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Y.Semnani M.D. Assistant Professor of Psychiatry Shahid Beheshti University of Medical Science

Mood disorders. Y.Semnani M.D. Assistant Professor of Psychiatry Shahid Beheshti University of Medical Science. An Overview of Mood Disorders. Gross Deviations in Mood Depression: “The Low” The “Common Cold” of Mental Illness Mania: “The High”

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Y.Semnani M.D. Assistant Professor of Psychiatry Shahid Beheshti University of Medical Science

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  1. Mood disorders Y.Semnani M.D. Assistant Professor of Psychiatry Shahid Beheshti University of Medical Science

  2. An Overview of Mood Disorders • Gross Deviations in Mood • Depression: “The Low” • The “Common Cold” of Mental Illness • Mania: “The High” • Abnormally Exaggerated Elation, Joy, or Euphoria

  3. An Overview of Mood Disorders Mania Depression

  4. The Structure of Mood Disorders • Unipolar Mood Disorder • only Depression • Bipolar Mood Disorder • Alternates Between Depression and Mania • Somewhat Misleading Term (only Mania?)

  5. The Nature of Mood Disorders • Depressive Disorders • Major Depression • Dysthymic Disorder • Double Depression • Bipolar Disorders • Bipolar I and Bipolar II Disorders • Cyclothymic Disorder

  6. Years Lived with Disability (YLD)Murray & Lopez “Global Burden of Disease”(WHO, Harvard University, World Bank) Disease frequency(million) percent • Major Depression 50.8 10.7 Iron Deficiency A 22 4.7 Falling 22 4.6 • Alcohol 15.8 3.3 COPD 14.7 3.1 • Bipolar Dis 14.1 3 Congenital malforms 13.5 2.9 Osteoarthritis 13.3 2.8 • Schizophrenia 12.1 2.6 • OCD 10.2 2.2

  7. Depressive Disorders Major Depression • Clinical Description 2 Weeks or More

  8. Major Depressive Episode: DSM-IV Criteria • Depressed mood and/or loss of interest or pleasure  2 weeks duration plus  4 following symptoms: • Associated symptoms • Physical:insomnia/hypersomnia, appetite/weight change, decreased energy, psychomotor change • Psychological:feelings of guilt or worthlessness, poor concentration, thoughts of death/suicidal intentions, hopelessness and helplessness

  9. Depressive Disorders Major Depression • Facts and Statistics • Mean Age of Onset is 25 Years • Length of Episode Varies • Remission is Common • Risk of Suicide • Somatic presentation in Eastern countries

  10. Depressive Disorders Dysthymia • Clinical Description • Similar to Major Depression BUT With a Different Course • Symptoms are Milder • Symptoms can Last 20-30+ Years • Persistently Depressed Mood for more than 2 Years • Cannot be Symptom Free > 2 Months

  11. Depressive Disorders Dysthymia • Clinical Description 2 Years or More

  12. Depressive Disorders Major Depression • Clinical Description 2 Weeks or More

  13. Depressive Disorders Dysthymia • Facts and Statistics • Mean Age of Onset Early 20s • Onset Prior to Age 20 • Greater Chronicity • Poor Prognosis • Stronger Family Link • Major Depressive Episodes are Common

  14. Depressive Disorders Double Depression • Clinical Description • Suffer From Both • Major Depression Episodes • Dysthymic Disorder • Dysthymic Usually Begins First • Associated With Severe Pathology • A Problematic Future Course

  15. Depressive Disorders Double Depression • Clinical Description Dysthymia Dysthymia Major Depression

  16. Double depression

  17. Bipolar Disorders • Major Features • Experience Both • Manic Episodes • Major Depressive Episodes • What are Manic Episodes?

  18. Manic Episode: Diagnostic Criteria • Elevated, expansive, or irritable mood for 1 week or longer, plus3 or more of the following • Inflated self-esteem or grandiosity • Decreased need for sleep • Pressured speech • Racing thoughts/flight of ideas • Distractibility • Psychomotor agitation/increased goal-directed activity • Excessive involvement in high-risk activities .

  19. Bipolar Disorders • Mania andHypomania 1 Week 4 Days

  20. Bipolar Disorders: Bipolar I • Clinical Description • Major Depressive Episodes Alternate With • Full Manic Episodes

  21. Bipolar Disorders: Bipolar I • Clinical Description Mania Major Depression

  22. Bipolar Disorders: Bipolar II • Clinical Description • Major Depressive Episodes Alternate With • Hypomanic Episodes

  23. Bipolar Disorders: Bipolar II • Clinical Description Hypomania Major Depression

  24. Bipolar Disorders: Cyclothymia • Clinical Description • Milder Depressive Episodes Alternate With • Hypomanic Episodes

  25. Bipolar Disorders: Cyclothymia • Clinical Description Hypomania Minor depression

  26. Mixed Episode: Diagnostic Criteria • Criteria met for both manic episode + Major Depressive Episode for 1 week

  27. Bipolar Disorders • General Facts and Statistics • Bipolar I • Onset Around 18 Years • Bipolar II • Onset Around 22 Years • 16% Commit Suicide • Cyclothymia • Typically Chronic

  28. Types of Major Mood Disorders High Recurrent Unipolar Mood Bipolar II Bipolar I Low

  29. Treatment of Depressive Disorders • Medications • Tricyclic Antidepressants Imipramine Amitriptyline Nortriptyline • Block Neurotransmitter Reuptake • Side Effects

  30. Treatment of Depressive Disorders • Medications • SSRIs • Block Reuptake of Serotonin Flouxetine Citalopram Sertraline Fluvoxamine • Side Effects

  31. Manic phase: Lithium Valporate Sodium Carbamazepine Gabapentin Lamotrigine Topiramate Depressive phase: Lithium Lamotrigine Mixed phase Valporate Sodium Carbamazepine Gabapentin Treatment of Bipolar Disorders

  32. Treatment of Mood Disorders • Psychological Interventions • Beck’s Cognitive Therapy • Interpersonal Psychotherapy • Usually Brief and Time Limited • Combined Treatments?

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