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Mood disorders ( affective disorders ) prof. MUDr. Eva Češková, CSc. Dept. of Psychiatry, Dept. of Psychiatry, Masaryk University, Brno Masaryk University, Brno
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Mood disorders ( affective disorders ) §epidemiology §etiology §classification.: major depressive disorder, bipolar I disorder, dysthymic disorder and cyclothymic disorder §diagnosis §differencial diagnosis §course and prognosis §treatment §literature
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Mood disorders ( affective disorders ) Mood disorders - the critical pathology in those disorders is one of mood
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Epidemiology Lifetime prevalence: major depressive disorder 15% (more in women) bipolar I disorder 1% Sex: major depressive disorder twofold often in women, Age: mean age of onset of depressive disorder 40 years, bipolar I disorder 30 years
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Etiology 1.Biological factors: § the biological amines, noradrenaline (dopamine) and serotonin - neurotransmitters most implicated in the pathophysiology of mood disorders §neuroendocrine dysregulation (alteration of hypothalamic-hypophysis-adrenal and hypothalamic-thyreoid axis) 2. Genetic factors 3. Psychosocial factors 4. Other factors : alteration of circadian rhythms, neuroimmune dysregulation
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Classification (DSM IV) 1. major depressive disorder 2. bipolar I disorder 3. dysthymic disorder 4. cyclothymic disorder Further classification major depressive disorder and bipolar I disorder: § according to the severity (mild, moderate, severe) §with and without psychotic features, congruent or incongruent (hallucinations and delusions) §according to the course (single episode, or recurrent, remission, further course specifiers)
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Diagnosis: major depressive disorder Minim. 5 symptoms, change from functioning: §depressed mood §diminished interest or pleasure §significant weight loss, or decrease or appetite §insomnia ( or hypersomnia) §psychomotor agitation or retardation §fatigue or loss of energy §feelings of worthlessness or guilt §diminished ability to think or concentrate, indecisiveness §recurrent thought of death
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Diagnosis: Bipolar I, manic episode At least 1 week of abnormally and persistently elevated, expansive or irritable mood, impairment in occupational functioning or social activities (not due to abuse or medical condition), min. 3 of the following symptoms: §grandiosity §decreased need for sleep, §more talkativeness §flight of ideas §distractibility §increase of goal directed activity §excessive involvement in pleasurable activities
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Diagnosis : dysthymic disorder Dysthymic disorder: a chronic disorder, with the depressed mood that lasts most of the day on most days Symptoms: §depressed mood for more days than not, for at least 2 y. 2 or more further symptoms: §poor appetite or overeating §insomnia or hypersomnia §low energy or fatigue §low self esteem §poor concentration or difficulty making decisions §feelings of hopelessness
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Diagnosis : Cyclothymic disorder §a mild form of bipolar II disorder, characterised by episodes of hypomania and episodes of mild depression §for at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous period with depressive symptoms that do not meet criteria for a major depressive episode
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Differential diagnosis Depressive disorders: §medical disorders (neurological, endocrine, infectious) §pharmacological Bipolar I: §other mental disorders (schizophrenia) §pharmacological
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Course and prognosis Depressive disorder: §untreated depression lasts 6-13 months § 5-10% have a manic episode §tends to be a chronic disorder §pts. tend to relapse Bipolar disorder: §most often starts with depression §is a recurring disorder §pts. have a poorer prognosis than do pts. with major depressive disorder § 50% have a second manic episode within 2 years
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Treatment Acute treatment vs. long-term with recurrent episodes Major depressive disorder: §biological treatment - antidepressants, ECT, sleep deprivation, light therapy §psychotherapy - cognitive-behavioural therapy Mania: §mood stabilisers §antipsychotics §ECT
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References : Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997 Goodwin FK, Jamison KR.: Manic-depressive Illness. New York: Oxford University Press, 1990.
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