MOOD DISORDER MANIA HYPOMANIA OTHER MOOD DISORDER

1. MOOD DISORERS
BY DR MOHIT BANSAL
PGT-2
DEPARTMENT OF PSYCHIATRY
KMCH

2. MOOD VS AFFECT
• MOOD- it is sustained and pervasive
emotional response.
• AFFECT – it is short lived idea or emotional
response to an idea or an event

3. CLASSIFICATION
MOOD DISORDER INCLUDES
1 MANIA
2 HYPOMANIA
3 DEPRESSIVE DISORDES
4 BIPOLAR MOOD [AFFECTIVE ]DISORDERS
5 RECURRENT DEPRESSIVE DISORDERS
6 PERSISTANT MOOD DISORDERS
[IT INCLUDES CYCLOTHYMIA AND DYSTHYMIA]
7 OTHER MOOD DISORDERS
[LIKE MIXED AFFECTIVE DISORDER & RECURRENT BRIEF DEPRESSIVE DISORDER]

4. HYPOMANIA
• It is lesser degree of mania , in which
abnormalities of mood and behavior are too
persistent and marker to be included under
cyclothymia but not accompanied by
hallucinations and delusions

5. • A]. Persistent mild elevation of mood
,increased energy , activity and usually marked
felling of well being ,increase sociability ,
talkativeness , decrease need for sleep , but
not to extent that they lead to severe
disruption of work or result in social rejection
• B].Symptoms should present at least for four
consecutive days

6. • C. ) [3 out of 7 if elevated mood , 4 out of 7 if
dysphoric mood ]
• 1. distractibility
• 2. increase interest in pleasurable and risk
taking activity
• 3. Grandiosity
• 4.Flight of ideas

7. • 5. Activity increased
• 6. Need for sleep decrease
• 7.Talkativeness
• D .] The episode is not attributable to the
physiological effect of substance

8. MANIA
1 Life time risk of mania is 0.8 -1 %
2 Disorder tends to occur in episodes
lasting usually 3-4 months
3 MANIA IS OF TWO TYPES
A . MANIA WITHOUT PSYCHOTIC
SYMPTOMS
B.MANIA WITH PSYCHOTIC SYMPTOMS

9. SYMPTOMS OF MANIA
A. elevated ,expansive ,irritable mood
B. [3 out of 7 if elevated mood , 4 out of 7 if dysphoric
mood ]
1. distractibility
2. increase interest in pleasurable and risk taking activity
3. Grandiosity
4.Flight of ideas
5. Activity increased
6. Need for sleep decrease
7.Talkativeness

10. • C. lead to severe disruption of work and result
in social rejection
• D. symptom last at least for one weak
• E . The episode is not attributable by the
physiological effect of substance

11. Bipolar mood[ affective ]disorders
• It is characterized by recurrent episodes of
mania and depression in the same patient at
different time
• These episodes can occur in any sequence
• The patient with recurrent episodes of mania
are also classified as bpad disorder

12. • Current episode of bipolar is specified as
• 1. hypomania
• 2. manic without psychotic symptoms
• 3.manic with psychotic symptom
• 4. mild or moderate depression

13. • 5. severe depression ,without psychotic
symptom
• 6. severe depression with psychotic symptom
• 7.mixed
• 8. in remission

14. BIPOLAR DISORDER TYPES
• BIPOLAR TYPE-1
• It is mania + depression
• prevalence = female =
male
• less suicidal risk
• commonly associated
with psychotic
symptoms
• BIPOLAR TYPE -2
• It is hypomania +
depression
• Prevalence = female>
male
• High suicidal risk
• very less chances of
psychotic symptoms

15. RECURRENT DEPRESSIVE DISORDER
• Characterized by recurrent at least two episodes
of depression
• current episode in recurrent depressive disorder
is specified as
• 1 mild
• 2 moderate
• 3 severe without psychotic symptoms
• 4 severe with psychotic symptoms
• 5 in remission

