Mood Disorders خلقی اختالالت

Bipolar Disorders دوقطبی اختالالت Depressive Disorders

افسردگی اختالالت

By : Dr SeddighHUMS

Episodes and Patternsها الگوها دوره و

Major depressive episode افسردگی عمده

Manic episode شیدایی دوره Mixed episode مختلط دوره Hypomanic episode هیبومانیک دوره Cycling patterns چرخشی الگوهای

Major depressive episodeعمده دوره افسردگی

Five or more of the following, most of the day and/or nearly every day, including at least symptom 1 or 2:

زیر 5 عالئم از بیشتر یا 1. Depressed mood افسرده خلق

– Sad, empty, weepy; irritable, angry 2. Loss of interest or pleasure in previously enjoyable

activities

لذت و عالقه فقدان 3. Change in weight or appetite اشتها و وزن تغییرات 4. Sleep changes خواب تغییرات

More depressive symptoms 5. Noticeable change in movement

حرکت در توجه قابل تغییرات 6. Fatigue خستگی 7. Feelings of worthlessness or guilt

گناه یا ارزشی بی احساس 8. Impaired cognition or volition

وتمرکز تفکر در اختالل 9. Repeated thoughts of death or suicide, or planned or

attempted suicide

خودکشی و مرگ مکرر افکار The five symptoms must occur in the same two weeks

باشد 5 داشته وجود هفته دو حداقل باید عالمت

Manic episode شیدایی دوره One week of persistently high, expansive, or irritable

mood, and 3 of:سه با پذیرهمراه تحریک یا و ،وسیع باال مستمرا خلق هفته یک

عالمت Grandiose self-esteem بینی خودبزرگ

Lower sleep need خواب به نیاز کاهش Overly talkative حرفی پر Racing thoughts افکار جویی سبقت Easily distracted پرتی حواس Increased activity or agitation

اژیتاسیون یا فعالیت افزایش High risk activities خطر پر فعالیتهای

Mixed episode مختلط دوره One week of both manic and major depressive

symptoms with rapidly alternating moods

سریع تغییر با شیدایی و افسردگی دودوره هر عالئم هفته یکخلق

Common symptoms: شایع عالئم

– Agitation آژیتاسیون – Insomniaبیخوابی – Irregular appetite (binge-fast) امساک و پرخوری– Delusions هذیان

– Thoughts of suicide خودکشی افکار

Hypomanic episode دوره هیپومانیک Four days of manic episode symptoms

4 شیدایی دوره عالئم روز Mood disturbance does not critically

نیست بحرانی خلقی آشفتگی impair ability to work or maintain social responsibilities

اجتماعی مسئولیت و کار انجام در عملکرد افت Response pattern is uncharacteristic

نیست منش به مربوط پاسخدهی الگوی Not euthymia نیست طبیعی خاق

Bipolar disorders دو اختالالت قطبی Bipolar I Disorder قطبی دو یک اختالالت تیپ

– One or more manic or mixed episodes– Usually one or more major depressive episodes– Subcategorized based on the character of the

most recent episode• Most recent episode depressed• Most recent episode manic• Most recent episode mixed

Bipolar I Disorder

Major Depressive

Episode

Manicor Mixed Episode

Manic or Mixed Episode

One or more manic episode

OR Depressed and manic episodes

OR

Bipolar disorders…

Bipolar II Disorder دو تیپ قطبی دو اختالالت – One or more major depressive episodes– One or more hypomanic episodes– NO manic or mixed episode

Cyclothymic Disorder سیکلوتایمیا اختالل– Two years of alternating hypomanic and depressive

symptoms – افسردگی عالئم و هیپومانیا متغییر های دوره سال دو

– No remission of more two months– NO major depressive, manic, or mixed episodes

Bipolar II Disorder

Major Depressive

Episode

Hypomanic Episode

Depressed and hypomanic episodes

Depressive disorders اختالالت افسردگی No history of manic, hypomanic, or mixed episodes

مختلط و مانیک،هیپومانیک های دوره قدان Major Depressive Disorder

عمده افسردگی اختالل– Current major depressive episode

Dysthymic Disorder دیستیمیا اختالل– Two years of chronically depressed mood– مزمن افسرده خلق سال دو– Two additional depression symptoms (appetite, sleep, energy,

concentration, low self-esteem, hopeless feelings)– درماندگی احساس و نفس به اشتها،خواب،انرژی،تمرکز،احترام

Likelihood of having another Major Depressive Episode if you’ve had…

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

1 episode 50%

2 episodes70%

3 episodes 90%

Patterns of mood disorders

-4

-3

-2

-1

0

1

2

3

4

1 2 3 4 5 6 7 8 9 10 11 12

MajorDepression

Bipolar I

Bipolar II

Manic

Hypo-manic

De-pressed

Weeks

Identify episodes:ManicMixedHypomanicMajor Depressive

More patterns...

