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

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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?