This document provides a history and overview of mood disorders including depression and bipolar disorder. It discusses epidemiology and prevalence, psychological and cognitive models, clinical features, diagnosis and classification in DSM and ICD systems, brain structural changes found in studies, associations with medical conditions like diabetes and issues in the elderly, and management approaches including psychological, pharmacological, and physical treatments. The pharmacological approaches cover treatment of unipolar and bipolar disorders with various antidepressants and mood stabilizers.
Bipolar disorder, also known as bipolar affective disorder (and originally called manic-depressive illness), is a mental disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis.
Bipolar disorder, also known as bipolar affective disorder (and originally called manic-depressive illness), is a mental disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis.
Bipolar disorders in DSM-5: strengths, problems and perspectivesLena Setianingsih
International Journal of Bipolar Disorders
Bipolar disorders in DSM-5: strengths, problems and perspective
Source :http://www.journalbipolardisorders.com/content/1/1/12
The recognition of bipolar disorder in primary careNick Stafford
Bipolar disorder and the complexities of screening and diagnosis in primary care. How more accurate detection and an integrated care pathway with secondary care can improve the diagnosis and outcome of the treatment of the disorder.
Social, Cultural and Ethnic Aspects of Mood DisordersImran Waheed
A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham
Bipolar depression: Diagnosis and TreatmentScott Eaton
Differentiating Depression in Bipolar Affective Disorder, Unipolar Depression and Borderline Personality Disorder.
How to treat this depression following the new CANMAT 2013 guidelines.
Mood disorders, also known as affective disorders, are a category of mental health conditions characterized by significant changes in mood that affect a person's daily functioning, emotions, and overall quality of life. There are several types of mood disorders, with the most common being depression and bipolar disorder. this ppt contains mood disorders which is useful for the students of Basic B.Sc. Nursing.
Bipolar disorders in DSM-5: strengths, problems and perspectivesLena Setianingsih
International Journal of Bipolar Disorders
Bipolar disorders in DSM-5: strengths, problems and perspective
Source :http://www.journalbipolardisorders.com/content/1/1/12
The recognition of bipolar disorder in primary careNick Stafford
Bipolar disorder and the complexities of screening and diagnosis in primary care. How more accurate detection and an integrated care pathway with secondary care can improve the diagnosis and outcome of the treatment of the disorder.
Social, Cultural and Ethnic Aspects of Mood DisordersImran Waheed
A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham
Bipolar depression: Diagnosis and TreatmentScott Eaton
Differentiating Depression in Bipolar Affective Disorder, Unipolar Depression and Borderline Personality Disorder.
How to treat this depression following the new CANMAT 2013 guidelines.
Mood disorders, also known as affective disorders, are a category of mental health conditions characterized by significant changes in mood that affect a person's daily functioning, emotions, and overall quality of life. There are several types of mood disorders, with the most common being depression and bipolar disorder. this ppt contains mood disorders which is useful for the students of Basic B.Sc. Nursing.
Running head BIPOLAR DISORDERBIPOLAR DISORDER9Page numb.docxsusanschei
Running head: BIPOLAR DISORDER
BIPOLAR DISORDER 9
Page number on page one?
Bipolar Disorder
Bipolar Disorder
Bipolar disorder is a term that is used to describe a mental illness, which has many dDysthymica effects on the mind and the body of its victims. The condition is also known as the manic-depressive disorder. Research that has been conducted shows that the condition is mostly found in young adults and since recently in children as well. Studies have also shown that in the United States alone the condition affects close to 4 million people and is slowly being considered as one of the most common disabilities amongst Americans. Women in their mid-forties are also at a high chance of developing the mental disorder. After developing the mental disease, a typical patient may experience up to ten episodes of other mental disorders in the course of their condition. For women who suffer rapid-cycling, they may experience more manic episodes and depressive episodes that happen after each other without leaving space for remission (National Collaborating Centre for Mental Health, UK, 2006). Comment by Dr. Barnes-Young: How do you know all of these things? Recall from week one course announcements and discussion feedback that a citation is needed every single time you refer to the work of another. Comment by Dr. Barnes-Young: This is not a scholarly source.
