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MOOD DISORDERS
-NANDU KRISHNA J
• Pervasive and sustained feeling tone
• That is experienced internally
• That influences a person’s behavior and
percepti...
• Mood disorders - are a group of clinical conditions
characterized by
• Loss of that sense of control
• A subjective expe...
• Unipolar disorders or Major Depressive disorder
(with only major depressive episodes)
• Bipolar disorders(with both mani...
• occurs without a H/O manic, mixed, hypomanic
episode.
• must last at least 2 weeks
• experiences two major symptoms
-dep...
• And also experiences at least four symptoms that
includes:
-changes in appetite and weight,
-changes in sleep and activi...
Incidence and Prevalence
• prevalance 5-17%
• 10-20% of chronically ill medical outpatients
Sex
• Women : Men = 2:1
Age
• ...
Marital status
• Poor interpersonal relationships
• Divorced or separated
Socioeconomic and cultural factor
• No correlati...
BIOLOGIC THEORIES
• Neurochemical factors
• Norepinephrine and Serotonin
• sensitivity of β-adrenergic receptors and
clini...
• Genetic factors
To identify specific susceptibility genes using
the molecular genetic methods.
• Endocrine-HPA axis
» HP...
• Immunological disturbance
lymphocyte proliferation; which
produce CRF and IL-1.
• Structural functional brain imaging
ab...
PSYCHOSOCIAL THEORIES
• Psychoanalytic theory:
loss of loved object
• Behavioral theory:
experience of uncontrollable
even...
Depression with specific features ie; specifiers are:
• Mild, moderate and severe
• Single episode or recurrent
• Chronic
...
• Severity: Mild, Moderate, or Severe level of
functional impairment
• Single episode: single episode of major depression
...
• With psychotic features – accompanied by
delusions or hallucination.
• With catatonic features – includes motor activity...
• Psychological tests
• Dexamethasone suppression test
• Toxicology screening test
• ICD 10 criteria
Treatment directed towards several goals
• First, the patient’s safety must be guaranteed
• Second, a complete diagnostic ...
Hospitalization: first and critical decision
» risk of suicide or homicide
» grossly reduced ability to get food and shelt...
• Psychotherapy
• Pharmacotherapy
• Physical therapy
TRICYCLIC ANTIDEPRESSANTS
Amitriptyline(75-150 mg daily), Imipramine(75-
150 mg daily), Clomipramine (75-150 mg daily)
• M...
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
citalopram (20-40 mg daily), fluoxetine (20-60
mg daily), sertaline (50-100 mg dai...
MONOAMINE OXIDASE INHIBITORS (MOAIs)
phenelzine (45-90 mg daily), tranylcypromine
(20-40 mg daily), moclobemide (300-600 m...
OTHER ANTIDEPRESSANTS
• Venlafaxine (75-375 mg daily)
• SNRIs(<150 mg)and SSRIs(>150 mg)
• Contraindicated in children and...
Physical therapies
• Electroconvulsive; Vagal nerve stimulation
• Photo therapy
• Repetitive transcranial magnetic stimula...
TCA OR SSRI
Depending on physician preference
Failed trial due to response or
rate-limiting adverse effect
Partial
respons...
Good prognostic factors
• Abrupt or acute onset
• Severe depression
• Typical clinical features
• Well adjusted pre-
morbi...
• A hypomanic episode:
lasts at least 4 days similar to a manic episode
except that it is not sufficiently severe to cause...
• Bipolar I disorder
-clinical course of one or manic episodes and,
sometimes, major depressive episode.
• Mixed episode
-...
Incidence and Prevalence
a lifetime prevalence of 1-2%
Sex
Women : Men ratio 1:1 (BPD1)
Age
Mean age of BPD is 20 years
ie...
• Neurotransmitters and structural hypothesis
excessive levels of norepinephrine and
dopamine, decreased serotonin
• Genet...
• Core features
- elevated/irritable mood includes
euphoria(grade 1), elation(grade 2),
exaltation(grade 3), ecstasy(grade...
