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Mood disorders ( affective disorders )

Mood disorders ( affective disorders ). prof. MUDr. Eva Češková, CSc. Dept. of Psychiatry, Masaryk University , Brno. Mood disorders ( affective disorders ). epidemiology etiology

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Mood disorders ( affective disorders )

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  1. Mood disorders ( affective disorders ) prof. MUDr. Eva Češková, CSc. Dept. of Psychiatry, Masaryk University , Brno

  2. Mood disorders ( affective disorders ) • epidemiology • etiology • classification.: major depressive disorder, bipolar I disorder, dysthymic disorder and cyclothymic disorder • diagnosis • differencial diagnosis • course and prognosis • treatment • literature

  3. Mood disorders ( affective disorders ) Mood disorders - the critical pathology in those disorders is one of mood

  4. Epidemiology Lifetime prevalence: major depressive disorder 15% (more in women) bipolar I disorder 1% Sex: major depressive disorder twofold often in women, Age: mean age of onset of depressive disorder 40 years, bipolar I disorder 30 years

  5. Etiology 1.Biological factors: • the biological amines, noradrenaline (dopamine) and serotonin - neurotransmitters most implicated in the pathophysiology of mood disorders • neuroendocrine dysregulation (alteration of hypothalamic-hypophysis-adrenal and hypothalamic-thyreoid axis) 2. Genetic factors 3. Psychosocial factors 4. Other factors : alteration of circadian rhythms, neuroimmune dysregulation

  6. Classification (DSM IV) 1. major depressive disorder 2. bipolar I disorder 3. dysthymic disorder 4. cyclothymic disorder Further classification major depressive disorder and bipolar I disorder: • according to the severity (mild, moderate, severe) • with and without psychotic features, congruent or incongruent (hallucinations and delusions) • according to the course (single episode, or recurrent, remission, further course specifiers)

  7. Diagnosis: major depressive disorder Minim. 5 symptoms, change from functioning: • depressed mood • diminished interest or pleasure • significant weight loss, or decrease or appetite • insomnia ( or hypersomnia) • psychomotor agitation or retardation • fatigue or loss of energy • feelings of worthlessness or guilt • diminished ability to think or concentrate, indecisiveness • recurrent thought of death

  8. Diagnosis: Bipolar I, manic episode At least 1 week of abnormally and persistently elevated, expansive or irritable mood, impairment in occupational functioning or social activities (not due to abuse or medical condition), min. 3 of the following symptoms: • grandiosity • decreased need for sleep, • more talkativeness • flight of ideas • distractibility • increase of goal directed activity • excessive involvement in pleasurable activities

  9. Diagnosis : dysthymic disorder Dysthymic disorder: a chronic disorder, with the depressed mood that lasts most of the day on most days Symptoms: • depressed mood for more days than not, for at least 2 y. 2 or more further symptoms: • poor appetite or overeating • insomnia or hypersomnia • low energy or fatigue • low self esteem • poor concentration or difficulty making decisions • feelings of hopelessness

  10. Diagnosis : Cyclothymic disorder • a mild form of bipolar II disorder, characterised by episodes of hypomania and episodes of mild depression • for at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous period with depressive symptoms that do not meet criteria for a major depressive episode

  11. Differential diagnosis Depressive disorders: • medical disorders (neurological, endocrine, infectious) • pharmacological Bipolar I: • other mental disorders (schizophrenia) • pharmacological

  12. Course and prognosis Depressive disorder: • untreated depression lasts 6-13 months • 5-10% have a manic episode • tends to be a chronic disorder • pts. tend to relapse Bipolar disorder: • most often starts with depression • is a recurring disorder • pts. have a poorer prognosis than do pts. with major depressive disorder • 50% have a second manic episode within 2 years

  13. Treatment Acute treatment vs. long-term with recurrent episodes Major depressive disorder: • biological treatment - antidepressants, ECT, sleep deprivation, light therapy • psychotherapy - cognitive-behavioural therapy Mania: • mood stabilisers • antipsychotics • ECT

  14. References : • Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997 • Goodwin FK, Jamison KR.: Manic-depressive Illness. New York: Oxford University Press, 1990.

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