Mood Disorder - Psychiatry - Lecture Slides, Slides of Psychiatry

Download Mood Disorder - Psychiatry - Lecture Slides and more Slides Psychiatry in PDF only on Docsity! Mood (Affective) Disorders Docsity.com Mood (Affective) Disorders • Mood disorders are very common, their life prevalence is up to 20 %, and they have a high level of morbidity and mortality as well as an immense impact on disabilities worldwide. • The fundamental disturbance is a change in mood or affect, usually to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity. • Most of these disorders tend to be recurrent, and the onset of individual episodes is often related to stressful events or situations. • The mood disorders may be subdivided into unipolar and bipolar types: 1. those that are characterized by depression only 2. those that are characterized by manic episode either alone or in combination with depression Docsity.com F32 Depressive Episode • Pathological sadness • Depressive episode: – depressed mood – loss of interest and enjoyment – reduced energy leading to increased fatigability and diminished activity – marked tiredness after only slight effort – reduced concentration and attention – reduced self-esteem and self-confidence – ideas of guilt and unworthiness – bleak and pessimistic views of the future – ideas or acts of self-harm or suicide, – disturbed sleep and diminished appetite Docsity.com F32 Depressive Episode • Clinical presentation shows marked individual variations – in some cases, anxiety, distress, and motor agitation may be more prominent at times than the depression – the mood change may also be masked (masked depression) by added features such as irritability, excessive consumption of alcohol, histrionic behaviour, and exacerbation of pre-existing phobic or obsessional symptoms, or by hypochondriacal preoccupations. • Depressive episode should last at least 2 weeks (typically several months), but shorter periods may be reasonable if symptoms are unusually severe and of rapid onset. • The lifetime prevalence: 17%; risk of recurrence >50%. Docsity.com F32 Depressive Episode • The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called „somatic“ symptoms: – loss of interest or pleasure in activities that are normally enjoyable (anhedonia) – lack of emotional reactivity to normally pleasurable surroundings and events – waking in the morning 2 hours or more before the usual time – depression worse in the morning – objective evidence of definite psychomotor retardation or agitation – loss of appetite – weight loss – loss of libido Docsity.com F32.1 Moderate Depressive Episode • An individual with moderate depressive episode suffers from more symptoms (four or more of the above symptoms are usually present) of greater severity and will usually have considerable difficulty in continuing with social, work or domestic activities. Docsity.com F32.2 Severe Depressive Episode without Psychotic Symptoms • In a severe depressive episode, the sufferer usually shows considerable distress or agitation. Loss of self- esteem or feelings of uselessness or guilt are likely to be prominent, and suicide is a distinct danger in particularly severe cases. ; a number of "somatic" symptoms are usually present. – Agitated depression – Major depression – Vital depression Docsity.com F32.3 Severe Depressive Episode with Psychotic Symptoms • Psychotic symptoms may be present, such as – delusions (ideas of sin, poverty or imminent disasters) – hallucinations (defamatory or accusatory voices or of rotting filth or decomposing flesh) – depressive stupor • Severe ordinary social activities are impossible • When the psychotic symptoms are consistent with the patient’s mood, they are referred to as mood congruent, when they are inconsistent, they are referred as mood incongruent. • Single episodes of: – major depression with psychotic symptoms – psychogenic depressive psychosis – psychotic depression – reactive depressive psychosis Docsity.com F33 Recurrent Depressive Disorder F33 Recurrent depressive disorder F33.0 Recurrent depressive disorder, current episode mild F33.1 Recurrent depressive disorder, current episode moderate F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms F33.4 Recurrent depressive disorder, currently in remission F33.8 Other recurrent depressive disorders F33.9 Recurrent depressive disorder, unspecified Docsity.com F30 Manic Episode F30 Manic episode F30.0 Hypomania F30.1 Mania without psychotic symptoms F30.2 Mania with psychotic symptoms F30.8 Other manic episodes F30.9 Manic episode, unspecified Docsity.com F30.0 Hypomania • Hypomania is characterized by – persistent mild elevation of mood for at least several days – increased energy and activity – usually marked feelings of well-being and both physical and mental efficiency • Increased sociability, talkativeness, overfamiliarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. There are no hallucinations or delusions Docsity.com F31 Bipolar Affective Disorder • Bipolar affective disorder is characterized by repeated, at least two episodes in which the patient’s mood and activity levels are significantly disturbed (manic or depressive syndromes, patients who suffer only from repeated episodes of mania are comparatively rare). • The first episode may occur at any age from childhood to old age. • The frequency of episodes and the pattern of remissions and relapses are both very variable. • The lifetime prevalence is between 0,5 an 1 %. Suicidality – about 19%. Comorbidity with alcohol and drug abuse • The rapid-cycling specifier identifies those patients who have had at least four episodes of a major depressive, manic, or mixed episode during the past 12 months. Docsity.com F31 Bipolar Affective Disorder F31 Bipolar affective disorder F31.0 Bipolar affective disorder, current episode hypomanic F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms F31.3 Bipolar affective disorder, current episode mild or moderate depression F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms F31.5 Bipolar affective disorder, current episode severe depression with 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 Docsity.com F34 Persistent Mood (Affective) Disorders • Persistent mood disorders are persistent and usually fluctuating disorders of mood in which individual episodes are not sufficiently severe to warrant being described as hypomanic or even mild depressive episodes. • Lasting more than 2 years F34 Persistent mood (affective) disorders F34.0 Cyclothymia F34.1 Dysthymia F34.8 Other persistent mood (affective) disorders F34.9 Persistent mood (affective) disorder, unspecified Docsity.com F34.1 Dysthymie • dysthymie: mírná chronická deprese • epidemiologie: celoživotní prevalence kolem 3% • etiopatogeneze: faktory genetické i vnější • léčba: jako u depresivní poruchy – kognitivně- bahaviorální psychoterapie, antidepresiva Docsity.com Treatment of Depression • Various antidepressants altering levels of central neurotransmitters are available to treat depression. • Their overall effectiveness: 65-70% • Mild to moderate depressive episode: SSRIs. • Severe depression: antidepressants with broader spectrum of effects, like SNRI or TCA. • Patients with insomnia or anorexia may do better with more sedating medication (mirtazapine, trazodon) • Patients with lethargy, hypersomnia, weight gain and lower levels of tension and anxiety may prefer the less sedating medications such as bupropion, reboxetin or stimulating SSRIs. • IMAOs or RIMA should be tried in refractory patients or patients with atypical depression. Docsity.com Treatment of Depression • Drug trials should last 4 to 8 weeks. • No response within 4 weeks of treatment - the dose should be increased or the patient should be switched to another drug. • In partial responders - augmentation strategy; coadministration of lithium carbonate or trijodthyronine. • Psychotic patient - adding on neuroleptics. • Anxious or agitated patients (also to improve the sleep quality) - benzodiazepine coadministration for a short period of time. • Lithium prophylaxis is an option to antidepressants. • Supportive psychotherapy. Docsity.com