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MOOD DISORDERS

MOOD DISORDERS. YARD.DOÇ.DR. N. BERFU AKBAŞ YEDİTEPE ÜNİVERSİTESİ PSİKİYATRİ AD. 1-DEPRESSIVE DISORDERS. - MAJOR DEPRESSIVE DISORDER( MDD ) %10-25 women , %5-12 men Persistant depressive disorder 2- BIPOLAR DISORDERS. Neurobiological approaches to aetiology. Monoamine hypothesis:

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MOOD DISORDERS

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  1. MOOD DISORDERS YARD.DOÇ.DR. N. BERFU AKBAŞ YEDİTEPE ÜNİVERSİTESİ PSİKİYATRİ AD

  2. 1-DEPRESSIVE DISORDERS -MAJOR DEPRESSIVE DISORDER( MDD ) %10-25 women, %5-12 men • Persistantdepressivedisorder 2- BIPOLAR DISORDERS

  3. Neurobiological approaches to aetiology • Monoamine hypothesis: Serotonin, noradrenaline, dopamine, • Aminoacid neurotransmitters Glutamate (), GABA() • Endocrine abnormalities HPA axis

  4. DSM5 CRITERIA for DEPRESSION • For at least 2 weeks, at least 5 of thebelowsymptomsshould be present: • Depressedmood* • Decreasedinterestorpleasure in activities* • Change in apetite • Sleepchanges • Pscyhomotoragitationorretardation • Fatigueorloss of energy • Feelings of worthlessnessorguilt • Concentrationdifficulties • Thoughts of death

  5. ETIOLOGY • BiogenicAmines ( norepinephrine, serotonin, dopamine ) • NeuroendocrineRegulation Adrenal axis ( cortisolhypersecretion) Thyroidaxis ( hypotyroidism) Growthhormone ( sleepabnormalities) • Limbicsystem, basalgangliaandhypothalamusmostaffected • Geneticfactors • Psychosocialfactors ( stress, personality)

  6. SPECIFIERS DESCRIBING MOST RECENT EPISODE • Psychoticfeatures • Melancholicfeatures (endogeneousdepression) • Atypicalfeatures (overeating, oversleeping...) • Catotonicfeatures ( immobility, negativism, mutism) • Postpartumonset

  7. DYSTHYMIA • Depressedmoodfor at least 2 years + 2 of thefollowing; • Apetitechanges, sleepchanges, lowenergy, low self-esteem, poorconcentration, feelings of hopelessness. • “İllhumored”, mostcasesearlyonset • DOUBLE DEPRESSION: dysthymia + MDD

  8. TREATMENT • Pharmacotherapy: • Tricyclicantidepressants: İmipramine ( tofranil), clomipramine ( anafranil ), amitriptiline ( laroxyl ), ( sideeffects: hypotension, arrithmias, seizures ) • Serotoninreuptakeinhibitors: Fluoxetine ( prozac), citalopram ( cipram), sertraline ( Lustral ), paroxetine ( paxil), essitalopram ( cipralex ) ( sideeffects: GI disturbance, bleeding? Bruxism? ) • ECT

  9. BIPOLAR DISORDERS • BIPOLAR 1 DISORDER: • %0.4-1.6, equalprevelanceamongsexes. • Onset is earlierthandepression • 1 parentBipolar: %25 risk in thesibling • Dx: At least 1 manicepisodelastingfor 1 week • Mania: at least 3 of following: -Grandiosity - psychomotoragitation -Decreasedneedforsleep - excessiveactivities -Talking -Flight of ideas -distractibility

  10. ManicPatientsare: • Excited, talkative, sometimesamusing • Cannot be interruptedwhilespeaking, loud • Delusionsoccur in %75 ( grandiose ) • %75 assaultiveortreatening • Unreliable, lying

  11. BIPOLAR II DISORDER • Presence of oneormoredepressiveepisodes • Presence of at leastonehypomanicepisode • Hypomania:at least 4 days 3 of thefollowing; • Grandiosity • Decreasedneedforsleep • Talkative • Flight of ideas • Distractibility • Psychomotoragitation • Excessivepleasurableactivities

  12. TREATMENT • Depressiveattacks: antidepressants • Manicattacks: moodstabilizers+ antipsychotics + benzodiazepines • MoodStabilizers: • Lithium • Antiepileptics • Thesedrugsareusedchronically

  13. CYCLOTHYMIC DISORDER -Episodes of hypomaniaandmilddepressionfor 2 years. -%1 life time prevalance, 15-25 yearsonset • F/M=3/2 • ınstability in relationships • Changes in moodareirregular, abrupt • Commonsubstanceusedisorders • Tx: moodstabilizers • Antidepressantsswitchto mania

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