Transcript short version

Module Three
Mood Disorders
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Lesson 1:What is disorder and how it is manifested
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Lesson 2: What are the causes of Depression
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Lesson 3: Which is the treatment of Depression
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Lesson 4: What is Bipolar Disorder
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Lesson 5: Which is the therapeutical treatment of
Bipolar Disorder
Lesson 1
WHAT IS DEPRESSION AND HOW IT IS
MANIFESTED
Step 1: Introduction
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The emotion of sadness is a common experience
of all people.
Depression is mental disorder, where the normal
emotion of sadness has over passed the usual
limits of sadness.
This disorder is extremely common. One in ten
people is attacked by it in any time of his life and
one in five will experience it some time during
his life.
Women are more prone to suffer Depression than
men.
It can often lead to suicide.
Step 2: Brainstormin
How does it feel and what is the behavior of
a person that suffers from Depression?
Step 3: Slide Projection
Slide 3.1.1: Symptoms of Depression
 Emotion of intense sadness that does not subside
 Lack of pleasure
 Tendency to avoid other people.
 uneasiness and anxiety
 Irritability
 Difficulties to sleep (insomnia)
 Very early waking up
 Anorexia and weight loss (some times the opposite)
 Decrease of sexual desire
 Sense of fatigue and lack of energy.
Step 3 (continued)
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Difficulty to accomplish his everyday tasks.
Difficulty to take major or minor decisions
Loss of interest
Thoughts of committing suicide
Guilt
Difficulties in paying attention and in
concentration
Loss of self – esteem
Psychotic symptoms (aberrant depressive ideas,
delusions)
Physical disturbances
Step 4: Theory Presentation
Verbal and no verbal communication
Communication between people is usually made
through exchange of verbal messages. This
requires:
 Listening and paying attention,
 Understanding of the content,
 Knowledge of the language structure (grammar
and syntaxes),
 Creating new sentences,
 Using common vocabulary with others,
 Remembering,
 Thinking,
 Putting his thoughts in words,
 Following social rules, as for example when to
answer and in what way so that the answer
responds to the question.
Step 5: (continued)
Verbal messages are either completed, or replaced by
no verbal. These include:
 Body posture
 Physical distance from the interlocutor
 Face expression
 Eye threat or its absence
 Various gestures
 Other elements of the persons behavior
People with serious mental disorders some times have
difficulties in verbal expression.
Step 6: Questions and comments
(5΄)
Lesson 2
WHICH ARE THE CAUSES OF
DEPRESSION
Step 1: Brainstorming
What do you think that are the causes of
Depression ?
Step 3: Slide projection
Slide 3.2.1: Factors related to the causes of
Depression
 Genetic
 Neurochemical
 Traumatic experiences
 Hard social situations
 Stressful situations
 Physical diseases
 Substance use especially alcohol and cocaine
 Perperium (after birth recovery)
Step 4: Slide Projection
Slide 3.2.2: Clinical course (progress) of
Depression
1 Case: long , gentle and insidious start
Step 4 (continued)
2nd case: long gentle and insidious start, plus acute
symptoms for a period of time.
Step 4 (continued)
3rd Case: Sudden start and total subsiding of
symptoms after a period of time.
Step 4 (continued)
4th Case: Sudden start, partial subsiding, relapses.
Step 4 (continued)
5th Case: Sudden or insidious start and chronic
duration.
Step 5: Questions and
comments (5΄)
Lesson 3
WHAT IS THE THERAPEUTICAL
TREATMENT OF DEPRESSION
Step 1: Slide Projection
Slide 3.3.1: Therapeutic interventions to
depressive patient
 Antidepressants
 Therapy with Lithium
 Psychotherapy
 Electrospasmic therapy
 Social interventions
Step 3: Slide Projection
What antidepressants do you use in your
practice?
Step 4 (continued)
Slide 3.3.2: Common antidepressants
Tricycles
 Imipramine
(Tofranil)
 Amitriptyline
(Saroten)
 Clomipramine
(Anafranil)
New
 Fluoxetine
(Ladose)
 Paroxetine
(Seroxat)
 Fluvoxamine
(Dumyrox)
 Venlafaxine
(Efexor)
 Nefazodone
(Nefirel)
Step 5: Slide Projection
Slide 3.3.3: Antidepressants’ side effects
 dry mouth, constipation, blurred vision
 drowsiness and fatigue
 Standing hypotension (low blood pressure)
 rapid heart rate excessive sedation or uncoordinated
movements while taking this medication
Tachycardia, arrhythmias and palpitation
 Sexual dysfunction
 Weight gain
 From newer antidepressants: nausea, migraine
headaches and insomnia.
