MOOD DISORDERSMOOD DISORDERS

DEPRESSIVE EPISODEDEPRESSIVE EPISODE

IntroductionIntroduction::

In these disorders, which include depressive In these disorders, which include depressive episodes, bipolar mood disorder and episodes, bipolar mood disorder and persistent mood disorder, there is a persistent mood disorder, there is a disturbance of mood that is not secondary disturbance of mood that is not secondary to organic causes, psychoactive substance to organic causes, psychoactive substance use or another psychiause or another psychia--

Tric disorder such as schizophrenia or Tric disorder such as schizophrenia or schizoaffective disorderschizoaffective disorder..

DEFINITIONDEFINITION::

This model shown in mental disorder after This model shown in mental disorder after sepesepe

Cific accident exampleCific accident example : :

11..deliverydelivery..

22..Surgical operationSurgical operation. .

It become appearance suddenly . sometime It become appearance suddenly . sometime slide gradual from depression into acute slide gradual from depression into acute depression or psychotic depressiondepression or psychotic depression..

CLINICAL FEATURESCLINICAL FEATURES::

Characteristic features of a depressive episode include Characteristic features of a depressive episode include depression of mood , anhedonia, reduced attention depression of mood , anhedonia, reduced attention and concentration ,ideas of guilt and worthlessness, and concentration ,ideas of guilt and worthlessness, lowered self-esteem and reduced energy, which in lowered self-esteem and reduced energy, which in turn causes tiredness and reduced activity. In turn causes tiredness and reduced activity. In turn ,these can lead to hopelessness and a belief that turn ,these can lead to hopelessness and a belief that life is not worth living , which can cause suicidal life is not worth living , which can cause suicidal thoughts .biological symptoms occur frequently. thoughts .biological symptoms occur frequently. The type of sleep disturbance that may occur in The type of sleep disturbance that may occur in depressive episodes are shown diagrammaticallydepressive episodes are shown diagrammatically..

MENTAL STATE EXAMINATIONMENTAL STATE EXAMINATION

11..AppearanceAppearance::Depressive facies include down turned eyes sagging Depressive facies include down turned eyes sagging of the corners of the mouth and a vertical furrow of the corners of the mouth and a vertical furrow between the eyebrows . There is typically poor eye between the eyebrows . There is typically poor eye contact . There may be direct evidence of weight contact . There may be direct evidence of weight loss, with the patient appearing emaciated and loss, with the patient appearing emaciated and dehydrated .indirect evidence of recent weight loss dehydrated .indirect evidence of recent weight loss may be indicated by the clothing appearing to be may be indicated by the clothing appearing to be too large. Evidence of poor self-care and general too large. Evidence of poor self-care and general neglect may include an unkempt appearance ,poor neglect may include an unkempt appearance ,poor personal hygiene and dirty clothingpersonal hygiene and dirty clothing..

CONTCONT..

22..Behaviour: psychomotor retardation typically Behaviour: psychomotor retardation typically occursoccurs..

33..Speech : the Speech : the patient'spatient's speech is typically slow, with long delays speech is typically slow, with long delays before questions are answeredbefore questions are answered..

44..Mood : it is low and sad , with feeling of Mood : it is low and sad , with feeling of hopelessness. The future seems bleak. Anxiety, hopelessness. The future seems bleak. Anxiety, irritability and agitation may also occur. The patient irritability and agitation may also occur. The patient may complain of reduced energy and drive, and an may complain of reduced energy and drive, and an inability to feel enjoyment (anhedonia). There is a inability to feel enjoyment (anhedonia). There is a loss of interest in normal activities and hobbiesloss of interest in normal activities and hobbies . .

CONTCONT..

55..Thought contentThought content::

Pessimistic thoughts occur concerning the Pessimistic thoughts occur concerning the past ,present and future. Suicidal and homicidal past ,present and future. Suicidal and homicidal thoughts may occur and should be checked for. thoughts may occur and should be checked for. Obsessions may occur secondary to depressionObsessions may occur secondary to depression

66 . .Abnormal beliefs and interpretation of eventsAbnormal beliefs and interpretation of events::

Ideas or delusions of a hypochondriacally or Ideas or delusions of a hypochondriacally or nihilistic nature may be presentnihilistic nature may be present. .

CONTCONT..

77 . .Abnormal experiencesAbnormal experiences::

In severe depressive episodes auditory In severe depressive episodes auditory hallucination may occur which are typically hallucination may occur which are typically in the second person and derogatory in in the second person and derogatory in contentcontent..

88 . .CognitionCognition: :

Concentration is characteristically poorConcentration is characteristically poor..

