
5. Negative life events
1. Hospitalization.
2. Pharmacotherapy
-Mood stabilizers
-Antipsychotics
3. Electroconvulsive Therapy (ECT)
The patient is...
5. Prevention of relapses
- Prophylaxis
- Therapeutic alliance
- Family education
6. Psychotherapy
Some psychotherapy trea...
THANK YOU
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Mood disorders slide

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Mood disorders slide

  1. 1. Presented by  RASYIDAH  SHARIFAH NAHIDHAH  SITI HAJAR
  2. 2.  Mood : prevailing internal emotional state  Affect: external display of feelings  Mood disorders are a category of illnesses that describe a serious change in mood. http://www.mentalhealthamerica.net
  3. 3.  Classification of mood disorders: • Major Depressive Disorder • Dysthymic Disorder Depressive (unipolar) • Bipolar I • Bipolar II • Cyclothymic disorder Bipolar • Substance induced mood disorder • Mood disorder due to general medical condition Etiologic
  4. 4.  Among 5 most common disorder.  Lifetime prevalence 5-20%.  Female to male ratio is 2:1  The incidence rate is greatest between ages 20-40.  Major cause of disability and suicide. American Medical Association researchers found that 27% of MEDICAL STUDENTS had depression or symptoms of it, and 11% REPORTED SUICIDAL thoughts during medical school!
  5. 5. ETIOLOGY: 1. Biological Factors  More common in monozygotic twins.  Unipolar depressions in a parent  Abnormalities in Amine Neurotransmitters  Neuroendocrine abnormalities in hypothalamic pituitary adrenal (HPA) axis. 2. Psychological Factors  Major life events  Interpersonal relations, absent or unsatisfactory significant special bonds have negative effect on self regards  Rapid hormonal changes  Distorted thinking  Lose hopefulness
  6. 6. Criteria For Major Depressive Episode : 5 Or More Of The Following For At Least 2 Weeks DEPRESSED MOOD1 ANHEDONIA 2
  7. 7. GUILT SLEEP DISTURBANCE 3 4
  8. 8. APPETITE ENERGY 5 6
  9. 9. CONCENTRATION SUICIDALITY PSYCHOMOTOR 7 8 9
  10. 10. Mood Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicidality Criteria For Major Depressive Episode : 5 Or More Of The Following For At Least 2 Weeks
  11. 11. 1. Other psychiatric disordes, sleep disorders and neurological disorders. 2. Endocrine disorders: Addison’s disease, Cushing’s disease, Hyper/hypothyroidism, Perimenstrual syndromes,etc. 3. Metabolic disorders: Hypoglycemia, Hypercalcemia, Porphyria. 4. Hematological disorders: anemia 5. Inflammatory conditions: SLE 6. Infections: Syphilis, Lyme disease, HIV encephalopathy 7. Medication related: Anti hypertensives, Steroids, etc 8. Substance misuse: Alcohol, benzodiazepine, opiates, marijuana, etc.
  12. 12.  There are NO specific tests. Investigations focus on exclusion of treatable causes or other secondary problems.  Standard tests: 1. Complete blood picture 2. ESR 3 .B12/folate 4. Liver function test 5. Thyroid function test 6. Glucose level 7. Calcium level
  13. 13.  Focused investigations :only if indicated by history and/or physical signs: 1. Urine or blood toxicology 2. Breathe or blood alcohol 3. Arterial blood gas( ABG) 4. Thyroid antibodies 5. Antinuclear antibody 6. Syphilis serology -----ETC
  14. 14.  Hospitalization If there is:  Serious risk of suicide  Serious risk of harm to others  Significant self -neglect  Severe depressive symptoms  Severe psychotic symptoms  Lack of breakdown of social supports  Initiation of ECT  Treatment resistant depression  A need to address comorbid conditions
  15. 15. First line of treatment: Anti-depressant  effective in 65-75% of patients.  The decision of choosing anti-depressant depends on:  Patient factor: age, sex, comorbid illness, previous response to antidepressants.  Symptomatology: sleep problem(sedative agents), lack or energy/hypersomnia (adrenergic stimulatory agents), OCD symptoms (clomipramine), risk of suicide (avoid TCA)  Eg. Tricyclic anti-depressant and Monoamineoxidase inhibitors.
