Presented by

RASYIDAH SHARIFAH

NAHIDHAH SITI HAJAR

MOOD

DISORDERS

INTRODUCTION Mood : prevailing internal emotional

state Affect: external display of feelings

Mood disorders are a category of illnesses that describe a serious change in mood.

http://www.mentalhealthamerica.net

Classification of mood disorders:

• Major Depressive Disorder• Dysthymic Disorder

Depressive

(unipolar)

• Bipolar I • Bipolar II• Cyclothymic disorder

Bipolar

• Substance induced mood disorder

• Mood disorder due to general medical condition

Etiologic

MAJOR DEPRESSIVE DISORDER

Among 5 most common disorder.

Lifetime prevalence 5-20%. Female to male ratio is 2:1 The incidence rate is greatest

between ages 20-40. Major cause of disability and

suicide.

American Medical

Association researchers

found that 27% of MEDICAL

STUDENTS had depression or

symptoms of it, and 11% REPORTED SUICIDAL

thoughts during medical school!

ETIOLOGY:

1. Biological Factors More common in monozygotic twins. Unipolar depressions in a parent Abnormalities in Amine Neurotransmitters Neuroendocrine abnormalities in hypothalamic pituitary

adrenal (HPA) axis.

2. Psychological Factors Major life events Interpersonal relations, absent or unsatisfactory

significant special bonds have negative effect on self regards

Rapid hormonal changes Distorted thinking Lose hopefulness

DIAGNOSISCriteria For Major Depressive Episode : 5 Or More Of The Following For At Least 2 Weeks

DEPRESSED MOOD1 ANHEDONIA

2

GUILT SLEEP DISTURBANCE

3 4

APPETITE

ENERGY

5

6

CONCENTRATION

SUICIDALITY

PSYCHOMOTOR

78

9

DIAGNOSIS

Mood Sleep Interest

Guilt Energy Concentration

Appetite Psychomotor Suicidality

Criteria For Major Depressive Episode : 5 Or More Of The Following For At Least 2 Weeks

DIFFERENTIAL DIAGNOSIS

1. Other psychiatric disordes, sleep disorders and neurological disorders.

2. Endocrine disorders: Addison’s disease, Cushing’s disease, Hyper/hypothyroidism, Perimenstrual syndromes,etc.

3. Metabolic disorders: Hypoglycemia, Hypercalcemia, Porphyria.

4. Hematological disorders: anemia

5. Inflammatory conditions: SLE

6. Infections: Syphilis, Lyme disease, HIV encephalopathy

7. Medication related: Anti hypertensives, Steroids, etc

8. Substance misuse: Alcohol, benzodiazepine, opiates, marijuana, etc.

INVESTIGATIONS

There are NO specific tests.

Investigations focus on exclusion of treatable causes or other secondary problems.

Standard tests:1. Complete blood picture2. ESR3 .B12/folate4. Liver function test

5. Thyroid function test 6. Glucose level7. Calcium level

INVESTIGATIONS

Focused investigations :only if indicated by history and/or physical signs: 1. Urine or blood toxicology 2. Breathe or blood alcohol 3. Arterial blood gas( ABG) 4. Thyroid antibodies 5. Antinuclear antibody 6. Syphilis serology -----ETC

MANAGEMENT

Hospitalization

If there is: Serious risk of suicide Serious risk of harm to

others Significant self -neglect Severe depressive

symptoms

Severe psychotic symptoms Lack of breakdown of social

supports Initiation of ECT Treatment resistant

depression A need to address comorbid

conditions

TREATMENT

First line of treatment: Anti-depressant effective in 65-75% of patients. The decision of choosing anti-depressant depends on: Patient factor: age, sex, comorbid illness, previous response

to antidepressants. Symptomatology: sleep problem(sedative agents), lack or

energy/hypersomnia (adrenergic stimulatory agents), OCD symptoms (clomipramine), risk of suicide (avoid TCA)

Eg. Tricyclic anti-depressant and Monoamineoxidase inhibitors.

TRICYCLIC ANTIDEPRESSANTS (TCA) Action: reuptake inhibition of norepinephrine(NE) and serotonin (5-HT), increasing both in

synaptic cleft

Examples : Imioramine (Tofranil) , Clomipramide (Anafranil) , Amitryptptiline (Tryptizol)

TCA are cheap drugs but have many side effects.

