Transcript Slide 1

Definition
A group of disorders of variable severity
in which the central symptom is
pervasive disturbance of mood (either
depression or mania) usually
accompanied by other characteristic
symptoms.
Major depressive
disorder
Epidemiology
The lifetime prevalence is 10% for
women, and 5% for men.
The lifetime prevalence in
monozygotic twins of patients is
50%.
I- Presence of one or more major
depressive episodes.
Major depressive episode
A- five or more of the following symptoms;
at least one of the symptoms is either (1)
depressed mood or (2) loss of interest:
1- Depressed mood for at least two weeks.
2- Loss of interest and pleasure in previously
interestable activities.
3- Insomnia or hypersomnia.
4- Psychomotor retardation or agitation.
5- Decreased or increased appetite and
loss or increase in weight.
6- Easy fatigability.
7- Decreased concentration.
8- Feelings of worthlessness or guilt.
9- Recurrent thoughts of death or
suicidal ideation, plan or attempts.
B- Not substance-induced or not due
to general medical condition.
II- There has never been a manic or
hypomanic episodes.
III- Significant impairment of
occupational and social functioning.
1- Dysthymic disorder:
a- Depressed mood for at least 2 years.
b- two or more of the following:
Poor appetite or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration.
Feelings of hopelessness.
c- Significant impairment of
occupational and social functioning.
2- Minor depressive disorder:
episodes of at least 2 weeks of
depressive symptoms but with fewer
than the five items required for major
depressive disorder.
3- Recurrent brief depressive
disorder:
recurrent episodes of depression that
last less than two weeks.
4- Premenstrual dysphoric disorder:
symptoms of depresed mood, anxiety,
affective lability, decreased interest in
activities regularly occur during the last week
of luteal phase and remit within a few days of
the onset of the menses.
5- Secondary mood disorder:
Substance-induced mood disorder.
Mood disorder due to general medical
condition.
I- Neurotransmitter hypothesis:
decreased activity of biogenic amines
serotonin, norepinephrine, and
dopamine.
II- Genetic theory:
Increase the incidence of depression in
subjects related to an affected person.
No consolidated studies correlate
between depression and specific
chromosomes.
III- Brain structure theory:
Some patients showed smaller caudate
nuclei, and frontal lobes.
Diminished basal ganglia blood flow.
IV- Psychosocial theory:
as indicated by cognitive triad;
Negative self-view “things are bad
because I’m bad”.
Negative interpretation of experience “
everything has always been bad”
Negative view of future “anticipation of
failure”.
A- Pharmacotherapy:
Serotonin specific reuptake
inhibitors (SSRIs):
Mode of action: inhibit reuptake of serotonin
so promote its action on postsynaptic
receptors.
Indications: major depressive disorder,
anxiety disorder, bulimia nervosa.
Adverse effects: nausea, decreased appetite,
delayed ejaculation.
Examples: fluoxetine, paroxetine.
Tricyclic antidepressants:
Mode of action: inhibit reuptake of
serotonin and norepinephrine so
promote their actions on postsynaptic
receptors.
Indications: major depressive disorder,
panic disorder.
Adverse effects: sedation, atropine-like
action.
Examples: imipramine, clomipramine.
Buprobion:
Mode of action: inhibit reuptake of dopamine
and norepinephrine so promote their actions
on postsynaptic receptors.
Indications: major depressive disorder,
attention deficit/hyperactivity disorder,
smoking cessation.
Adverse effects: mild symptoms of weight
loss, dry mouth or constipation.
B- Electro-convulsive therapy:
is useful in refractory major
depressive disorder, major
depressive episode with suicidal
attempts or with psychotic
symptoms (like delusions and
hallucinations).
C- Psychotherapy:
1- Cognitive therapy:
aims to correct negative cognitions.
2- Supportive psychotherapy:
aims to provide emotional support.
3- Family therapy:
if patient’s depression is disrupting the family
stability, or when depression is related to
family dynamics.
Bipolar I disorder
Epidemiology:
The lifetime prevalence is 0.4-1.6%.
The lifetime prevalece in
monozygotic twin of patients is up to
90%.
I- Presence of one or more manic
episodes.
Manic episode
A- Elated mood or irritable mood for one week
or more.
B- If mood is elated (3) or more of the
following must be present but if mood is
irritable (4) or more of the following must be
present:
1- Inflated self-esteem or grandiosity.
2- Decreased need for sleep.
3- More talkative than usual.
4- Flight of ideas.
5- Distractability.
6- psychomotor agitation.
7- Loss of normal social and
sexual inhibition.
8- Excessive involvement in
pleasurable activities that have a
high potential for painful
consequences.
C- Not substance-induced or not due to
general medical condition.
II- With or without presence of major
depressive episodes.
III- Significant impairment of
occupational and social functioning.
1- Bipolar II disorder:
major depressive episodes with hypomanic
episoes.
2- Cyclothymic disorder:
Numerous episodes of hypomania and
numerous episodes of depressive
symptoms for at least 2 years.
The symptoms are not sufficient to
diagnose manic episodes or major
depressive episodes.
Significant social and occupational
impairment.
3- Secondary mood disorder:
Substance-induced mood disorder.
Mood disorder due to general medical
condition.
I- Neurotransmitter hypothesis:
increased activity of biogenic amines
serotonin, norepinephrine, and
dopamine.
II- Genetic theory:
Increase the incidence of bipolar I
disorder in subjects related to an
affected person.
Associations between bipolar I disorder
and genetic markers have been reported
for chromosomes 5, 11, X.
III- Brain structure theory:
Some patients showed enlarged
cerebral ventricles.
Magnetic resonance spectroscopy
showed abnormal regulation of
membrane phospholipid metabolism.
IV- Psychosocial theory:
feeling of inadequacy and worthlessness are
converted by means of denial, reaction
formation and projection to grandiose
delusions.
A- Hospitalization:
especially with severily psychomotor
agitated patients.
B- Pharmaotherapy:
Mood stabilizers:
used in the treatment and prevention of
manic and depressive episodes of
bipolar disorders.
Lithium: it is the standard treatment of
bipolar disorder. the therapeutic blood
level is 0.8-1.2 mEq/litre. Serum level
must be done regularly to safeguard
againt subtherapeutic or toxic levels.
Valproate: the first-line drug in bipolar
disorder with dysphoric mood, and
rapid cycling bipolar disorder. has
broad therapeutic index and effective
at levels of 50-125 microgram/ml.
Lamotrigine: the most effective drug in
controling depressive episodes of
bipolar disorder, and do not require
blood monitoring.
During manic episode
antipsychotic drugs (see treatment of
schizophrenia) are used to promote
rapid amelioration of the symptoms.
During major depressive episode
antidepressant drugs (see treatment of
major depressive disorder) may be
used especially buprobion or SSRIs in
combination with mood stabilizers to
avoid switching to mania.
B- Electroconvulsive tharpy:
is at least equal to lithium in the treatment of
acute and severe manic episodes.
D- Psychotherapy:
Cognitive therapy; to increase compliance
with pharmacotherapy.
Supportive therapy: with chronic patients
who may have significant interepisodic
residual symptoms and social dysfunction.
Family therapy: if patient’s disorder is
disrupting the family stability, and because
the disorder is strongly familial.