The conditionBipolar disorder is characterized by two specific mood swings, namely mania, and depression. These mood swings that almost constantly affect bipolar people can further be divided into three subcategories, namely bipolar I disorder (BD-I), bipolar II disorder (BD-II), and cCylothymia. This The purpose of this paper seeks is to discuss the bipolar disorder in general, as well as summarizeing a short history of the condition, the subcategories of the condition, the symptoms, causes, and treatments of the disease (Miklowitz & Alloy, 2009). Comment by Dr. Barnes-Young: ? What is your source on this? Comment by Dr. Barnes-Young: The disorder is divided into three categories not the mood swings. Comment by Dr. Barnes-Young: What about your case study?
The existence of the bipolar disorder was discovered during the ancient Greek era. The Greeks took it that this type of manic depression disorder was a condition of the blood, choler, phlegm, and black bile. The condition was thought to be associated with human body fluids because these fluids are responsible for homeostatic imbalances within the human body. According to the Greek academics, ensuring that the body was in a homeostatic equilibrium would cause humans to develop a need to purge themselves or release into the blood stream specific amounts and quantities of these fluids. Plato, the scholar, was strongly founded on the belief that the disorder was caused by inspirations such as God, love, and writings. Other scholars slightly agreed with Plato but imagined that the disorder was as a result of environmental factor ...
Bipolar Disorder IIYanetsi AlayonJunior M. PeraltaSt. ThomMerrileeDelvalle969
Bipolar Disorder II
Yanetsi Alayon
Junior M. Peralta
St. Thomas University
NUR 530 Psychopathology
Dr. Seraphin
September 22nd, 2022
Fictitious Patient Case Study
JM is a Hispanic Mexican woman aged 67 years. She has a long history of hypomanic episodes and depression.
For the past 5 years, JM has had variable diagnoses of borderline personality, and major depression.
Most recently she was diagnosed with Bipolar Disorder II.
For the past week, the patient has been experiencing expansive, elevated, and irritable mood that has been present mostly during the day, more severe in the morning, and occurs almost every day.
Although bipolar disorder affects people from different races equally, there is a high incidence of the condition among the Hispanic and Latino population.
2
A review of his symptoms points out that she indeed has had numerous episodes of depression which began about 5 years ago, but more clear hypomanic episodes emerged about a month ago.
Her preeminent personal conflict, and hyper-sexuality during hypomanic episodes resulted in the provisional diagnosis of borderline personality.
Based on the full history of the patient, it is suspected that the patient is having bipolar disorder type 2.
“Since my husband’s death, 5 years ago, I have felt very alienated and lonely,” patient stated.
For the past year, JM has been taking mood stabilizers but continues having lower-level symptoms of depression. Mood stabilizers taken: valproic acid 250 milligrams (mg) 2 times a day.
The condition is normally characterized with depression. The depressive episodes last for about a week. Therefore, symptoms of bipolar disorder are closely related with those of depression. The symptoms often last for days, weeks, months or years.
3
Allergies
Having a history of asthma, the patient is allergic to pollen and cold
Aspirin
Non-steroidal anti-inflammatory drugs, such as ibuprofen, and naproxen.
The patient is also allergic to a class of medication known as beta blockers.
There is a close association between allergies and mental illness. For instance, Asthma increases the risk of bipolar disorder, depression and anxiety.
4
Physical findings and Psychiatric findings
The patient admits feeling depressed and having a diminished interest in almost all activities.
The patient denies an increase in appetite though there is not weight gain.
Excessive guilt
Psychomotor agitation
JM admits feeling a diminished need for sleep
There is clear evidence of distractibility
The patient admits to having suicidal thoughts.
Hypomania is characterized by irritable mood
Vital Signs
BP: 127/82 mmHg.- the condition is associated with a higher risk of cardiovascular death and high blood pressure.
Heart rate (pulse): 88 bpm.
Respiratory rate: 26 breaths per minute.
Temperature: 37 °C
Weight: 92 Kg
Height: 6 feet
BMI: 25
Mild headache.
No labs/diagnostic tests were reviewed.
Bipolar patients are at a greater risk of hyperte ...
