Mood Disorders ppt (kc) (Ajinkya Wankhede).pptx

Mood disorders

1. Topic : Mood Disorders Presented by : Akshay ware Guided by: Hod - Dr. Archana dachewar mam Associate professor - dr.sharma sir Assistant professor – dr.kumre sir

2. Mood disorders Definition : A group of illnesses characterised by severe disturbance of mood and serious changes in the emotional status that interfere with person’s everyday life. The abnormality is more intense & persistent than normal variation in mood and often lead to problems in occupational, social functioning.
Mood disorders are called as Affective disorders. It is a disorder in which a person experiences long periods of extreme happiness, extreme sadness, or both.

3. Classification of Mood disorders Manic episode Bipolar affective di sorder Depressive episode Recurrent depressive disorder Persistent mood disorder Other mood disorder Unspecified mood disorder

4. Mania Mania is an affective disorder with consistent elevated mood with increased physical and mental activity present in an individual at least for few days or a week. When the mood is elevated that person seems to be cheerful optimistic, irritable easily become violent.

5. Etiology ▸ The ex act mechanism by which mania occurs is not yet known. Biological Factors Genetic Monozygotic twins Bio chemical Factors Excess Level of norepinephrine and dopamine Social pressures Environmental influence Sociocultural factor

6. Clinical Features Elevated, expansive or ir ritable mood Psychomotor activity Speech and thought Goal-directed activity Other features

7. Diagnosis DIAGNOSTIC EVALUATION: ▸ History collection Mental status examination ▸ Psychological tests such as young mania rating scale ▸ Based on sign and symptoms

8. Treatment 1. PHARMACOTHERAPY : ▸ Mood stabilizers: Lithium (900-2100mg/day) ✔Carbamazepine (600-1800mg/day) ✔ Sodium valproate (600-2600mg/day) Antipsychotics : ✓ Olanzapine ( 10-20 mg/day) ✓ Chlorpromazine (300-1000mg/day) ✓ Haloperidole (5-20mg/day) Sedtives /Hypnotics : ✓ Benzodiazepines (lorazepam, clonazepam) .

9. 3. PSYCHOSOCIAL TREATMENT: ▸ Family and marital therapy is used to decrease interfamilial and interpersonal difficulties and to reduce or modify stressors. The main purpose is to ensure continuity of treatment and adequate drug compliance. 2. ELECTROCONVULSIVE THERAPY (ECT) ►ECT can also be used for acute manic excitement if not adequately responding to antipsychotics and lithium.

10. Depression DEFINITION : Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. CLASSIFICATION Mild depressive episode Moderate depressive episode Severe depressive episode

11. Etiology BIOLOGICAL THEORIES: Neurochemical like norepinephrine and serotonin level isdecreased Genetic factors Changes in the body's balance of hormones SOCIOLOGICAL THEORIES: Stressful life events e.g. death, marriage, financial loss PSYCHOSOCIAL THEORIES: According to Freud (psychoanalytic theory) due to loss of a loved object.

12. Symptoms ▸ Depressed mood , Loss of interest▸ Suicidal thoughts Depressivecognitions : Hopelessness , Helplessness , Worthlessness , Unreasonable guilt Self blame Psychomotor activity: Think, walk and act slowly Answered after a long delay Feeling of uneasiness Psychotic features: Hallucination present Nihilistic delusions, delusion of poverty and delusion of guilt is present

13. Diagnosis DIAGNOSTIC EVALUATION: History collection Mental status examination Psychological tests such as Hamilton rating scale for assess severity of depression

14. Treatment 1. PSYCHOPHARMACOLOGY :▸ Selective serotonin reuptake inhibitors (SSRIs) like Citalopram (20-40mg/day) fluoxetine (20-40mg/day) ▸ Tricyclic antidepressants (TCA) like Amitriptyline (75-150mg/day) Imipramine (150-300mg/day) Monoamine oxidase inhibitors (MAOIS) Isocarboxazid (30-60mg/day) phenelzine (45-90mg/day)

15. 2. PHYSICAL THERAPIES: ▸ ECT Therapy : Severe depression with suicidal risk is the important indication for ECT ▸ Light therapy: Sometimes called phototherapy involves exposing the patient to an artificial light source during winter months to relieve seasonal depression.

