Mood Disorders اختلالات خلقی Bipolar Disorders اختلالات دوقطبی Depressive Disorders اختلالات افسردگی By : Dr Seddigh HUMS

Episodes and Patterns دوره ها و الگوها n Major depressive episode افسردگی عمده n Manic episode دوره شیدایی n Mixed episode دوره مختلط n Hypomanic episode دوره هیبومانیک n Cycling patterns الگوهای چرخشی

Major depressive episode دوره افسردگی عمده n Five or more of the following, most of the day and/or nearly every day, including at least symptom 1 or 2: 5 یا بیشتر از علائم زیر n 1. Depressed mood خلق افسرده –Sad, empty, weepy; irritable, angry n 2. Loss of interest or pleasure in previously enjoyable activities فقدان علاقه و لذت n 3. Change in weight or appetite تغییرات وزن و اشتها n 4. Sleep changesتغییرات خواب

More depressive symptoms n 5. Noticeable change in movement تغییرات قابل توجه در حرکت n 6. Fatigue خستگی n 7. Feelings of worthlessness or guilt احساس بی ارزشی یا گناه n 8. Impaired cognition or volition اختلال در تفکر وتمرکز n 9. Repeated thoughts of death or suicide, or planned or attempted suicide افکار مکرر مرگ و خودکشی n The five symptoms must occur in the same two weeks 5 علامت باید حداقل دو هفته وجود داشته باشد

Manic episode دوره شیدایی n One week of persistently high, expansive, or irritable mood, and 3 of: یک هفته خلق مستمرا بالا ،وسیع و یا تحریک پذیرهمراه با سه علامت n Grandiose self-esteem خودبزرگ بینی n Lower sleep need کاهش نیاز به خواب n Overly talkativeپر حرفی n Racing thoughtsسبقت جویی افکار n Easily distractedحواس پرتی n Increased activity or agitation افزایش فعالیت یا اژیتاسیون n High risk activitiesفعالیتهای پر خطر

Mixed episode دوره مختلط n One week of both manic and major depressive symptoms with rapidly alternating moods یک هفته علائم هر دودوره افسردگی و شیدایی با تغییر سریع خلق n Common symptoms: علائم شایع –Agitation آژیتاسیون –Insomniaبیخوابی –Irregular appetite (binge-fast)پرخوری و امساک –Delusions هذیان –Thoughts of suicideافکار خودکشی

Hypomanic episodeدوره هیپومانیک n Four days of manic episode symptoms 4روز علائم دوره شیدایی n Mood disturbance does not critically آشفتگی خلقی بحرانی نیست n impair ability to work or maintain social responsibilities افت عملکرد در انجام کار و مسئولیت اجتماعی n Response pattern is uncharacteristic الگوی پاسخدهی مربوط به منش نیست n Not euthymia خاق طبیعی نیست

Bipolar disorders اختلالات دو قطبی n Bipolar I Disorder اختلالات دو قطبی تیپ یک –One or more manic or mixed episodes –Usually one or more major depressive episodes –Subcategorized based on the character of the most recent episode Most recent episode depressed Most recent episode manic Most recent episode mixed

Bipolar I Disorder Major Depressive Episode Manic or Mixed Episode Manic or Mixed Episode One or more manic episode OR Depressed and manic episodes OR

Bipolar disorders… n Bipolar II Disorder اختلالات دو قطبی تیپ دو –One or more major depressive episodes –One or more hypomanic episodes –NO manic or mixed episode n Cyclothymic Disorder اختلال سیکلوتایمیا –Two years of alternating hypomanic and depressive symptoms –دو سال دوره های متغییر هیپومانیا و علائم افسردگی –No remission of more two months –NO major depressive, manic, or mixed episodes

Bipolar II Disorder Major Depressive Episode Hypomanic Episode Depressed and hypomanic episodes

Depressive disorders اختلالات افسردگی n No history of manic, hypomanic, or mixed episodes قدان دوره های مانیک،هیپومانیک و مختلط n Major Depressive Disorder اختلال افسردگی عمده –Current major depressive episode n Dysthymic Disorder اختلال دیستیمیا –Two years of chronically depressed mood –دو سال خلق افسرده مزمن –Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings) –اشتها،خواب،انرژی،تمرکز،احترام به نفس و احساس درماندگی

Likelihood of having another Major Depressive Episode if you’ve had… Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode 1 episode 50% 2 episodes 70% 3 episodes 90%

Patterns of mood disorders Manic Hypo- manic De- pressed Weeks Identify episodes: Manic Mixed Hypomanic Major Depressive

