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Mood   Disorders ( a ffective Mood   Disorders ( a ffective

Mood Disorders ( a ffective - PowerPoint Presentation

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Mood Disorders ( a ffective - PPT Presentation

disorders 1 What is a mood disorder Mood is a persons subjective emotional state Affect pattern of the observable o bjective behaviours eg ID: 749979

depression mood bipolar depressive mood depression depressive bipolar disorder irritable loss depressed episode major mnemonics arts elevated clip disorders symptoms anhedonia week

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Slide1

Mood Disorders(affective disorders)

1Slide2

What is a mood disorder?

Mood is a person’s

subjective

emotional stateAffect – pattern of the observable (objective) behaviours e.g. facial expressions that are associated with subjective feelings, like moodMood disorders involve a depression or elevation of mood as the primary disturbance

2Slide3

Types of mood disorders

Depressive

Disorders

Bipolar Disorders3Slide4

4

Depressed Mood – Depression

Unipolar

Depression

Slide5

5

Elevated Mood – Mania (Manic Phase)

Depressed Mood – Depression

Bipolar

DisorderSlide6

Types of mood disorders 6

Depressive

Bipolar

Mood Disorder Due to General Medical ConditionSubstance

-

Induced

Mood

Disorder

Adjustment

Mood

Disorder

PRIMARY

SECONDARY

:Slide7

Types of Mood Disorders

7

Depressive

DisordersMajor Depressive Disorder MDD(Unipolar Depression) Major Depressive EpisodeReccurent

Dysthymic

Disorder

(

Dysthymia

)

Depressive

Disorder

NOS (Not

Other

Specified

)Slide8

Major Depressive Episode

Depressed mood

or

Anhedonia (loss of interest and pleasure)8Slide9

Major Depressive Episode

Depressed mood

or

Anhedonia (loss of interest and pleasure)Persistently decreased sleep (early, middle, late insomnia) or increased sleep (atypical symptom) if

only

sleep

problems

 CONSIDER „

masked

depression

9Slide10

Major Depressive Episode

Depressed mood

or

Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep

if

only

sleep

problems

consider

masked

depression

Feelings of worthlessness or inappropriate

guilt (severe depression  delusions of guilt)

Low

energy or fatigue

(↓

hygene

, ↓

grooming

)

(

severe

cases

- „

leaden

paralysis

”)

Decreased

concentration

or indecisiveness

,

memory

complaints

greatly

impair

work

function

(

eldery

patients

-

false

diagnosis

of dementia)Decrease or increase (atypical) in appetite OR significant weight loss or gainPsychomotor changes (retardation or agitation)

10Slide11

Major Depressive Episode

Depressed mood

or

Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep if only sleep

problems

masked

depression

Feelings of worthlessness or inappropriate

guilt

(

severe

depression

delusions

of guilt) Low energy or fatigue

(↓ hygene, ↓ grooming) ( severe

cases- „leaden paralysis”)

Decreased

concentration

or indecisiveness

, memory complaints

 greatly impair work function

(eldery patients- false diagnosis of dementia)

Decrease or increase

(atypical)

in

appetite

OR

significant weight loss or gain

Psychomotor

changes (r

etardation

or

agitation

)

Re

current thoughts of death, suicidal ideation

s

(2/3 poeple with depression)

, or

suicide

attempt

11Slide12

Major Depressive Episode

Depressed mood

or

Anhedonia (loss of interest and pleasure)Persistently decreased (early, middle, late insomnia) or increased (atypical symptom) sleep if only sleep

problems

masked

depression

Feelings of worthlessness or inappropriate

guilt

(

severe

depression

delusions

of guilt) Low energy or fatigue

(↓ hygene, ↓ grooming) ( severe

cases- „leaden paralysis”)

Decreased

concentration

or indecisiveness

,

memory

complaints

greatly

impair

work

function

(

eldery

patients

-

false

diagnosis

of

dementia

)

Decrease or increase

(

atypical

)

in

appetite

OR

significant weight loss or gain

Psychomotor

changes (retardation or agitation)Recurrent thoughts of death, suicidal ideations (2/3 people with depression) , or

suicide

attempt

Other

symptoms

:

anxiety

, morning worsening of symptoms, chronic pain (if only chronic pain- „masked depression”)

