PSYCHIATRY – MOOD DISORDERS

In this video of PSYCHIATRY – MOOD DISORDERS following concepts are discussed:

Hello welcome my dear students we’re going to do all this particular session mood disorders and another word in english for mood is effect so you often call it effective disorders or mood disorders as you look at the slide there are four important conditions to be included under mood disorders number one is major depressive disorder what we used to call in the olden

Days as endogenous depression so we call it major depressive disorder the second one is bipolar disorder if you remember in the olden days this used to be called as manic depressive psychosis or mdp but now we call it bipolar disorder number three i’m including two disorders dysthymic and cyclodynamic disorder what is this dynamic disorder this dynamic disorder

Is a less severe form of number one that’s major depressive disorder and cyclodynamic disorder is the less severe form of number two that’s bipolar disorder so major depressive disorder and bipolar disorder minor form of major depressive is dysthymia and minor form of bipolar disorder is cyclothymia what’s the difference between major depressive bipolar taken

Together and this dynamic and cyclodynamic taken on the other side these dynamic and cyclodynamic disorders they are non-episodic and there are no psychotic symptoms at all and this should be present for two years then you label it as dysdemia or cyclodiamia the last condition on the slide is mood disorder due to a general medical condition or due to substance

Abuse so we don’t include if there’s a general medical condition leading to mood disorder and substance abuse producing mood disorder it’s a separate category so major depressive disorder bipolar disorder dysdamic and cyclodynamic and lastly mood disorder due to general medical condition or substance abuse what’s major depressive disorder you have to have five

Of nine important symptoms known symptoms for most of the time for at least a two week period continuously for two weeks you need to have five of the known nine symptoms the course involves an episode of unhappiness decreased interest and pleasure in usual activities decreased sex desire and decreased appetite decreased appetite should be amounting to more than

Five percent of weight loss plus there is insomnia that’s lack of sleep and there’s chronic sense of fatigue there is another kind of depression which is called a typical depression in which sometimes you get weight gain and you get excess sleep that’s opposite but that’s a typical depression coming to the major depressive disorder what are the diagnostic criteria

According to the diagnostic and statistical manual i am showing you on this particular table those nine important symptoms number one subjective feeling or observation by others of depressed mood so there is sadness hopelessness feeling of emptiness and low self-esteem low self-confidence the second one is decreased interest or pleasure in normally pleasurable

Things which we call anatomia number three change in appetite and weight loss so there’s loss of appetite and weight number four is insomnia is the usual one and in a typical depression you get hypersomnia and these patients typically have nighttime awakenings and a very typical symptom is early morning awakenings in a typical depression you have over sleeping

Next one is psychomotor agitation or retardation so that there is much slowing down or in few cases speeding up the sixth symptom is daily fatigue and loss of energy there’s very little vigor or desire to accomplish the goals we go to the next three symptoms on the next slide symptom number seven a sense of guilt or worthlessness which is called poor self-image

Number eight problem in concentrating and thinking so that there’s attentiveness or memory problems and the last one is recurrent thoughts of death or the attempt or thought or plan for suicide this is criterion a you have to have five out of these nine symptoms the criterion b for diagnosis of major depressive disorder is mania should be ruled out and mania

Should be absent criterion c is there is distressed or impaired social or occupational functioning criterion d is no medical condition or substance use should be present it has to be ruled out and the last criterion is criterion e it should not be due to bereavement less than for a period of two months so you have to have criterion a b c d e all five amongst

A for a it should be five of nine symptoms b mania absent c disturbance in the social and occupational functioning d no medical condition or substance abuse and criterion e you have to rule out the bereavement which is of less than two months duration mask depression and sad seasonal affective disorder have to be ruled out there are different conditions mass

Depression what is this in this the patient is totally unaware about his symptoms of depression instead the patient presents to the primary care physician with vague physical symptoms like headache body ache these are the symptoms reported and there’s absence of identifiable organic cause for this headache body act like symptoms and there is presence of weight

Loss and there’s also insomnia this is called mask depression because the patient is unaware about his depression the next condition must be ruled out is seasonal affective disorder which especially happens during winter and especially in the areas where there are very short days and this is called seasonal affective disorder or sad and this is treated with

