精神病学：Mood disorders

1、Mood disorders,Bipolar (affective) disorder,Learning objectives and requirement,Definition of bipolar disorder Types of bipolar disorder The epidemiology of bipolar disorder Its genetic , psychological or social cause Symptoms of mania Diagnosis of bipolar disorder Treatment of bipolar disorder,Defi

2、nition,Bipolar affective disorder used to be called manic depressive psychosis. It is a disorder characterized by episodes of major depression and, at other times, mania, where mood is abnormally elated. Between episodes, the person returns to their normal self, usually with good insight into the pr

3、evious episode.病程.ppt,Type of Bipolar disorder,Bipolar (affective) disorder is mainly divided into Bipolar disorder and Bipolar disorder. Biopolar disorder Consisting of episodes of mania cycling with depressive episode Biopolar disorder Consisting of episodes of hypomania cycling with major depress

4、ive episode,Epidemiology,Bipolar disorder has a lifetime prevalence of about 1-2%. with men and women equally affected. Mean age at first onset is in the twenties, although the first episode is occasionally in late life. After a first manic episode, the risk of recurrence is about 70,Causes -Predisp

5、osing factors,Bipolar disorder has a strong genetic component. A family history of bipolar disorder and major depression is common. The concordance rate in monozygotic twins is approximately 50% ,20% in dizygotic and it rises to 80% if major depression in the co-twin is counted as well as bipolar di

6、sorders,causes Precipitating factors,Stressful life events are important in triggering both manic and depressive episodes. Childbirth can be a precipitant. Street drug (narcotics)use, including cannabis(大麻), heroin Sometimes a first manic episode can be triggered by antidepressant drug treatment or

7、the use of drugs such as steroids(prednisone,Symptoms- manic episode (mania,1. Mood: Elated, sometimes irritable 1.1Elationpicture1.ppt is an affective state of joyous gaiety which is out of keeping with life circumstances. It often present infectious gaiety, sometimes irritability,Symptoms- manic e

8、pisode (mania,1.2 Appearance May be disheveled, unshaven; clothes and make-up may be bright and bizarre,Symptoms- manic episode (mania,2.Behaviour 2.1 Often restless and overactive; socially uninhibited, with over familiarity. Patients start many activities but leave them unfinished as new ones catc

9、h their fancy. A “hunger” for social interchange,Symptoms- manic episode (mania,2.2 Sleep is often reduced. The patient wakes early feeling lively and energetic; often he gets up and busies himself noisily, to the surprise of other people,Symptoms- manic episode (mania,2.3 Appetite is increased and

10、food may be eaten greedily with little attention to conventional manners,Symptoms- manic episode (mania,2.4 Sexual desires are increased and behavior may be uninhibited,Symptoms- manic episode (mania,3. Disturbance of thoughts,Symptoms- manic episode (mania,3.1 Speech Pressure of speech increased an

11、d difficult to interrupt,Symptoms- manic episode (mania,3.11 Their speech is often rapid and copious or plentiful as thoughts crowd into their minds in quick succession. 3.12 flight of ideas is that the patients thoughts and conversation move quickly from one topic to another topic so that one train

12、 of thought is not completed before another appears,Symptoms- manic episode (mania,flight of ideas , often with nonstop ideas connected by puns , rhymes (clangs) and bizarre associations. l love you my darling, you are beautiful, you are the one, you are the one, the red light is on, so lll carry on

13、! l love you you are beautifulyou are the sunlets have funfuntasticplasticdrasticfun in the sunumhyum yum hee heel love you,Symptoms- manic episode (mania,3.2 Self-important ideas 3.21Expansive ideas ,one of self-important ideas , are very common,Symptoms- manic episode (mania,Expansive ideas The pa

14、tient believes that his ideas are original, his opinions are important and his work is outstanding,Symptoms- manic episode (mania,Many patients become extravagant, spending more than they can afford on expensive cars, jewellery, and etc,Symptoms- manic episode (mania,Others make reckless decisions t

15、o give up good jobs, or embark on plans for harebrained and risky business ventures,Symptoms- manic episode (mania,3.22 Grandiose delusion Grandiose delusion are beliefs of exaggerated self-importance. The patient may think himself wealthy , endowed with unusual abilities (e.g. having supernatural p

16、owers or a special person. (e.g. being royalty,Symptoms- manic episode (mania,3.23. Other abnormal beliefs: Delusions can occur, either persecutory or reference,Symptoms- manic episode (mania,4. Abnormal experiences Auditory hallucinations can occur, with grandiose themes,Symptoms- manic episode (ma

17、nia,5. Self-appraisal Insight is usually lost in acute mania,Symptoms- manic episode (mania,The Central Clinical Features-mania Elation Over-activity Flight of ideas Self-important ideas,Diagnosis -manic episode,Criteria for Mania-DSM-t Criteria for Hypomania-DSM,Diagnosis -Bipolar disorder,This dis

18、order is characterized by repeated episodes in which the patients mood and activity levels are significantly disturbed. These disturbance consist of at least one episode of any type of manic episode (mania/hypomania), and another episode of any type of depression, between which the person usually re

19、turns to normal. The mood is out of keeping with the individuals circumstances,Diagnosis -Bipolar disorder,Bipolar disorder: Consisting of episodes of mania cycling with depressive episode One essential criterion for a diagnosis is a past or present history of a manic episode. Bipolar disorder: Pres

20、ence (or history) of one or more major depression Presence (or history) of at least one hypomanic episode There has never been a manic episode or a mixed episode,Differential diagnosis,1.Organic diseases 2.Schizophrenia,Catatonic Type of schizophrenia ： Apathy,Negativism, Waxy flexibility, Airpillow

21、, stupor due to depression： mild stupor, depressive feeling,Management,Preparation A detailed history is required, including family history and drug history. Acute mania often needs inpatient admission because of the behavioural disturbance. Physical investigations will include thyroid function to exclude hyperthyroidism,Management,Pharmacotherapy A. Drug treatment initia