16. PERSISTENT MOOD DISORDERS
• IT IS CHARACTERISED BY PERSISTENT
MOOD SYMPTOMS WHICH LAST FOR
MORE THAN 2 YEARS , BUT NOT SEVERE
ENOUGH TO BE LABELLED AS EVEN
HYPOMANIA OR MILD DEPRESSIVE
EPISODE

17. • DYSTHYMIA
• If symptom consist of
persistent mild
depression the disorder
is called as dysthymia
• CYCLOTHYMIA
• If symptoms consist of
persistent instability of
mood between mild
depression and mild
elation , the disorder is
cyclothymia

18. OTHER MOOD DISORDER
• IT INCLUDES DIAGNOSIS OF MIXED AFFECTIVE
EPISODE
• In this full clinical picture of depression and
mania is present either at the same time
intermixed or alternates rapidly with each
other [rapid cycling] without a normal
intervening period of euthymia

19. COURSE OF BIPOLAR DISORDER
• occurs in early age [third decade]
• An average manic episode last for 3-4 months
whereas average depressive episode last for 4-
6 months
• Unipolar depression last longer than bipolar
depression
• With rapid institution of t/t major symptoms
of mania are controlled within 2 weeks and of
depression within 6-8 weeks

20. • Chronic depression is usually characterized by
less intense depression ,hypochonrical
symptoms ,alcohol dependence , personality
disorder
• As age increases interval b/w two episodes
decreases ,the duration of episodes and their
frequency increases

21. • not all pt have relapse ,but up to 75% have
second episode
• Pt with greater than 4 episode of bipolar
mood disorder in a year is called rapid cycling
• Pt with greater than 4 episode of bipolar
mood disorder in a month is called ultra rapid
cycle
• When mania and depression alternate very
rapidly [ in hours ] it is called ultra ultra rapid
cyclers /ultradian

22. PROGNOSIS
• GOOD PROGNOSTIC
FACTOR
• 1. short duration of
manic episode
• 2. advanced age of onset
• 3. few suicidal thoughts
• 4. few co-morbidity either
medical or psychiatric
• POOR PROGNOSTIC
FACTORS
• 1. poor occupation status
• 2. alcohol dependence
• 3.psychotic features
• 4. poor drug compliance
• 5. male gender
• 6. inter episodic
depressive features

23. AETIOLOGY
• 1] GENITIC FACTORS – CHROMOSOME 18q
,22q , heritability 70-80%
• 2 ]. Biological. – hpa axis dysfunction , bdnf
level changes
• 3] .Psycho immunological - Increase in level of
IL-6
• 4] neuro-imaging – a.]variation in grey matter
volume of , striatum ,thalamus ,corpus
collasum

24. B]. Increase activation in circuit involving
superior & medial frontal cortex and insula

25. BIOLOGICAL THEORIES
1.] GENITIC HYPOTHESIS – life time risk of first
degree relatives of bipolar mood disorder pt is 25
% and recurrent depressive disorder is 20%
• children with one parent bipolar mood disorder
27%
• Children with both parent bipolar mood disorder
74%
• As per these evidence genetic factor are very
important in making children vulnerable to mood
disorder

26. • 2.] BIOCHEMICAL THEORY
a. monoamine hypothesis – it suggest
catecholamine (histamine , nor epinephrine
dopamine and serotonin ) in central nervous
system at one or more sites
b. Functional increase in mania and decrease in
depression of nor epinephrine and 5-HT in
synaptic cleft
c. Pt with severe depression with marked
decrease in the serotonergic function
evidenced by decrease of 5-HIAA level

27. • 3.] NEUROENOCRINE THEORY
• Mood symptoms are seen with many
endocrine disorders like hypothyroidism
,cushing's disease and addision disease

28. • 4]. BRAIN IMAGING
• WE CAN DO CT SCAN ,PET SCAN ,MRI ,SPECT
• FINDINGS IN THIS INCLUDES
• A. Ventricular dilatation
• B. white matter hyper –intensities
• C . changes in blood flow and metabolism

29. • 5] OTHER THEORIES
• A. PSYCHOANALYTIC THEORIES
• B. PRESSENCE OF STRESS
• C. SLEEP ABNORMALITY
• D.COGNETIVE AND BEHAVIOURAL THEORIES

