Mood disorders
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Mood disorders Mood disorders Presentation Transcript

  • MOOD DISORDERS BY Ahmed albehairy, md. Psychiatry consultant, moh.
  • Mood Disorders , Types- Affective disorders.- Include: major depressive disorders. bipolar disorders , I, II, III. Dysthymic disorder. Cyclothymic. mood disorder due to GMC. substance induced mood disorders. NOS, depression & bipolar
  • EpidemiologyLife time prevalenceMDD 10-25% W, 5-12%MDysthymic disorders 6%BAD 6%BAD I 0.4 -1.6%BAD II 0.5%Rapid cycling 5-15% of BADCyclothymic 0.4-1 %
  • EpidemiologySex : MDD, W < M, BAD W=M manic ---W, DEP.--- MAge : BAD onset 30, + all ages MDD ALL agesSociocultural: MDD--- Single, divorced
  • EtiologyBiological:- Biogenic amines : dopamine, serotonin, noradrenaline. ( HVA) , ( 5-HIAA), ( MHPG) in urine , blood and CSF.MDD --- DEC 5-HIAAVIOLENCE, SUICIDE--- DEC 5-HIAADEP---- DEC DOPAMINEMANIA --- INC DOPAMINE
  • EtiologyBiological:- Neuroendocrine abnormalitiesHTPA axis, dec TSH, GH, FSH, LH AND nocturnal secretion of melatonin.- Immunity , dec in both dep, mania.
  • EtiologyBiological:- Sleep : in depression delayed sleep onset, multiple awakening, short REM latency with inc. 1st REM . Sleep deprivation--- AD- KINDLING- GENETIC.- Neuroanatomical.
  • EtiologyPsychosocial:- psychoanalytical.- Cognitive.- Learned helplessness.- Stressful life events.
  • INVSTIGATION- DST.- CT, MRI- RATING SCALES- Bech, zung, MADRS.- RORSCHACH.- TAT
  • Clinical PicturesDepressive episode.Manic episode.HypomanicBipolar I,II,IIIRapid cyclerUltra rapid cyclerMelncholic depressionSeasonal or recurrent dep
  • Clinical PicturesPostpartum onset .Atypical dep. Hysterical dysphoriaCatatoniaPseudodementiaDepression in children.DysthymiaDouble depression.Cyclothymic.Psychotic depressionchronicNOS ( recurrent brief, premenstrual).
  • Differential diagnosisOrganic br. ( tumor, myxedema madness, mercury)SIMSCHIZOPHRENIAGRIEFPDSCHIZOAFFECTIVESLEEP DISORDERSANXIETY, SOMATOFORM,
  • Course & PrognosisMDD --- 15% SUICIDEMDD --- NATURAL HISTORY 10 MS.75% of have 2nd episode of depression, in 6ms.Average no of dep episodes is 5.50%recover,30%partial recover, 20% chronic.45%manic recurs, last 3 m , average 10 in life .
  • Treatment MDD BAD AD MOOD STAB. ECT ADPSYCHOLOGICAL ECT PSYCHOLOGICAL
  • When should ECT be considered?- Suicidality, dangerousness.- Failure to respond to several Ads- Threatening acute symptoms.- Agitation, psychotic.- Intolerable S E OF AD- History of +ve response to ECT.- Medical condition precluding the use of Ads.
  • PHASES OF DEPRESSIONTREATMENT Acute Treatment (4 –6 weeks) Goal is to eliminate signs and symptoms of depression; Select antidepressant based on target symptoms, medical/psychiatric history, drug interactions, side effects After 4-6 weeks reassess adequacy of response If no response or partial response, increase dose of medication or switch to another antidepressant
  • PHASES OF DEPRESSIONTREATMENT Acute Treatment (4 –6 weeks) Goal is to eliminate signs and symptoms of depression; Select antidepressant based on target symptoms, medical/psychiatric history, drug interactions, side effects After 4-6 weeks reassess adequacy of response If no response or partial response, increase dose of medication or switch to another antidepressant
  • PHASES OF TREATMENTContinuation Treatment (6 months) Goal is to prevent relapse following symptomatic recovery/remission Continue full therapeutic antidepressant dose for 6 months after symptoms abate At the end of continuation phase, antidepressant should be tapered gradually to avoid discontinuation symptoms If symptoms recur, patient is likely to respond to same antidepressant previously prescribed; continue medication for 6 months at therapeutic dose
  • Common Side Effect of AntidepressantsTCA : dry mouth, constipation, drowsiness, orthostatic hypotension, weight gain,,++ IOP.Bupropion, seizure, agitation,insomnia.Trazodone: sedation, priapism.SSRI: insomnia, agitation, headache, nausea. Fluxetine ( akathesia). Paroxetine , dry mouth.Venlafaxine: hypertension, nausea.Mirtazepine: wt gain and sedation.MAOI --- TYRMINE, SSRI,LETHALITY : TCA OVERDOSE, serotenorgig syndrome
  • Hot Items in Choosingmedications in DepressionPsychotic dep--- AP +AD, ECTMelancholic ----- AD + ECT( REC)Atypical ---------- SSRISeasonal -------- AD + phototherapyPostpartum ------ ? BAD, in hospital
  • Hot Items in Choosing medications in Depressionrisk Lower moderate higherBreast feeding TCA, Flupenthexol Amoxipen, MAOI, mianserine, VENLAFAXINE mirtazepine, SSRI, trazodoneCVS SSRI,Mianserine, MAOI, TCA, mirtazepine, venlafaxine trazodonediabetus SSRI,TRAZODON FLUXETINE, MAOI E, VENLAFAXINE MIANSERINE , MIRTAZEPIN E, TCA
  • Hot Items in Choosing medications in Depressionrisk Lower moderate higherOLD AGE VENLAFAXINE, MAOI, TCA MIRTAZEPINE, SSRI, MIANSERINE, VENLAFAXINE TRAZODONEPREGNAN ?// TRYPTOPHAN TCA,MAOI,MECY RTIZAPINE,V ENLAFAXINE, MIANSERINERENAL MIANSERINE,TCA,TR SSRI,MIRTEZ VENLAFAXINE, AZODONE,TRYPTOP APINE,MAOI, FLUXETINE HAN DULEXTINE
  • Hot Items in Choosing medications in Depressionrisk Lower moderate higherEpilepsy MAOI, SSRI, DULOXETINE, AMOXIPINE, MIANSERINE, MAPROTILINE MIRTAZEPINE, TCA, VENLAFAXINEGLAUCO MAOI, SSRI, DELUXTINE, TCAMA TRAZODONE MIRTAZEPINE VENLAFAXINELIVER MIANSERINE, DULOXETINE,MIRTAZ MAOI PAROXETINE EPIMNE, SSRI,TCA, VENLAFAXINE
  • Mood Stabilizerslamotrigine/Lamictallithiumquetiapine/Seroqueldivalproex/Depakotecarbamazepine/Tegretololanzapine/Zyprexaoxcarbazepine/Trileptalomega-3 fatty acids /fish oilclozapineatypical (2nd generation) antipsychotics
  • LTG LIT VPK CRB OXC OM3 OLZ QUTIP ARIP Hexperience ++ ++ ++ ++ + + +Ad effect ++ + + + + + + ++ +Short term se ++ + + +Few long termrisk ++ + +++ ?No wt + + + +Low cost ++ ++ ++ + + +Fast antimanic + ++ ++maintenance + + + + ++ +pregnancy ? ? ?Breast feeding usa usa ++
  • Thank you