Mood Disorders | Anatomy2Medicine
mood disorders

Mood Disorders

    • Emil Kraeplin    for the first time, described Manic-DepressivePsychosis:
    • Depressed mood is characterized by

 

  • Loss of energy and interest
  • Difficulty in concentrating
  • Thoughts of suicide

 

    • Flight of Ideas. Rapid continuous verbalizations producing constant shift from one idea to another; ideas tend to be connected, usually seen in mania.
    • Depression could be the manifestation of

 

  • Alzheimer’s Disease   
  • CNS infections
  • Dementia

 

    • Pick’s Disease.

 

  • A form of presenile dementia due to atrophy of the frontal and temporal lobes.

 

      • Usually occurs between the ages of 40 and 60 years, more often in women than in men, and involves progressive, irreversible loss of memory, deterioration of intellectual functions, disordered emotions, apathy, speech disturbances, and disorientation.

 

  • Course may take a few months to 4-5 years to progress to complete loss of intellectual function.

 

    • Vitamin’ deficiencies are known to cause depression
      • Thiamine
      • Cyanocobalamin
      • Folate
    • Drugs  that can precipitate mania,

 

  • Amphetamine      
  • Bromocriptine
  • Disulfiram

 

    • Carbamazepine is a mood stabilizer.
    • Drus can cause depression,
      • Methyldopa
      • Oral contraceptives
      • Reserpine
      • Clonidine
      • Cyproheptadine
      • Corticosteroids
    • Paradoxical symptoms of depression

 

  • Agitation
  • Weight gain
  • Hyperphagia

 

    • Manic people characteristically exhibit
      • Always “on the go”
      • Buying sprees
      • Irritable mood
      • Hypersexuality
      • Rapid shift from topic to topic, i.e., “flight of ideas”
      • Pressure of speech
      • Joking, teasing
      • Punning, i.e., association by double meaning
      • Markedly inflated self esteem
      • Delusion of grandeur, and
      • Loss of insight, etc.
    • Causation of depression is linked to the deficiency of Serotonin
    • Mania is characterized by

 

  • Insomnia
  • Grandeur delusion

 

      • Pressure of speech

 

  • Affective disorders include
  • Adjustment reaction
  • Reaction formation
  • Depression

 

    • Obsessive compulsive neurosis is an anxiety disorder.
    • Endogenous depression is most common in Middle aged adults

 

  • ‘Major depressive disorder’

 

      • More common in women than in men
      • More common in middle aged adults than in adolescents

 

  • More common in single or divorced people

 

 

    • Depressed patient shows

 

  • Stooped posture
  • Social withdrawal
  • Slowed/delayed responses to questions

 

    • Stereotypy. Persistent repetition of words, postures or movements without meaning; seen in catatonic partial stupors.
    • Good prognostic indicators for major depression.
      • Absence of psychotic symptoms
      • Stable and sound family and social functioning
      • Absence of comorbid psychiatric disorder
    • Bad prognostic indicators in Bipolar-I disorder
      • Male gender
      • Presence of suicidal thoughts
      • Psychotic features
    • The factors indicating good prognosis in Bipolar-1 disorder include —
      • Short duration of manic episodes
      • Advanced age of onset
      • Few suicidal thoughts
      • Few coexisting psychiatric or medical problems.
    • Indications for psychotherapy in the treatment of depression

 

  • Lack of motivation

 

      • Inappropriate guilt feelings
      • Chronic feelings of helplessness or hopelessness
      • Mild to moderate situational depression
      • Apathy, decreased enjoyment
      • Diminished sexual desire or gratification

 

  • Insignificant weight gain

 

      • Restlessness
      • sluggish thinking
      • Social withdrawal
      • Fear of rejection

 

  • Hypochondriasis

 

      • No genetic loading
      • Dependent, Inadequate and Masochistic personality disorders.
    • The first symptom to improve in depressed patient, who has been started on antidepressants is Sleep

 

  • Antidepressants are devoid of sexual adverse effects
  • Nefazodone
  • Mirtazapine
  • Bupropion

 

 

 

  • The treatment of choice in acute severe depression is Electro-convulsive Therapy

 

  • Lithium is used in the prophylactic management of Manic depressive psychosis
  • Classical clinical Vignette on depression treatment
    • A 54-year old man has presented with pain in back,lack of interest in recreational activities, low mood,lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests, electrocardiogram did no reveal any abnormality. This patient should be treated with Sertraline (SSRI)
  • Drugs used as prophylactic treatment in manic depressive psychosis
    • Lithium carbonate
    • Oxcarbazepine
    • Divalproate
  • Drugs and their actions
    • Chlorpromazine. It’s a phenothiazine group antipsychotic.
    • Clomipramine. A tricyclic antidepressant.
    • Clonazepam. A benzodiazepine anticonvulsant.
    • Clobazam. An antiepileptic.
  • “Drug of choice” for depression in a tollywood actress from Hyderabad of 24 years of age will be Bupropion . Bupropion has the least potential for causing sexual dys- function.
  • Drugs that can be used as augmentation therapy in depressed patients, who have not responded satisfactorily to antidepressants,
    • Lithium
    • Liothyronine
    • L-Tryptophan
  • The initial stage of acute mania is managed by
    • Electroconvulsive therapy
    • Haloperidol
    • Clonazepam