nMood: Sustained emotional state.

n

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

n

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:

nRelationship with parents: deprivation of maternal affection through separation and divorced

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

Clinical features of depressive disorder:

n

n depressed mood

n  negative  thinking

n  lack of enjoyment

n  reduced energy

n  slowness

n

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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