DSM-IV CRITERIA FOR MAJOR DSM-IV CRITERIA FOR MAJOR DEPRSSIVE EPISODEDEPRSSIVE EPISODE

A-at least five of the following symptoms have been A-at least five of the following symptoms have been present during the same 2-week period represent a present during the same 2-week period represent a symptoms is either (1) or (2)symptoms is either (1) or (2)::

11--depressive mood most of the day ,nearly every day, depressive mood most of the day ,nearly every day, as indicated by either subjective report (e.g. feels as indicated by either subjective report (e.g. feels sad or empty) or observation by others (e.g. sad or empty) or observation by others (e.g. appears tearful) . In children and adolescents this appears tearful) . In children and adolescents this can be irritable moodcan be irritable mood..

22 - -markedly diminished interest or pleasure in allmarkedly diminished interest or pleasure in all

CONTCONT..

Or almost all, activities most of the day , nearly Or almost all, activities most of the day , nearly every dayevery day..

33--significant weight loss when not dieting or weight significant weight loss when not dieting or weight gain (e.g. a change ofgain (e.g. a change of>5% body weight in a >5% body weight in a month), or a decrease or increase in appetite month), or a decrease or increase in appetite nearly every day . In children consider failure to nearly every day . In children consider failure to make expected weight gainmake expected weight gain. .

44--Insomnia or hypersomnia nearly every dayInsomnia or hypersomnia nearly every day. .

55--Psychomotor agitation or retardationPsychomotor agitation or retardation

CONTCONT..

((observable by othersobservable by others ) )nearly every daynearly every day. .

66--fatigue or loss energy nearly every dayfatigue or loss energy nearly every day..

77--feelings of worthlessness or excessive or feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)inappropriate guilt (which may be delusional)

Nearly every dayNearly every day..

88--diminished ability to think or concentrate ,or diminished ability to think or concentrate ,or indecisiveness, nearly every dayindecisiveness, nearly every day. .

99--recurrent thoughts of death (not just fear ofrecurrent thoughts of death (not just fear of

CONTCONT..

Dying), recurrent suicidal ideation without a Dying), recurrent suicidal ideation without a specific plan , or a suicide attempt or a specific plan , or a suicide attempt or a specific plan for committing suicidespecific plan for committing suicide..

B-Exclude a mixed episode (in which a manic B-Exclude a mixed episode (in which a manic episode also occurs)episode also occurs)..

C-The symptoms cause clinically significant C-The symptoms cause clinically significant distress or impairment in social ,occupationaldistress or impairment in social ,occupational

Or other important areas of functioningOr other important areas of functioning..

CONTCONT..

D-The symptoms are not caused either by a D-The symptoms are not caused either by a direct physiological action of a substance (e.gdirect physiological action of a substance (e.g..

Drug of abuse ,or medication), or by general Drug of abuse ,or medication), or by general medical condition (e.g. hypothyroidism)medical condition (e.g. hypothyroidism). .

E-The symptoms are not better accounted for E-The symptoms are not better accounted for by bereavementby bereavement . .

DIFFERENTIATION DIFFERENTIATION FROM BEREAVEMENTFROM BEREAVEMENT

11 - -Guilt about things other than action taken Guilt about things other than action taken or not taken by the survive at the time of or not taken by the survive at the time of deathdeath..

22--Thoughts of death other than the survive Thoughts of death other than the survive feeling that he or she would be better off dead feeling that he or she would be better off dead

,or should have died with the deceased,or should have died with the deceased. .

33--Morbid preoccupation with worthlessnessMorbid preoccupation with worthlessness..

44--Marked psychomotor retardationMarked psychomotor retardation . .

ATYPICAL TYPES OF ATYPICAL TYPES OF DEPRESSIONDEPRESSION

DEPRESSIVE STUPORDEPRESSIVE STUPOR::

This is rare these days because of effective This is rare these days because of effective treatmenttreatment..

MASKED DEPRESSIONMASKED DEPRESSION::

Depressive patients may present with somatic Depressive patients may present with somatic or other complain instead of a depressed or other complain instead of a depressed moodmood..

SEASONAL AFFECTIVE DISORDER(SAD)SEASONAL AFFECTIVE DISORDER(SAD)

CONTCONT..

The onset depressive episodes is related to a The onset depressive episodes is related to a particular time or seasonparticular time or season. . AGITATED DEPRESSIONAGITATED DEPRESSION::This occur in the elderlyThis occur in the elderly. . INVESTIGATIONINVESTIGATION::

The physical examination should include a The physical examination should include a careful inspection for any evidence of self- careful inspection for any evidence of self- harm, such as scars on the wristsharm, such as scars on the wrists..

TYPE OF DEPRESSIONTYPE OF DEPRESSIONTRANSIENT TRANSIENT DEPRESSIONDEPRESSION

MILD MILD DEPRESSIONDEPRESSION..

MODERATE MODERATE DEPERSSIONDEPERSSION..

SEVERE SEVERE DEPRESSIONDEPRESSION..

Life's Life's everyday everyday disappointmedisappointmentsnts..

Normal grief Normal grief responseresponse..

Dysthymic Dysthymic disorderdisorder..

Major Major depressive depressive disorderdisorder..

