Module Three Mood Disorders

1. Module ThreeMood Disorders • Lesson 1:What is disorder and how it is manifested • Lesson2: What are the causes of Depression • Lesson3: Which is the treatment of Depression • Lesson4: What is Bipolar Disorder • Lesson5: Which is the therapeutical treatment of Bipolar Disorder

2. Lesson 1 WHAT IS DEPRESSION AND HOW IT IS MANIFESTED

3. Step 1: Introduction • The emotion of sadness is a common experience of all people. • Depression is mental disorder, where the normal emotion of sadness has over passed the usual limits of sadness. • This disorder is extremely common. One in ten people is attacked by it in any time of his life and one in five will experience it some time during his life. • Women are more prone to suffer Depression than men. • It can often lead to suicide.

4. Step 2: Brainstormin How does it feel and what is the behavior of a person that suffers from Depression?

5. Step 3: Slide Projection Slide 3.1.1: Symptoms of Depression • Emotion of intense sadness that does not subside • Lack of pleasure • Tendency to avoid other people. • uneasiness and anxiety • Irritability • Difficulties to sleep (insomnia) • Very early waking up • Anorexia and weight loss (some times the opposite) • Decrease of sexual desire • Sense of fatigue and lack of energy.

6. Step 3 (continued) • Difficulty to accomplish his everyday tasks. • Difficulty to take major or minor decisions • Loss of interest • Thoughts of committing suicide • Guilt • Difficulties in paying attention and in concentration • Loss of self – esteem • Psychotic symptoms (aberrant depressive ideas, delusions) • Physical disturbances

7. Step 4: Theory Presentation Verbal and no verbal communication Communication between people is usually made through exchange of verbal messages. This requires: • Listening and paying attention, • Understanding of the content, • Knowledge of the language structure (grammar and syntaxes), • Creating new sentences, • Using common vocabulary with others, • Remembering, • Thinking, • Putting his thoughts in words, • Following social rules, as for example when to answer and in what way so that the answer responds to the question.

8. Step 5: (continued) Verbal messages are either completed, or replaced by no verbal. These include: • Body posture • Physical distance from the interlocutor • Face expression • Eye threat or its absence • Various gestures • Other elements of the persons behavior People with serious mental disorders some times have difficulties in verbal expression.

9. Step 6: Questions and comments (5΄)

10. Lesson2 WHICH ARE THE CAUSES OF DEPRESSION

11. Step 1:Brainstorming What do you think that are the causes of Depression ?

12. Step 3: Slide projection Slide 3.2.1: Factors related to the causes of Depression • Genetic • Neurochemical • Traumatic experiences • Hard social situations • Stressful situations • Physical diseases • Substance use especially alcohol and cocaine • Perperium (after birth recovery)

13. Step 4: Slide Projection Slide 3.2.2: Clinical course (progress) of Depression 1Case: long , gentle and insidious start

14. Step 4 (continued) 2ndcase: long gentle and insidious start, plus acute symptoms for a period of time.

15. Step 4 (continued) 3rd Case: Sudden start and total subsiding of symptoms after a period of time.

16. Step 4 (continued) 4thCase: Sudden start, partial subsiding, relapses.

17. Step 4 (continued) 5thCase: Sudden or insidious start and chronic duration.

18. Step 5: Questions and comments (5΄)

19. Lesson3 WHAT IS THE THERAPEUTICAL TREATMENT OF DEPRESSION

20. Step 1: Slide Projection Slide 3.3.1: Therapeutic interventions to depressive patient • Antidepressants • Therapy with Lithium • Psychotherapy • Electrospasmic therapy • Social interventions

21. Step 3: Slide Projection What antidepressants do you use in your practice?

22. Step 4 (continued) Slide 3.3.2: Common antidepressants Tricycles • Imipramine (Tofranil) • Amitriptyline (Saroten) • Clomipramine (Anafranil) New • Fluoxetine (Ladose) • Paroxetine (Seroxat) • Fluvoxamine (Dumyrox) • Venlafaxine (Efexor) • Nefazodone (Nefirel)

23. Step 5: Slide Projection Slide 3.3.3: Antidepressants’ side effects • dry mouth, constipation,blurred vision • drowsinessand fatigue • Standing hypotension (low blood pressure) • rapid heart rate excessive sedation or uncoordinated movements while taking this medicationTachycardia, arrhythmias and palpitation • Sexual dysfunction • Weight gain • From newer antidepressants: nausea, migraine headaches and insomnia.