Full spectrum light exposure what’s the etiology and occurrence of major depressive disorder the biological factors involve heredity and decreased levels of amines in the brain then the psychosocial factors present in the childhood as well as adulthood and major depressive disorder is fairly more common in females 10 to 24 and in males 5 to 12 percent there is

Association with chronic illness many times and there is an association of bereavement with major depressive disorder these patients usually don’t go for treatment in the early stages the reason is number one it may be masked depression so that the patient is unaware number two affordability of consuming or taking the drugs and number three patient is not

Ready to accept the disease unacceptability of the disease due to these three causes patients don’t often go for treatment in the earlier phases the treatment is done with antidepressant drugs and the antidepressant drugs are supposed to increase the amines if you remember the biochemistry of behavior in depressive disorders major depressive disorder you’re

Supposed to have less levels of amines so the aim of treatment the goal of treatment is to increase the level of amines most probably by inhibiting the reuptake of amines as you see on the slide the first group is tricyclic or heterocyclic antidepressant drugs like desi brahmin nortriptyline amitriptyline chlamy brahmin doxapin and imeibramin so there are

Pramins and tryptolenes in the tcs next important group is ssri that’s selective serotonin reuptake inhibitors as you know serotonin is an important neurotransmitter involved in depression so you have settings and prams in this group fluoxetine peroxide in cetalopram and acetyl prime and two more sultraline and fluoxamine the next group is selective serotonin

And norepinephrine reuptake inhibitors namely manulafaxine and 18. the next group is non-selective mao inhibitors monoamine oxidase inhibitors like phenylsine and transcycline and lastly a newer agent is a selective and reversible inhibitor of mao a monoamine oxidase a and the name of the drug is mochalow bemide so these are various anti-depressant drugs used

For management the next option is ect or electro convulsion therapy passing electric current through the brain while the patient is unconscious or when the patient is anesthetized when to go for ect indications for ect include severe and resistant cases resistant to the anti-depressant treatment intolerance or non-compliance to antidepressant drugs pregnancy

And acutely suicidal patients you can think of ect in these four conditions ect is less effective if the patient is already receiving benzodiazepines for any purpose the next modality of treatment approved by the united states of america food and drug administration that is usafda in 2008 is called tms or transcranial magnetic stimulation here the patient is

Not given an anesthetic agent and tiny electrical currents are produced in localized areas of brain using electromagnetic apparatus so ect and dms are two more modalities of treatment the psychological treatment of depression involves psychoanalytic therapy interpersonal therapy family therapy and behavioral and cognitive therapies next we move on to bipolar

Disorder as you look at the name is bipolar there are two poles of the disease one is mania and the other one is depression bipolar type 1 has both depression and mania while bipolar 2 has got depression and hypomania the psychotic symptoms are more common in bipolar disorder and during the manic episode the patient typically gets delusions and there are themes

Of power and influence the functioning returns to absolutely normal in between the episodes that’s the great thing about bipolar disorder and this differentiates bipolar disorder from schizophrenia or from schizoaffective disorder in which the functioning never never returns to normal in between the episodes what is mania that’s one pole of bipolar disease mania

Is inflated self-image excess optimism increased energy level and activity and rapid thoughts and speech which is called racing thoughts there’s decreased need for sleep there’s decreased appetite the sex interest is likely to be more and there’s a lack of modesty in dressing and behavior and the patient is unable to control the aggressive impulses if three to

Four of these symptoms are present up to at least one week period needing hospitalization then you call it mania the patient may have psychotic delusions and there may be also social impairment leading to various legal difficulties let’s come to dsm 4 tr criteria dsm 4 text revision criteria for mania criterion a there should be one week of elation and expansion

That self-importance and the patient should be irritable mood and patient is easily bothered criterion b is three to four symptoms out of the known symptoms look at the symptoms interesting symptoms inflated self-image or self-esteem decreased need for sleep talkativeness or pressured speech flight of ideas distractibility and loss of concentration and the patient

Has extreme hyperactivity and agitation there’s non-directed and non-purposeful movement on the part of the patient activities of negative consequences include running of telephone bills credit cards and physically dangerous activities and depression should be absent that’s very important that’s criterion b criterion c indicates distressed or impaired social and

