![Page 1: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/1.jpg)
Psychotic andPsychotic andMood Disorders
ی با ر ر ا دی پزش یاران سال اول روا یکلاس د پز ل ل ن ی س
ان؛ وه ی ا وم پزش ه ع ی دا پزش 93/6/16روا
![Page 2: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/2.jpg)
22
![Page 3: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/3.jpg)
M d A i P h ti N ifi
SymptomsMood Anxious Psychotic Non-specific
Depressed mood Anxiety/Worry Delusion Aggression
Loss of interest Phobia Hallucination Agitation/RestlessnessLoss of interest Phobia Hallucination Agitation/Restlessness
Elevated mood Rumination Disorganized speech Irritability
Hopelessness Avoidance Disorganized behavior ImpulsivityHopelessness Avoidance Disorganized behavior Impulsivity
Worthlessness Safety behaviors Mood swing
Helplessness Hypervigilance Talkativeness
Guilt feeling Panic attack Grandiosity
Attempted suicide Safety behaviors Difficulty concentrating
O ti it R tl S lf i jOveractivity Restlessness Self-injury
Overfamiliarity Exaggerated startle response Insomnia
Being easily fatiguedg y g
![Page 4: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/4.jpg)
Symptom → Syndromey p y
Depressed mood + Loss of interest +
Insomnia + Low self-esteem + Hopelessness p
Major Depressive Episode
44
![Page 5: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/5.jpg)
Symptom → Syndromey p y
A i
GAD
Adjustment DisorderTalkativeness Anxiety
Substance-induced
Adjustment Disorder
Compulsion OCDOrganic
Manic Episode Bipolar Disorder
Schizoaffective Disorder
Hyperthyroidism
Schizoaffective Disorder
Substance-induced
55OrganicSubstance-induced/Abuse
![Page 6: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/6.jpg)
MoodMood
Depressed mood/ Loss of interest
Elevated/ Expansive moodElevated/ Expansive mood
Irritable mood (Less specificity)
Affective instability (Less specificity)
66
![Page 7: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/7.jpg)
Adjustment
MDD
Adjustment
Dysthymic
MDD
Rec Brief
y y
Minor dep
Bip dep
0% 20% 40% 60% 80% 100%
![Page 8: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/8.jpg)
88
![Page 9: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/9.jpg)
يهاي كليدي اختلال دوقطبي نشانه
Depressed mood
L f i t tLoss of interest
Euphoria
Irritability
Overactivity
99
![Page 10: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/10.jpg)
ييهاي اختلال دوقطبي ويژگي
Highly recurrent
Familial [etiology]
Depression: Predominant affect
Hypo/mania: Hallmark
Depression: Predominant affectProfound disability
Suicide: a major outcome
Subsyndromal symptoms: Predominant features
j
1010Comorbidity is the rule rather than exception.
![Page 11: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/11.jpg)
I th li iIn the clinic:
depression/anxiety symptoms > i / imania/hypomania symptoms
1111
![Page 12: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/12.jpg)
Bipolar I DisorderBipolar I Disorder
MajorMania Major Depression
![Page 13: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/13.jpg)
Bipolar I DisorderBipolar I Disorder
Major Mania
jDepression
MixedMixed
![Page 14: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/14.jpg)
Bipolar I DisorderBipolar I Disorder
![Page 15: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/15.jpg)
M i H i
Mania Hypomania
Psychosis+
+ ―
Dysfunction+ ―+ ―
Significant aggression+ ―+
Duration ≥ 7 days or any if aggression
≥ 4 daysgg
![Page 16: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/16.jpg)
Bipolar II DisorderBipolar II Disorder
Hypo MajorHypo-mania
Major Depression
![Page 17: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/17.jpg)
Bipolar II DisorderBipolar II Disorder
![Page 18: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/18.jpg)
1818
![Page 19: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/19.jpg)
PsychosisPsychosis
Delusion
HallucinationHallucination
Disorganized speech
Disorganized behavior
1919
![Page 20: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/20.jpg)
2020
Bryan Charnley, 1991
![Page 21: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/21.jpg)
“Mania” whose author is Florencio Yllana, a contemporary artist of Philippine origin (bornPhilippine origin (born 1977), presently living in Brazil. The painting was done in 2001 following the acute manic episode in the course of BD in the artist (Rybakowski JK 2010)artist. (Rybakowski JK, 2010)
2121
![Page 22: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/22.jpg)
Psychotic DisordersPsychotic Disorders
Schizophrenia
Schizoaffective DisorderSchizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Another Medical ConditionAnother Medical Condition
Substance-induced
2222
![Page 23: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/23.jpg)
Psychotic+Affective
Psychotic+ Affective Remission Psychotic+
Affective
Psychotic+ Affective Psychotic Psychotic+Affective
Psychotic+ Affective Affective Psychotic+
Affective
Psychotic+ PsychoticPsychotic+ Affective Psychotic Affective Psychotic
+Affective
![Page 24: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/24.jpg)
Treatment OptionsTreatment Options
Placebo; Sham ECT
Medications
Psychotherapy
ECT
rTMS
VNS
![Page 25: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/25.jpg)
Antidepressants: 8) NDRIs (bupropion)
1) TCAs (imipramine)
2) Atypical TCAs (mianserin)
10) NASSAs (mirtazapine)
11) MASSAs (agomelatine)2) Atypical TCAs (mianserin)
3) MAOIs (tranylcypromine)
11) MASSAs (agomelatine)
12) SSREs (tianeptine)
4) RIMAs (moclobemide) 13) Serotonin Modulator and Stimulator (vortioxetine)
5) SSRIs (fluoxetine)
6) SNRIs (venlafaxine)
14) SRI+5HT1aPA (vilazodone)
6) SNRIs (venlafaxine)
7) NRIs (reboxetine)
15) Herbal: St. John's wort
16) SNDRIs (amitifadine)
8) SARIs (trazodone)
) ( )
![Page 26: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/26.jpg)
Treatment algorithmg
Remission
New drugPartial remission
Increase ORAugmentation/ Combination
Poop out
No Response Switch
Poop out = losing the efficacy
![Page 27: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/27.jpg)
Augmentation agents:1) Folic acid1) Folic acid
2) Omega-3 fatty acids
3) Buspirone
4) SGAs
5) Stimulants
6) Liothyronine
7) Lithium
8) Wake-promoting agents:8) Wake promoting agents:
modafinil
9) D i i t9) Dopamine agonists:
pramipexole
![Page 28: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/28.jpg)
Major side effectsMajor side effects
Lithium Renal failure Toxicity Diabetes i i idinsipidus
Valproate Teratogenicity Hepatotoxicity
Lamotrigine Serious rash
i l i b lli li id i i h iAtypical antipsychotics
Diabetes mellitus Hyperlipidemia Weight gain
2828
![Page 29: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/29.jpg)
Strengths Weaknesses
i hi i i id i iLithium Antisuicide Toxicity
Valproate High tolerance For women in Valproate High tolerance For women in fertility ages
Lamotrigine High tolerance TitrationNo weight gain
Low teratogenicityNo antimanicSerious rash
Atypical Antipsychosis Metabolic ypantipsychotics
p ysyndromes
2929
![Page 30: Psychotic and Mood Disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · Md Ai PhtiN ifi Symptoms Mood Anxious Psychotic on-spec c Depressed mood Anxiety/Worry Delusion Aggression](https://reader033.vdocuments.us/reader033/viewer/2022060707/6072b53ef54e764c7c23b1f9/html5/thumbnails/30.jpg)
3030