• Psychotic features
-delusions
-hallucinations
• Other symptoms
-over religiosity
-over spending/expansive ideas
-over fa...
Somatic treatment
• Antidepressants enhanced
by a mood stabilizer
• Lithium carbonate (serum level 0.5-1.0 mmol/L)
• Antip...
Psychosocial treatment
• Cognitive therapy
• Interpersonal therapy
• Psychoanalytic psychotherapy
• Behavior therapy
• Gro...
Other mood disorders include:
• Cyclothymia
• Dysthymia
• Depressive disorder not otherwise specified
Minor depressive dis...
Mood disorders:major depressive and bipolar disorder
Mood disorders:major depressive and bipolar disorder
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Mood disorders:major depressive and bipolar disorder

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a basic description about mood disorders mainly MDD and bipolar disorder. Can be made useful in presentations and theory exams. Subject was imbibed from different presentations and DSM IV manual. Thanks for viewing.

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Mood disorders:major depressive and bipolar disorder

  1. 1. MOOD DISORDERS -NANDU KRISHNA J
  2. 2. • Pervasive and sustained feeling tone • That is experienced internally • That influences a person’s behavior and perception of the world. • Distinguished from affect – the external expression of mood.
  3. 3. • Mood disorders - are a group of clinical conditions characterized by • Loss of that sense of control • A subjective experience of great distress. • Importance : virtually always impair interpersonal, social and occupational functioning Elevated mood Depressed mood Others expansiveness Lack of energy / interest Change in activity level Flight of ideas Feeling of guilt Change in cognitive abilities Decreased sleep Difficulty of concentration Change in speech Grandiose ideas Loss of appetite Change in biological functions Thoughts of death/ suicide
  4. 4. • Unipolar disorders or Major Depressive disorder (with only major depressive episodes) • Bipolar disorders(with both manic and depressive episodes/ with manic episodes alone) Three additional categories of mood disorders • Cyclothymia(less severe form of BPD) • Dysthymia (less severe form of UPD) • Hypomania (episode of manic symptoms that does not meet the DSM-IV-TR criteria for manic episode)
  5. 5. • occurs without a H/O manic, mixed, hypomanic episode. • must last at least 2 weeks • experiences two major symptoms -depressed mood -loss of interest or pleasure
  6. 6. • And also experiences at least four symptoms that includes: -changes in appetite and weight, -changes in sleep and activity, -psychomotor agitation or retardation, -lack of energy, -feelings of worthlessness or inappropriate guilt, -problems thinking and making decisions, -recurring thoughts of death or suicide.
  7. 7. Incidence and Prevalence • prevalance 5-17% • 10-20% of chronically ill medical outpatients Sex • Women : Men = 2:1 Age • Mean age of MDD: 40 years but recently, the incidence of MDD is increasing in <20 years of age –(alcohol and drug abuse)
  8. 8. Marital status • Poor interpersonal relationships • Divorced or separated Socioeconomic and cultural factor • No correlation for MDD Comorbidity • Increased risk of having one or more additional comorbid Axis I disorders like alcohol abuse or dependence, panic disorder, obsessive compulsive disorder, social anxiety disorder. • Worsen the progress and increase the risk of suicide
  9. 9. BIOLOGIC THEORIES • Neurochemical factors • Norepinephrine and Serotonin • sensitivity of β-adrenergic receptors and clinical antidepressant responses direct role • Depletion of serotonin depression • SSRIs are effective in the treatment of depression. • Dopamine ; Acetylcholine (Ach) ; Gamma- Aminobutyric acid (GABA)
  10. 10. • Genetic factors To identify specific susceptibility genes using the molecular genetic methods. • Endocrine-HPA axis » HPA activity; hallmark of stress responses » Hypercortisolemia suggests central disturbances • Alteration in the sleep neurophysiology » premature loss of deep (slow wave) sleep » nocturnal arousal » REM latency, which persist after recovery of a depressive episode.