-4

-3

-2

-1

0

1

2

3

1 2 3 4 5 6 7 8 9 10 11 12

CyclothymiaDysthymia

Manic

Hypo-manic

De-pressed

Depressive Disorders NOS

Premenstrual dysphoric disorder

قاعدگی از پیش اختالل Minor depressive disorder

جزئی افسردگی اختالل– Fewer than five symptoms

Recurrent brief depressive disorder

گذرا کننده عود افسردگی اختالل– Monthly episodes lasting <2 weeks

Postpsychotic depressive disorder of Schizophrenia

اسکیزوفرنیا سایکوز از پس افسردگی اختالل– Residual phase phenomenon

Mood Disorder Specifiersترین تازه کننده توصیف های شاخص

دوره These specifiers may be applied to mood disorder diagnoses,

where appropriate:– Mild/moderate/severe w/o psychotic features

– / / سایکوتیک/ ویژگیهای بدون یا با شدید متوسط خفیف– With:psychotic/ catatonic/ melancholic/ atypical features (m-

older, a-younger)– / / / آتیپیکال : مالنکولیک کاتاتونیک سایکوزیس ویژگیهای با

– In remission/chronic/seasonal pattern– فصلی / / مزمن بازگشت الگوی با

– With postpartum onset زایمان از پس شروع با– Rapid cycling for Bipolar I or II Disorder تندچرخ سیر با

Etiology of mood disordersخلقی اختالالت شناسی سبب

Psychoanalytic theory: Evaluation of experiences گذشته تجارب بررسی Cognitive theories: Thought patterns تفکر الگوهای Interpersonal theory: Rejectionطرد Biological theories: Genes and NTs نوروترانسمیترها و ژنها Existential theory: Loss of meaning معنا از بودن خالی

Psychoanalytic theory

Oral fixation: در دهانی تثبیت مرحله

Depends on others for self-esteem

Super ego کننده انتقاد فراخود

Cognitive theories

Beck’s theory:

بدبینانه (NegativeTriad) منش

گرایی منفی (Negative schemas) تکرار

شده تحریف (Characteristic biases) تفکر

DEPRESSION

Characteristic biases

Arbitrary inference دلخواه استنباطکافی قرائن بدون خاص استنتاج

Selective abstraction ویژه انتزاعواحد جزئی روی تمرکز

Overgeneralization مفرط تعمیموباریک کوتاه ای تجربه بر مبتنی استنتاج

Magnification and minimizationنمایی کوچک و بزرگنمایی

رخدادها اهمیت افزایش یا کاهش

Assessment of Beck’s theory

Depressed people do show cognitive biases in their thinking

Their apparent pessimism, however, is accurate

The theory is correlational, not causal The model is multidimensional Treatment based on the theory is helpful

Helplessness/hopelessness theories / ناامیدی درماندگی تئوری Learned helplessness (Seligman & Maier,

1967) شده آموخته درماندگی Attributional reformulation (Abramson,

Seligman & Teasdale, 1978) اسنادی اصالح– Personal/Environmental (a.k.a. Internal/External)

– محیطی/ فردی– Stable/Unstable ناپایدار / پایدار– Global/Specific / محدود گیر همه

Hopelessness: Add diatheses of low self-

esteem and hopelessness

Interpersonal theory بین تئوری فردی Reduced interpersonal support Experiences of rejection

– Due to social structure• Inadequate social networks• Others may dislike them

– Elicited by patient• Consequences of behavioral choices• Critical comments by spouse

– Poor social skills and seeking reassurance

Behavioral theories

Learned helplessness/hopelessness is a behavioral theory with a cognitive twist.

Reduction in reinforcement leads to a reduction in activity.

Depressive behaviors are reinforced. Depressed people have taken part in

fewer pleasant events.

Biological theories زیست تئوری شناختی

Genetics:ژنتیک – Bipolar MZ concordance = 43% to 72%– Bipolar DZ concordance = 6% to 25%– Unipolar MZ concordance = 46%– Unipolar DZ concordance = 20%

Linkage analysis: Mixed results– Multiple genes?– Chromosomes 13 and 22

Brain chemistry theoriesمغز شیمیایی تئوری

Serotonin and norepinephrine Drug treatments: Tricyclics, MAOIs, and

SSRIs But the time course doesn’t match Current hypothesis: Antidepressant

drugs change the density or sensitivity of postsynaptic serotonin receptors

Neuroendocrine theory

Hypothalamus-pituitary-adrenocortical axis

High levels of cortisol correlate with depression

Dexamethasone Suppression Test identifies major depressive episodes

Existential theory

Frankl and the search for meaning A spiritual approach: Logotherapy Suffering has meaning: What is it? Reversing helplessness?