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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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