16. 3. PSYCHOSOCIAL TREATMENT: Psychotherapy- It is based on psychoanalytic interventions emphasizes helping patients gain insight into the cause of their depression. Cognitive therapy - It aims at correcting the depressive negative cognitions like hopelessness, helplessness and replace them with new cognitive and behavioural responses. Group therapy - It is useful for mild case of depression. In group negative feelings such as anxiety, anger, guilt and emotional growth is improved through expression of their feelings. Family therapy- It is used to decrease intrafamilial and interpersonal difficulties and to reduce or modify stressors which may help in faster and more complete recovery. Behavioral therapy- It includes social skills training, problem solving techniques, self control therapy and decision making techniques.

17. Bipolar Disorder DEFINITION ▸ This is characterized by recurrent episodes of mania and depression in the same patient at different times. Typically, the patient experiences extreme highs (mania) alternating with extreme lows (depression).

18. Etiology ETIOLOGY Precise cause unknown ▸ Genetic, biochemical and psychological factors ▸ Stressful events ▸ Hypothyroidism

19. Sign and symptoms Manic phase Depressive phase Low self esteem Overwhelming inertia Feeling of hopelessness,Apathy Difficulty in concentrating or thinking clearly Psychomotor retardation Suicidal idelation Expansive, grandiose or hyperirritable mood Increased psychomotor for activity Excessive social extroversion Rapid speech with frequent topic changes Decreased need for sleep and food Impulsivity Impaired judgement

20. Diagnosis & Treatment DIAGNOSTIC EVALUATION: ▸ Based on sign and symptoms ▸ History taking TREATMENT : Lithium ( 900-2100mg/day) ▸ Carbamazepine (600-1800mg/day) ▸ Antidepressants ▸ Antipsychotic

21. Persistent mood (Affective) disorders Persistent mood disorders are Persistent mood symptoms Lasting more than 2 years Classification Cyclothymia Dysthymia

22. Cyclothymia Cyclothymia is persistent instability of mood, involving periods of mild depression and mild elation is typical The mood swings are usually perceived by individual as being unrelated to life events. ETIOLOGY UTI Genetic factors family history of bipolar disorders Major depression substance abuse or suicide.

23. Clinical Features of cyclothymia Hypomanic symptoms A heightened state of euphoria Irrational behaviour Talkative Hyperactivity Attentional Shift Irritability Depression symptoms A state of low mood and oversion Mood swings Low self esteem Insomnia Feeling fatigued Suicidal thoughts

24. Diagnosis Rule out psychiatric and physical disorders which mimic cyclothymiac disorders Eg.Endocrine disorders Uremia Vitamin deficiency (vit.B12 , Folate)

25. Treatment Lithium( 900-2100mg/day) Carbamazepine (600-1800mg/day) Valproic acid (250-500mg/day) Verapamil Various antidepressants Individual psychotherapy Family therapy

26. Dysthymia Dysthymia (Neurotic/reactive depression) represents a chronic, milder form of depression which does not fulfill the criteria for recurrent depressive disorder especially in terms of severity persisting for months or years. Patient usually have periods of days or weeks when they describe themselves as well, but most of the time they feel tired and depressed. It usually begins in adult life and lasts for at least several years, sometimes indefinitely. The lifetime prevalence is approximately 3%, more common in women.

27. Symptoms of Dysthymia Sadness and hopelessness Fatigue and lack of energy Loss of interest in activities Irritability and self-criticism Lack of concentration Sleep problems Overeating or poor appetite Hopelessness, excessive crying, guilt, Helplessness

28. Treatment short term psychotherapy behavior therapy Gro up therapy

29. Difference between cyclothymia & Dysthymia Cyclothymia Cyclothymia is characterized by alternating episodes of both euphoria and depression Treatment include antipsychotic and antidepressants Have an increased risk of developing bipolar disorder later in life Dysthymia Dysthymia is characterized only by phases of mild depression Treatment include anti depressant drug therapy along with psychotherapy Have an increased risk of deveping severe chronic depression over time