Mood disorders are characterized by a sense of loss of control over one's mood and subjective distress. They include conditions like bipolar disorder and recurrent depressive disorder. Bipolar disorder involves alternating periods of mania and depression, while recurrent depressive disorder involves two or more episodes of major depression. Core features of mania include elevated or irritable mood, increased speech, decreased need for sleep, and increased psychomotor activity, while depression is marked by depressed mood, anhedonia, and loss of energy. Treatment involves mood stabilizers, antipsychotics, benzodiazepines, antidepressants, or electroconvulsive therapy. Prognosis depends on factors like age of onset, duration of episodes, and presence of psych

1. MOOD
DISORDERS

2. EMOTIONS
AFFECT: MOOD:
Short-lived, emotional Sustained and pervasive
Response to an event

3.  Healthy persons experience a wide range of
moods and have a large repertoire of emotional
expressions, feel in control
 Mood disorders are a group of clinical conditions
which are characterized a by sense of loss of
control over one’s mood and subjective sense of
distress, impaired interpersonal, social and
occupational functioning

4. History
 Hippocrates (400 B.C.) used the terms mania
and melancholia to describe mental
disturbances
 Roman physician (30 A.D.) described
melancholia as depression caused by black bile

5.  In 1854, Jules Farlet described a condition
called folie circulaire: alternating moods of
depression and mania
 In 1899, Emil Kraepelin described manic-
depressive psychosis using most of the criteria
that psychiatrists use now

6. CLASSIFICATION
 Manic Episode
 Depressive Episode
 Bipolar Affective Disorder
 Recurrent Depressive Disorder
 Persistent Mood Disorder (cyclothymia
and dysthymia)

7. Mania: Clinical Features
 Core features
 Elevated/irritable mood
 Increased speech
 Decreased need for sleep
 Increased psychomotor activity
 Psychotic features
 Delusions
 Hallucinations
 Others
7

8. 1. Elevated/ irritable mood:
o Euphoria/ Grade 1: mild elevation of mood, increased
sense of psychological well being and happiness, not in
keeping with ongoing events
o Elation/ Grade 2: moderate elevation of mood, feeling of
confidence and enjoyment, along with increased
psychomotor activity
o Exaltation/ Grade 3: severe elevation of mood, intense
elation with delusions of grandiosity
o Ecstasy/ Grade 4: very severe elevation of mood,
intense sense of rapture or blissfulness
8

9. 2. Increased speech
o Volubility
o Acceleration
o Pressured speech- difficult to interrupt
o Flight of ideas- shift from topic to topic with
cues
o Prolixity- ordered flight of ideas
3. Increased psychomotor activity
o Over activity/ restlessness
o Excitement
o Stupor
9

10. 4. Psychotic symptoms
 Delusions: grandiose, love, persecutory
 Hallucinations

11. 5. Other symptoms
o Over religiosity
o Over spending/ expansive ideas
o Over familiarity/ disinhibition
o Appearance
o Appetite may be increased, but decreased
food intake due to over-activity
o Decreased need for sleep

12. Psychiatric Interview
 http://www.youtube.com/watch?v
=zA-fqvC02oM&feature=relmfu

13. DEPRESSIVE EPISODE: Clinical
Features
1. Depressed Mood:
 Pervasive and persistent sadness
 Quantitatively and qualitatively different from
sadness encountered in normal depression or
grief
 Varies little from day to day and is often
unresponsive to environmental stimuli

14. 2. Anhedonia:
 Loss of interest or pleasure in almost all
activities/ earlier pleasurable activities
 Results in social withdrawal
 Decreased ability to function in occupational and
interpersonal areas

15. 3. Anergia:
 Easy fatigability
 Increased effort to perform simple tasks

16. 4. Depressive ideation:
 Hopelessness
 Helplessness
 Worthlessness
 Feelings of guilt
 Death wishes
 Suicidal ideas

17. 5. Psychomotor Activity:
 Younger patients (less than 40): slowed thinking and
activity, decreased energy, monotonous voice
 Older patients: agitation, marked anxiety, restlessness
 Severe depression: stupor

18. 6. Biological functions/ somatic syndrome:
 Insomnia
 Loss of appetite and weight
 Loss of sexual drive
 Early morning awakening (atleast 2 hrs)
 Diurnal variation

19. 7. Psychotic Symptoms:
 Delusions of guilt, nihilism, poverty
 Hallucinations

20. Other symptoms
 Difficulty in concentration
 Forgetfulness
 Low self-esteem
 Decreased self-confidence

21. Psychiatric Interview
 http://www.youtube.com/watch?v
=4YhpWZCdiZc

22. Bipolar affective disorder
 Characterized by repeated episodes of disturbed
mood and activity levels
 Disturbance consisting of elevation of mood,
increased energy and activity on some occasion
and on others of low mood, decreased energy
and activity
 Recovery is usually complete in between the
episodes
22

23. Recurrent Depressive Disorder
 Recurrent (at least 2 depressive episodes) of
unipolar depression
 First episode occurs later than in bipolar, usually
in the 5th decade
 Episodes last between 3 to 12 months
 Recovery is usually complete
 Often precipitated by stressful life events

24. Persistent Mood Disorders
 Persistent mood symptoms lasting for more than 2 years
 Not severe enough to be labeled as even hypomanic or
mild depressive
 Persistent mild depression: dysthymia
 Persistent instability of mood between depression and
mania: cyclotymia