12

5

symptoms present for ≥ 2 weeksSlide13

Diagnosis of depression: (AD) SIG E CAPS (

medical mneumonic commonly

used

in the real world to diagnose depression)131 or 2 major symptoms: Anhedonia and/or Depressed mood + ≥ 4 minor symptoms ≥ 2 weeks (SIG E CAPS)

S

leep

↑ ↓

(

changes

in

sleep

pattern

)

I

nterest

(

loss of interest in activities)Guilt ↑ (feelings of worthlessness)Energy ↓ (fatique

)Concentation

/Cognition/Decisiveness ↓ (

difficulty

concentrating

/

decline

in

cognition

/

Indecisiveness

A

ppetite

↑ ↓

(

changes

in

appetite

)

P

sychomotor

↑ ↓

(

retardation

or

agitation

)

S

uicide

/

Death

(preoccupation)Slide14

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

Depressed mood

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide15

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

Depressed mood

S

leep- changes

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide16

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

Depressed mood

S

leep- changes

I

nterest- loss

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide17

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

Depressed mood

S

leep- changes

G

uilt/worthlessness

I

nterest- loss

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide18

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

D

epressed mood

S

leep- changes

E

nergy loss- fatique

G

uilt/worthlessness

I

nterest- loss

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide19

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

D

epressed mood

S

leep- changes

E

nergy loss- fatique

G

uilt/worthlessness

C

oncentration- difficulties /Indecisiveness

I

nterest- loss

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide20

Depression clip arts mnemonics (AD) SIG E CAPS

A

nhedonia/

D

epressed mood

S

leep- changes

E

nergy loss- fatique

G

uilt/worthlessness

C

oncentration- difficulties /Indecisiveness

I

nterest- loss

A

ppetite- changes

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide21

Depression clip arts mnemonics (AD) SIG E CAPS

21

A

nhedonia/

D

epressed mood

S

leep- changes

E

nergy loss- fatique

G

uilt/worthlessness

C

oncentration- difficulties /Indecisiveness

I

nterest- loss

A

ppetite- changes

P

sychomotor-retardation or agitation

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide22

Depression clip arts mnemonics (AD) SIG E CAPS

22

A

nhedonia/

D

epressed mood

S

leep- changes

E

nergy loss- fatique

G

uilt/worthlessness

C

oncentration- difficulties /Indecisiveness

I

nterest- loss

A

ppetite- changes

S

uicide/Death-preocupattion

P

sychomotor-retardation or agitation

Anhedonia or Depressed mood and ≥ 4 of below for ≥ 2 weeksSlide23
Slide24

Major Depressive Disorder

specifiers

24Slide25

Major Depressive Episode

specifiers

25Slide26

Major Depressive Disorder- diagnostic criteria

26Slide27

The Reccurent Course of Major Depressive

Disorder

27

School

Friends

Job

Marriage

Out of

job

Finances

Physical health

Depression

DepressionSlide28

Major Depressive Disorder (outside psychiatric

setting)

Up to

1/4

of patients with major medical comorbidity (cerebrovascular accidences, diabetes, cancer) will develop MDD, what has the huge effect on worsening their health.Less than half of primary care patients with mental illness receive ANY treatment.50-70% MDD is NOT accurately diagnosed or treated in primary setting.Roughly 80% of all antidepressants are prescribed by non psychiatrists (Mark at all. 2009)28Slide29

Major Depressive Disorder- prognosis

For

many

patiens MDD can be a chronic relapsing illnessRelapse within 6 months of recovery – 1/4 patientsRisk of having another episode:≥ 60% if one previous episode≥ 90% if three previous episodes  severity of next episodes is greater5%-10% will go on to develop Bipolar DisorderChronically ill – 1/3 of patients

The

overall

mortality

risk

↑ 2

times

(

suicides

,

medical

illnesses

)

The

risk

of death by suicide ↑ 26 times in untreated patients29Slide30

Major Depressive Disorder-Course

Approx. 50%

people

with

first-episode depression experience a prodromal period (mild depressive symptoms and anxiety)Untreated mild/moderate episodes can last 1-6 months severe 6-8 months and even >12 months Treated depressive episode lasts on average 3 months

30Slide31

Major Depressive Disorder- epidemiology

Lifetime risk:10%-25% for women

5%-12% for men

Lifetime risk for developing depression is increasing

(for people born after The II World War)Average age of onset in mid-20’s (trend of increasingly younger age of depression onset)31Slide32

