1. IN THE NAME OF GOD MOOD DISORDERS MOHAMAD NADI M.D PSYCHIATRIST

2. MOOD DISORDERS Historical perspective black bile and melancholia Endogenous vs. reactive depression Neurotic vs. psychotic depression

3. MOOD DISORDERS DSM-IV-TR 5 Mood Disorders: Major depressive disorder Dysthymic disorder Bipolar disorders Cyclothymic disorder mood disorder NOS (Not Otherwise specified )

4. MOOD DISORDERS Diagnostic issues – Types of symptoms Mood and Emotion Cognition Behaviour and Motivation Physical

5. MOOD DISORDERS Major depression symptoms include feelings of sadness, loss of interest or inability to experience pleasure, unexplained weight loss, difficulty sleeping, fatigue, difficulty concentrating, feelings of worthlessness or guilt, suicidal thoughts, agitation or slowing down And functional impairment

6. Major depressive disorder A.Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is (1) depressed mood or (2) loss of interest or pleasure.

7. Major depressive disorder (1) Depressed mood (2) Diminished interest or pleasure in all, or almost all, activities (3) Significant weight loss when not dieting or weight gain or decrease or increase in appetite. (4) Insomnia or hypersomnia. (5) Psychomotor agitation or retardation

8. Major depressive disorder (6) Fatigue or loss of energy (7) Feelings of worthlessness or excessive or inappropriate guilt (8) Diminished ability to think or to concentrate (9) Recurrent thoughts of death B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

9. Major depressive disorder estimates suggest about 5-10% of people suffer from depression twice as common in women – biological differences, expression of symptoms, social acceptability, role strain and stress 50% recurrence rate

10. Major depressive disorder Problem of underdiagnosis no obvious marker for depression stigma associated with diagnosis of depression

11. Major depressive disorder Etiology of Depression Biologic Theories – Genetic – Biochemical Cognitive Theories _ Object loss _ aggression turned inward

12. Risk Factors for Depression Chronic Illness Female Gender Bereavement Perfectionistic Situational stressors Previous History Family History Social Isolation

13. Dysthymia many of the same symptoms as major depressive disorder, but less severe dysthymia persists for at least 2 years with only brief times mood returns to normal chronic sadness

14. Treatment of Major depressive disorder Selective Serotonin Reuptake Inhibitors Tricyclic Antidepressants (TCA’s) Monoamine Oxidase Inhibitors ECT Psychoterapy

15. BIPOLAR DISORDERS Mania A.A distinct period of elevated or irritable mood, lasting at least 1 week. B. During the period of mood disturbance 3 or 4 of the following have persisted and have been present to a significant degree:

16. – 1. Inflated self-esteem or grandiosity – 2. Decreased need for sleep – 3. More talkative than usual – 4. Flight of ideas – 5. Distractibility – 6. Increase in goal-directed activity – 7. Excessive involvement in pleasurable activities Mania BIPOLAR DISORDERS

17. Hypomania less severe episodes of mania less severe episodes of mania less functional impairment less functional impairment less duration less duration BIPOLAR DISORDERS

18. Bipolar disorders Bipolar I and II Bipolar I – at least one or more manic episodes with or without one or more depressive episodes Bipolar II – at least one hypomanic episode with one or more episodes of major depression

19. Bipolar disorders Cyclothymia Alternating mood episodes: fluctuation between mild depression and hypomania Duration at least 2 years

20. Treatment of bipolar disorders Mood stabilizers – Lithium Anticonvulsants– Valproat sodiom Antipsychotics – Risperidon Psychoterapy – CBT ECT