25. Next Class
 Course and Prognosis
 Epidemiology
 Treatment
 Differential Diagnosis
 Co-morbidities
 Other syndromes of depression and mania

26. Psychiatric Interviews
 http://www.youtube.com/watch?v
=4YhpWZCdiZc
 http://www.youtube.com/watch?v
=zA-fqvC02oM&feature=relmfu

27. Course and Prognosis
 Average manic episode lasts for 3-4 months
 Average depressive episode lasts for 4-6
months
 Unipolar depression is usually longer than
bipolar depression
 As age advances, intervals between 2 episodes
shorten; duration and frequency increases

28. Epidemiology
Prevalence
Annual incidence is <1%, milder forms often
missed
Sex ratio
Equal prevalence among men and women
Manic episodes more common in men and
depressive episodes more common in women
28

29. Age of onset
Onsetearlier than depressive episode
Ranges from 5-50yrs; mean age 30yrs
Marital status
More common in divorced and single persons
Socioeconomic status
Higher than average incidence among upper
socioeconomic status
29

30. Classification
 Bipolar type 1- having clinical course of
one or more manic episodes and major
depressive episodes
 Bipolar type 2 – characterized by episodes
of major depression and hypomania
30

31. Diagnosis- ICD 10 criteria
 Hypomania- lesser degree of mania
o Persistent mild elevation of mood- euphoria
o Marked feelings of well being and efficiency
o Increased energy and activity
o Decreased need for sleep
o Increased sociability and talkativeness
o Not leading to severe disruption of work or
social rejection
o Present for several days on end (4 days)
31

32.  Mania without psychotic symptoms
o Last for at least 1wk
o Severe enough to disrupt ordinary work and
social activities
o Elated mood
o Increased energy with over activity
o Pressured speech
o Decreased need for sleep
o Marked distractibility
o Disinhibited, overspending
o Expansive ideas
32

33.  Mania with psychotic symptoms
o More severe form
o Delusions- grandiose and/or persecutory
o Perceptual abnormalities
o Severe and sustained physical activity,
excitement
o Flight of ideas, incoherence
o Impaired personal care
33

34. Etiology
Biological theories
2.Genetic factors
3.Neurotransmitter theories- inconsistent
o Dopamine- raised in mania and vice versa
4.Neuroendocrine theories
o CSF somatostatin- raised in mania and vice
versa
5.Neuroimaging and anatomy
o Regions involved in regulation of normal
emotions- PFC, antr cingulate, hippocampus,
amygdala 34

35. Contd-
Psychosocial theories
2.Life events and stress
o Play a formative role in depression;
precipitating in mania
o More often precede first rather than the
subsequent episodes
35

36. Course
 Most often first episode is depression
 Average manic episode lasts 3-4mnths
and depressive episodes 4-6mnths
 Long term follow up- 15% are well, 45%
are well with multiple relapses, 30% in
partial remission, 10% are chronically ill
36

37. Treatment
 Pharmacological- Acute- Mood stabilizers
Antipsychotics
Benzodiazapines
Antidepressants
ECTs
Prophylaxis- Mood
stabilizers
 Non pharmacological- Psycho education
CBT
Interpersonal 37

38. Contd-
Mood stabilizers
Lithium- exact mechanism of action
unknown
Indications- acute mania
prophylaxis of unipolar
and
bipolar disorder
adjuvant to
antidepressant
impulsive/ aggressive
behavior 38

39. Contd-
Precautions- RFT, TFT, ECG
Adverse effects- CNS- tremors,
seizures,
cognitive impairment,
delerium
Renal- DI, polyurea, dypsia
CVS- hypokalemia- T wave
Abnormal thyroid function
GI- nausea, diarrhoea
Skin- acne, psoriasis
39

40. Contd-
 Sodium valproate- acute mania,
prophylaxis
750-2500mg/day
rapid onset of
response
 Carbamazepine
 Oxcarbazepine
 Lamotrigine- depression, prophylaxis; skin
 Topiramate
40

41. 41

42. Summary
 Clinical features- 4 core features
psychotic features
others
 Management- pharmacological- acute
prophylaxis
non-pharmacological
42

43. Poor prognostic factors
 Young onset
 Longer duration of episodes
 Presence of psychotic features
 Inter episode depressive features
 Premorbid poor occupational status
 Comorbid medical and psychiatric
problems
43

44. Etiology
Biological theories
2.Genetic factors
o 3 fold increase in biological relative
o Increased concordance rate for monozygotic
twins
o Chromosome 18, 21, 22
4.Neurotransmitter theories- inconsistent
o Serotonin and norepinephrine- depression
o Dopamine- reduced in depression and
increased in mania 44

45. Contd-
1. Neuroendocrine theories
o Elevated HPA activity, hypothyroidism-
depression
o CSF somatostatin- raised in mania and vice
versa
3. Neuroimaging and anatomy
o Regions involved in regulation of normal
emotions- PFC, antr cingulate, hippocampus,
amygdala
o Ventricular enlargement 45

46. Contd-
Psychosocial theories
•Psychoanalytic theory- mania as defense
against underlying depression
•Life events and stress
o Play a formative role in depression;
precipitating in mania
o More often precede first rather than the
subsequent episodes
6.Cognitive theory- depression
46

47. Course
 Most often first episode is depression
 10-20% experience only manic episodes
 Manic episodes typically have rapid onset
 Average manic episode lasts 3-4mnths
and depressive episodes 4-6mnths
 Long term follow up- 15% are well, 45%
are well with multiple relapses, 30% in
partial remission, 10% are chronically ill
47