nMood: Sustained emotional state.
nAffect: Short term emotional state that is observed by others.
nEmotion: Derived from latin word “Emovere” means subjective feelings.
nMood disorder: a) State of depression called depressive disorder.
n b) State of elation called Mania or hypomania
Classification of Mood Disorder:
n1) Unipolar: Major Depressive disorder
n Age of onset usually 30 years
n2) Bipolar : Mania/ Hypomania/depressive/ mixed
n Age of onset about 20 years.
nSymptoms may be mild, moderate or severe.
n Major Depressive Disorder
n In Major Depressive Disorder there is combination of misery and malaise. Depression is a major cause of disability and suicide.
Epidemiology and Etiology:
n Prevalence : Male 3 to 5%
Female 6 to 8%
n Male: Female- 1: 2
Age- 18 to 44 year
Higher rate in unemployed and divorced
Etiology
n1) Biological causes: genetic -twice the risk in 1st degree relatives of proband
Twin study concordance rate is high in MZ than DZ twin
Biochemical Decreased secretion of three monoamine neurotransmitters such as
Serotonin, Adrenaline, Dopamine
Endocrine Abnormalities:
Cushing's syndrome
Addison’s disease
Hypothyroidism
Hyperthyroidism
Premenstrual period
Child birth
Menopause
Disturbance of Immune Function:
lowering of natural killer cells activity
Psychological causes:
nPremorbid personality –cyclothymic personality
nStressful life events
nBereavement
nAutomatic negative thought
Social causes:
Family discord
Disruption of parent child relationship
Non caring and overprotective parenting
Poor social support
Empty nest Syndrome : Children go away from house for
study, learning, marriage and other causes. Parents live
alone and may develop depression.
Husband in abroad
nRelationship with parents: deprivation of maternal affection through separation and divorced
Clinical features of depressive disorder:
n depressed mood
n negative thinking
n lack of enjoyment
n reduced energy
n slowness
n Sleep disturbance
n Diurnal variation of mood
n Anorexia, wt. loss
n constipation
n loss of libido
n amenorrhoea
nAnhedonia
n Psychomotor retardation
n Agitation
n delusion- Hypochondriacal, persecutory, nihilistic, delusion of guilt
Depressive cognition:
n worthlessness about present condition
n pessimistic thought about future
n guilty feelings about past trivial acts
n suicidal plan
Management of depression
nBiological therapy by drugs
nPsychological therapy
n Social therapy
Treatment:
nA) Monoamine reuptake inhibitor
Tricyclic antidepressant
Amitriptyline- 75-300mg/day
Imipramine -do
nortriptyline-do
clomipramine-- do
Selective serotonin reuptake inhibitors
■Fluoxetine, paroxetine, sertraline,fluvoxamine etc
nMirtazepine 30-45mg/day
n Venlafaxie 75-375mg/day
n Duloxetine 60mg/day
n Reboxetine 12mg/day
n Mianserine
n Trazodone, Bupropion
Other treatment:
nElectroconvulsive therapy
nBright light therapy
n Mood stabilizer -- lithium, carbamazepine, sodium valproate, lamotrigine.
Psychological and social treatment:
nCognitive behavior therapy
n Supportive psychotherapy
n Social treatment
n Occupational therapy
n Recreational therapy
n Social support and follow-up
Mania:
nCore features are----
nElevated mood, increased activity, self important ideas. Less severe form is hypomania.
nEpidemiology-prevalence 1%
Age of onset- 17-21years
Male: female - equal
Clinical features:
nOpposite to depression
n mood cheerful, optimistic
n Appearance-- brightly colored clothing
physical exhaustion
energetic, busy noisily
n Sleep reduced , speech rapid, grandiose delution, delusion of persecution, insight impaired.
Management:
nTypical antipsychotics- high dose to be given.
Chlorpromazine- 1000mg/day
Haloperidol---up to 30mg/day
n Atypical antipsychotics-
nMood stabilizers
nElectroconvulsive therapy resistant to medication.
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