psychiatry -mood disorders

1. Mood disorders
S. Anusha
M.Sc (N) Lecturer

2. • Affect : which is a short-lived emotional
response to an idea or an event.
• Mood : which is a sustained and pervasive
emotional response which colors the whole
psychic life .

3. Classification
Acc. to ICD-10
• F 30 - Manic episode
• F31 – Bipolar mood (affective) disorder
• F 32– Depression episode
• F 33– Recurrent depressive disorder
• F 34– Persistent mood disorder (including
cyclothymia & dysthymia)
• F 38– Other mood disorders ( including mixed
affective & recurrent brief depressive disorder)

4. etiology
• Biological theories : 1. Genetics
• Biochemical theories :
 excessive levels of nor-epinehrine and dopamine .
 Imbalance between cholinergic and noradrenaline.
• Brain imaging :
 Lesions in the brain area
 White matter intensite
 Dilation of ventricles
 Changes in the blood flow and metabolism

5. • Neuro - endocrine theories: hypothroidism
• Psychosocial theories :
 Psycho family dynamics during early life are
responsible are manic behavior in later life.
 Dynamic theories : stress
 Cognitive & behavioral theories : learned behavior

6. mania
Definition :-
it is a syndrome in which the control features
are elevated (or) irritable mood with acceleration of
thoughts and action.

7. Incidence & course
• Life time risk of manic episode about 0.8 – 1%
• Episode last for 3 – 4 months followed by complete
recovery
• Future episodes may be Mania, Depression (or)
Mixed.

8. Classification of mania icd-10
• F30 – manic episode
• F 30.0– hypomania
• F 30.1– mania without psychotic symptoms
• F 30.2– mania with psychotic symptoms

9. Types of Mania
Hypomania
Acute mania
Chronic
mania
Delirious
mania

10. Psychopathology
Precipitating event
Predisposing
factors,
Genetic influence
Family history of bipolar disorder
Past episode of mania,
Electrolyte imbalance,
Cerebral lesion
Past exp.,
Existing cond.,

11. Cognitive appraisal
primary
Threat to (or) loss of self esteem
secondary
Defense mechanism : denial,
regression, reaction formation
Quality of response

12. Adaptive Maladaptive
Denial of
depression
Symptoms of
mania

13. Signs & symptoms
4 stages of elevated mood :
• Euphoria : increased sense of psychological
wellbeing & happiness not in keeping with ongoing
events
• Elation : moderate elevation of mood with increased
psychomotor activity
• Exaltation : intense elation of mood with delusions of
grandeur
• Ecstasy : severe elevation of mood intense sense of
rapture or blissfulness seen in delirious or stuporous
mania

19. Delirious mania
• Extreme hyperactivity
• Dehydration
• Severe weight loss
• Decreased immunity & fever
• May even lead to death if not treated

23. Depression

40. Psycho-pharmacology

43. Psychotherapy

46. prognosis

48. Nursing management

50. Bipolar disorder

51. • Introduction :
Bipolar mood or affective disorder is
characterized by recurrent episodes of mania
and depression in the same patient at different
times.
Earlier known as manic depressive
psychosis (MDP)

52. • Definition :
it is a brain disorder that cause unusual
shifts in a person’s mood energy & ability to
function. It is a long term illness which has to
be carefully managed throughout a person’s
life.

53. Incidence & prevalence
• 3-4/1000 population
• 3:2 male: female
• Observed more in : high social classes,
unmarried, widowhood, professionals
• Age : 20-35 yrs (mania)
35-50 yrs (depression)
0.6%-2% for both men and woman

54. Etiology
• Etiology is not known.
• Theories: biological factors
• • Genetic hypothesis
• • Biochemical theories
• • Neuroendocrine theories
• • Sleep studies
• • Brain imaging
• Social factors

55. Genetic hypothesis
• The life-time risk for the first degree relatives
getting bipolar disorder is 25%.
• Children with one parent having bipolar
disorder has a risk of 27% of life time risk,
children with both parents having bipolar
disorder is 74%.
• The risk in monozygotic twins is 65% and
dizygotic twins is 20%.

56. Biochemical theories
• Catecholamine's abnormality (norepinephrine,
dopamine and serotonin) in one or more sites
at brain.
• Acetyl choline and GABA may also play a
role.
• The effects of antidepressants and mood
stabilizers also provide additional evidence.

57. Neuroendocrine theories
• Mood symptoms are prominently present in
endocrine disorders like hypothyroidism,
Cushing’s disease, and Addison’s disease.

58. Sleep studies
• In depression, decreased REM latency (i.e.,)the
time between falling asleep and the first REM
period is decreased).
• Increased duration of the first REM period.
• Delayed sleep onset.

