Mood disorders Mood disorders Dr.Saman Anwar Faraj M.B.Ch.B, F.I.B.M.S(PSYCHIATRY)

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Text of Mood disorders Mood disorders Dr.Saman Anwar Faraj M.B.Ch.B, F.I.B.M.S(PSYCHIATRY)

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  • Mood disorders Mood disorders Dr.Saman Anwar Faraj M.B.Ch.B, F.I.B.M.S(PSYCHIATRY)
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  • Mood Disorder Mood change is the main psycho pathological feature. Mood change is the main psycho pathological feature. The abnormality is more intense and persistent than normal variation in mood and often lead to problems in occupational and social functioning. The abnormality is more intense and persistent than normal variation in mood and often lead to problems in occupational and social functioning.
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  • Mood disorder mood disorder is the term given for a group of diagnoses in the DSM IV TR disorders in ICD 10. mood disorder is the term given for a group of diagnoses in the DSM IV TR disorders in ICD 10.DSM IV TRDSM IV TR English psychiatrist Henry Maudsley proposed an overarching category of affective disorder. The term was then replaced by mood disorder, as the latter term refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others. English psychiatrist Henry Maudsley proposed an overarching category of affective disorder. The term was then replaced by mood disorder, as the latter term refers to the underlying or longitudinal emotional state, whereas the former refers to the external expression observed by others.Henry MaudsleyHenry Maudsley Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder commonly called clinical depression or major depression, and bipolar disorder, formerly known as "manic depressive" and described by intermittent periods of manic and depressed episodes. Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder commonly called clinical depression or major depression, and bipolar disorder, formerly known as "manic depressive" and described by intermittent periods of manic and depressed episodes.manichypomanicmajor depressive disorderbipolar disorder depressedmanichypomanicmajor depressive disorderbipolar disorder depressed
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  • Classification of mood disorders DSM-IV-TR describes the following episodes : 1-Major Depressive Episode: lasts for 2 weeks 2-Manic Episode: one week 3-Hypomanic Episode: four days 4-Mixed Episode: one week
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  • Classification of Mood Disorders contd Major Depressive Disorder Major Depressive Disorder Bipolar I Disorder= having a clinical course of one or more manic episodes and, sometimes, major depressive episodes. Bipolar I Disorder= having a clinical course of one or more manic episodes and, sometimes, major depressive episodes. Bipolar II Disorder: episodes of major depression and hypomania Bipolar II Disorder: episodes of major depression and hypomania Dysthymic Disorder : 2years Dysthymic Disorder : 2years Cyclothymiacs Disorder Cyclothymiacs Disorder
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  • Epidemiology of mood disorders; 19.3% of the general population develops a mood disorder (14.7% men, 23.9% women) 19.3% of the general population develops a mood disorder (14.7% men, 23.9% women) 21.3% of women & 12.7%of men develop major depression. 21.3% of women & 12.7%of men develop major depression. Average age of onset for bipolar illness is mid to late twenties. Average age of onset for bipolar illness is mid to late twenties. Average age of onset of depression is mid thirties. Average age of onset of depression is mid thirties. Bipolar disorder occurs more in high socioeconomic groups. Bipolar disorder occurs more in high socioeconomic groups. Mania and depression are manifested by symptoms involving the effective, cognitive, Physical, social, and spiritual aspects of the individual. Mania and depression are manifested by symptoms involving the effective, cognitive, Physical, social, and spiritual aspects of the individual.
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  • Major depressive disorder Common disorder, with a lifetime prevalence of about 15%,perhaps as high as 25% in women. Common disorder, with a lifetime prevalence of about 15%,perhaps as high as 25% in women. The incidence of major depressive disorder is also high in primary care patients,in whom it approaches 10%, and in medical inpatients, in whom it approaches 15%. The incidence of major depressive disorder is also high in primary care patients,in whom it approaches 10%, and in medical inpatients, in whom it approaches 15%. An almost universal observation, is the two-fold greater prevalence of the disorder in women than in men. An almost universal observation, is the two-fold greater prevalence of the disorder in women than in men. The reasons for this difference have been hypothesized to involve hormonal differences, the effect of childbirth, and differing psychosocial stresses for women and for men. The reasons for this difference have been hypothesized to involve hormonal differences, the effect of childbirth, and differing psychosocial stresses for women and for men.