Brain fag syndrome,hypochondriasis and conversion disorderDr.Emmanuel Godwin
Brain fag syndrome,hypochondriasis and conversion disorder are forms of somatoform disorder....This are disorders that present with Physical symptoms with an unexplained cause.
Examining the history, classification, causes and treatment of psychological ...Pubrica
What do we think? What do we feel? How do we react to a particular situation?
How do we define it?
How To Examine Whether Someone Is A Patient Of Mental Illness Or Not?
How To Do A Patient’s History Examined Systematically?
The main classes of mental illness :
Cause and Treatment of psychological disorder:
Detailed Information: https://bit.ly/2VGGP1Q
Reference: https://pubrica.com/services/physician-writing-services/
Why pubrica?
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-74248 10299
Related Topics:
Literature gap and future research
Meta-Analysis in evidence-based research
Biostatistics in clinical research
Scientific Communication in healthcare
Depression is a psychological state of mind. It is a major problem faced by most of the people especially the youths. all the reasons why depression is caused what are it's symptoms signs how must the person be treated is explained in this slide
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Mood Disorders
History
Depression was described in most of the Holy
Books.
It was thought to be due to evil spirits or as a
punishment for angering the gods.
Hippocrates (460–377 bc) described melancholia
whom he thought as a brain disorder caused by
excess of black bile.
The concept of melancholia remained for many
centuries with different explanations ranging
from supernatural powers to changes in the
blood.
2
3. Mood Disorders
History
Email kreaplin differentiated manic depressive
illness from dementia praecox. His approach was
mostly Biological while Sigmund Freud and
Adolph Meyer in the middle of the 20th Century
adopted a psychological approach to depression
as introjection of anger towards loved objects.
Deperssion was later classified into endogenous
and neurotic depression, with the endogenous
type thought to be responding to ECT.
3
4. Mood Disorders
History
Hippocrates described Mania too.
Physicians throughout the centuries associated
Melancholy with Mania.
The term Bipolar disorder entered DSM III for
the first time in 1980.
British literature use the term affective disorders.
Psychiatry Volume 8, Issue 4, Pages 107-144
(April 2009)
4
5. Mood Disorders
Epidimiology
The prevalence of mood disorders depend on
the definition applied.
An American study ( National Comorbidity
Survey) found a life prevalence of 20.8% and an
age of onset of 30 years.
Lifetime prevalence of major depression is 4-
19% of the population. It is twice in females as in
males.
Major age of onset is 25-30 years.
5
6. Mood Disorders
Epidimiology
Bipolar I disorder life time prevalence is 1-5%, for
dysthymia is 3-7% and 0.5% for cyclothymia.
The prevalence depends on the classification used .
Major depressive disorder.
Dysthymia
Bipolar disorders.
cyclothymia.
Recurrent brief depressive disorder.
Recurrent brief hypomania.
Schizoaffective disorder.
6
7. Mood Disorders
Epidimiology
Onset is usually insidious for depression and
more acute in mania.
Mood disorders in general are recurrent and
bipolar disorders usually have more episodes
than unipolar disorders.
Long term prognosis of mood disorders in
general is better than that of schizophrenia and
schizoafffective disorder.
7
8. Mood Disorders
Epidimiology
Patients with mood disorders have higher risk of
suicide (15-30)% compared with the general
population.
Mortality from mood disorders especially
depression is greater than in the general
population.
8
9. Mood Disorders
psychological models
Cognitive behavioural models:
Is based on five areas: social, cognitive,
behaviour, physiololgical and mood.
This model is based on the clinical features that
maintain the patient’s current state and interfere
with his improvement.
Social include interpersonal, family, and marital
problems.
Cognitive include negative automatic thoughts
and images, assumptions and schemas.
9
10. Mood Disorders
psychological models
Social model for depressive disorder
In childhood sexual and physical abuse, parental
indifference, loss of a parent. In adults social
isolation, physical illness, unemployment,
women with fulltime work and having three
preschool childern.(Brown and Harris 1980).
Psychodynamic model for depression
Low actual self representation, insecure adult
attachment and primitive superego.
10
11. Cognitive symptoms in mood
disorders
Coginitive disorders are important symptoms in
mood disorders and some of the symptoms may
remain even after remission. Impairments in
memory, decision making are examples.