30. DIFFRERENTIAL DIAGNOSIS
• 1 . ORGANIC CAUSES LIKE-DEMENTIA ,
DELERIUM
• 2. ACUTE AND TRANSIENT PSYCHOTIC
DISORDERS
• 3. DELUSIONAL DISORDER
• 4. ADJUSTMENT DISORDER

31. MANAGEMENT
• A] PHARMACOLOGICAL T/T
• B] NON PHARMACOLOGICAL T/T
• C ] ELECTROCONVULSIVE THERAPY

32. PHARMACOLOGICAL T/T
• DRUGS USED ARE
• 1]. MOOD STABLIZERS – LITHIUM ,SODIUM
VALPROATE , CARBAMAZEPINE ,
BENZODIZAPINES
• 2] ANTIDEPRESSANTS -
• A. TCA – eg . Imipramine , amitryptiline
• B.] SSRI – fluoxitine , sertaline
• C]. – SNRI – venlafaxine , duloxitine

33. lithium
• Mainly used for t/t of mania and for
prevention of further episode of bipolar
disorder
• Response take approx 2 week to come
• Usual therapeutic dose is 900-1500 mg
• Therapeutic dose of lithium – 0.8-1.2 meq/lt
• Lithium > 2 meq /lt is toxic

34. • 3] . ANTIPSYCHOTIC DRUGS - in this we mainly
use drugs like risperidone , olanzapine ,
quetiapine , haloperidol , aripiprazole

35. NON PHARMACOLOGICAL T/T
• 1 . COGNITIVE BEHAVIOUR THERAPY
• 2. BEHAVIOUR THERAPY
• 3. GROUP THERAPY
• 4 . PYSCHOANALYTIC PSYCHOTHERAPY
• 5. FAMILY THERAPY

36. ECT
INDICATIONS
• 1. SEVERE DEPRESSION WITH SUICIDAL RISK
• 2. SEVERE DEPRESSION WITH STUPOR ,
PSYCHOMOTOR RETARDATION
• 3. SEVERE T/T REFRECTIVE DEPRESSION
• 4. INTOLERANCE TO DRUGS

37. Which of following is not the feature
of mania?
A Disorientation
B delusion of grandeur
C elation
D pressure of speech

38. Number of days require to diagnose
hypomania?
A 4 Days
B 7 days
C 21 days
D one month

39. Which of the following statement is
untrue about hypomania?
A in severe hypomania patient needs to be
admitted.
B minimum duration is 4 days.
C hypomania is seen in type -2 bipolar disorder.
D psychotic symptom are always seen.
E delusion of grandiosity are not present usually.

40. A67 year old lady is brought in by her 6 children saying that she
has gone senile . Six month after her husband death she has
become more religious ,spiritual ,give lots of money in donation
.she is occupied in too many activities and sleep less . She know
believes that she has goal to change the society .she does not
like being brought to the hospital and is argumentative on being
questioned on her doings . The diagnosis is.
A depression
B schizophrenia
C mania
D impulse control disorder

41. A 22 year old male suffer from decreased sleep ,
increased sexual activity , excitement and spending
excessive money for 8 days . The diagnosis is
• A confusion
• B mania
• C hyperactivity
• D loss of money

42. A patient was brought to doctor with non stop talking
,singing , uncontrollable behavior and apparent loss of
contact and reality .it is diagnosed as a case of acute
mania which of following drug are used for rapid
control of symptoms?
• LITHIUM
• HALOPERIDOL
• VALPORATE
• DIAZEPAM

43. A 22 year old female brought the OPD by her friend
because she thinks that salman khan is in love with her
. What is it called ?
• A erotomania
• B Unipolar mania
• C neurosis
• D behavior problem

44. NEEDS A GREAT
DEAL OF
ATTENTION IT’S
FINAL TABOO AND
IT NEED TO BE
FACED AND DEALT
WITH
• LET’S TALK TO PSYCHIATRIC ILLNESS
THANKYOU…