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Mood and Affective Disorders

Mood and Affective Disorders. Dr Aseni Wickramatillake. What is a mood disorder?. Mood: An individual’s personal state of emotions Affect : An individual’s appearance of mood Moods can be elevated or depressed. Mood Disorders . Emotional state characterized by. Depression. Mania.

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Mood and Affective Disorders

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  1. Mood and Affective Disorders Dr AseniWickramatillake

  2. What is a mood disorder? • Mood: • An individual’s personal state of emotions • Affect : • An individual’s appearance of mood • Moods can be elevated or depressed

  3. Mood Disorders Emotional state characterized by Depression Mania • intense sadness, feelings of futility and worthlessness, and withdrawal from others • ten times greater than mania • elevated mood, expansiveness, or irritability, often resulting in hyperactivity. • ten times less than depression

  4. Causes of Mood Disorders • Childhood loss, bereavement • Genetic influences • The depressed brain • Negative moods feed negative thoughts • Helplessness/Hopelessness • Negative attribution: negative reasons we give for why an event occurred • Poor social networking

  5. Causes of Mood Disorders • Neurotransmitters • Circadian Rhythms • High levels of cortisol • Stress

  6. Neurotransmitters • Depression is associated with low levels of serotonin or norepinephrine • Serotonin regulate our emotional reactions • more impulsive and wide moods swings are seen during low serotonin levels • Medications increase the availability of serotonin and/or norepinephrine in the synapse

  7. Neurotransmitters and Mood Disorders

  8. Symptoms of Depression • Depressed mood • Dejection • Excessive and prolonged mourning • Worthlessness, lack of joy. • Pessimism • Decreased energy • Disinterest and loss of motivation • Self-accusations of being incompetent

  9. Symptoms of Depression • Social Withdrawal • Lowered Work Productivity • Lack Of Personal Cleanliness • Slow Speech And Bodily Movements • Loss Of Appetite/Weight • Constipation • Sleep Disturbance • Disruption Of Menstrual Cycle And Aversion To Sexual Activity.

  10. Types of Mood Disorders • Depressive Disorders / Unipolar Disorders • Major depressive disorders • Dysthymic disorder • Depressive disorders not otherwise specified • Bipolar Disorders: Characterized by • one or more manic or hypomanic episodes + one or more depressive episodes • Bipolar disorder I • Bipolar disorder II • Cyclothymic disorder

  11. Major Depressive Disorder • No history of mania, hypomania, or mixed episode • Prevalence : Female > Male • Average age of onset in mid-20’s • If untreated, average duration of first episode is 6-9 months; often recur • Recurrent episodes(2 or more episodes)

  12. Major Depressive Episode • 5 or more symptoms (1 must be either depressed mood or loss of interest) for ≥ 2 weeks • Symptoms: • Depressed mood • Loss of interest in activities (anhedonia) • Significant weight loss or gain; decrease or increase in appetite • Insomnia or hypersomnia • Psychomotor agitation or regardation • Fatigue or loss of energy • Feelings of worthlessness or guilt • Poor concentration or indecisiveness • Recurrent thoughts of death or suicide or attempts of suicide

  13. Dysthymic Disorder • Less severe • Chronic “low grade” depression • Depressed mood nearly every day for > 2 years • No more than 2 months symptom free • Prevalence equal in males and females • Age on onset in the 20’s • Slow response to treatment – may need higher doses, longer duration of treatment

  14. Symptoms of DysthymicDisorder • Depressed mood most of day for most days • plus ≥ 2 of the following for >2 years • poor appetite or overeating • insomnia or hypersomnia • low energy or fatigue • low self-esteem • poor concentration or difficulty making decisions • feelings of hopelessness

  15. Hypomania and Mania Hypomania Mania • “High” Mood • Overactive Behavior • Poor Judgment • Delusions (Rare), • Attempts To Be Dominating • Grandiose. • Pronounced overactivity • Grandiosity • Irritability • incoherent speech • Lack of tolerance for criticism • Lack of restraint

  16. Diagnosis of Manic Episodes • Abnormally and persistently elevated, expansive, or irritable mood for at least 1 week • With 3 additional symptoms

  17. Symptoms of Manic Episodes • Inflated self-esteem/grandiosity (Belief that one has special talents, powers, and abilities) • Decreased need for sleep (3 hrs.) • Unusual talkativeness or rapid speech • Flight of ideas/racing thoughts • Irritable

  18. Symptoms of Manic Episodes • Marked distractibility • Increased energy, enthusiasm, self-assertion at work, school, or in social situations Increased • Excessive involvement in pleasurable activities with potential for painful consequences (spending money, excessive alcohol/drug use, reckless driving, and risky sex)

  19. Hypomanic Episode • Elevated, expansive, or irritable mood for at least 4 days • Symptoms similar to manic episode, except no marked impairment/hospitalization

  20. Mixed Episode • criteria for bothmajor depressive episode anda manic episode at the same time • Symptoms persist for at least 1 week

  21. Bipolar Affective Disorder • Lifetime prevalence is 1% • Average onset age is late teens-early 20 • Occurs equally often in men and women • Stronger genetic relationship

  22. Bipolar Disorder I • Single manic episode • no past major depressive episode • Most recent episode hypomanic • at least 1 past manic or mixed episode • Most recent episode manic • at least 1 past major depressive, manic, or mixed episode • Most recent episode mixed • at least 1 past major depressive, manic, or mixed episode • Most recent episode depressed • at least 1 past manic or mixed episode

  23. Bipolar Disorder II • Alternate between hypomanic and major depressive episodes • At least 1 or more Major Depressive Episode • At least 1 Hypomanic Episode • Never a Manic or Mixed Episode

  24. Bipolar Affective Disorder Bipolar I Bipolar II • At least one manic or mixed episode • No need for a prior depressive episode • More severe illness than Bipolar II and easier to diagnose • Prevelance : men= women • At least one previous major depressive episode • At least one hypomanic episode • Less severe than Bipolar I and more difficult to diagnose • Prevelance: women>men

  25. Cyclothymic Disorder • Alternate between numerous episode of depressed and hypomanicsymptoms which does not meet criteria for major depressive episode • Present for at least 2 yrs • Never free of symptoms for longer than 2 months. • No major depressive, manic, or mixed episode

  26. Rapid cycling • Change in four or more mood episodes within any 1 year period • Can be very difficult to treat

  27. Comparison Depressive Disorder Bipolar Disorders • Age of onset : late 20s • than unipolar.ikely to exhibit anxiety • Prevelance: 8-19% of adult population has major depressive disorder. • Age of onset : early 20s • Greater psychomotor retardation and risk of suicide greater for bipolar • Prevelance: 1%-2% of adult population • Respond to lithium

  28. Treatment of Depression • Medical • Antidepressants • tricyclics • MAO inhibitors • SSRIs • others • Psychosocial • Cognitive-behavioral therapy • Interpersonal therapy • Other • Electroconvulsive therapy (ECT) • Light

  29. Treatment of Bipolar Disorder • Lithium is the best treatment • Lithium blood levels should be monitored • Large number respond well initially • Side effects • Excessive thirst and urination • Damage to kidneys and thyroid • Adjunctive treatments • Benzodiazepines • Seclusion and restraint • Sleep aids • ECT • Psychosocial treatment

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