Download Mood Disorder: Management in the Modern Age

29/09/2015
Mood Disorder: Introduction
Richard Morriss
Professor of Psychiatry
University of Nottingham
Why Now?
• £30bn NHS funding gap by 2020 requires transformational
change
• 25% people with mood disorder receive first line treatment
• Demand for more flexible, person-centred care and selfmanagement
• Advances in computer science and bio-engineering
• Rapid growth in smart technologies
• Britain is ready for digital mental health
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29/09/2015
Years lived lost due to disability in the world in 2010
Vos T et al Lancet 2012
Rank order
1. Low back pain
11. Osteoarthrosis
2. Major depressive disorder
12. Drug use disorders
3. Iron deficiency anaemia
13. Hearing loss
4. Neck pain
14. Asthma
5. COPD
15. Alcohol use disorders
6. Other musculoskeletal
16. Schizophrenia
7. Anxiety
17. Road injury
8. Migraine
18. Bipolar disorder
9. Diabetes mellitus
19. Dysthymia
10.Falls
20. Epilepsy
Mortality (suicide in young – 3rd highest cause of death 15-49),
older 2x SMR CVS, renal (not just lithium) & respiratory disease
Osby, U. et al. Arch Gen Psychiatry 2001;58:844-850.
Copyright restrictions may apply.
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Depression
• 2 weeks of depressed mood or loss of interest and
pleasure almost every day and all day plus 3 or 4:
change in sleep pattern and unrefreshed
change in appetite/weight
loss of energy
slowed down or agitated
poor concentration/ ability to decide
decreased confidence, self-worth
excessive guilt
thoughts of death or suicide
Types of depression
• Major depression. 2 weeks, more severe
• Dysthymia. 2 years persistent, mild (2-5 symptoms).
• Bipolar depression
• Depression with psychosis.
• Seasonal affective disorder. Seasonal pattern
• Adjustment disorder to life change.
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Bipolar Disorder
• Bipolar disorder is a cyclical mood disorder
• Abnormally elevated mood or irritability
alternates with depressed mood
– bipolar I – at least one manic or mixed episode
– bipolar II – at least one major depressive episode
and at least one hypomanic episode
Clinical features of Bipolar Disorder
Presentation
Key features
Mania
Elevated, expansive or irritable mood
With or without psychotic symptoms
Marked impairment in functioning
Hypomania
Elevated, expansive or irritable mood
Less impairment of functioning
Depression
Mild, moderate or severe
With or without psychotic symptoms
Rapid cycling
At least four episodes in 1 year
Mixed states
Manic and depressive features
present during same episode
Treatments for depression relatively ineffective in bipolar disorder and vice versa
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Each person’s course of illness is unique
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LIFE Scores:TAU
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Time (weeks)
Depression
Mania
Link with creativity
• Mark Twain, Edgar Allen Poe, Walt Whitman, Sylvia Plath,
Tennessee Williams, Ernest Hemingway, Viriginia Woolf, Ezra
Pound, Charles Mingus, Gustav Mahler, Paul Gauguin, Georgia
O'Keeffe, Jackson Pollack, Vincent van Gogh.
• Ozzy Osbourne, Jean-Claude Van Damme, Axl Rose, Sinéad
O'Conner, Peter Gabriel, Kurt Cobain, Stephen Fry, Russell
Brand, Catherine Zeta Jones, John Cleese, Spike Milligan etc.
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Key Challenges to address
• Already 60,000 apps for mental health
• Earlier user involvement and needs-led design briefs
• Social inequalities: 25% poorest households have no internet
access
• Privacy, trust, consent and data security
• Limited research evidence of clinical effectiveness
• Developing appropriate, agile research methods for evaluation
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Key Challenges to address (2)
• Developing robust business models for digital products
• Identifying and translating research innovations in computer
science and engineering to benefit mental healthcare
• Regulation and quality control for mHealth apps
• Scalability and implementation: from local to national
• Interoperability – connectivity of apps and m-health with NHS
N3, EPR, clinician decision support systems
• Clinicians – tend to be older, did not grow up with m-Health
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