Download Mood disorders ( affective disorders )

Mood disorders
( affective disorders )
prof. MUDr. Eva Češková, CSc.
Dept. of Psychiatry,
Masaryk University , Brno
Mood disorders ( affective disorders )
 epidemiology
 etiology
 classification.: major depressive disorder, bipolar I
disorder, dysthymic disorder and cyclothymic
disorder
 diagnosis
 differencial diagnosis
 course and prognosis
 treatment
 literature
Mood disorders ( affective
disorders )
Mood disorders - the critical pathology in
those disorders is one of mood
Epidemiology
Lifetime prevalence:
major depressive disorder
bipolar I disorder
15% (more in women)
1%
Sex: major depressive disorder twofold often in
women,
Age: mean age of onset of depressive disorder 40
years, bipolar I disorder 30 years
Etiology
1.Biological factors:
 the biological amines, noradrenaline (dopamine)
and serotonin - neurotransmitters most
implicated in the pathophysiology of mood
disorders
 neuroendocrine dysregulation (alteration of
hypothalamic-hypophysis-adrenal and
hypothalamic-thyreoid axis)
2. Genetic factors
3. Psychosocial factors
4. Other factors : alteration of circadian rhythms,
neuroimmune dysregulation
Classification (DSM IV)
1. major depressive disorder
2. bipolar I disorder
3. dysthymic disorder
4. cyclothymic disorder
Further classification major depressive disorder and
bipolar I disorder:
 according to the severity (mild, moderate, severe)
 with and without psychotic features, congruent or
incongruent (hallucinations and delusions)
 according to the course (single episode, or recurrent,
remission, further course specifiers)
Diagnosis: major depressive disorder
Minim. 5 symptoms, change from functioning:
 depressed mood
 diminished interest or pleasure
 significant weight loss, or decrease or appetite
 insomnia ( or hypersomnia)
 psychomotor agitation or retardation
 fatigue or loss of energy
 feelings of worthlessness or guilt
 diminished ability to think or concentrate,
indecisiveness
 recurrent thought of death
Diagnosis: Bipolar I, manic episode
At least 1 week of abnormally and persistently elevated,
expansive or irritable mood, impairment in occupational
functioning or social activities (not due to abuse or
medical condition), min. 3 of the following symptoms:
 grandiosity
 decreased need for sleep,
 more talkativeness
 flight of ideas
 distractibility
 increase of goal directed activity
 excessive involvement in pleasurable activities
Diagnosis : dysthymic disorder
Dysthymic disorder: a chronic disorder, with the
depressed mood that lasts most of the day on most days
Symptoms:
 depressed mood for more days than not, for at least 2 y.
2 or more further symptoms:
 poor appetite or overeating
 insomnia or hypersomnia
 low energy or fatigue
 low self esteem
 poor concentration or difficulty making decisions
 feelings of hopelessness
Diagnosis : Cyclothymic disorder
 a mild form of bipolar II disorder,
characterised by episodes of hypomania and
episodes of mild depression
 for at least 2 years, the presence of numerous
periods with hypomanic symptoms and
numerous period with depressive symptoms
that do not meet criteria for a major depressive
episode
Differential diagnosis
Depressive disorders:
 medical disorders (neurological, endocrine,
infectious)
 pharmacological
Bipolar I:
 other mental disorders (schizophrenia)
 pharmacological
Course and prognosis
Depressive disorder:
 untreated depression lasts 6-13 months
 5-10% have a manic episode
 tends to be a chronic disorder
 pts. tend to relapse
Bipolar disorder:
 most often starts with depression
 is a recurring disorder
 pts. have a poorer prognosis than do pts. with
major depressive disorder
 50% have a second manic episode within 2 years
Treatment
Acute treatment vs. long-term with recurrent
episodes
Major depressive disorder:
 biological treatment - antidepressants, ECT, sleep
deprivation, light therapy
 psychotherapy - cognitive-behavioural therapy
Mania:
 mood stabilisers
 antipsychotics
 ECT
References :
 Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and
Sadock´s synopsis of psychiatry, Baltimore: Williams
and Wilkins, 1997
 Goodwin FK, Jamison KR.: Manic-depressive Illness.
New York: Oxford University Press, 1990.