24. Step 6: Questions and comments (5΄)

25. Lesson4 WHAT IS BIPOLAR DISORDER

26. Step 1:Introduction • Depression might appear in combination with an opposite emotional state, euphoria which characterizes Mania. It is then called “Manio-Depressive Disorder” or “Bipolar Disorder” as it is named nowadays. • Bipolar Disorder, like Schizophrenia, is considered as a psychotic disorder with long and serious course • Patients with this disorder appear Depressive episodes as well as manic episodes. Either one might appear first.

27. Step 1 (continued) • It is possible that some patients appear severe episodes of Depression only, while the characteristics of euphoric behavior and hyperactivity are really mild and do not cause any problem. Other might appear only manic episodes, but it is not very common. • The time in between the episodes the person might feel perfectly well. • In some patients episodes alternate in high rate.

28. Step 1 (continued) • Some times at the beginning of the disease, if there are intense psychotic characteristics, it is difficult to distinguish a manic from a schizophrenic episode. • The depressive episodes manifested in Bipolar Disorder are usually serious. • Bipolar Disorder affects about 1 every 100 persons, men as well as women. • Depends on genetic background. • Difficult social situations and stressful every-day situations worsen the development (progress) of this disorder.

29. Step 2:Brainstorming What is the behavior of a manic patient?

30. Step 3: Slide projection Slide 3.4.1: Manic Symptoms Symptoms related to mood : • Assiduous euphoric mood • Irritability • Temporary depression Symptoms related to concentration, speech and thinking: • Easy distraction of attention • Pressurized talking, loss of ideas • High self esteem

31. Step 3 (continued) Somatic/ Biological/ Behavior symptoms: • High mobility and activity (physical, social, working, sexual) • Dangerous or socially improper behavior • Insomnia with no feeling of fatigue • Good appetite, but loss of weight because of hyperactivity.

32. Step 4: Questions and comments(5΄)

33. Lesson5 WHICH IS THE THERAPEUTICAL TREATMENT OF BIPOLAR DISORDER

34. Step 1:Introduction Bipolar Disorder, without therapeutical treatment, has the tendency to manifest successive manic and depression episodes, which as the time pass become more often and more severe, while the intermediate free of symptoms periods become shorter.

35. Step 2:Slide Projection one yearς Many years Slide 3.5.1: Development of Bipolar Disorder with and without treatment. Θεραπεία συντήρησης therapy of acute phase Συνεχιζόμενη Θεραπεία

36. Step 3:Brainstorming Leaflet 3.5.1: Clinical case What are the needs of a patient that should be attended and in what way during his/ her treatment ?

37. Step 4:Slide projection Slide 3.5.2: Therapeutical treatment for Bipolar Disorder Episode treatment Depression episode: • Antidepressants medication • Other psychosocial interventions. Manic episode: • Hospitalisation • Medical treatment (with antipsychotic and tranquilizers) • Limitation of manic behavior.

38. Step 4 (continued) Continued therapy from preventing relapses • Continuation of the medication • Supporting psychotherapy • Other psychosocial interventions Preservation therapy • Administration of lithium or other drugs that stabilize mood • Psychosocial interventions

39. Step 5: Theory presentation Lithium • Lithium is a chemical substance like sodium and potassium it is used as a simple salt. • It is useful for the treatment and the prevention of manic episodes. • Common Lithium drugs are:Milithin, Priadel, Lithiofor. • Before the patient starts the lithium treatment he undergoes urine, blood tests and an electrocardiograph. With these tests the function of the kidneys, liver, thyroid are checked out.

40. Step 5 (continued) • measuring the lithium levels in the blood (at first very often and later onevery1-2 months) is essential as the level at which the drug is efficient is not far from the toxicity level. • Person in lithium medication should have a low in salt diet. • It needs extra care when a person on lithium medication shows vomiting, diarrhea or dehydration. • It shouldn’t be administered in pregnant women or in people with kidney failure.

41. Step 5 (continued) Slide 3.5.3: Lithium side effects Early signs • Nausea, vomiting, diarrhea • Fear at voluntary movements • Dry mouth, thirst • Fatigue • congested nose, metallic taste Later signs • hypothyroid • Weight gain • ataxia, joint dysfunction • Arrhythmias • Kidney disease

42. Step 5 (continued) Lithium poisoning • Terror (phobias) • Ataxia • Uncoordinated movements • Rushed speech • Confusion • Loss of orientation • Spasms (convulsion) • Coma

43. Step 7: Questions and comments(5΄)