Post on 21-Feb-2018
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Elmeida Effendy
Psychiatric Department
Medical Faculty- USU
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=affective disorders
Mood disorders is preferred cause it refers to
sustained emotional states, not merely tothe external affective! expression of a
transitory emotional state
Mood may "e normal, elevated or depressed
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$ormal persons experience a %ide ran&e of
mood ' have an e(ually lar&e repertoire of
affective expressions ) they feel in control,
more or less, of their moods and effects
*n mood disorders the sense of control is lost,' there is a su"+ective experience of &reat
distress
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Patients %ith elevated mood
Expansiveness
Fli&ht of ideas
Decreased sleep
.ei&htened self-esteem
/randiose ideas
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Patients %ith depressed mood
oss of ener&y ' interest
Feelin&s of &uilt
Difficulty concentratin&
oss of appetite
2hou&ht of death or suicide
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4ther si&ns ' symptoms 5han&es in activity level
5o&nitive a"ilities Speech
6e&etative functions sleep, sexual activities!
7esult in impaired interpersonal, social and
functionin&
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ma+or depressive episode MDD= unipolar
depression
Manic ' depressive episode "ipolar
disorder
Manic episodes alone "ipolar disorder Manic episode alone = unipolar mania =
pure mania=euphoric mania
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: ma+or depressive disorderMDD=unipolardepression!occurs %ithout a history of amanic, mixed or hypomanic episode
MDD must last at least # %ee;s
: manic episode is a distinct period of ana"normally ' persistently elevated,
expansive or irrita"le mood lastin& for atleast 1 %ee;
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: hypomanic last at least 0 days ' similar
to a manic episode except that is not severe
enou&h to cause impairment in social oroccupational functionin& ' no psychotic
features are present
oth mania ' hypomania are associated %ith *nflated self-esteem
Decreased need for sleep
Distracti"ility
/reat physical ' mental activity
4verinvolvement in pleasurea"le "ehavior
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ipolar * disorder 1 or more manic episodes,
' sometimes ma+or episodes episode
: mixed episode is a period of at least 1
%ee; in %hich "oth manic episode ' a ma+or
depressive episode occur almost daily
ipolar ** disorder episodes of ma+or
depression ' hypomania
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Dysthymicdisorder at least # years of
depressed mood that is not severe enou&h to
fit the dia&nosis of ma+or depressive epidode
5yclothymicdisorder at least # years of
fre(uently occurrin& hypomanic symptomsthat cannot fit the dia&nosis of manic
episode ' of depressive symptoms that
cannot fit the dia&nosis of ma+or depressive
episode
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iolo&ical Factors:"normalities in "io&enic amine meta"olites
such as 3 hydroxy indole acetic acid 3-.*::!,homovanilic acid .6:! ' -methoxy-0-
hydroxyphenyl&lycol M.P/! in "lood, urine '5SF
$euroendocrine 7e&ulation
Sleep :"normalities
5ircadian rhytms
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/enetic Factors Psychososial Factors
ife events ' environmental Stress Stress accompanyin& the first episode results in lon&-
lastin& chan&es in the "rain@s "iolo&y on& lastin& chan&es may alter the functional states of
various neurotransmitter ' intra neuronal si&nalin&
systems loss of neuron ' excessive reduction insynaptic contacts
Personality Factors $o sin&le personality trait predispose a person to
depression
4"sessive-compulsive disorder, histrionic ' "orderline&reater ris;
Psychodynamic Factors5o&nitive 2heory
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Psychodynamic Factors Psychodynamic Factors in Depression
Freud ' :"raham Distur"ance in the infant-mother relationship durin&
oral-phase
in;ed to real or ima&ined o"+ect
*ntro+ection of the departed o"+ects, defens mechanism
invo;ed to deal %ith o"+ect@s loss
oss o"+ect is re&arded %ith a mixture of love ' hate,feelin&s of an&er are directed in%ard at the self
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Psychodynamic Factors in Mania
:"raham manic episode may reflect an ina"ility to
tolerate a developmental tra&edy, such as loss of aparent
7esult from a tyrannical supere&o,%hich produces
intolera"le self criticism that is then replaced "y
euphoric self satisfaction
e%in manic patient@s e&o as over%helmed "ypleasura"le impulses such as sex or "y feared
impulses such as a&&ression
Alein defensive reaction to depression, usin&
manic defenses such as omnipotence, the person
develops delusion &randeur
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5o&nitive 2heory
:aron ec; co&nitive triad of depression
1B vie%s a"out the self- a ne&ative self-precept
#BEnvironment C a tendency to experience the %orld as
hostile ' demandin&B Future expectation of sufferin& ' failure
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Depressed mood
Mar;edly diminished interest or pleasure inall
Si&nificant %ei&ht loss %hen not dietin& or%ei&ht &ain chan&e of more than 3 of "ody%ei&ht in amonth!
*nsomnia or hypersomnia
Psychomotor a&itation or retardation
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Fati&ue or loss of ener&y
Feelin&s of %orthlessness or excessive or
inappropriate &uilt
Diminished a"ility to thin; or concentrate 7ecurrent thou&hts of death
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*nflated self esteem or &randiosity
Decreased need for sleep feels rested afteronly hours sleep!
More tal;ative than usual or pressure to ;eeptal;in&
Fli&ht of ideas or su"+ective experience thatthou&hts are racin&
Distracti"ility
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*ncrease in &oal directed activity socially,
%or;, school, sexually!
Excessive involvement in pleasura"leactivities that have a hi&h potential for
painful conse(uences
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