Cognitive impairments indicate ventromedial
prefrontal area involvement.
The resilience of some pateints who do not
develop mood disorders despite exposure to
adverse environmental events is being studied
to find ways of prevention of mood disorders.
11
12. Mood disorders
clinical features
Depression
There are three groups of symptoms:
emotional symptoms, psychomotor symptoms,
and negative beliefs.
Negative belief such as low self esteem and
inappropriate guilt, feeling of hopelessness,
helplessness and worthlessness.
psychomotor symptoms include reduced
movements, activity, facial expression, decreased
verbal activity and withdrawal, increased activity
such as agitation in the form of hand wringing to
pacing. 12
13. Mood disorders
clinical features
Depression
Affect is a relatively transient state of feeling
depressed, sad or blue.
Chronic depression is diagnosed when it lasts for
more than two years.
Double depression occurs when the patient has
both major depression and dysthymia.
13
14. Mood disorders
clinical features
Mania
The three cardinal symptoms of mania include:
emotions, psychomotor symptoms, and expansiveness
or increased self-esteem.
The symptoms in hypomania are less sever than mania.
There is elevated spirit mixed with irritability and hostility.
There is decreased need for sleep and excessive motor
activity.
There is decreased concern about money with
overspending and running into debts.
There is inflated self esteem and overestimating one’s
abilities.
There is pressure of speech and loud speech.
14
15. Mood disorders
clinical features
Mania
The patient might have psychotic symptoms as
flights of ideas, excessive distractability and
grandiose delusions. Unlike schizophrenia the
psychotic symptoms are mood congruent.
To diagnose hypomanic episode 4 days of
symptoms are necessary and for a manic episode
one week of symptoms is required.
15
16. Mood disorders
Diagnosis and Classification
There was a lot of confusion regarding
classification of Mood Disorders.
The DSM and ICD used different classifications.
Nevertheless in the newer versions they got
closer.
Depression is both a mood or symptom and a
syndrome.
It is calssified into mild, moderate and sever. It
could be a single episode or recurrent.
16
17. Mood disorders
Diagnosis and Classification
The symptoms must last for at least 14 days.
They include loss of interest, lack of energy,
impairment of sleep, appetite or concentration
and suicidal thoughts.
Dysthymia: a constant or recurrent mild
depression lasting for at least two years.
Manic states: in a manic episode the patient has
elevated, expansive or irritable mood and other
symptoms that could last for at least one week.
17
18. Mood disorders
Diagnosis and Classification
Bipolar I disorder is diagnosed when the patient
has at least one manic episode. In the manic
episode the patient Has elevated, expansive or
irritable mood for at least one week. The
condition is sever and requires hospitalization.
Hypomania is less sever and does not require
hospitalization and lasts for at least four days.
Mania indicates bipolar I disorder and
hypomania alternating with major depression
indicates bipolar II disorder.
18
19. Mood disorders
Diagnosis and Classification
Both psychotic depression and melancholia
were not adequately described in the
classificaton systems available. Both ICD and
DSM failed to specify the close association of
depressive disorder and anxiety.
Presence of anxiety could confuse the
diagnosis.
19
20. Mood disorders
Diagnosis and Classification
Manic patients usually do not complaint of their
symptoms and they are observed by realtives
and their doctors.
There is decreased need for sleep, disinhibition
and increased energy.
Robert Kendell Psychiatry 8:2
20
21. Mood disorders
Diagnosis and Classification
To diagnose any of the mood disorders the
symptoms need to interfere with the life of the
patient, must not be due to substance abuse,
not secondary to another medical disorder and
due to another mental disorder such as
schizophrenia.
21
22. Brain structural changes in
mood disorders
Hippocampal volume is reduced in patients
with major depressive disorder.
Studies on both disorders bipolar disorder and
major depressive disorder revealed changes in
the amygdala too.
Lithium and antidepressants produced changes
in the gray matter size in some studies
compared to preclinical data.
Sophia frangou Psychiatry 8:4
22
23. Depression and diabetes mellitus
Clinically significant depression is associated with a
65% increased risk of diabetes mellitus.
Characteristics of depression frequently found in the
community, namely nonsevere depression,
persistent depression, and untreated depression,
may play a role in the development of diabetes in a
predominantly elderly adult population.