59. Brain imaging
• CT scan, MRI scan of brain, PET scan and
SPECT have yielded inconsistent, but
suggestive findings.
• Findings include ventricular dilatation, white
matter hyper-intensities, and changes in the
blood flow and metabolism in prefrontal
cortex, anterior cingulate cortex, and caudate.

60. Social factors :
• Stressful life events
• Social pressures
• Rejection of children by parents
• Loss of loved one
• Difficulty in interpersonal relationship
• Financial difficulties
• Unemployment, poor job opportunities

61. • Failures in life
• Maladaptive behavior
• Unhealthy comparison
• Parental influence
• Trying to escape from reality
• Uncontrollable events

62. Types
• Bipolar I: Characterized by episodes of
severe mania and severe depression.
• Bipolar II: Characterized by episodes of
hypomania (not requiring hospitalization)and
severe depression.

63. Clinical features
• Depression Form:
- constantly feeling sad or worthless
- sleeping too much or too little
- feeling tired and having little energy
- appetite and weight changes
- problems focusing
- thoughts of suicide

65. • Manic Form:
- increase in energy level
- less need for sleep
- easily distracted
- nonstop talking
- increased self confidence
- focused on getting things done, but does not
accomplish much
- is involved in risky activities even though bad
things may happen

66. A current episode can be
• Hypomanic
• Manic without psychotic symptoms
• Manic with psychotic symptoms
• Mild or moderate depression
• Severe depression without psychotic symptoms
• Severe depression psychotic symptoms
• Mixed or In remission

67. Prognostic factors
Good prognostic factors
• Acute or abrupt onset
• Typical clinical features
• Severe depression
• Well adjusted premorbid personality
• Good response to treatment

68. Poor prognostic factors
• Co-morbid medical disorders, personality
disorders or alcohol dependence
• Double depression
• Catastrophic stress or chronic ongoing stress
• Unfavourable early environment
• Marked hypochondriacal features, or mood
incongruent psychotic features
• Poor drug compliance

69. Psychopharmacology
• Antidepressants
• ECT
• Lithium
• Antipsychotics
• Other mood stabilizers

70. Nursing management
• High risk for violence
• Alteration in mood pattern
• Ego deficit ( lack of confidence)
• Variation in life style pattern
• Altered concentration and attention
• Impaired cognition (inc. sensitivity)
• Impaired communication and socialization
• Altered nutrition
• Altered sleep pattern

71. Dysthymia

72. • It is a sub-clinical psychotic condition.
• It is derived from 2 Greek words, “dys” means
“abnormal (or) disordered”, “thymia” means
“interpretation (or) feelings”.

73. • Dysthymia is a form of mood disorder in
which chronic mild neurotic / reactive
depression exists atleast for 2 years. It is also a
paradoxical disorder, which fairly exhibits
mild symptoms on a day-to-day basis.
However, over a lifetime it can have severe
effects.

74. incidence
• Common in women
• Age of onset is last third decade
• 5% of general population will be affected

75. Etiology
• Psychological factors : personality defects, ego
disintegration
• Internal conflicts
• Interpersonal disturbances
• Disappointments in life
• threatened loss in adult life
• Disparity between real & fantasized situations.

76. Clinical features
• Duration of symptoms
ranging 2mnth-2yrs.
• Depressed mood
• Insomnia
• Fatigue
• Poor self image
• Decreased concentration
• Anhedonia
• Psychomotor
retardation
• Decreased sexual
urge
• Feels hopelessness,
worthlessness,
helplessness

77. Therapies
Psycho therapy
• Cognitive therapy
• Behavioral therapy
• Interpersonal therapy
• Alternative therapy
• Meditation
• Yoga
• Relaxation exercises
• Acupunture
• Herbal medicine

78. Complications
• Work impairment
• Suicide
• Social problems like divorce, social isolation,
unemployment.

79. cyclothymia

80. • It is a milder form of biploar II disorder
consists of recurrent mood disturbances
between episodes of hypomania &
dysthymic mood ( mild depression)

81. Prevalence
• Early onset – late teenage or 20’s
• Life time risk 0.4-1%
• Equal in both sexes ( but woman seeks
treatment)

82. causes
• Genetic factor: both mono and dizygotic twins.
• Psychosocial factor: stressful events
faulty life events
interpersonal difficulities
loss
marital difficulities
unprovoked
disagreement with family & co-workers.

83. Clinical features
• Mood swings unrelated to life events.
• Irritable.
• Lack of control on mood.
• Rapid, abrupt changes in mood.
• Social and Personal dysfunctioning.
• Work impairment.