  16. 16. TRICYCLIC ANTIDEPRESSANTS (TCA)  Action: reuptake inhibition of norepinephrine(NE) and serotonin (5-HT), increasing both in synaptic cleft  Examples : Imioramine (Tofranil) , Clomipramide (Anafranil) , Amitryptptiline (Tryptizol)  TCA are cheap drugs but have many side effects. Selective Serotonin Reuptake Inhibitors (SSRI)  Action: more selective inhibitory effect on reuptake of serotonin.  Lesser side effects than TCA  Examples: 1. Fluoxetine (Prozac) 2 Sertaline (Lustral) 3. Paroxetine (Seroxat) 4. Fluvoxamine (Faverin)
  17. 17. Second line of treatment:  When the first line treatment fail.  Unacceptable side effects from 1st line drug.  Change of antidepressant to different class or the same class with different side effect. Electro convulsive therapy May be use when there are severe biological features (significant weight loss/ reduced appetite) or marked psychomotor retardation.
  18. 18.  Mild, chronic depression for at least 2 years.  Common psychiatric comorbidities: major depression (up to 75%), “ Double Depression” anxiety disorders (up to 50%), personality disorders (20–40% ) somatoform disorders (2.8%–45.2%), substance abuse (up to 50%)  Difficult to diagnose due to soft mood symptoms, distracting comorbidities and lack of patient recognition.  Treatment includes psychotherapy mainly
  19. 19. DEFINITION - known as manic-depressive illness - a brain disorder - causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks
  20. 20. BIPOLAR I -manic episodes that last at least 7 days BIPOLAR II -a pattern of depressive episodes and hypomanic episodes CYCLOTHYMIC DISORDER -numerous periods of hypomanic symptoms, periods of depressive symptoms lasting for at least 2 years OTHER SPECIFIED OR NON- SPECIFIED BIPOLAR AND RELATED DISORDER -bipolar disorder symptoms that do not match the three categories listed above
  21. 21. MANIC EPISODE:  Feel very “up,” “high,” or elated  A lot of energy  Increased activity levels  Trouble sleeping  Talk really fast about a lot of different things  Be agitated, irritable, or “touchy”  Feel like their thoughts are going very fast  Think they can do a lot of things at once  Do risky things, like spend a lot of money or have reckless sex
  22. 22. DEPRESSIVE EPISODE:  Feel very sad, down, empty, or hopeless  decreased activity levels  trouble sleeping, they may sleep too little or too much  Feel like they can’t enjoy anything  Feel worried and empty  trouble concentrating  Forget things a lot  Eat too much or too little  Feel tired or “slowed down”  Think about death or suicide
  23. 23.  The lifetime prevalence is 0.4-1.6%  Male : female is equal.  The 1st episode of mania usually occurs in the early 20  Most likely associated with comorbid suctance abuse or dependence.  Manic episodes often begin abruptly over hours to days and escalate in 1 to 2 weeks  10-20% of hospital 1st admissions for depression later develop a bipolar disorder.  15-20% of bipolar patients commit suicide.
  24. 24.  A distinct period of elevated, expansive or irritable mood at least 1 week  3 of the following, if mood is only irritable: -Self-esteem: highly inflated, grandiosity. -Sleep: decreased need for sleep, rested after only a few hours. -Thoughts: racing thoughts and flight of ideas. -Attention: easy distractibility. -Activity: increased goal directed activity. -Hedonism: high excess involvement in pleasurable activity (sex, travel)
  25. 25.  Substance induce mood disorder and mood disorder 2ry to medical condition are the essential differential diagnosis: -Endocrine disorders -Neurological conditions -Systemic disorders -Drugs -Recreational drugs
  26. 26. 1. Brain Structure and Functioning 2. Genetics 3. Family History 4. Substance abuse 5. Negative life events
  27. 27. 1. Hospitalization. 2. Pharmacotherapy -Mood stabilizers -Antipsychotics 3. Electroconvulsive Therapy (ECT) The patient is continue treatment for 4-6 months after resolution of the symptoms then preventive treatment considered.
  28. 28. 5. Prevention of relapses - Prophylaxis - Therapeutic alliance - Family education 6. Psychotherapy Some psychotherapy treatments used to treat bipolar disorder include: • Cognitive behavioral therapy (CBT) • Family-focused therapy • Interpersonal and social rhythm therapy • Psychoeducation
  29. 29. THANK YOU

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