Download MOOD DISORDERS

Mood disorders
Department of Psychology
P.G. Govt. College for Girls
Sector-11, Chandigarh
Introduction
 Affect: A short lived emotional response to an idea or
an event
 Mood: A sustained and pervasive response which
colors the whole psychic life.
Introduction contd…
 Depression and mania are the opposite ends of same
spectrum
 These are the two poles apart , thus generating the
terms unipolar depression and bipolar disorder.
 It can also occur as a mixed state , hypomania or
rapid cycling
Prevalence rate
-
DIAGNOSIS
RATE
Major depressive disorder
Female :20 -25 %
Male 7-12%
Dysthymic disorder
6%
Bipolar disorder - I
0.4-6%
Bipolar disorder - II
0.5%
Mood [affective] disorders
According to ICD –10
Chapter F
:
:
F30-F39
ICD –10 Classification……..
F30
:
Manic episode
 F30.0
Hypomania
 F30.1
Mania without psychotic symptoms
 F30.2
Mania with psychotic symptoms
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
 .20
 .21
 F30.8 Other manic episodes
ICD –10 Classification
F31 :
 F31.0:
Bipolar affective disorder
Bipolar affective disorder, current episode
hypomania
 F31.1 :
Bipolar affective disorder, current episode
mania without psychotic symptoms
 F31.2 :
Bipolar affective disorder, current episode
mania with psychotic symptoms
 .20 With mood-congruent psychotic symptoms
 .21 With mood-incongruent psychotic symptoms
ICD –10 Classification…….
 F31.3 :
Bipolar affective disorder, current episode mild
or moderate depression
 .30 Without somatic syndrome
 .31 With somatic syndrome
• F31.4:
Bipolar affective disorder, current episode
severe depression without psychotic symptoms
ICD –10 Classification…….
 F31.5
Bipolar affective disorder, current episode severe
depression with psychotic symptoms
 .50 With mood-congruent psychotic symptoms
 .51 With mood-incongruent psychotic symptoms
 F31.6
Bipolar affective disorder, current episode mixed
 F31.7
Bipolar affective disorder, currently in remission
 F31.8
Other bipolar affective disorders
 F31.9
Bipolar affective disorder, unspecified
ICD –10 Classification……..
F32 :
 F32.0 :
Depressive episode
Mild depressive episode
 .00 Without somatic syndrome
 .01 With somatic syndrome
 F32.1 :
 .10
 .11
Moderate depressive episode
Without somatic syndrome
With somatic syndrome
ICD –10 Classification……..
 F32.2 : Severe depressive episode without psychotic symptoms
 F32.3: Severe depressive episode with psychotic symptoms
 .30 With mood-congruent psychotic symptoms
 .31
With mood-incongruent psychotic symptoms
 F32.8 : Other depressive episodes
 F32.9 :Depressive episode, unspecified
ICD –10 Classification………
F33 :
Recurrent depressive disorder
 F33.0 :Recurrent depressive disorder, current episode mild
 .00 Without somatic syndrome
 .01 With somatic syndrome
 F33.1: Recurrent depressive disorder, current episode
moderate
 .10
 .11
Without somatic syndrome
With somatic syndrome
ICD –10 Classification
 F33.2 : Recurrent depressive disorder, current episode severe
without psychotic symptoms
 F33.3 :Recurrent depressive disorder, current episode severe with
psychotic symptoms
 .30 With mood-congruent psychotic symptoms
 .31 With mood-incongruent psychotic symptoms
 F33.4 :Recurrent depressive disorder, currently in remission
 F33.8 :Other recurrent depressive disorders
 F33.9
:Recurrent depressive disorder, unspecified
ICD –10 Classification
F34
:
 F34.0
Cyclothymia
 F34.1
Dysthymia
 F34.8
Other persistent mood [affective] disorders
 F34.9
Persistent mood [affective] disorder,
unspecified
Persistent mood [affective] disorders
ICD –10 Classification
F38
:
 F38.0
Other single mood [affective] disorders
 .00
Other mood [affective] disorders
Mixed affective episode
 F38.1
Other recurrent mood [affective] disorders
 .10 Recurrent brief depressive disorder
 F38.8
Other specified mood [affective] disorders
F39
:
Unspecified mood [affective] disorder
Clinical features of depression
 Sad mood: Persistent and pervasive sadness of mood


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Patient not responsive to external environment
Lack of interest
Diminished activity
Weakness leading to fatigability
Depressed mood
Complete anhedonia: lack of pleasure
Clinical features depression….
 Depressive ideations: Helplessness, hopelessness,






