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Affective disorders

Affective disorders. Shaul Lev-Ran, MD Shalvata Mental Health Center. Major Depressive disorder Dysthymic disorder Cyclothymia Bipolar II disorder Bipolar I disorder. Major depressive disorder. Prevalence=15% F>M Mean age of onset=40 Genetic

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Affective disorders

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  1. Affective disorders Shaul Lev-Ran, MD Shalvata Mental Health Center

  2. Major Depressive disorder • Dysthymic disorder • Cyclothymia • Bipolar II disorder • Bipolar I disorder

  3. Major depressive disorder • Prevalence=15% • F>M • Mean age of onset=40 • Genetic • 1st degree relative of MDD – 2-3 times the chance of suffering from MDD

  4. Depression is 2nd only to IHD as major cause of disability and early death in industrialized countries

  5. Major Depressive Episode 5 of the following for at least 2 wks: 1. depressed mood 2. markedly diminished interest or pleasure 3. psychomotor disturbances 4. fatigue/loss of energy 5. feelings of worthlessness or guilt 6. suicidal thoughts or attempt 7. weight loss 8. sleep disturbances 9. difficulty concentrating, thinking, or deciding

  6. Consequences • Functional impairment • self • family • occupational • financial • Morbidity and mortality • Worse outcome of disease than control • Cardiac – independent prognostic factor • Sudden death • suicide

  7. Specifiers describing depressive episode • With psychotic features • With melancholic features • With atypical features • With catatonic features • Postpartum onset

  8. Treatment - goals • 5 X R • (achieve) Response • (achieve) Remission • (achieve) Recovery • (prevent) Relapse • (prevent) Recurrence

  9. Treatment-strategies • What, where & how? (focus, locus, modus): • What – major concerns, type of depression • Where? • Suicidal risk • Support system • Compliance • Psychosocial stressors • Level of functional impairment

  10. What= Biopsychosocial approach: • Bio=medication, others (ECT, TMS, VNS…) • Psycho= • Explaining the diagnosis • Treatment plan and objectives • Assessment • Advantages: deals with secondary consequences (marital discord, occupational difficulties), adherence to medication • Social=couples, family, occupational, etc.

  11. Prognosis • Untreated episode – 6-13 months • Treated episode – 3 months • Tends to be chronic – • 25% recurrence in 6 m. after discharge • 50% recurrence in 2 yrs. • 75%recurrence in 5 yrs.

  12. Bipolar I disorder • Prevalence=1% • M=F • Mean age of onset=30 • At least 1 manic episode • Most often starts with depressive episode • 10-20% - only manic episodes • Genetic • 1st degree relative with BP – 8-18 times the chance for BP • 1 parent with BP – 25% chance of affective dis. • 2 parents with BP – 50-75% chance of affective dis.

  13. Manic episode • Abnormally elevated, expansive or irritable mood lasting 1 wk. or requiring hospitalization. • At least 3 of the following: • Inflated self esteem or grandiosity • More talkative/pressure to keep on talking • Flight of ideas (including subjective feeling) • Distractability • Increase in goal directed activity • Excessive involvement in pleasurable activity with high potential for painful consequence

  14. Mixed episode • The criteria for both manic episode and MD episode are met nearly every day for at least one week

  15. Specifiers describing recurrent episodes • Rapid cycling -4 or more episodes in 1 yr. • With seasonal pattern

  16. Affective disorders • Major Depressive disorder (unipolar) • Major depressive episodes • Dysthymic disorder • Milder & more chronic depression • Cyclothymia • Hypomanic episodes and milder depression • Bipolar II disorder • Hypomanic episodes and major depressive episodes • Bipolar I disorder • Manic episodes and major depressive episodes

  17. Bipolar II disorder • Includes at least one hypomanic episode: • Lasting at least 4 days • Criteria similar to manic episode • The episode is not severe enough to cause marked impairment in functioning and there are no psychotic features

  18. Dysthymic disorder • At least 2 years • No major depressive episode for first two years • 2 of the following • Eating disturbances • Sleeping disturbances • Fatigue/low energy • Low self esteem • Poor concentration or difficulty making decisions • Feelings of hopelessness

  19. Cyclothymia • At least two years of hypomanic and minor depressive episodes • No major depressive, manic or mixed episode for first two years

  20. Treatment-strategies • Where, what & how? (focus, locus, modus): • Where? • Danger to self and others • Significant harm to self or others • Support system • Compliance • Psychosocial stressors • Level of functional impairment

  21. What= Biopsychosocial approach: • Bio=medication, others (ECT, TMS, VNS…) • Psycho= • Explaining the diagnosis • Treatment plan and objectives • Assessment • Advantages: deals with secondary consequences (marital discord, occupational difficulties), adherence to medication • Social=couples, family, occupational, etc.

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