Prof. Elham aljammas oct 2015 MOOD DISORDER AFFECTIVE DISORDER

MOOD Disorders الاضطرابات الوجدانية These are group of functional disorders which characterized by mood changes, the mood is depressed in case of depression, while the mood is high or eliated in case of mania and Hypomania accompany by change in thinking and perception. These are group of functional disorders which characterized by mood changes, the mood is depressed in case of depression, while the mood is high or eliated in case of mania and Hypomania accompany by change in thinking and perception. - The average incidence of affective disorder is 3-4 per 1000 population. - The average incidence of affective disorder is 3-4 per 1000 population. - Depression is common disorder - Depression is more common in female than male a proportion of 3 females to 2 males

Classification of mood disorders Classification of mood disorders Major depression (Bipolar I disorder) Major depression with psychotic symptoms Moderate depression Agitated depression of old age Manic-depressive psychosis (Bipolar II disorder) Mania and Hypomania (Bipolar I disorder) Depression associated with physical illness Depression associated with Myxoedema, Hypopitutarism or adrenal dysfunction Depression due to the treatment with steroid therapy Depression due to brain diseases.

Aetiology Aetiology 1. Genetic causes It is usually accepted that heridity play an important role in major depression It is usually accepted that heridity play an important role in major depression The earlier the onset of the illness the stronger genetic loading It is polygenic mode of inheritante 2. Stressful life events is an important precipitating factor. 3. Brain amines theory ( concerning monoamines) 4. Electrolytes – play a role in the pathogenesis of affective disorder. 5. No consistent finding in CT & MRI finding on pathogenesis of mood disorder.

6. Early parent child relationship concerning the mother – child relationship in which the child regress later under stress and strain of life. 7. Personality study : psychotic depression said to have dysthymic personality ( insecure, Obsessional sensitive ) while manic – depressive psychosis have cycloid personality ( more sociable, active, energetic) psychotic depression said to have dysthymic personality ( insecure, Obsessional sensitive ) while manic – depressive psychosis have cycloid personality ( more sociable, active, energetic) 8. Endocrine changes : psychological changes may accompany endocrine disorder, thyroid, adrenal dysfunction associated with mood changes. psychological changes may accompany endocrine disorder, thyroid, adrenal dysfunction associated with mood changes.

Features of major depression 1. Onset – it is of gradual onset, patient gradually lost interest with surrounding. 2. Mood-the mood in depressive illness is usually sad, unhappy, gloomy facial expression as loss or paralysis of feeling, patient develop guilt feeling and self blame, feeling missary and malaise. In sever depressed mood. The mood in the morning is very sad and gradually clear up and become better mood towards the evening. 3. Pessimistic feeling or idea. 4. Anxiety – depression often complicated by anxiety, when depersonalization present it due to anxiety

5. A gitation and retardation- agitation is common in some cases Retardation. Both motor and psychic activity (lake of movement, while in some cases retardation depressive stupor. 6. Delusion-delusion in depressive illness is due to disturbe mental mechanism, it take the form of guilt feeling, sin feeling disease feeling. Paranoid idea takes the form of blaming, himself for the depression. Nihlistic D patient feeling he is nothing and his body is not present. 7.Hallucination-Auditory H. hearing voices accusing him. Visual Hallucination is uncommon in depression takes the form of seeing the views of death, eg. Seeying coffin waiting for him, 8.Suicidal and homicidal idea

9. Sleep disturbance – is common in depression. 10.Physical symptoms( somatic symptoms) this may be secondary to autonomic disturbance. 11.Hysterical and Obsessional symptoms disturbance may accompany the depressed mood. 12. Changes in personality but not to the degree of disintegration and deterioration of personality which occur in schizophrenia. Patient neglect his personal appearance & hyogein.

Differential Diagnosis Differential Diagnosis 1. Mild to moderate depression by different signs & symptoms as well personality difference. 1. Mild to moderate depression by different signs & symptoms as well personality difference. 2. Manic depressive psychosis 3. Depression associated with physical disease. 4. Depression associated with organic brain disease like brain tumor, head injury, parkinsonism and others.

Treatment of major depression 1. If there is suicidal or homicidal idea hospitalization under observation is necessary it means sever depression, several drugs were used to elevate the mood of depressed patient all these drugs tended to increase the brain level of monoamines. 2. One of the following antidepressant drugs should be given : Impramine ( tofranil) 25-50mg t.d.s or Amitriptyline (Tryptizol) mg tds or SSRI-like fluoxetine 20 mg x3/ day. Impramine ( tofranil) 25-50mg t.d.s or Amitriptyline (Tryptizol) mg tds or SSRI-like fluoxetine 20 mg x3/ day. 3. Minor T. like Diazepam 5-10 mg at night.

The patient should be on the above treatment for at least 2 weeks If no improvement noticed A course of ECT should be given provided the patient general health is normal. After the acute phase controlled either to continues with the patient on the above drugs maintenance dose or to stope all the above treatment and start the patient on Lithium Salts provided the patient suotable for it Lithium mg single dose in the morning act as prophylactic as well as theraputic Lithium mg single dose in the morning act as prophylactic as well as theraputic

4. Supportive psychorherapy should be carried out with the patient reassurance, explaining, the symptoms for the patient and educate the patient regarding the treatment. 4. Supportive psychorherapy should be carried out with the patient reassurance, explaining, the symptoms for the patient and educate the patient regarding the treatment. Prognosis of Major Depression The majority of cases spontanous re-life of symptoms % of cases relapses is common, 20% pases to chronic state 5% of these 20 need Leucotomy is recommended. The majority of cases spontanous re-life of symptoms % of cases relapses is common, 20% pases to chronic state 5% of these 20 need Leucotomy is recommended.