Selective Serotonin Reuptake Inhibitors (SSRI)

Action: more selective inhibitory effect on reuptake of serotonin.

Lesser side effects than TCA

Examples: 1. Fluoxetine (Prozac)2 Sertaline (Lustral)3. Paroxetine (Seroxat)4. Fluvoxamine (Faverin)

Second line of

treatment:

When the first line treatment fail.

Unacceptable side effects from 1st line drug.

Change of antidepressant to different class or the same class with different side effect.

Electro convulsive therapyMay be use when

there are severe biological features (significant weight loss/ reduced appetite) or marked psychomotor retardation.

Mild, chronic depression for at least 2 years. Common psychiatric comorbidities: major

depression (up to 75%), “ Double Depression” anxiety disorders (up to 50%), personality disorders (20–40% ) somatoform disorders (2.8%–45.2%), substance abuse (up to 50%)

Difficult to diagnose due to soft mood symptoms, distracting comorbidities and lack of patient recognition.

Treatment includes psychotherapy mainly

DYSTHYMIC DISORDER

DEFINITION

- known as manic-depressive illness

- a brain disorder

- causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks

BIPOLAR DISORDER

TYPES

BIPOLAR I-manic episodes that last at least

7 days

BIPOLAR II-a pattern of depressive episodes and hypomanic

episodes

CYCLOTHYMIC DISORDER

-numerous periods of hypomanic symptoms, periods of depressive symptoms lasting

for at least 2 years

OTHER SPECIFIED OR NON-SPECIFIED BIPOLAR AND RELATED DISORDER

-bipolar disorder symptoms that do not match the three

categories listed above

SYMPTOMS & SIGNS

MANIC EPISODE:

Feel very “up,” “high,” or elated A lot of energy Increased activity levels Trouble sleeping Talk really fast about a lot of different things Be agitated, irritable, or “touchy” Feel like their thoughts are going very fast Think they can do a lot of things at once Do risky things, like spend a lot of money or have reckless sex

DEPRESSIVE EPISODE:

Feel very sad, down, empty, or hopeless decreased activity levels trouble sleeping, they may sleep too little or too much Feel like they can’t enjoy anything Feel worried and empty trouble concentrating Forget things a lot Eat too much or too little Feel tired or “slowed down” Think about death or suicide

BIPOLAR I DISORDER

The lifetime prevalence is 0.4-1.6% Male : female is equal. The 1st episode of mania usually occurs in the early 20 Most likely associated with comorbid suctance abuse or

dependence. Manic episodes often begin abruptly over hours to days

and escalate in 1 to 2 weeks 10-20% of hospital 1st admissions for depression later

develop a bipolar disorder. 15-20% of bipolar patients commit suicide.

DIAGNOSIS

A distinct period of elevated, expansive or irritable mood at least 1 week

3 of the following, if mood is only irritable:

-Self-esteem: highly inflated, grandiosity.

-Sleep: decreased need for sleep, rested after only a few

hours.

-Thoughts: racing thoughts and flight of ideas.

-Attention: easy distractibility.

-Activity: increased goal directed activity.

-Hedonism: high excess involvement in pleasurable activity

(sex, travel)

Substance induce mood disorder and mood disorder 2ry to medical condition are the essential differential diagnosis:

-Endocrine disorders -Neurological conditions-Systemic disorders -Drugs-Recreational drugs

RISK FACTORS

1. Brain Structure and Functioning2. Genetics3. Family History4. Substance abuse 5. Negative life events

MANAGEMENT1. Hospitalization.

2. Pharmacotherapy

-Mood stabilizers

-Antipsychotics

3. Electroconvulsive Therapy (ECT)

The patient is continue treatment for 4-6 months after resolution of the symptoms then preventive treatment considered.

5. Prevention of relapses

- Prophylaxis

- Therapeutic alliance

- Family education

6. Psychotherapy

Some psychotherapy treatments used to treat bipolar disorder

include:

• Cognitive behavioral therapy (CBT)

• Family-focused therapy

• Interpersonal and social rhythm therapy

• Psychoeducation

THANK YOU