Which of the following has to be present for diagnosis of manic-depressive psychosis?
Ans. a (Loss of interest or pleasure) (Ref. H's medicine 18th/ch. 391)QBipolar DisorderA mood disturbance in patient that experiences manic symptoms for > 1 week & causes significant impairment in his/her functioning levelQDysthymiaA milder form of depression lasting at least 2 years.QCyclothymic DisorderA chronic mood disorder (mild Bipolar II Disorder) characterized by many periods of Depressed Mood & many periods of Hypomanic Mood for > 2 years.MAJOR DEPRESSIVE DISORDER (MAJOR DEPRESSION)# Mood disorder that presents with at least a 2-week course of symptoms that is a change from the patient's previous level of functioning.# Must have depressed mood or anhedonia (absence of pleasure)# Risk Factors/Epidemiology- Women > Men (2:1) due to several factors, such as hormonal differences- Onset is 40 years# Biology:- Neurotransmitters abnormalities: ( | ) Serotonin, Norepinephrine & Dopamine Q- *** Serotonin metabolites (5 HOIAA) |in suicide & aggression0- Other risk factors include family history, exposure to stressors & behavioral reasons, such as learned helplessness.# Symptoms- Typical Features (Vegetative Changes of Depression)# It is characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedonia: (mnemonic - SIGECAPS)# Sleep disturbance# Loss of Interest (anhedonia)# Guilt or feelings of worthlessness# Loss of Energy# Loss of Concentration# Change in Appetite/weight# Psychomotor retardation or agitation# Suicidal ideations# Depressed mood# Lifetime prevalence of major depressive episode--5-12% male, 10-25% female.# Major depressive disorder, recurrent--requires 2 or more episodes with a symptom-free interval of 2 months.- Atypical Features# Appetite, Weight & Sleep (Hypersomnia)# May Also Include Psychotic features: Worse prognosis# Treatment:- Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressants (TCA) & Monoamine Oxidase Inhibitors (MOI)- Electro-Convulsive Therapy (ECT) may be indicated if patient is suicidal or worried about side effects from medications. 0- Individual Psychotherapy: To help the patient deal with conflicts & sense of loss- Cognitive Therapy: To change the patient's distorted thoughts about self & world.Mood disorder subtypesTypesCharacteristicsDysthmia# Depressed mood# Loss of interest or pleasure# Chronic (at least 2 years)Cyclothymia (nonpsychotic)# Alternating states# Chronic# Often not recognized by affected personSeasonal affective disorder (SAD)# Depressive symptoms during winter months (shortest days, so least amount of light)# Caused by abnormal melatonin metabolism# Treat with bright light therapyUnipolar depression(major depression)# Symptoms for at least 2 weeks# Must be a change from previous functioning# May be associated with anhedonia, no motivation, feelings of worth lessness, reduced concentration, weight loss or gain, depressed mood, recurrent thoughts, insomnia or hypersomnia, psychomotor agitation or retardation, somatic complaints, delusions or hallucinations (mood congruent), loss of sex drive# Diurnal improvement as day progresses# Suicide: 60% of depressed patients have suicidal ideation; 15% die by suicide# Neurochemistry: "biogenic amine theory of depression"- caused by decreased NE/5HT# Sleep: REM in first half of sleep, REM consistency, stage 4 sleep, REM time overall, early morning wakeningBipolar disorder(manic-depression)# Symptoms of major depression and symptoms of mania (period of abnormal and persistent elevated, expansive, or irritable mood)# Subtype- Bipolar I: Mania more prominent- Bipolar II: recurrent depressive episodes, plus hypomanic episodes- Rapidly cycling bipolar disorder: If alternates within 48-72 hours# Manic symp: self-esteenmor grandiosity, low frustration tolerance, need for sleep, fight of ideas, excessive involvement in activities, weight loss,anorexia, erratic and uninhibited behavior, libido
Loss of interest or pleasure
Recurrent suicidal ideation
Indecisiveness
Insomnia
Mood Disorders