MOOD DISORDERS.ppt

1、MOOD DISORDERS,Ruying Zhou M.D. Ph.D Mental Health Center of West China Hospital, Sichuan University,Contents,Some concepts Epidemiological data and the DALY Symptoms and syndromes Diagnostic systems Medication and psychotherapy,Basic concepts,Emotion: A feeling state involving a pattern of facial a

2、nd bodily changes, cognitive appraisals, and beliefs. Fear, Anger, Disgust, Surprise, Sadness, Well-being etc. Mood: the background of emotion during a period of time.,Different names,Mood disorders Affective disorders Bipolar disorders Manic depression Depression Mania,Depression Major Depression D

3、ysthymic Disorder Bipolar Disorder Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder,Mood Disorders,Depression,Major Depression,Dysthymic Disorder,normal mood,normal mood,Bipolar II Disorder,Bipolar Disorder,normal mood,normal mood,Bipolar I Disorder,Cyclothymic Disorder,normal mood,DALYs

4、(Disability Adjusted Life Years): Lost years of healthy life regardless of whether the years were lost to pre-mature death or disability.,Bipolar Disorder Symptoms,Mania and depression are the opposing phases in bipolar disorder.,Bipolar Disorder Symptoms,Mania: A person in the manic phase may feel

5、indestructible, full of energy, and ready for anything. Other times that person may be irritable and ready to argue with anyone who tries to get in the way. Unrealistic plans, an increase in sexual affairs, or other reckless behavior, such as wild driving, also may occur. Less sleep and food than us

6、ual are needed.,Bipolar Disorder Symptoms,The person withbipolar disordermay talk very quickly and jump from subject to subject. They often exhibit pressured speech during mania. Self-esteem may be inflated. Any decisions that are made with regard to business and finances are often not good ones.,Bi

7、polar Disorder Symptoms,Thesebehaviors, which can be quite upsetting, usually prompt a family member to take notice and try to get the person help. Most people who are going through the manic phase ofbipolar disorderdeny that anything is wrong with them and refuse to see a medical professional. They

8、 are grandiose and may have delusions (false ideas) of grandeur (greatness).,Depression: Although mania is alternate with depression, most people have more depressive episodes than manic ones. Sadness and crying are common. Depressed peoplemay not care enough to wash or comb their hair, change cloth

9、es, or even get out of bed in the morning. Thesepeople may sleep too much (hypersomnolence) or have difficulty getting to sleep (insomnia).,Bipolar Disorder Symptoms,Many of these peoplehave no interest in food or have no appetite and lose weight. However, some eat excessively. People with depressio

10、n have trouble thinking; they may forget to do important things such as paying bills because they feel so down. They withdraw from friends.,Bipolar Disorder Symptoms,Hobbies that used to bring pleasure suddenly hold no interest forpeople whoare depressed. Depression brings feelings of hopelessness a

11、nd helplessness. People whoare depressed may not see a point in living anymore and may actually think about ways to kill themselves.,Bipolar Disorder Symptoms,Diagnosis,DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (APA) ICD-10: International Statistical Classific

12、ation of Diseases (WHO),List of DSM-IV Codes,296.0 x Bipolar I Disorder Single Manic Episode 296.2x Major Depressive Disorder Single Episode 296.3x Major Depressive Disorder Recurrent 296.40 Bipolar I Disorder Most Recent Episode Hypomanic 296.4x Bipolar I Disorder Most Recent Episode Manic,List of

13、DSM-IV Codes,296.5x Bipolar I Disorder Most Recent Episode Depressed 296.6x Bipolar I Disorder Most Recent Episode Mixed 296.7 Bipolar I Disorder, Most recent episode Unspecified 296.80 Bipolar Disorder NOS 296.89 Bipolar II Disorder 296.90 Mood Disorder NOS,DSM IV Major Depressive Episode A. Five (

14、or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical

15、condition, or mood-incongruent delusions or hallucinations.,DSM IV Major Depressive Episode (1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescen

16、ts, can be irritable mood.(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others),DSM IV Major Depressive Episode (3) significant weight loss when not dieting or weight

17、gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (4) insomnia or hypersomnia nearly every day(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being

18、slowed down),DSM IV Major Depressive Episode (6) fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)(8) diminished ability to think or concentrate,

19、 or indecisiveness, nearly every day (either by subjective account or as observed by others),DSM IV Major Depressive Episode (9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide B

20、. The symptoms do not meet criteria for a Mixed Episode.C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.,DSM IV Major Depressive Episode D. The symptoms are not due to the direct physiological effects of a substance

21、 (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).E. The symptoms are not better accounted for by Bereavement.,DSM IV Manic Episode,A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any dura

22、tion if hospitalization is necessary). During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree,DSM IV Manic Episode,inflated self-esteem or grandiosity decreased need for sleep

23、(e.g., feels rested after only 3 hours of sleep) more talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing,DSM IV Manic Episode,5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 6. increas

24、e in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences,DSM IV Manic Episode,C. The symptoms do not meet the criteria for a Mixed Episode. D. The mood

25、 disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.,DSM IV Manic Episode,E. The symptoms are not du

26、e to the direct physiological effects of a substance (e.g. a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism).,DSM IV Mixed Episode,A. The criteria are met both for a Manic and for a Major Depressive episode nearly every day during at least a 1-w

27、eek period. B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. ,DSM IV Hypomanic Episod

28、e,A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood. ,Depression Treatment,Self-Care at Home lifestyle changes and choices that will help the patients through the rough times and ma

29、y prevent depression from returning Try to identify and focus on activities Talk with friends and family and consider joining a support group. Communicating and discussing feelings,Depression Treatment Self-Care at Home,Try to maintain a positive outlook. Regular exercise and proper diet are essenti

30、al to good health. Try to get enough rest and maintain a regular sleeping pattern. Avoid drinking alcohol or using any illicit substances.,Depression Treatment,Medical treatment: Therapy usually includesantidepressant medication and supportive care such as psychotherapy. Other less widely used thera

31、pies, such as electroconvulsive therapy, are used in severe cases.,Depression Treatment Medications,The major classes of antidepressant medication are the selective serotonin re-uptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs), the monoamine oxidase inhibitors (MAOIs), and the atypica

32、l antidepressants.,SSRI affect levels of serotonin in the brain. For many people, these medications are the first choice. Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paroxetine) Fluvoxamine (Luvox) Citalopram (Cipramil) Escitalopram (Lexapro),Depression Treatment Medications,Depression Treat

33、ment Medications,TCAs are old drugs with more side effects Amitriptyline Clomipramine Desipramine Doxepin,Imipramine Nortriptyline Protriptyline Trimipramine,Depression Treatment Medications,The atypical antidepressant medications work differently than the commonly used SSRIs. Mirtazapine Bupropion Nefazodone Trazodone Venlafaxine,Depression Treatment Other Therapy,Psychotherapy MECT,Bipolar Disorder Treatment,Medical Treatment (1) medications to stabilize mood swings (2)counseli