Occupational functioning and the criterion d is you must rule out medical condition or substance use so that’s mania hypomania as the word indicates is a less severe form in which there’s inflated self-esteem and talkativeness for at least four day period for four days and severe social or occupational impairment or psychotic symptoms are absent then you call

It hypomania hospitalization may not be required in a case of hypomania management of these conditions bipolar disorder for long term you need more stabilizers and for short-term treatment you might need anti-psychotic drugs because patient has psychotic symptoms and the patient patient is hyperactive and agitated so you might need sedative drugs as far as the

Mood stabilizers are concerned lithium carbonate is an age-old mood stabilizer and the newer moon stabilizers are mostly anti-convulsant drugs which include carbon myazopine vaporic acid diablo procs these are especially useful in the rapid cycling bipolar disorder in which there may be more than four episodes in a year sometimes lithium is combined with

Anti-convulsion agents for short-term treatment that’s the acute condition you need sedatives in the form of lorazepam or diazepam or clonazepam you might use antipsychotic drugs in especially in acute phases because the patient has very severe psychotic symptoms and you may use haloperidol or olanzapine or respiraton hello peridol especially by intravenous

Root of administration in addition to this supportive family and group psychotherapy will be useful next we’re going to discuss what is this dynamic disorder and what is cyclothymic disorder if you remember the initial discussion this dynamic disorder is a less severe form of major depression and cyclodiamond disorder is a less severe form of bipolar disease

This dynamic disorder is more commonly seen in females and the incidence is six percent cyclodynamic disorder there’s no sex difference and it is less common that’s one percent in this diameter there is low self-esteem and decreased productivity but most importantly there is no anedonia that is incapacity to obtain pleasure or there is no suicidal tendencies

There is no suicide suicidality in cyclothymic disorder there’s alternating dysthymia and hypomania so it’s less severe form of the mania and less severe form of the depression so that’s cyclothymic disorder treatment for this diameter and cyclothymia is obviously similar to major depression and similar to bipolar disorder respectively dysthymia is a less

Severe form of depression so the treatment is anti-depressants and psychotherapy and cyclodynamic disorder is a less severe form of bipolar so management is similar to the bipolar disease with mood stabilizing agents what are the various psychiatric conditions in which depression may be associated and it might confuse you patients with schizophrenia after an

Acute psychotic episode very often present with symptoms of depression and you need to rule out this condition that’s schizophrenia then in somatoform disorders eating disorders and anxiety disorders many times you may come across depression adjustment disorders is a very important issue in which the patient might present with depression but you must rule out

Adjustment disorder and the substance abuse and withdrawal obviously we are going to rule it out before labeling the patient as having major depressive disorder in the substance abuse disorders substance induced mood disorders abuse or withdrawal of an agent can lead to depression for example the older antihypertensive agent like reserve pin plus a beta blocker

Like propranolol plus many anti-cancer drugs and corticosteroids their abuse and weight trouble can lead to depression steroid use for chronic periods or in high doses can lead to elation so also the sympathomimetic drugs like amphetamine and cocaine they can lead to elation withdrawal of stimulant drugs withdrawal of opiates and sedative hypnotic drugs often

Leads to depression so these are some of the drugs some of the substances which are associated with mood disorder and as i said a few minutes ago the other differential diagnosis which we must rule out is adjustment disorders there are two types of adjustment disorders number one is adjustment disorder with depressed mood and this happens within two months of a

Stressor that is change of place change of environment change of persons around and this can lead to adjustment disorder and the patient might look like a patient with depression because it’s adjustment disorder with depressed mood and this may be persistent for up to six months the second one is adjustment disorder with normal derivement within two months of

Incident so this is different because there’s normal bereavement patient is coming within two months of the incident so it’s called adjustment disorder with normal bereavement so we went into various mood disorders and just to summarize the mood disorders the first one was major depressive second one is bipolar the third one is dysthymia and cyclothymia and the

Fourth one is mood disorder due to general medical condition or due to substance abuse i am sure this brief discussion is going to be useful to you make a good use of it all the best thanks for listening

Transcribed from video
PSYCHIATRY – MOOD DISORDERS By MD CRACK