1. CHAPTER 16 Mood Disorders

2. Mood Mood can be defined as a pervasive and sustained emotion or feeling tone that influences a persons behavior and colours his or her perception of being in the world. Definition # Mood disorders are defined by the presence of mood episodes # mood episodes represent a combination of symptoms comprising a predominant mood state that is abnormal in quality or duration, e.g. major depressive, manic, mixed, hypomanic. # types of mood disorders include 1. depressive (major depressive disorder, dysthyma) 2. bipolar (bipolar I/II disorder, cyclothyma) N.B: This bipolar mood disorder earlier known as manic depressive psychosis.characterized by recurrent episodes of manic episodes and depression in the same patient at different time. Bipolar – those who had at least one episode of depression and one

3. of mania where repeated maniac episodes occur, this depression is called bipolar. Unipolar – those with a history of at least 3 separate episodes of retarted or psychotic depression, complete remission between and no episode of mania. # secondary to GMC, substances, medications Medical workup of Mood Disorder # routine screening: physical examination, CBC, thyroid function test, electrolytes, extended electrolytes, urinalysis, drug screen # additional screening: neurological consultation, chest x ray, ECG, CT

4. Mood episodes Criteria for major depressive episode according to DSM-IV A.≥5 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 symptom is either 1) depressed mood or 2) loss of interest or pleasure B.Note: do not include symptoms that are clearly due to a GMC, mood incongruent delusions or hallucinations # depressed mood most of the day, nearly everyday, as indicated by either subjective report or observation made by others # markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly everyday. # significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly everyday. # insomnia or hypersomnia nearly everyday #psychomotor agitation or retardation nearly everyday #fatigue or loss of energy everyday # feelings of worthlessness or excessive or inappropriate guilt # diminished ability to think or concentrate or indecisiveness, nearly everyday

5. # feelings of worthlessness or excessive or inappropriate guilt # diminished ability to think or concentrate or indecisiveness, nearly everyday # recurrent thoughts of death (not just fear of dying), recurrent suicidal idcation without a specific plan, or a suicide attempt or a specific plan for commiting suicide B. The symptoms do not meet criteria for a mixed episode. C. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning D. The symptoms are not due to the direct physiological effects of a substance or a GMC

6. E. The symptoms are not better accounted for bybereavement; the symptoms persist for longer than 2 months; symptoms are charecterized by marked functional impairement, morbid preoccupation with worthlessness; suicidal ideation, psychotic symptoms or psychomotor retardation. HOW A DEPRESSIVE PATIENT COMMONLY PRESENTS 1.Sad mood, weeping spells, lack of pleasure 2.Feeling of worthlessness, hopelessness or excessive guilt 3.Loss of interest in the surroundings 4.Sleeplessness 5.Loss of appetite and weight 6.Decreased psychomotor activity 7.Ideas of death, suicide or homicide 8.Decreased production of thoughts 9.Heaviness in head 10.Excessive concern with physical health 11.Reduced interest in sexual activity or loss of libido 12. reduced interest in looking after self 13. may remit spontaneously or change into manic phase.

7. Features/ specifiers 1.Psychotic – with hallucinations or delusions 2.Chronic – lasting two years or more 1.Catatonic – at least two of : motor immobility; excessive motor activity; extreme negativism or mutism; peculiarities of voluntary movement; echolalia or echopraxia 3.Melancholic – quality of mood is distinctly depressed, mood is worse in the morning, early morning awakening, marked weight loss,excessive guilt, psychomotor retardation. 4.Atypical – increased sleep, weight gain, leaden paralysis, rejection hypersensitivity 5.Postpartum 6.Seasonal – pattern of onset at the same time each year

8. TREATMENT Antidepressant mood stabilizer anty psychotic psychotherapy

9. The End