  11. 11. • Immunological disturbance lymphocyte proliferation; which produce CRF and IL-1. • Structural functional brain imaging abnormal hyper densities • Neuroanatomical considerations mood disorders involve pathology of brain mainly in regions like prefrontal cortex, anterior cingulate,hippocampus and the amygdala.
  12. 12. PSYCHOSOCIAL THEORIES • Psychoanalytic theory: loss of loved object • Behavioral theory: experience of uncontrollable events • Cognitive theory: negative expectations SOCIOLOGICAL THEORY • Stressful life events
  13. 13. Depression with specific features ie; specifiers are: • Mild, moderate and severe • Single episode or recurrent • Chronic • With melancholic features • With psychotic features • With catatonic features • With atypical features • With postpartum onset • With seasonal pattern
  14. 14. • Severity: Mild, Moderate, or Severe level of functional impairment • Single episode: single episode of major depression • Recurrent: 2 or more episodes of major depression • Chronic: full criteria for a major depressive episode have been met continually for at least the past 2 years • With melancholic features – severe depression with lack to do something that used to bring pleasure and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt, agitation.
  15. 15. • With psychotic features – accompanied by delusions or hallucination. • With catatonic features – includes motor activity that involve either uncontrollable and purposeless movement or fixed and inflexible posture. • With atypical features – includes the ability to be cheered by happy events, increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in arms or legs. • With peripartum onset • With seasonal pattern – related to changes in seasons and reduced exposure to sunlight
  16. 16. • Psychological tests • Dexamethasone suppression test • Toxicology screening test • ICD 10 criteria
  17. 17. Treatment directed towards several goals • First, the patient’s safety must be guaranteed • Second, a complete diagnostic evaluation of the patient is necessary • Third, a treatment plan that addresses not only immediate symptoms but also the patients prospective well-being should be initiated.
  18. 18. Hospitalization: first and critical decision » risk of suicide or homicide » grossly reduced ability to get food and shelter » the need for diagnostic procedures » history of rapidly progressing symptoms » rupture of patient’s usual support system
  19. 19. • Psychotherapy • Pharmacotherapy • Physical therapy
  20. 20. TRICYCLIC ANTIDEPRESSANTS Amitriptyline(75-150 mg daily), Imipramine(75- 150 mg daily), Clomipramine (75-150 mg daily) • MOA: They inhibit the re-uptake of the amines norepinephrine and serotonin at synaptic clefts. • SIDE EFFECTS mainly sedation, anticholinergic effects, postural hypotension, lowering of the seizure threshold and cardiotoxicity. • TCAs may be dangerous in overdose and in people who have coexisting heart disease, glaucoma and prostatism. Pharmacotherapy
  21. 21. SELECTIVE SEROTONIN REUPTAKE INHIBITORS citalopram (20-40 mg daily), fluoxetine (20-60 mg daily), sertaline (50-100 mg daily) • These are less cardiotoxic and sedative than TCAs, and fewer anticholinergic effects. • They are safer in overdose, but can still cause headache, nausea, anorexia and sexual dysfunction. • Interact with other drugs increasing serotonin to produce serotonin syndrome.
  22. 22. MONOAMINE OXIDASE INHIBITORS (MOAIs) phenelzine (45-90 mg daily), tranylcypromine (20-40 mg daily), moclobemide (300-600 mg daily) • MOA: These drugs increase the availability of NTs at synaptic clefts by inhibiting metabolism of NE and serotonin. • They can cause potentially dangerous interactions with drugs such as amphetamines, and foods rich in tyramine such as cheese and red wine called cheese reaction. • This is due to accumulation of amines on the systemic circulation, causing a potentially fatal hypertensive crisis.
