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Mood and Mood Disorders (BIPOLAR DISORDER (BP 1
Full Manic episode
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Mood and Mood Disorders
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DEPRESSION
Risk factors
- F>M
- Age 25-50yrs
- Fx (dep, Alco, Social)
- Childhood Experiences
DIAGNOSTIC CRITERIA
Low Mood +/- Anhedonia on most days for 2 weeks+ 5/9 of:
- M-Mood
- S-Sleep Changes
- I- Interest
- G-Guilt/Worthlessness
- E- Energy
- C- Concentration Changes
- A-Appetite Changes
- P-Psycomotor retardation/agitation
- S - Suicide Ideation
Major Depressive Disorder (MDD)
1 Year after Diagnosis without TX::
- 40% Symptoms
- 20% Symptoms don't meet criteria
- 40% No Mood Disorder
Persistent
Depressive Disorder (PDD):
- Depressed Mood most of time for >/= 2 yrs
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BIPOLAR DISORDER
BP 1
- Full Manic episode
- Commonly accompanied by MDE (not essential though)
BP 2
- MDD + Hypomania
- in lifetime never manic
Risk Factors
- High SES
- Genetic: 60-65% Fx
Cyclothymia
- Periods of Hypotmania and depressive Symptoms
- Dont meet full criteria for MDE/BP
DIAGNOSTIC CRITERIA
- Manic Episode
- A: Period - Abnormally/persistently elevated/inflated mood
*B: During- >/=3 of:
- G- Grandiosity/High Self-Esteem
- S- Sleep
- T-Talkative
- P- Pleasurable Activities/Painful Consequences
- A-Activities - ( High Goal Directed)
- D- Distractable
- Hypomanic Episode
- A+B >/+4 days
- Absence of:
- Psychiatric Features
- Uncharacteristic Change in Function
- Marked Impairment
DIAGNOSIS
Examinations
- BMI
- Self-Harm Signs
- Endocrine: Giotre, Cushingoid
- Respiratory: Sleep Apnoea,Restless Legs, COPD,Malignancy
Neuro:Parkinsons, Motor/Sensory Deficits,Cerebrovascular Disease
Investigations
- FBC
- U&E's
- LFT's
- ECG
- Inflammatory Markers
- Vitamin Deficiency
- STD's
- Beta-HCG
- Urine & Blood Drug Screening
DDX:
- Depression
- BD 1&2
- Adjustment Disorder (lifechange)
- Sleep Apneoa
- Hypothyroidism
- Neuro-
Degenerative Disorders
Biopsycosocial and Lifestyle model
- Predisposing
- Precipitating
- Perpetuating
- Why this person,Why this disease, Why now)
Factors
- Biological: ECT, medications
- Psychological: CBT/ Mindfullness
- Social: Support, Family, employment, Housing
- Lifestyle:
*S- Smoking,Sleep
*N-Nutrition
*A- Alcohol/drugs
*P- Physical Activity
EPIDEMIOLOGY Depression
- 10% Primary Care
- 15% Lifetime Risk
- 2F:M
- Mean age @ diagnosis: 27yrs
- 80% Affected = </= 2 lifetime episodes
- 54% recover within 12 months
- 12% Chronic
- 12.2% MDD
- 3-6% PDD
Bipolar 1
- 0.6% Lifetime risk
- F=M
- Mean age @ diagnosis: Late 20's
- mean age of Onset: Late Teens
- 1:3 Manic:Depressive
Bipolar 2
- Lifetime Prevalence 0.6%
- Higher F:M
- Median Onset: 29yrs
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