Transcript (2) loss of interest or pleasure. Major depressive disorder

IN THE NAME OF GOD
MOOD
DISORDERS
MOHAMAD NADI M.D
PSYCHIATRIST
MOOD DISORDERS
Historical perspective
• black bile and melancholia
• Endogenous vs. reactive depression
• Neurotic vs. psychotic depression
MOOD DISORDERS
DSM-IV-TR 5 Mood Disorders:
• Major depressive disorder
• Dysthymic disorder
• Bipolar disorders
•Cyclothymic disorder
•mood disorder NOS (Not Otherwise
specified )
MOOD DISORDERS
Diagnostic issues – Types of symptoms
• Mood and Emotion
• Cognition
• Behaviour and Motivation
• Physical
MOOD DISORDERS
Major depression
• symptoms include feelings of sadness,
loss of interest or inability to experience
pleasure, unexplained weight loss,
difficulty sleeping, fatigue, difficulty
concentrating, feelings of worthlessness or
guilt, suicidal thoughts, agitation or
slowing down
• And functional impairment
Major depressive disorder
A. Five (or more) of the following
symptoms have been present during the
same 2-week period and represent a
change from previous functioning; at
least one of the symptoms is
(1) depressed mood or
(2) loss of interest or pleasure.
Major depressive disorder
(1) Depressed mood
(2) Diminished interest or pleasure in all, or
almost all, activities
(3) Significant weight loss when not dieting
or weight gain or decrease or increase in
appetite.
(4) Insomnia or hypersomnia.
(5) Psychomotor agitation or retardation
Major depressive disorder
(6) Fatigue or loss of energy
(7) Feelings of worthlessness or excessive
or inappropriate guilt
(8) Diminished ability to think or to
concentrate
(9) Recurrent thoughts of death
B. The symptoms cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Major depressive disorder
• estimates suggest about 5-10% of people
suffer from depression
• twice as common in women – biological
differences, expression of symptoms, social
acceptability, role strain and stress
• 50% recurrence rate
Major depressive disorder
Problem of underdiagnosis
• no obvious marker for depression
• stigma associated with diagnosis of
depression
Major depressive disorder
Etiology of Depression
Biologic Theories
– Genetic
– Biochemical
Cognitive Theories
_ Object loss
_ aggression turned inward
Risk Factors for Depression
• Chronic Illness
• Female Gender
• Bereavement
• Perfectionistic
• Situational stressors
• Previous History
• Family History
• Social Isolation
Dysthymia
• many of the same symptoms as major
depressive disorder, but less severe
• dysthymia persists for at least 2 years
with only brief times mood returns to
normal
• chronic sadness
Treatment of Major depressive disorder
•Selective Serotonin Reuptake Inhibitors
•Tricyclic Antidepressants (TCA’s)
• Monoamine Oxidase Inhibitors
• ECT
•Psychoterapy
BIPOLAR DISORDERS
Mania
A. A distinct period of elevated or irritable
mood, lasting at least 1 week.
• B. During the period of mood disturbance
3 or 4 of the following have persisted and
have been present to a significant degree:
BIPOLAR DISORDERS
Mania
– 1. Inflated self-esteem or grandiosity
– 2. Decreased need for sleep
– 3. More talkative than usual
– 4. Flight of ideas
– 5. Distractibility
– 6. Increase in goal-directed activity
– 7. Excessive involvement in pleasurable
activities
BIPOLAR DISORDERS
Hypomania
• less severe episodes of mania
• less functional impairment
• less duration
Bipolar disorders
Bipolar I and II
• Bipolar I – at least one or more manic episodes
with or without one or more depressive episodes
• Bipolar II – at least one hypomanic episode with
one or more episodes of major depression
Bipolar disorders
Cyclothymia
• Alternating mood episodes: fluctuation
between mild depression and hypomania
• Duration at least 2 years
Treatment of bipolar disorders
•Mood stabilizers – Lithium
•Anticonvulsants– Valproat sodiom
•Antipsychotics – Risperidon
•Psychoterapy – CBT
•ECT