Antonio Campayo, Peter de Jonge, Juan F Roy, Pedro Saz, Concepción de la Cámara,
Miguel A. Quintanilla, Guillermo Marcos, Javier Santabárbara, and Antonio Lobo
Am J Psychiatry 2010 167: 580-588.
23
24. Depression in the elderly
A study in Pakistan revealed an increase in the
prevalence of depression in the elderly and they
atributed that to the change in the family system
from extended to nuclear system.
Depression in the elderly: "Does family system
play a role?" A cross-sectional
study
BMC Psychiatry 2007, 7:57
24
25. Management of mood disorders
It is necessary that every patient, whom we
suspect to have mood disorders, should be
thoruoghly assessed by careful and full history
and mental state examination. The notes of the
social worker and clinical psychologists should be
studied too. The necessary investigations to
exclude other possible causes should be done
including full blood count, drug screening ,
hormonal essays including thyroid function tests,
EEG, CT scan and if necessary other
neuroimaging techniques.
25
26. Management of mood disorders
It is important to find out if the case in unipolar
or part of a bipolar disorder.
Risk assessment is a must to find out if the
patient is a risk to himself in the form of suicide
or self harm. The risk to others including
homicidal risk is necessary too.
The targets of our management should include
the patient and the caregivers too.
26
27. Management of mood disorders
The line of management depends on whether
the disorder is acute or chronic, bipolar unipolar,
recurrent or a single episode.
The choice of the treatment method should be
made by discussion with the patient, his relatives
and individual physician.
The treatment methods include:
Psychological
Pharmacological
Physical
27
28. Management of mood disorders
Psychological treatments
According to the National Institute for Health and
Clinical
Excellence guideline for depression, psychological
treatments are the treatments of choice for mild
depressive episodes.
In moderate depressive episodes they are an
alternative to antidepressant medication, and for
severe depressive episodes cognitive therapy
in combination with antidepressants is the
treatment of choice.
Only cognitive therapy is established as effective in
preventing the recurrence of depressive episodes. 28
29. Management of mood disorders
Psychological treatments
From an evidence-based perspective, cognitive
therapy for depression is the best established
psychological treatment for mood disorders.
In contrast, psychological treatments can be
effective in preventing recurrence of bipolar
episodes, although there is little evidence for
their effectiveness in acute bipolar episodes
(depression, mania, hypomania, or mixed
affective episodes).
29
30. Management of mood disorders
Psychological treatments
Psychological treatments for depression include:
Cognitive therapy, behaviour therapy, cognitive
behaviour therapy, problem solving, interpersonal
therapy and psychodynamic therapy.
Psychological treatment for bipolar disorder needs
to be longer and includes psychoeducation,
prevention of relapse and encouraging the patient
to comply with the medication.
Richard Morriss and Jan Scott
Psychiatry 8:4
30
32. Pharmacological
management of unipolar
affective disorder
Tricyclic antidepressants:
These drugs have many side effects including
anticholinergic effects, hypotension and
tachycardia and cardiac toxicity which makes
them dangerous in toxicity and overdoses.
Tricyclic antidepressants should not be used as
first line treatment in mild to moderate
depression.
They are recommended for severely ill
inpatients. 32
33. Pharmacological
management of unipolar
affective disorder
Specific serotonin reuptake inhibitors:
Including fluoxetene, paroxetene, fluvoxamine,
citalopram, sertraline, escitalopram.
They are recommended by NICE as first line
pharmacological treatment of depression
because they have less side effects compared to
tricyclic antidepressants. They are relatively safer
in overdoses. However they might lead to gastric
irritation, nausia, vomitting, headache, increased
anxiety and sexual dysfunction.
33
34. Pharmacological
management of unipolar
affective disorder
Specific serotonin reuptake inhibitors:
They cause decreased arousal, drive and
difficulty reaching orgasm. These side effects
might lead to noncompliance.
The initial increased anxiety might lead to
suicide.
34
35. Pharmacological
management of unipolar
affective disorder
Monoamine oxidase inhibitors MAOIs :
They are used for atypical depression with
reversed biological symptoms as increased
appetite and weight. It is recommended by NICE
for those who do not respond to SSRIs. The
ireversible MAOIs have serious interaction with
drugs and food containing tyramine.
