Classification of Mood DisordersInternational Classification of Diseases (ICD-10) came into use in WHO Member States as from 1994F30 Manic episodeF31 Bipolar affective disorderF32 Depressive episodeF33 Recurrent depressive disorderF34 Persistent mood (affective) disordersF38 Other mood (affective) disordersF39 Unspecified mood (affective) disorder
Criteria for depressive episode DSM- III-R/DSM-IVSymptoms present nearly every day in same 2-week period Change from normal functioningKey symptoms (n = 2) Depressed mood ,AnhedoniaAncillary symptoms (n 7) Fatigue/loss of energy Weight/appetite loss/gain Insomnia/hypersomnia Observed agitation/retardation Low self-esteem/guilt Impaired thinking/concentration Suicidal thoughts =Criteria: one key, five symptoms in total Plus Significant distress Or Social impairment Exclusions Not mixed episode Not substance related Not organic Not bereavement Not psychotic
ICD-10• Episode must have lasted at least 2 weeks with symptoms nearly every day Change from normal functioning Key symptoms (n 3) Depressed mood Anhedonia Fatigue/loss of energy• Ancillary symptoms (n 7) Weight and appetite change Sleep disturbance Subjective or objective Agitation/retardation Low self- esteem/confidence Self reproach/guilt Impaired thinking/concentration Suicidal thoughts• Criteria: Mild episode: two key, four symptoms in total• Moderate: two key, six symptoms in total• Severe: three key, eight symptoms in total = = Exclusions No history (ever) of manic symptoms Not substance related Not organic
Key points – epidemiology and impact• Depression is a common mental disorder, affecting around 5% of the population over a 12-month period, with around 20% of people likely to experience depression over the course of their lifetime.• Women are nearly twice as likely to experience depression than men, and depression more commonly affects people who are divorced or separated, or who have experienced violence or abuse, as well as those experiencing socioeconomic adversity.• The majority of the disability attributed to mental and neurological disorders in the world is due to depression: nearly 33% as measured by disability-adjusted life- years.• In highand middle-income countries, depression is the leading cause of disability and, primarily due to changes in demographic and disease distribution patterns, its contribution to global disability is projected to increase over future decades.• Depression is related to a range of biological, sociocultural and psychological factors, and though there are strong links between adversity and its onset these events are not necessarily predictive of depression for individuals.• At least half of all people affected by depression experience more than a single episode, and the risk of recurrence increases with each successive episode.
Symptoms of dysthymic disorder• For diagnostic purposes at least two of these symptoms must be experienced for most of the day, for more days than not, for at least 2 years• Disturbed sleep – insomnia or hypersomnia • Poor concentration or difficulty making decisions • Reduced energy or fatigue (anergia)• Disturbed appetite – may be increased or decreased• Feelings of hopelessness or pessimism• Low self-esteem
Features of mixed anxiety and depressive disorder Diagnosis based on the presence of symptoms of anxiety and depression, but neither is clearly predominant Neither type of symptom is present to the extent that justifies a diagnosis if considered separately Symptoms should be present for at least 4 weeks, and result in significant distress or functional impairmentTypical symptoms include those listed below • Anxiety • Persistent nervousness • Palpitations, chest pain, dizziness • Irritability • Fearful anticipation • Excessive alertnessDepression • Sleep disturbance • Fatigue or low energy • Hopelessness or pessimism • Poor concentration • Low self-esteem or feelings of worthlessness
Diagnostic features of bipolar disorder(Mania)A distinct period of abnormally and persistently elevated or irritable mood, lasting at least 1 week (or 4 days for hypomania/ bipolar II disorder)The mood change is severe enough to disrupt normal activitiesSeveral of the following symptoms are present:– inflated self-esteem or grandiosity– decreased requirements for– racing thoughts or flight of ideas– reduced attention or distractibility– increased talkativeness– increased activity levels or agitation– increased involvement in activities that have a risk of adverse consequences (sexual relationships, business ventures, spending sprees)• .
Sleep hygiene activities for improving sleep quality •• A clear routine is important, and a consistent waking time is more important than bedtime: get up at the same time each day, 7 days a week• If you are not asleep after about 20 minutes, go to another room and do something relaxing, such as listening to soothing music, before returning to bed• Keep your bedroom dark, reducing stimulation such as noise; keep the room cooler rather than warmer• Avoid stimulating activity such as heated discussions or work before going to sleep• A regular exercise program helps sleep, but not in the hours prior to bedtime• Avoid caffeine (coffee, tea, cola drinks) within 7 hours of bedtime• Avoid alcohol in the evening, as it can reduce the quality of sleep or make you wake in the night• A light carbohydrate snack before bed may be helpful• Avoid naps; sleep should be reserved for bedtime• A wind-down routine before going to bed (e.g. reading, having a warm bath or listening to music) can make it easier to sleep