Etiology of Mood Disorders

32Slide33

SEROTONINERGIC ACTIVITY: PET STUDY

HEALTHY CONTROL

PATIENT DURING DEPRESSIONSlide34

SPECTSlide35

Types of mood disorders

35

Depressive

disordersMajor Depressive Disorder(Unipolar Depression)Single EpisodeReccurentDysthymic Disorder

1

1

2Slide36

Dysthymic Disorder

36

Associated with ≥ 2 of the following:

decreased or increased appetite

decreased or increased sleeplow energy or fatiguelow self-esteempoor concentration or indecisivenesshopelessnessDepressed mood nearly every day

for > 2 years

Milder

but

chronic

depression

.Slide37

Who was dysthymic in „Winnie the

Pooh”?

37Slide38

Eeyore

38Slide39

Types of Mood Disorders

39

Depressive

DisordersMajor Depressive Disorder Single EpisodeReccurentDysthymic Disorder

Adjustment

Mood

DisorderSlide40

Adjustment Disorder

with Depressed M

ood

40

stress related disturbanceSlide41

Adjustment Disorder with

Depressed Mood

Depressive symptoms that develop within 3 months of a

stressor

(negative and positive events)Symptoms do not meet criteria for another mood episodeSymptoms are clinically significant because of:Marked distress is in excess of what would be expected ORSignificant social or occupational impairment41Slide42

Bereavement (mourning, grief)

“Normal” reaction to the loss of a loved one

May have several depressive symptoms

Consider diagnosis of major depressive episode if:

Symptoms persist > 2 months after lossPresence of any of the following:Guilt (except for actions taken or not taken at time of death)Profound and persistent anhedoniaMarked psychomotor retardationDecreased self-esteemSuicidal ideationHallucinations other than hearing voice or seeing image of deceased person42Slide43

A well-known man who

suffered from depression…

43Slide44

Famous people suffering from

depression

44

Hugh Laurie

J.K.Rowling

Gwyneth

PaltrowSlide45

BIPOLAR DISORDERSSlide46

Aretaeus

of

Cappadocia

150 AD, mania and melancholy are the same illnessJules Francois Baillarger1853 The illness was separated from schizophrenia

Extreme

mood

changes

are

different

phases

of

the

same

illness

Emil

Kraepelin 1899 Name: manic-depressive illness

Karl Kleist

1953

separated out unipolar depression,

The term: Bipolar DisorderSlide47

Types of Mood Disorders

Bipolar

Disorders

Bipolar I DisorderBipolar II DisorderCyclothymic Disorder

47

Bipolar

NOS (Not

Other

Specified

)Slide48

Bipolar I and Bipolar II

48Slide49

Manic EpisodeElevated (or irritable) mood for >1 week

(or less if must be hospitalized)

49Slide50

Manic Episode

Elevated (or irritable) mood for >1 week (or less if

must

be hospitalized)≥ 3 of following (4 if mood irritable):50Decreased need for sleepSlide51

Manic Episode

Elevated (or irritable) mood for >1 week week (or less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):51Decreased need for sleepIncreased goal-directed activitySlide52

Manic Episode

Elevated (or irritable) mood for >1 week week (or less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):52Decreased need for sleepIncreased goal-directed activityDistractibilitySlide53

Manic Episode

Elevated (or irritable) mood for >1 week week (or less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):53Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughtsSlide54

Manic Episode

Elevated (or irritable) mood for >1 week week (or

less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):54Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts

Excessive involvement in pleasurable activities with high riskSlide55

Manic Episode

Elevated (or irritable) mood for >1 week week (or less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):55Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts

Excessive involvement in pleasurable activities with high risk

Pressured speechSlide56

Manic Episode

Elevated (or irritable) mood for >1 week week (or less

if

must be hospitalized)≥ 3 of following (4 if mood irritable):56Decreased need for sleepIncreased goal-directed activityDistractibilityFlight of ideas, racing thoughts

Excessive involvement in pleasurable activities with high risk

Pressured speech

GrandiositySlide57

Diagnosis of mania: (DIG FAST) (medical

mneumonic commonly

used

in the real world to remember symptoms of mania)57

D

istractibility (and easy frustration)