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  • Major depressive disorder The mean age of onset is about 40 years ; 50% of all patients have an onset between age of 20-50. The mean age of onset is about 40 years ; 50% of all patients have an onset between age of 20-50. Although uncommonly, MDD can also begin in childhood or in old age. Although uncommonly, MDD can also begin in childhood or in old age. Some recent studies suggest that the incidence of MDD may be increasing among people less than 20 years old. Some recent studies suggest that the incidence of MDD may be increasing among people less than 20 years old. MDD occurs most often in people without close interpersonal relationships or in those who are divorced or separated. MDD occurs most often in people without close interpersonal relationships or in those who are divorced or separated. No correlation have been found between socio-economic status and MDD No correlation have been found between socio-economic status and MDD
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  • Etiology Although the etiology of MDD is ambiguous and complex, it can be divided into three main groups: biological,genetic,and psychosocial. Although the etiology of MDD is ambiguous and complex, it can be divided into three main groups: biological,genetic,and psychosocial. 1. Biological factors: a. Biogenic amines :norepinephrine, and serotonin are the most implicated. a. Biogenic amines :norepinephrine, and serotonin are the most implicated. b. Other neuro-chemical factors: GABA,and neuroactive peptides particularly vasopressin, and the endogenous opiates. b. Other neuro-chemical factors: GABA,and neuroactive peptides particularly vasopressin, and the endogenous opiates. c. Neuro-endocrine regulation :adrenal, thyroid and growth hormone. c. Neuro-endocrine regulation :adrenal, thyroid and growth hormone. d. brain imaging abnormalities: still inconclusive. d. brain imaging abnormalities: still inconclusive. 2. Genetic factors : genetic data strongly indicate that significant genetic factor is involved in the development of mood disorders. First degree relatives of MDD are 1.5-2.5 times more likely to have bipolar I disorder, and 2-3 times to have MDD. The concordance rate for MZ twins is about 50% while in DZ twins is 10-25%. genetic data strongly indicate that significant genetic factor is involved in the development of mood disorders. First degree relatives of MDD are 1.5-2.5 times more likely to have bipolar I disorder, and 2-3 times to have MDD. The concordance rate for MZ twins is about 50% while in DZ twins is 10-25%.
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  • 3. Psychosocial factors : a- life events and environmental stress: a- life events and environmental stress: The life event most often associated with a person later development of depression is losing a parent before the age of 11. The environmental stressor most often associated with the onset of an episode is the loss of a spouse. The life event most often associated with a person later development of depression is losing a parent before the age of 11. The environmental stressor most often associated with the onset of an episode is the loss of a spouse. b- Family. b- Family. c- premorbid personality factors. c- premorbid personality factors. d- learned helplessness. d- learned helplessness. e- cognitive theory. e- cognitive theory.
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  • Signs and symptoms Two hallmarks of depression symptoms key to establishing a diagnosis are: 1. Loss of interest in normal daily activities You lose interest in or pleasure from activities that you used to enjoy. 2. Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.
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  • Signs and Symptoms Contd 3. Sleep disturbances Insomnia or Sleeping too much Waking in the middle of the night or early in the morning and not being able to get back to sleep. Insomnia or Sleeping too much Waking in the middle of the night or early in the morning and not being able to get back to sleep. 4. Impaired thinking or concentration Trouble concentrating or making decisions. Trouble concentrating or making decisions. Problems with memory.( difficulty with short term memory). Problems with memory.( difficulty with short term memory).
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  • Signs and Symptoms Contd 5. Changes in weight An increased or reduced An increased or reduced 6. Fatigue or slowing of body movements. lack of energy. lack of energy. Feel as tired in the morning. Feel as tired in the morning