Non Psychotic Disordres

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Mood Disorders

Definitions• The mood or affective disorders are

characterized by a primary disturbance in internal emotional state causing subjective distress & problems in functioning

• Given the patient’s current social & occupational situation he or she emotionally feels- somewhat worse than would be expected (dysthymia)

- very much worse than would be expected (depression)

- somewhat better than would be expected (hypomania)

- very much better than would be ecpected (mania)

Con’t (2)

• The Categories of mood disorders are:- Major depressive disorder- Bipolar disorder (I & II)- Dysthymic disorder- Cyclothymic disorder

Con’t (3)

Epidemiology• There are no differences in the occurrence

of mood disorders associated with ethnicity, education, marital status, or income

• The lifetime prevalence of mood disorder is

a. Major depressive disorder: 5%-12% for men10%-20% for women

b. Bipolar disorder: 1% overall; no sex differencec. Dysthymia disorder: 6% overall; up to 3 times more common in womend. Cyclothymic disorder: less than 1% overall;

no sex difference

Classification of Mood Disorder• Major depressive disorder

1. characteristic- recurrent episodes of depression, each

continuing for at least 2 weeks

2. Masked depression- 50% of depressed patients seem unaware of

or deny depression- often visit primary care doctors complaining

of vague physical symptoms- these complaints may be mistaken for

hypochondriasis- depressed patients show other symptoms of

depression

Con’t (2)

3. Suicidal risk

- increased risk for suicide

- certain demographic, psychosocial, & physical factors affect this risk

- the 5 top risk factors for suicide from highest to lowest risk are:

I. Serious prior suicide attempt

II. Age older than 45 years

III. Alcohol dependence

IV. History of rage & violent behavior

V. Male sex

• Bipolar disorderThere are episode of - both mania & depression (bipolar I disorder) or - both hypomania & depression (bipolar II disorder)There is no simple manic disorder because depressive symptoms eventually occur. Therefore, one episode of symptoms of mania or hypomania defines bipolar disorder

In some patients, (e.g., poor patients with low acces to health care) a mood disorder with psychotic symptoms can become severe enough to be misdiagnosed as schizophreniaa. Delusions can occur in depression as well as in maniab. In contrast to psychotic disorder in which patients are chronically impaired, in mood disorders the pateint’s mood & functioning usuall return to normal between episode

Symptoms of Depression Mania

- Depressed mood- Reduced interest or

pleasure- Reduced energy &

motivation- Anxiety- Sleep problems- Cognitive problems- Psychomotor retardation

oragitation

- Decreased appetite- Diurnal variation in

symptoms- Suicidal ideation- Suicide

- Psychotic symptoms - Elevated mood- Grandiosity &

expansiveness- Irritability & impulsivity- Disinhibition- Assaultiveness- Distractibility- Flight of ideas- Pressured speech- Impaired judgment- Delusions

Dysthymic disorder & Cyclothymic disorder

• Dysthymic disorder involves dysthymia continuing over a 2-year period with no discrete episodes of illness

• Cyclothymic disorder involves periods of hypomania & dysthymia occuring over a 2-year with no discrete episodes of illness

• In contrast to major depressive disorder & bipolar disorder respectively, dysthymic disorder & cyclothymic disorder are less severe, nonepisodic, chronic, & never associated with psychosis

Etiology

The biologic etiology1. Altered neurotransmitter

activity2. A genetic component,

strongest in bipolar disorder

3. Physical illness & related factors

4. Abnormalitas of the limbic-hypothalamic-

pituitary-adrenal axisThe psychosocial etiology1. Loss of a parent in

childhood2. Loss of a spouse3. Low self-esteem &

negative interpretation of live events

4. “Learned helplessness”

Psychosocial factors are not involved in the etiology of mania or hypomania

The Genetics of Bipolar Disorder

Group Approximate Occurrence(%)

The general population 1%

Child who has one bipolar parent or 20%

sibling (or dizygoitc twin)

Child who has two bipolar parents 60%

Monozygotic twin of a person with 75%

bipolar disorder

Differential diagnosis of depression

Medical Conditions- Cancer, particularly pancreatic & other gastrointestinal tumors- Viral illness- Endocrinologic abnormalities, particularly hypothyroidism- Neurologic illness- Nutritional deficiency- Renal or cardiopulmonary disease

Psychiatric & Pharmacologic conditions- Schizophrenia - Anxiety disorders - Somatoform disorders - Eating disorders - Drug & alcohol abuse - Prescription drug use

Treatment

- Depression is successfully treated in most patients- Only about 25% of patients with depression seek &

receive treatment

a. Patients do not seek treatment

b. Women are more likely than men to seek treatment

- Untreated episodes of depression & mania are usually self-limiting & last approximately 6-12 months & 3 months, respectively

- The most effective treatments for the mood disorders are pharmacologic

Con’t (2)

• Pharmacologic treatment- Depression & dysthymia antidepressant agents- Antimanics

• Psychological treatment- psychoanalytic interpersonal, family, behavioral & cognitive therapy- psychological treatment in conjunction with medication is more effective than either type of treatment alone

Con’t (3)

• ECT

The primary indication for ECT is major depressive disorder. It is used when:

- The symptoms do not respond to antidepressant medications

- Antidepressants are too dangerous or have intolerable side effects. Thus, ECT may be particularly

useful for elderly patients

- Rapid resolution of symptoms is necessary