EPIDEMIOLOGYEPIDEMIOLOGY

INCIDENCEINCIDENCE::In males ,80-200 new cases per 100000 populIn males ,80-200 new cases per 100000 popul--

Ation per year . In females ,250-7800 new Ation per year . In females ,250-7800 new cases per 100000 population per yearcases per 100000 population per year..POINT PREVALENCEPOINT PREVALENCE::

In the west ,1.8-3.2In the west ,1.8-3.2%of males ,and 2.0-9.3% %of males ,and 2.0-9.3% of females . The point prevalence of of females . The point prevalence of depressive symptom in western population is depressive symptom in western population is up to 20%up to 20%..

CONTCONT..

LIFETIME RISKLIFETIME RISK::

In the general population of western countries In the general population of western countries 5-12% in males and 9-26% in females5-12% in males and 9-26% in females . .

AGE OF ONSETAGE OF ONSET::

On average , around the late 30s. However ,it On average , around the late 30s. However ,it can start any where from childhood to old can start any where from childhood to old ageage..

SEX RATIOSEX RATIO::

CONTCONT..

Commoner in femalesCommoner in females. .

MARRIAGEMARRIAGE::

Higher incidence in those who are not Higher incidence in those who are not married , including the divorced and married , including the divorced and separatedseparated..

SOCIAL CLASSSOCIAL CLASS::

11))Have three or more children under the age Have three or more children under the age of 14 to look afterof 14 to look after..

CONTCONT..

22))Do not work outside the homeDo not work outside the home..

33))Do not have somebody to confide in, that isDo not have somebody to confide in, that is, ,

There is a lack of intimacyThere is a lack of intimacy..

44))Lost their own mother before the age of11, Lost their own mother before the age of11, through death or separationthrough death or separation..

AETIOLOGYAETIOLOGY::

##Women may be more likely to admit to Women may be more likely to admit to feeling depressedfeeling depressed..

CONTCONT..

##Depression may be underdiagnosed in man , Depression may be underdiagnosed in man , who may be more likely to engage in who may be more likely to engage in excessive alcohol consumption and therefore excessive alcohol consumption and therefore be diagnosed rather than depressionbe diagnosed rather than depression..

MANAGEMENTMANAGEMENT::11))HOSPITALIZATIONHOSPITALIZATION::

Less severe episodes can be treated by GPs in Less severe episodes can be treated by GPs in the community or by psychiatrists in out the community or by psychiatrists in out clinicsclinics..

CONTCONT..

22))DRUG TREATMENTDRUG TREATMENT::Antidepressant medication is the mainstay of Antidepressant medication is the mainstay of treatment for moderate and severe depressive treatment for moderate and severe depressive episodes . Mild depressive symptoms can also episodes . Mild depressive symptoms can also benefit from such treatmentbenefit from such treatment..

33))ELECTROCONVULSIVE THERAPY ELECTROCONVULSIVE THERAPY (ECT)(ECT)::

This may used as a first line of treatment in This may used as a first line of treatment in the following relatively rare conditionthe following relatively rare condition::

CONTCONT..

**Very low fluid intake ,resulting in oliguriaVery low fluid intake ,resulting in oliguria..

**Depressive stuporDepressive stupor . .

**A dangerously high risk of suicideA dangerously high risk of suicide..

PSYCHOSURGERYPSYCHOSURGERY::

This is considered only extremely This is considered only extremely rarely ,when all other treatment for severe rarely ,when all other treatment for severe chronic handicapping depression have failedchronic handicapping depression have failed..

PHOTOTHERAPYPHOTOTHERAPY::

CONTCONT..

SADSAD with an autumn or winter onset can be with an autumn or winter onset can be treated with high- intensity lighttreated with high- intensity light..PSYCHOTHERAPIESPSYCHOTHERAPIES::

@@Cognitive therapyCognitive therapy..@@Group therapyGroup therapy..

@@Psychoanalytic PsychotherapyPsychoanalytic Psychotherapy..@@Family therapyFamily therapy..@@Marital therapyMarital therapy..

SOCIAL MILIEUSOCIAL MILIEU::Increased activity and social contact should be Increased activity and social contact should be encouraged. The development of confiding encouraged. The development of confiding relationships has a protective function in relationships has a protective function in preventing relapsepreventing relapse..PROGNOSISPROGNOSIS::

The outcome in general is better the greater The outcome in general is better the greater the length of follow-up. The risk of relapse is the length of follow-up. The risk of relapse is reduced if antidepressant medication is reduced if antidepressant medication is continued for 6 months after the end of the continued for 6 months after the end of the depressive episode .over all, the suicide rate depressive episode .over all, the suicide rate is around 9%is around 9%..

REFERENCEREFERENCE

PSYCHIATRY FORPSYCHIATRY FOR::

Basant k.puriBasant k.puri..

Name of studentName of student::

SAMIAH AL-JHANYSAMIAH AL-JHANY..

SAMIAH AL-HARBYSAMIAH AL-HARBY..