Dr. Badaruddin Junejo

MOOD DISORDERS • One of their feature is mood abnormality • Mood: is sustained abnormality of inner subjective feelings. That may be: – Depressed as in depression – Elated / limitable / Euphoric as in manic – Blunt / flat – in schizophrenia – Anxious in Anxiety and phorias – Incongruent – in schizophrenia – Labile

Classification of mood disorders • •

Bipolar disorders Depressive disorders

Bipolar disorders: A.

Manic Episode • • •

Hypomania Mania Mania with Psychosis

B. Bipolar affective disorders • • • • •

Currently hypomania Currently Mania Currently depressed Currently Mixed In remission

Clinical Features • Appearance • Mood • Depressive Cognitions – – – –

Pessimistic thoughts Hopelessness Suicide Guilt

• Psychomotor changes • Biological Symptoms • Other features – – – – –

Depersonalization Obsessional symptoms Panic disorders Dissociative symptoms Poor memory

• Physical symptoms • Psychotic symptoms

Epidemiology • Life time risk

0.3 -1.5%

• Male and female ration 1:1 • Mean age of onset

21 yrs

• Co-morbidity with Anxiety disorders and substance abuse

Why the people harm themselves? • • • • • •

Social Economical Mental Disappointed Chronic illness Environmental

Etiology • Genetic • Poly genetic inheritance • Linkages to 4,12,18 chromosomes • Association with gene coding for serotonin transporters and A form of mono-amino –oxidase

• Personality:

cyclothymic

• Early environment: - Parental deprivation / discord. - Relationship with parents - Sexual or physical abuse

Etiology cont= • Precipitant factors: - Recent life event - Vulnerable factors - Physical illness • Psychological factors: - Freud’s theory - Cognitive theory • Neurobiological factors: - Monoamine hypothesis • Endocrine Abnormalities: - Cushing’s Syndrome - Addison’s disease - Thyroid disease

Course and Prognosis • Bipolar disorder: – Average length of manic episode is 6 mths – 90% of Patients experience further episodes of mood disorders – In 25 yrs follow by bipolar disorder patients experience 10 episodes of mood disturbance – Interval between episodes become shorter and shorter – Nearly all patients recover from acute episode – Rapid cyclers have poor outcome

Course and Prognosis Cont= • Prognostic factors: – Bipolar – Poor social support – Poor physical health – Co-morbid substance misuse – Co-morbid personality disorder

Management • Assessment: – – – – –

Diagnosis Severity Etiology Effects of illness on others Person’s resources

• Immediate treatment: – Drugs – ECT – Psychotherapy

• Continuation treatment: – Long term follow up to prevent relapse. – Use of Mood stabilizers • • • • •

Lithium Carbamezapine Sodium valproate Lamotrigine Gabapentine

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