Non Psychotic Disordres

Sabar
Mood Disorders
Definitions
• The mood or affective disorders are
characterized by a primary disturbance in internal
emotional state causing subjective distress &
problems in functioning
• Given the patient’s current social & occupational
situation he or she emotionally feels
- somewhat worse than would be expected (dysthymia)
- very much worse than would be expected (depression)
- somewhat better than would be expected (hypomania)
- very much better than would be ecpected (mania)
 Con’t (2)

• The Categories of mood disorders are:

- Major depressive disorder
- Bipolar disorder (I & II)
- Dysthymic disorder
- Cyclothymic disorder
 Con’t (3)

Epidemiology
• There are no differences in the occurrence of
mood disorders associated with ethnicity,
education, marital status, or income
• The lifetime prevalence of mood disorder is
a. Major depressive disorder: 5%-12% for men
10%-20% for women
b. Bipolar disorder: 1% overall; no sex difference
c. Dysthymia disorder: 6% overall; up to 3 times more
common in women
d. Cyclothymic disorder: less than 1% overall;
no sex difference
 Classification of Mood Disorder
• Major depressive disorder
1. characteristic
- recurrent episodes of depression, each
continuing for at least 2 weeks

2. Masked depression
- 50% of depressed patients seem unaware of or
deny depression
- often visit primary care doctors complaining of
vague physical symptoms
- these complaints may be mistaken for
hypochondriasis
- depressed patients show other symptoms of
depression
 Con’t (2)

3. Suicidal risk
- increased risk for suicide
- certain demographic, psychosocial, & physical
factors affect this risk
- the 5 top risk factors for suicide from highest to
lowest risk are:
I. Serious prior suicide attempt
II. Age older than 45 years
III. Alcohol dependence
IV. History of rage & violent behavior
V. Male sex
• Bipolar disorder
There are episode of
- both mania & depression (bipolar I disorder) or
- both hypomania & depression (bipolar II disorder)
There is no simple manic disorder because depressive
symptoms eventually occur. Therefore, one episode of
symptoms of mania or hypomania defines bipolar disorder

In some patients, (e.g., poor patients with low acces to health

care) a mood disorder with psychotic symptoms can become
severe enough to be misdiagnosed as schizophrenia
a. Delusions can occur in depression as well as in mania
b. In contrast to psychotic disorder in which patients are
chronically impaired, in mood disorders the pateint’s mood &
functioning usuall return to normal between episode
Symptoms of Depression
- Depressed mood
- Reduced interest or pleasure
- Reduced energy & motivation
- Anxiety
- Sleep problems
- Cognitive problems
- Psychomotor retardation or
agitation
- Decreased appetite
- Diurnal variation in symptoms
- Suicidal ideation
- Suicide
- Psychotic symptoms
Mania
- Elevated mood
- Grandiosity & expansiveness
- Irritability & impulsivity
- Disinhibition
- Assaultiveness
- Distractibility
- Flight of ideas
- Pressured speech
- Impaired judgment
- Delusions
 Dysthymic disorder & Cyclothymic disorder
• Dysthymic disorder involves dysthymia continuing
over a 2-year period with no discrete episodes of
illness

• Cyclothymic disorder involves periods of hypomania

& dysthymia occuring over a 2-year with no
discrete episodes of illness

• In contrast to major depressive disorder & bipolar

disorder respectively, dysthymic disorder &
cyclothymic disorder are less severe, nonepisodic,
chronic, & never associated with psychosis
 Etiology
The biologic etiology 1. Loss of a parent in
1. Altered neurotransmitter childhood
activity 2. Loss of a spouse
2. A genetic component, 3. Low self-esteem & negative
strongest in bipolar disorder interpretation of live events
3. Physical illness & related 4. “Learned helplessness”
factors
4. Abnormalitas of the limbic-
hypothalamic-pituitary-
adrenal axis
The psychosocial etiology
Psychosocial factors are not involved in the etiology of mania or
hypomania
 The Genetics of Bipolar Disorder

Group Approximate Occurrence(%)

The general population 1%

Child who has one bipolar parent or 20%

sibling (or dizygoitc twin)

Child who has two bipolar parents 60%

Monozygotic twin of a person with 75%

bipolar disorder
 Differential diagnosis of depression
Medical Conditions
- Cancer, particularly pancreatic & other gastrointestinal tumors
- Viral illness
- Endocrinologic abnormalities, particularly hypothyroidism
- Neurologic illness
- Nutritional deficiency
- Renal or cardiopulmonary disease

Psychiatric & Pharmacologic conditions

- Schizophrenia - Anxiety disorders
- Somatoform disorders - Eating disorders
- Drug & alcohol abuse - Prescription drug use
 Treatment
- Depression is successfully treated in most patients
- Only about 25% of patients with depression seek &
receive treatment
a. Patients do not seek treatment
b. Women are more likely than men to seek
treatment
- Untreated episodes of depression & mania are
usually self-limiting & last approximately 6-12
months & 3 months, respectively
- The most effective treatments for the mood
disorders are pharmacologic
 Con’t (2)

• Pharmacologic treatment
- Depression & dysthymia  antidepressant agents
- Antimanics

• Psychological treatment
- psychoanalytic interpersonal, family, behavioral &
cognitive therapy
- psychological treatment in conjunction with
medication is more effective than either type of
treatment alone
 Con’t (3)

• ECT
The primary indication for ECT is major depressive
disorder. It is used when:
- The symptoms do not respond to antidepressant
medications
- Antidepressants are too dangerous or have intolerable
side effects. Thus, ECT may be particularly useful
for elderly patients
- Rapid resolution of symptoms is necessary