Step 6: Questions and
comments (5΄)
Lesson 4
WHAT IS BIPOLAR DISORDER
Step 1: Introduction
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Depression might appear in combination with
an opposite emotional state, euphoria which
characterizes Mania. It is then called “ManioDepressive Disorder” or “Bipolar Disorder”
as it is named nowadays.
Bipolar Disorder, like Schizophrenia, is
considered as a psychotic disorder with long
and serious course
Patients with this disorder appear Depressive
episodes as well as manic episodes. Either
one might appear first.
Step 1 (continued)
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It is possible that some patients appear severe
episodes of Depression only, while the
characteristics of euphoric behavior and
hyperactivity are really mild and do not cause any
problem. Other might appear only manic
episodes, but it is not very common.
The time in between the episodes the person
might feel perfectly well.
In some patients episodes alternate in high rate.
Step 1 (continued)
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Some times at the beginning of the disease, if
there are intense psychotic characteristics, it is
difficult to distinguish a manic from a
schizophrenic episode.
The depressive episodes manifested in Bipolar
Disorder are usually serious.
Bipolar Disorder affects about 1 every 100
persons, men as well as women.
Depends on genetic background.
Difficult social situations and stressful every-day
situations worsen the development (progress) of
this disorder.
Step 2: Brainstorming
What is the behavior of a manic patient?
Step 3: Slide projection
Slide 3.4.1: Manic Symptoms
Symptoms related to mood :
 Assiduous euphoric mood
 Irritability
 Temporary depression
Symptoms related to concentration, speech and
thinking:
 Easy distraction of attention
 Pressurized talking, loss of ideas
 High self esteem
Step 3 (continued)
Somatic/ Biological/ Behavior symptoms:
 High mobility and activity (physical, social,
working, sexual)
 Dangerous or socially improper behavior
 Insomnia with no feeling of fatigue
 Good appetite, but loss of weight because
of hyperactivity.
Step 4: Questions and
comments (5΄)
Lesson 5
WHICH IS THE THERAPEUTICAL
TREATMENT OF BIPOLAR
DISORDER
Step 1: Introduction
Bipolar Disorder, without therapeutical
treatment, has the tendency to manifest
successive manic and depression episodes,
which as the time pass become more often
and more severe, while the intermediate
free of symptoms periods become shorter.
Step 2: Slide Projection
Slide 3.5.1: Development of Bipolar Disorder with and
without treatment.
one yearς
Many years
Θεραπεία συντήρησης
therapy
of acute phase
Συνεχιζόμενη
Θεραπεία
Step 3: Brainstorming
Leaflet 3.5.1: Clinical case
What are the needs of a patient that should
be attended and in what way during his/
her treatment ?
Step 4: Slide projection
Slide 3.5.2: Therapeutical treatment for Bipolar
Disorder
Episode treatment
Depression episode:
 Antidepressants medication
 Other psychosocial interventions.
Manic episode:
 Hospitalisation
 Medical treatment (with antipsychotic and
tranquilizers)
 Limitation of manic behavior.
Step 4 (continued)
Continued therapy from preventing relapses
 Continuation of the medication
 Supporting psychotherapy
 Other psychosocial interventions
Preservation therapy
 Administration of lithium or other drugs that
stabilize mood
 Psychosocial interventions
Step 5: Theory presentation
Lithium
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Lithium is a chemical substance like sodium
and potassium it is used as a simple salt.
It is useful for the treatment and the
prevention of manic episodes.
Common Lithium drugs are: Milithin,
Priadel, Lithiofor.
Before the patient starts the lithium
treatment he undergoes urine, blood tests
and an electrocardiograph. With these tests
the function of the kidneys, liver, thyroid are
checked out.
Step 5 (continued)
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measuring the lithium levels in the blood (at first
very often and later onevery1-2 months) is
essential as the level at which the drug is efficient
is not far from the toxicity level.
Person in lithium medication should have a low
in salt diet.
It needs extra care when a person on lithium
medication shows vomiting, diarrhea or
dehydration.
It shouldn’t be administered in pregnant women
or in people with kidney failure.
Step 5 (continued)
Slide 3.5.3: Lithium side effects
Early signs
 Nausea, vomiting, diarrhea
 Fear at voluntary movements
 Dry mouth, thirst
 Fatigue
 congested nose, metallic taste
Later signs
 hypothyroid
 Weight gain
 ataxia, joint dysfunction
 Arrhythmias
 Kidney disease
Step 5 (continued)
Lithium poisoning
 Terror (phobias)
 Ataxia
 Uncoordinated movements
 Rushed speech
 Confusion
 Loss of orientation
 Spasms (convulsion)
 Coma
Step 7: Questions and
comments (5΄)