  23. 23. OTHER ANTIDEPRESSANTS • Venlafaxine (75-375 mg daily) • SNRIs(<150 mg)and SSRIs(>150 mg) • Contraindicated in children and adolescents • S/E include hypertension above 150 mg dose, glaucoma, • Mirtazapine (15-45 mg daily) • Noradrenergic and specific serotonergic antidepressant (NaSSA) • Superior to SSRIs and SNRIs • S/E include weight gain, somnolence, excess sedation, dry mouth.
  24. 24. Physical therapies • Electroconvulsive; Vagal nerve stimulation • Photo therapy • Repetitive transcranial magnetic stimulation Three short term psychotherapies • Cognitive psychotherapy • Interpersonal psychotherapy • Behavior therapy Other therapies include • Psychoanalytic therapy • Marital and family therapy Psychosocial therapies
  25. 25. TCA OR SSRI Depending on physician preference Failed trial due to response or rate-limiting adverse effect Partial response Cross to alternative agent (TCA or SSRI) Either switch to alternative agent or attempt augmentation Failed trial Trial of second line agent with evidence of activity in TCA nonresponders. Alternatively treat with ECT. Full remission Maintain as described above Maintain treatment for at least 4-6 months in case of first time episode; longer in case of recurrent disease Full remission Algorithm for treating patient with MDD Uncomplicated, physically healthy outpatient without any contraindication to a specific class of antidepressant
  26. 26. Good prognostic factors • Abrupt or acute onset • Severe depression • Typical clinical features • Well adjusted pre- morbid personality • Good response to treatment Poor prognostic factors • Double depression • Co-morbid physical disease, personality disorders or alcohol dependence • Chronic ongoing stress • Poor drug compliance • Marked mood incongruent features
  27. 27. • A hypomanic episode: lasts at least 4 days similar to a manic episode except that it is not sufficiently severe to cause impairment in social or occupational functioning, and no psychotic features are present. • A manic episode: is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1 week(or less if the patient is hospitalized)
  28. 28. • Bipolar I disorder -clinical course of one or manic episodes and, sometimes, major depressive episode. • Mixed episode -a period of at least 1 week in which both a manic episode and a major depressive episode occur almost daily. • Bipolar II disorder -a variant of bipolar disorder characterised by episodes of major depression and hypomania rather than mania
  29. 29. Incidence and Prevalence a lifetime prevalence of 1-2% Sex Women : Men ratio 1:1 (BPD1) Age Mean age of BPD is 20 years ie; late adolescent or early adulthood (18 for BPD 1 and 22 for BPD 2) Socioeconomic and cultural factors BPD 1: upper socioeconomic group
  30. 30. • Neurotransmitters and structural hypothesis excessive levels of norepinephrine and dopamine, decreased serotonin • Genetic considerations • Psychodynamic theories: faulty family dynamics
  31. 31. • Core features - elevated/irritable mood includes euphoria(grade 1), elation(grade 2), exaltation(grade 3), ecstasy(grade 4). - increased speech associated with volubility, acceleration, pressured speech-difficult to interrupt - decreased need for sleep - increased psychomotor activity like over activity / restlessness, excitement, stupor.
  32. 32. • Psychotic features -delusions -hallucinations • Other symptoms -over religiosity -over spending/expansive ideas -over familiarity/ disinhibition -appearance
  33. 33. Somatic treatment • Antidepressants enhanced by a mood stabilizer • Lithium carbonate (serum level 0.5-1.0 mmol/L) • Antipsychotics like olanzapine, haloperidol, quetiapine and risperidone • Other drugs like sodium valproate, carbamazepine, benzodiazepine
  34. 34. Psychosocial treatment • Cognitive therapy • Interpersonal therapy • Psychoanalytic psychotherapy • Behavior therapy • Group therapy • Family and marital therapy
  35. 35. Other mood disorders include: • Cyclothymia • Dysthymia • Depressive disorder not otherwise specified Minor depressive disorder Recurrent brief depressive disorder Postpsychotic DD of schizophrenia Premenstrual dysphoric disorder • Bipolar disorder not otherwise specified Mixed anxiety-depressive disorder Atypical depression

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