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Mood disorder - Course & Prognosis (Course (Bipolar has earlier age of…
Mood disorder - Course & Prognosis
Course
Bipolar has earlier age of onset (3rd decade)
Unipolar is common between age groups: late 3rd and 5th-6th decades
Average manic episode lasts for 3-4 months, depressive episode lasts from 4-6 months
Unipolar lasts more than bipolar episodes
As age increases, intervals between episodes shorten & duration of episodes, frequency tends to increase
Some patients have more than 4 episodes per year known as rapid cyclers. Almost many of them are women
Prognosis
better than schizophrenia
Good prognostic factors
Acute/abrupt onset
typical clinical features
severe depression
well adjusted premorbid personality
good response to treatment
Poor prognostic factors
Co-morbid medical disorder/personality disorder/alcohol dependence
Double depression
catastrophic stress/chronic ongoing stress
unfavourable early environment
marked hypochondriacal features
poor drug compliance
Aetiology
Biological theories
Genetic Hypothesis
life time risk for 1st deg relatives of bipolar is 25^, recurrent depressive disorder is 20%
life time risk for children of one parent with bipolar is 27%, and with both parents is 74%
for monozygotic twins is 65%, dizygotic twins is 20% for bipolar; the same for unipolar is 46% and 20% respectively
Biochemical theories
abnormality in monoamine [ catecholamine (norepinephrine & dopamine) and serotonin] in CNS could be responsible
Acetylcholine & GABA could also be involved
patients suffering from severe depression with suicidal intent/attempt have decrease in serotonergic function, decreased urinary and plasma 5-HIAA levels
Neuroendocrine theories
mood symptoms present more prominently in many endocrine disorders, hypothyroidism, cushing's disease & addison's disease
neuroendocrine and biochemical are closely interrelated
endocrine function is often disturbed with cortisol hyper-secretion, non-suppression with dexamethasone challenge, blunted TSH response to TRH, & blunted growth hormone production during sleep
Sleep studies
sleep abnormalities are common. decreased REM latency is observed
Brain imaging
have yielded inconsistent, yet suggestive findings
findings include ventricular dilatation, white matter hyper-intensities and changes in blood flow and metabolism in several parts of brain
Psychosocial theories
Psychoanalytic theories
loss of libidinal object, intense craving for narcissism/self love are some of the postulates of this theory
Stress
increased number of stress life before onset / relapse have effect and play a role in mania
Cognitive & Behavioural theroies
include depressive negative cognition, learned helplessness & anger directed inwards