IN THE NAME OF GOD

MOOD DISORDERS

MOHAMAD NADI M.D

PSYCHIATRIST

MOOD DISORDERS

Historical perspective

• black bile and melancholia

• Endogenous vs. reactive depression

• Neurotic vs. psychotic depression

MOOD DISORDERS

DSM-IV-TR 5 Mood Disorders:

• Major depressive disorder

• Dysthymic disorder

• Bipolar disorders

•Cyclothymic disorder

•mood disorder NOS (Not Otherwise specified )

MOOD DISORDERS

Diagnostic issues – Types of symptoms

• Mood and Emotion

• Cognition

• Behaviour and Motivation

• Physical

MOOD DISORDERS

Major depression

• symptoms include feelings of sadness, loss of interest or inability to experience pleasure, unexplained weight loss, difficulty sleeping, fatigue, difficulty concentrating, feelings of worthlessness or guilt, suicidal thoughts, agitation or slowing down

• And functional impairment

Major depressive disorder

A.Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is

(1) depressed mood or

(2) loss of interest or pleasure.

Major depressive disorder

(1) Depressed mood

(2) Diminished interest or pleasure in all, or almost all, activities

(3) Significant weight loss when not dieting or weight gain or decrease or increase in appetite.

(4) Insomnia or hypersomnia.

(5) Psychomotor agitation or retardation

Major depressive disorder

(6) Fatigue or loss of energy

(7) Feelings of worthlessness or excessive or inappropriate guilt

(8) Diminished ability to think or to concentrate

(9) Recurrent thoughts of death

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Major depressive disorder

• estimates suggest about 5-10% of people suffer from depression

• twice as common in women – biological differences, expression of symptoms, social acceptability, role strain and stress

• 50% recurrence rate

Major depressive disorder

Problem of underdiagnosis

• no obvious marker for depression

• stigma associated with diagnosis of depression

Major depressive disorder

Etiology of Depression

Biologic Theories– Genetic– Biochemical

Cognitive Theories_ Object loss_ aggression turned inward

Risk Factors for Depression

• Chronic Illness• Female Gender• Bereavement• Perfectionistic• Situational stressors• Previous History• Family History• Social Isolation

Dysthymia

• many of the same symptoms as major depressive disorder, but less severe

• dysthymia persists for at least 2 years with only brief times mood returns to normal

• chronic sadness

Treatment of Major depressive disorder

•Selective Serotonin Reuptake Inhibitors

•Tricyclic Antidepressants (TCA’s)

• Monoamine Oxidase Inhibitors

• ECT

•Psychoterapy

BIPOLAR DISORDERS

Mania

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

• B. During the period of mood disturbance 3 or 4 of the following have persisted and have been present to a significant degree:

– 1. Inflated self-esteem or grandiosity– 2. Decreased need for sleep– 3. More talkative than usual– 4. Flight of ideas– 5. Distractibility– 6. Increase in goal-directed activity– 7. Excessive involvement in pleasurable activities

Mania

BIPOLAR DISORDERS

HypomaniaHypomania

• less severe episodes of manialess severe episodes of mania

• less functional impairmentless functional impairment

• less durationless duration

BIPOLAR DISORDERS

Bipolar disorders

Bipolar I and II

• Bipolar I – at least one or more manic episodes with or without one or more depressive episodes

• Bipolar II – at least one hypomanic episode with one or more episodes of major depression

Bipolar disorders

Cyclothymia

• Alternating mood episodes: fluctuation between mild depression and hypomania

• Duration at least 2 years

Treatment of bipolar disorders

•Mood stabilizers – Lithium

•Anticonvulsants– Valproat sodiom

•Antipsychotics – Risperidon

•Psychoterapy – CBT

•ECT