More patterns... Manic Hypo- manic De- pressed

Depressive Disorders NOS n Premenstrual dysphoric disorder اختلال پیش از قاعدگی n Minor depressive disorder اختلال افسردگی جزئی – Fewer than five symptoms n Recurrent brief depressive disorder اختلال افسردگی عود کننده گذرا –Monthly episodes lasting <2 weeks n Postpsychotic depressive disorder of Schizophrenia اختلال افسردگی پس از سایکوز اسکیزوفرنیا –Residual phase phenomenon

Mood Disorder Specifiers شاخص های توصیف کننده تازه ترین دوره n These specifiers may be applied to mood disorder diagnoses, where appropriate: –Mild/moderate/severe w/o psychotic features –خفیف/متوسط/شدید/ با یا بدون ویژگیهای سایکوتیک –With:psychotic/ catatonic/ melancholic/ atypical features (m- older, a-younger) –با : ویژگیهای سایکوزیس/کاتاتونیک/ملانکولیک/آتیپیکال –In remission/chronic/seasonal pattern –با الگوی بازگشت / مزمن /فصلی –With postpartum onset با شروع پس از زایمان –Rapid cycling for Bipolar I or II Disorder با سیر تندچرخ

Etiology of mood disorders سبب شناسی اختلالات خلقی n Psychoanalytic theory: Evaluation of experiencesبررسی تجارب گذشته n Cognitive theories: Thought patternsالگوهای تفکر n Interpersonal theory: Rejectionطرد n Biological theories: Genes and NTs ژنها و نوروترانسمیترها n Existential theory: Loss of meaningخالی بودن از معنا

Psychoanalytic theory n Oral fixation:تثبیت در مرحله دهانی Depends on others for self-esteem n Super ego فراخود انتقاد کننده

Cognitive theories n Beck’s theory: منش بدبینانه (NegativeTriad) تکرار منفی گرایی (Negative schemas) تفکر تحریف شده (Characteristic biases) DEPRESSION

Characteristic biases n Arbitrary inferenceاستنباط دلخواه استنتاج خاص بدون قرائن کافی n Selective abstraction انتزاع ویژه تمرکز روی جزئی واحد n Overgeneralizationتعمیم مفرط استنتاج مبتنی بر تجربه ای کوتاه وباریک n Magnification and minimization بزرگنمایی و کوچک نمایی کاهش یا افزایش اهمیت رخدادها

Assessment of Beck’s theory n Depressed people do show cognitive biases in their thinking n Their apparent pessimism, however, is accurate n The theory is correlational, not causal n The model is multidimensional n Treatment based on the theory is helpful

Helplessness/hopelessness theories تئوری درماندگی/ناامیدی n Learned helplessness (Seligman & Maier, 1967)درماندگی آموخته شده n Attributional reformulation (Abramson, Seligman & Teasdale, 1978)اصلاح اسنادی –Personal/Environmental (a.k.a. Internal/External) –فردی/محیطی –Stable/Unstableپایدار /ناپایدار –Global/Specificهمه گیر/محدود n Hopelessness: Add diatheses of low self- esteem and hopelessness

Interpersonal theoryتئوری بین فردی n Reduced interpersonal support n Experiences of rejection –Due to social structure Inadequate social networks Others may dislike them –Elicited by patient Consequences of behavioral choices Critical comments by spouse –Poor social skills and seeking reassurance

Behavioral theories n Learned helplessness/hopelessness is a behavioral theory with a cognitive twist. n Reduction in reinforcement leads to a reduction in activity. n Depressive behaviors are reinforced. n Depressed people have taken part in fewer pleasant events.

Biological theoriesتئوری زیست شناختی n Genetics:ژنتیک –Bipolar MZ concordance = 43% to 72% –Bipolar DZ concordance = 6% to 25% –Unipolar MZ concordance = 46% –Unipolar DZ concordance = 20% n Linkage analysis: Mixed results –Multiple genes? –Chromosomes 13 and 22

Brain chemistry theories تئوری شیمیایی مغز n Serotonin and norepinephrine n Drug treatments: Tricyclics, MAOIs, and SSRIs n But the time course doesn’t match n Current hypothesis: Antidepressant drugs change the density or sensitivity of postsynaptic serotonin receptors

Neuroendocrine theory n Hypothalamus-pituitary-adrenocortical axis n High levels of cortisol correlate with depression n Dexamethasone Suppression Test identifies major depressive episodes

Existential theory n Frankl and the search for meaning n A spiritual approach: Logotherapy n Suffering has meaning: What is it? n Reversing helplessness?