Mood disorders affective disorders prof MUDr Eva ekov

Mood disorders ( affective disorders ) prof. MUDr. Eva Češková, CSc. Dept. of Psychiatry, Masaryk University , Brno

Mood disorders ( affective disorders ) § epidemiology § etiology § classification. : major depressive disorder, bipolar I disorder, dysthymic disorder and cyclothymic disorder § diagnosis § differencial diagnosis § course and prognosis § treatment § literature

Mood disorders ( affective disorders ) Mood disorders - the critical pathology in those disorders is one of mood

Epidemiology Lifetime prevalence: major depressive disorder bipolar I disorder 15% (more in women) 1% Sex: major depressive disorder twofold often in women, Age: mean age of onset of depressive disorder 40 years, bipolar I disorder 30 years

Etiology 1. Biological factors: § the biological amines, noradrenaline (dopamine) and serotonin - neurotransmitters most implicated in the pathophysiology of mood disorders § neuroendocrine dysregulation (alteration of hypothalamic-hypophysis-adrenal and hypothalamic-thyreoid axis) 2. Genetic factors 3. Psychosocial factors 4. Other factors : alteration of circadian rhythms, neuroimmune dysregulation

Classification (DSM IV) 1. major depressive disorder 2. bipolar I disorder 3. dysthymic disorder 4. cyclothymic disorder Further classification major depressive disorder and bipolar I disorder: § according to the severity (mild, moderate, severe) § with and without psychotic features, congruent or incongruent (hallucinations and delusions) § according to the course (single episode, or recurrent, remission, further course specifiers)

Diagnosis: major depressive disorder Minim. 5 symptoms, change from functioning: § depressed mood § diminished interest or pleasure § significant weight loss, or decrease or appetite § insomnia ( or hypersomnia) § psychomotor agitation or retardation § fatigue or loss of energy § feelings of worthlessness or guilt § diminished ability to think or concentrate, indecisiveness § recurrent thought of death

Diagnosis: Bipolar I, manic episode At least 1 week of abnormally and persistently elevated, expansive or irritable mood, impairment in occupational functioning or social activities (not due to abuse or medical condition), min. 3 of the following symptoms: § grandiosity § decreased need for sleep, § more talkativeness § flight of ideas § distractibility § increase of goal directed activity § excessive involvement in pleasurable activities

Diagnosis : dysthymic disorder Dysthymic disorder: a chronic disorder, with the depressed mood that lasts most of the day on most days Symptoms: § depressed mood for more days than not, for at least 2 y. 2 or more further symptoms: § poor appetite or overeating § insomnia or hypersomnia § low energy or fatigue § low self esteem § poor concentration or difficulty making decisions § feelings of hopelessness

Diagnosis : Cyclothymic disorder § a mild form of bipolar II disorder, characterised by episodes of hypomania and episodes of mild depression § for at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous period with depressive symptoms that do not meet criteria for a major depressive episode

Differential diagnosis Depressive disorders: § medical disorders (neurological, endocrine, infectious) § pharmacological Bipolar I: § other mental disorders (schizophrenia) § pharmacological

Course and prognosis Depressive disorder: § untreated depression lasts 6 -13 months § 5 -10% have a manic episode § tends to be a chronic disorder § pts. tend to relapse Bipolar disorder: § most often starts with depression § is a recurring disorder § pts. have a poorer prognosis than do pts. with major depressive disorder § 50% have a second manic episode within 2 years

Treatment Acute treatment vs. long-term with recurrent episodes Major depressive disorder: § biological treatment - antidepressants, ECT, sleep deprivation, light therapy § psychotherapy - cognitive-behavioural therapy Mania: § mood stabilisers § antipsychotics § ECT

References : § Kaplan HI, Sadock BJ, Grebb JA. : Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997 § Goodwin FK, Jamison KR. : Manic-depressive Illness. New York: Oxford University Press, 1990.