I

rresponsibility (and erratic uninhibited behaviour)

G

randiosity

F

light of ideas (and racing thoughts)

A

ctivity increased (with weight loss and increased libido)

S

leep decreased

T

alkativenessSlide58

Mania (clip arts mnemonics) DIG FAST

58

Elevated expansive mood

or

Irritable moodSlide59

Mania (clip arts mnemonics) DIG FAST

59

Elevated expansive mood

or

Irritable mood

D

istractibility

Slide60

Mania (clip arts mnemonics) DIG FAST

60

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour Slide61

Mania (clip arts mnemonics) DIG FAST

61

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour

G

randiositySlide62

Mania (clip arts mnemonics) DIG FAST

62

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour

G

randiosity

F

light of ideas/Racing thoughtsSlide63

Mania (clip arts mnemonics) DIG FAST

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour

G

randiosity

F

light of ideas/Racing thoughts

A

ctivity increased/ Psychomotor agitation Slide64

Mania (clip arts mnemonics) DIG FAST

64

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour

G

randiosity

F

light of ideas/Racing thoughts

A

ctivity increased/ Psychomotor agitation

S

leep decreasedSlide65

Mania (clip arts mnemonics) DIG FAST

65

Elevated expansive mood

or

Irritable mood

D

istractibility

I

rresponsibility and erratic uninhibited behaviour

G

randiosity

F

light of ideas/Racing thoughts

A

ctivity increased/ Psychomotor agitation

S

leep decreased

T

alkativenessSlide66

The Course of Bipolar I

66

Mania

Depression

Mixed state

Mania

Depression

School

Friends

Job

Marriage

Finances

Physical healthSlide67

Bipolar Disorder specifiersSlide68

Bipolar Disorder specifiersSlide69

The Course of Bipolar -Rapid cycling

69

Qualifier for Bipolar I

and

Bipolar II Disorder≥ 4 mood episodes (any type) within any 1 year period difficult to treatSlide70

Rapid cyclingSlide71

Bipolar I

- diagnosis

At least

one manic

or mixed episodeNo need for a prior depressive episodeSymptoms cause significant impairment in social and/or occupational functioning Symptoms do not result from a drug of abuse, medication, other treatment, or general medical conditionCould be delusions  what need additional treatment71Slide72

Bipolar I- frequency of symptoms

Paul E. Keck, Jr, MD, Roger S. McIntyre, MD, FRCPC, and Richard C. Shelton,

Bipolar Depression: Best Practices for the Outpatient

MDCNS Spectr. 2007;12:12(Suppl 20):1-16Slide73

Bipolar II Disorder

73Slide74

Hypomanic Episode

Elevated, expansive, or irritable mood lasting > 4 days –

clearly different

from baselineThree or more of the following (four if mood irritable):Little need for sleepIncreased goal-directed activityFlight of ideas, racing thoughtsDistractibilityExcessive involvement in pleasurable activities with high riskRapid speechOverconfidenceClear change in functioning but no marked impairment in social or occupational functioning74Slide75

Bipolar II

Disorder- diagnosis

At least

one

previous major depressive episodeAt least one hypomanic episodeLess severe than Bipolar I and more difficult to diagnose75Slide76

Bipolar II- frequency of symptoms

Paul E. Keck, Jr, MD, Roger S. McIntyre, MD, FRCPC, and Richard C. Shelton,

Bipolar Depression: Best Practices for the Outpatient

MDCNS Spectr. 2007;12:12(Suppl 20):1-16Slide77

Bipolar Disorders- Epidemiology

Lifetime risk:Bipolar I Disorder: 1% (men = women)Bipolar II Disorder: 0,4% (

adults

)

* 3-4% (adolescens) *Age of onset late teens to early 20’s * Merikangas KR, Lamers F. Curr Opin Psychiatry. 2012 Jan;25(1):19-2377Slide78

Famous bipolar people

Mel Gibson

Curt Cobain

Robert Downey jr.Slide79

Types of mood disorders

Bipolar

Disorders

Bipolar I Bipolar II Cyclothymic Disorder

79

Bipolar

NOSSlide80

Cyclothymic Disorder80

Hypomanic episodes and depressive symptoms alternate

over at least 2 years

Several distinct

periods of hypomanic and depressive symptoms (not MDD)Symptom-free periods are < 2 months ≥ 2 years