35
36. Pharmacological
management of unipolar
affective disorder
Monoamine oxidase inhibitors MAOIs :
The reversible MAOIs as Meclobemide has less
risk of interaction but therapeutically less
effective.
Those drugs lead to postural hypotension ,
overstimulation, sexual dysfunction, weight gain
and possibly addiction.
36
37. Pharmacological
management of unipolar
affective disorder
Serotonin and noradrenaline reuptake
inhibitors SNRIs:
Venlafaxine and duloxetene.
Venlafaxine is more potent than SSRIs and
recommended by NICE for severely depressed
patients with monitoring the blood pressure.
Doluxetene is not as potent as Venlafaxine and it
might lead to initial nausea.
Both drugs lead to nausea, hypertension,
increased anxiety and sexual dysfunction.
37
38. Pharmacological
management of unipolar
affective disorder
Other antidepressants:
reboxetene: is selective noradrenaline reuptake
inhibitor. It has anticholinergic side effects and
sexual dysfunction. Neverthelss it is well
tolerated but evidence of its effectiveness is
scarce.
mirtazepine: is α 2 adrenoceptor antagonist. It
cause sedation and weight gain. Therefore it
liked by patients with insomnia and disliked by
obese patients.
38
39. Pharmacological
management of unipolar
affective disorder
Other antidepressants:
Mianserine is a tetracyclic drug and is α2
adrenoceptor antagonist. It is less popular now
because of agranulocytosis.
39
43. Pharmacological
management of bipolar
affective disorder
Mood stabilizers:
Lithium : it is an antimanic and used prophylactic
ally for bipolar disorder. It requires careful and
continuous monitoring to avoid toxicity. Side
effects include anorexia, metallic taste and
diarrhea, polyuria and nephrogenic diabetes
incipidus, tremor, weakness, cardiac toxicity,
goitre and teratogenic effect.
43
44. Pharmacological
management of bipolar
affective disorder
Mood stabilizers:
Carbamazepine: it is used as an antimanic drug
and for prevention of affective psychosis.
However, its popularity has declined because its
efficacy decreases with time as it is liver enzyme
inducer and induces its own metabolism. It
reduces the effectiveness of other
anticonvulsants and contraceptives. It causes
sedation, ataxia and diplopia. The serious toxic
effects is Steven Johnson's syndrome.
44
45. Pharmacological
management of bipolar
affective disorder
Mood stabilizers:
Valproate: it is antimanic and has been used
prophylatically but the evidence is not strong
for its action.
Side effects include gastric irritation, nausia,
increased appetite, weight gain, tremor and
thrombocytopenia. It could cause alopacia and
hepatic damage too therefore it should not be
used in patients with active liver disease.
45
46. Pharmacological
management of bipolar
affective disorder
Mood stabilizers:
Lamotrigine:
Is an antiepileptic in complex partial and
generalized tonic clonic fits.
It is used for treatment of mania, depression,
rapid cycling bipolar II disorder.
Side effects:
Headache, sedation, ataxia, diplopia, nausia
46
47. Pharmacological
management of bipolar
affective disorder
Mood stabilizers:
Lamotrigine:
Other side effects include rash and Stevens
Johnson’s syndrome.
It does not induce liver enzyme p 450 and
has no effect on psychotropic medication.
47
48. Pharmacological
management of bipolar
affective disorder
Antipsychotics
Atypical antipsychotics as olanzepine,
resperidone, quetiepine and aripiprazole
are effective as antimanic drugs in acute
cases and prophylactically in bipolar
disorder. They are useful in maintenance
therapy. Olanzepine and aripiprazole are
effective as continuation therapy after
acute treatment.
48
49. Pharmacological
management of bipolar
affective disorder
Antipsychotics
The possibility of producing
extrapyramidal side effects is less than
typicals but weight gain and metabolic
syndrome is a strong limiting factor for
their use.
49
50. Pharmacological
management of bipolar
affective disorder
Antidepressants
Are used for depression but not
prophylactically especially when there is
risk of switching to mania. They could be
combined with a mood stabilizer to avoid
that risk.
50