Please enable JavaScript.
Coggle requires JavaScript to display documents.
Mood Disorder - Clasification (Other Syndromes of depression & mania…
Mood Disorder - Clasification
Emotions are of types
Affect - short-lived emotional response to an idea/event
Mood - sustained & pervasive emotional response that colors the whole psychiclife
Classification
Manic episode
life time risk is 0.8-1%
lasts for 3-4 months followed by complete clinical recovery
features
Elevated, Expansive or Irritable mood
4 stages that elevated mood can pass through
Euphoria (mild elevation of mood) - Increase sense of psychological well being and happiness. Seen in Stage 1-hypomania
Elation (moderate elevation of mood) - feeling of confidence & enjoyment along with increase in psychomotor activity. Seen in Stage 2-mania
Exaltation (severe elevation of mood) - intense elation with delusions of grandeur. Seen in Stage 3-severe mania
Ecstasy (very severe elevation of mood) - intense sense of rapture/blissfulness. Seen in Stage 4-delirious/stuporous mania
Psychomotor activity
increased psychomotor activity ranging from over activeness & restless to manic excitement
Speech & Thought
more talkative than usual, describes thoughts racing in mind, develops pressure of speech, speaks loudly and uses playful language with jokes, rhyme etc.
flight of ideas (shifts from topic to topic). As severity increases, incoherence may occur
can be delusions of grandeur with markedly inflated self-esteem. Hallucinations could occur
Distractibility is a common feature
Goal-directed activity
alert and trying to do many things at once.
in hypomania, ability to function becomes much better as there is increase in productivity/creativity.
In mania, there is marked increase in activity with excessive planning. Decrease in functioning in later stages due to many activities and distractibility.
Other features
Sleep is reduced. Appetite may be increased
Some cases may have psychotic features such as delusions, hallucinations
Depressive episode
Features
Depressed Mood
sadness of mood/loss of interest and/or pleasure in almost all activities (pervasive & persistent sadness).
loss of interest results in social withdrawal. If severe it may lead to anhedonia
Depressive Ideation/Cognition
3 common types
Hopelessness - no hope in future
Helplessness - no help is possible now
Worthlessness - inferiority/feeling of inadequacy
can lead to self reproach & guilt-feeling
Suicidal ideas maybe present
Psychomotor Activity
in younger patients, retardation is more common characterized by slow thinking and activity. Also there is a decrease in energy and the patient has a monotonous voice. In severe form, patient can become stuporous
In older patients, agitation is common. Anxiety, restlessness and feeling of unease is common. Irritability maybe present.
Physical Symptoms
heaviness of head, vague body aches are common. Hypochondriacal features maybe present. Reduced energy and easy fatiguability are common complaints.
Biological functions
disturbance of biological fns. is common with insomnia, loss of appetite and weight.
If disturbance is severe, it is called as melancholia (somatic syndrome).Presence indicates severity is high & implies a good response to somatic methods of treatment
Somatic characteristics
Significant decrease in appetite/weight
Early morning awakening (at-least 2 hrs earlier to regular)
Diurnal variation - depression worst in the morning
pervasive loss of interest/reactivity to pleasurable stimuli
psychomotor agitation/retardation
Psychotic features
15-20% of depressed patients have psychotic symptoms like delusions, hallucinations/stupor. Can be either mood congruent or mood incongruent
Suicide
risk is more if the following presence is indicated
Presence of marked hopelessness
Males; age>40; unmarried; divorced/widowed
written/verbal communication of intent for suicide
early stages of depression
recovering from depression
period of 3 months from recovery
Absence of underlying organic cause - if secondary to organic cause, diagnosis of organic mood disorder should be made.
Bipolar mood (affective) disorder
known as Manic depressive psychosis (MDP) - recurrent episodes of mania & depression in same patient at different times
episodes can occur in any sequence. Unipolar mania patients with recurrent episodes are also classified under this as they are rare.
Episode
Hypomanic
manic with psychotic symptoms
manic without psychotic symptoms
mild/moderate depression
severe depression without psychotic symptoms
severe depression with psychotic symptoms
mixed
in remission
further classified into bipolar I & II
Bipolar I - characterised by episodes of severe mania & depression
Bipolar II - episodes of hypomania & severe depression
Recurrent Depressive Disorder
characterised by recurrent (atleast 2) depressive episodes (unipolar depression)
current episode is specified as
mild
moderate
severe without psychotic symptoms
severe with psychotic symptoms
in remission
Persistent mood disorder
persistent mood symptoms lasting for more than 2 yrs ( 1 year in children & adolescents) but not severe
if symptoms consist of persistent mild depression, disorder is called as dysthymia
if symptoms consist of persistent instability of mood between mild depression & elation, then its called cyclothymia
Other mood disorder
mixed affective episodes. frequently missed diagnosis. depression/mania is either present at same time intermixed or alternates rapidly.
Other Syndromes of depression & mania
Involutional Melancholia
form of severe depression which occurs between 40-65 yrs of age
characterised by marked agitation, presence of psychotic features and multiple somatic symptoms
Mixed Anxiety Depressive Disorder
characterised by presence of depressive & anxiety symptoms
seen more frequently in medical outpatient departments & primary care centres
Masked Depression
depressive mood is not apparent & hidden behind somatic symptoms. common in elderly.
treatment similar to depressive episode
Depressive equivalents
certain conditions although not part of depressive syndrome are thought to be comparable to depression.
disorders include - agoraphobia, chronic pain, paraesthesias, panic attacks, alcoholism, drug abuse, hysteria, ocd and eating disorder
Atypical Depression
do not present with classical/typical features of depression
Depression with predominant anxiety
subjective in contrast to the objective restlessness seen in agitated depression
phobic anxiety depersonalisation syndrome
common in women from 20-40 yrs. characterised by diffuse anxiety, panic attacks, depersonalisation, derealisation & depressive features
non-endogenous depression
characterised by absence of neurotic traits & significant stressful life events
hysteroid-dysphoric depression
marked fluctuations of mood ranging from near normal to severe depression
Double depression
major depressive episode, superimposed on an underlying dysthymia/neurotic depression
Agitated depression
severe depression with marked motor restlessness/agitation. either seen alone/alongwith melancholia. common after the age of 40yrs. treatment requires addition of antipsychotics/benzodiazepines
Seasonal mood disorder
either bipolar mood disorder/recurrent depressive episode. commonly seen in women
Secondary depression & Secondary mania
both depressive & manic episodes can occur secondary to certain physical diseases & drugs
Neurotic depression
characterised by
presence of mild to moderate depression
depressive symptoms
other neurotic symptoms such as anxiety, obsessive symptoms
preoccupation with stressful condition
renamed as dysthmia/dysthymic disorder
defined as any mild depression that is not severe enough to be called a depressive episode
common in females with average age of onset in late third decade