worthlessness
Guilt feelings
Difficulty in concentration
Indecisiveness
Slowed thinking
Lack of energy and initiative
Suicidal ideations with nihilism
Clinical features depression….
Psychomotor activity
Slowness in
thinking and
activity
Depressive
stupor
Clinical features depression….
Physical features:
 Multiple physical complaints
(heaviness of head, vague body aches & paines)
 Easy fatigability
Clinical features Depression….
Biological features:
 Insomnia
 Reduced appetite
 Reduced weight
 Loss of libido
Clinical features depression…..
Psychotic features:
 Nihilistic delusions
 Delusions of guilt
 Delusions of poverty
Clinical features for mania
Elevated , expansive or irritable mood which may pass
through following stages:
 Euphoria: Mild elevation of mood
 Elation: Moderate elevation
 Exaltation: Severe elevation
 Ectasy
Clinical features for mania…
OVERACTIVITY
RESTLESSNES
MANIC
EXCITEMENT
Clinical features for mania…
Speech and thought:
 Over talkativeness
 Pressure of speech
 Flight of ideas
 Delusions of grandeur:
Ability, Identity, Role
Clinical features for mania…
Goal directed activity:
 Increased activity
 Over planning
 Poor judgment
Other features:
 Decreased sleep
 Increased appetite
Bipolar mood disorder
It is characterized by recurrent episodes of mania and
depression in same patient at different times
SUBTYPES :
 Bipolar I
 Bipolar II
Bipolar mood disorder……….
 Bipolar I Disorder
 One or more manic episodes usually alternating
with major depressive episodes
 Manic episodes – periods of abnormally and
persistently elevated, expansive or irritable
mood
 Bipolar II Disorder
 Major depressive episode and at least one
hypomanic episode
 No manic episode
Bipolar mood disorder………..
The current episode can be specified as :
 Hypomania
 Mania without psychotic symptoms
 Mania with psychotic symptoms
 Mild or moderate depression
 Mixed or remission
 Severe depression with/ without psychotic symptoms
Recurrent depressive disorder
It is characterized by recurrent depressive
episodes:
 The current episode can be specified as :
 Mild Depression
 Moderate Depression
 Severe depression with / without psychotic symptoms
Persistent mood disorder
It is characterized by persistent mood symptoms for
more than 2 years :
 Dysthymia
 Cyclothymia
Dysthymia……..
 Milder form of depressive illness
 Symptoms less severe but chronic
 Criteria
 Depressed or irritable mood most of the day,
occurring more days than not for at least 2 years
 No more than 2 months in which s/s not present
 No manic or depressive episode
 Important because of chronic nature
Cyclothymia……
 Resembles Bipolar I Disorder with less severe
symptoms
 Repeated episodes of nonpsychotic depression and
hypomania for at least 2 years
 Diagnosed only if a major depressive or manic episode
has never been present
Other mood disorders
The full clinical picture of ,mania and depression are
present either:
 at same time intermixed or
 alternates rapidly with each other without a normal
intervening period of euthymia
Course and prognosis
 BMD has early age of onset ( 3rd decade ) than RDD
 UNIPOLAR DEPRESSION is common in 3rd decade and 5th






to 6th decade
Average manic episode lasts for 3-4 months
Average depressive episode lasts for 4–6 months
Nearly 40% of depressives with episodic course improve in
3 months
60% of which may last for two or more years improve in 6
months
80% improve in one year
15-20 % develop a chronic course
Prognosis
Good prognostic factors:
 Acute onset
 Typical clinical features
 Severe depression
 Well adjusted pre morbid personality
 Good response to treatment
Prognosis
Poor prognostic factors:
 Co-morbid medical disorder, PD
 Double depression
 Chronic stress
 Unfavorable environment
 Mood incongruent psychotic features
 Hypochondriacal features
 Poor drug compliance
Etiology:
1. Genetic Hypothesis: life time risk for
 First degree relatives of Bipolar Mood Disorder is 25%
 Recurrent Depressive Disorder is 20%
 Children of one parent with Bipolar Mood Disorder is
27%
 Both parents with Bipolar Mood Disorder is 74%
Etiology contd…….
2. Biochemical theories:
 The monoamine hypothesis
 Postsynaptic alteration in receptors number and
function
 Decrease in serotonergic function
Etiology contd…….
3. Brain Imaging (MRI, PET scan):
 Ventricular dilatation
 Changes in blood flow and metabolism
Etiology contd…….
4. Learned Helplessness:
Seligman Experiment of dogs
Predisposing Factors
 Genetic
 Physiological
 Endocrine system (HPA axis and HPT axis)
 Cortisol (hyper-secretion)
 Neurotransmission
Dysregulation hypothesis
 Abnormal transmission of serotonin
 Biological rhythms
 Periodic variations in physiological and
psychological functions

Predisposing Factors
 Psychological
 Psychodynamic factors
Anger turned inward
 Learned helplessness
 Passivity, negative expectations, feelings of
helplessness, hopelessness, and powerlessness
 Cognitive
 Errors in thinking and unrealistic attitudes
 Errors precede mood changes

Precipitating Stressors
 Stress due to major or minor life events
 Loss of attachment
 Disruptions of patterns
 Loss of self-esteem
 Interpersonal discord
 Physical conditions
 Impairment of social role performance
 Certain events more predictive than others
 Abuse, multiple family disadvantages
Management/ Treatment
Acute phase treatment:
 To achieve euthymia and thereby current episode to
conclusion
Continuation phase treatment:
Maintainance phase treatment:
 To prevent the future episodes
Acute phase treatment
 Choose the venue for treatment
 Select the appropriate mood stabilizer: Medicines
 Manage the agitation and psychosis
 Optimize the patient’s sleep
Mood stabilizers
 Lithium
 Valporate
 Carbamazepine
 Atypical antipsychotics
Management of agitation and
psychosis
 Benzodiazapines
 Anti psychotics
 Optimizing sleep: Bedtime dose of benzodiazepine
or anti psychotic
Maintainance phase
It is indicated in following cases:
 Partial response to acute treatment
 Poor symptom control during continuation treatment
 More than 3 episodes
 More than 2 episodes with early age of onset or
reoccurrence within 2 years of stopping anti
depressants
 chronic depression
Electrconvulsive Therapy(ECT)
Indications for ECT :
 Severe depression with suicidal risk
 Severe depression with stupor
 Catatonia
 Treatment refractory depression
 Delusional depression
 Intolerance to drugs
Psychosocial treatment
 Cognitive behavior therapy
 Behavior therapy
 Group therapy
 Family and marital therapy
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