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Lect 6: Mood disorders & psychosis (Depression (Classification …
Lect 6: Mood disorders & psychosis
Depression
Classification
Diagnostic & stats manual IV (DSM-IV) -> American system
Severity based on no. of symptoms & degree of impairment
Mild, moderate, severe
Psychotic symptoms
Delusions
False, fixed beliefs -> persist despite evidence to contrary
Guilt
Hallucinations
Occur in any sensory modality (auditory, visual, olfactory)
Mood -> per 2nd person auditory -> inner voice demeaning yourself
Depressive disorders
Requisite no. of symptoms
X identifiable organic cause
X normal rxn to death of a loved one
Epidemiology of depression
Common
Occurrence in primary care -> major depression diagnosis missed in nearly 50% cases
Suicide -> 15% of depressed patients commit suicide
Depressed mood -> diurnal variation
Diminished interest -> anhedonia
Lack of energy -> anergia
Appetite & weight loss
Sleep disturbance
Worthlessness/guilt
Aetiology of depression
Complex
Genetic studies
Greater incidence in 1st degree relatives
Monoamine hypothesis (NA,DA)
Neuroendocrine dysfun
Environment
Psychological/social/physical stress -> High levels of cortisol -> depressed
Depressed -> modulation of stress & cortisol dysregulated
Treatment of depression
Biological treatments
Antidepressants
SSRIs (paroxetine)
TCAs (amitriptyline)
Serotonin (depression with anxiety)
Electroconvulsive therapy (ECT)
Vagal nerve stimuln (VNS)
Psychosurgery
Psychological treatments
Psychotherapy
Cognitive behavioural therapy (CBT)
Supportive psychotherapy
Social factors
Unemployment
Alcohol misuse
Relationship issues
Summary
High occurrence rate -> 17% lifetime prevalence
High rate of recurrence -> Up to 80%
High mortality -> 10-15%
Worldwide morbidity (The global burden of disease, 1996)
Unipolar major depression -> 10.7% of global popn
Prevalence
Depression -> 1 in 10 ppl
What are mood disorders?
Pathological change of mood
Depression
Mania
Biological, psychological & behavioural changes
Spectrum of severity -> severe with psychosis to mild sub-syndromal symptoms
Impt distinction between unipolar (depression alone) & bipolar disorders (highs & lows)
Bipolar disorder
Epidemiology
Common
Rates in men & women =
Onset 15-24
In primary care -> diagnosis delay 5-10 years
Burden of disorder
Patients are symptomatic for half their lives -> depression is most common presentation
Direct NHS annual cost -> 199 milli
Aetiopathologies
Similar to depression
Stronger genetic loading -> 80% of variants related to genes
Family, twin & adoption studies
Complex inheritance patterns
Vulnerability of bipolar disorder transitioned than actual diagnosis itself
Concordance between monozygotic than dizygotic twins
Classification
ICD-10 bipolar affective disorder
Mood episode specified as:
Depressed, manic or mixed
Severity
Presence of psychotic symptoms
DSM-IV bipolar disorders
Bipolar 1 (mania with/without depression)
Bipolar 2 (depression & hypomania)
Bipolar disorder neuropathology
Studies at infancy stage
Inconsistent findings
Methodological limitations
Ventricular enlargement
Hippocampus & amygdala debated
Moore et al 2001 -> cerebral white matter lesions linked with poorer outcome
Mood disorder -> mania + depression often with psychotic symptoms
Episodes one after another separated by remission intervals
9-year reduction in lifespan
Suicide rate -> 20%
Hypomania/mania
Elevated mood
Inflated self esteem
Decreased need for sleep
Treatment
Biological treatments
Lithium -> mood stabilisers
Anticonvulsants
Valproate
Antidepressants -> avoid if can as it causes ppl to get high
Antipsychotics -> block DA
Typical & Atypical
Clozapine
ECT
Schizo
Heterogenous syndrome
Include often bizarre, abnormal thoughts
Linked with a reduction in social func & alteration in personality
X split personality
Characteristics
Abnormal thoughts -> delusions
Persecutory
Reference
Thought process & speech
Poverty
Thought block
Hallucinations
2nd/3rd person
Though eco
Abnormal effect
Flat
Inappropriate
**
More neurological **
Motor abnormalities
Posturing
Catatonic excitement
Cognitive deficits
IQ
Memory
Executive func
Language
Schizophrenia DSM-IV & Schizophrenia ICD10
Profound impact on func
Present for long term -> 6 months
Clinical Phases
Premorbid & prodromal phases
Social & cognitive deficits in childhood
Subtle motor, linguistic dysfunc
Merges into prodromal phase
Func decline
Course
80%at least 1 further episode in 5 years