Affective Disorder
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AFFECTIVE DISORDERS Dr. Adel Alzayed Kuwait university – medical college Department of Psychiatry
Objectives
To understand Affective disorder and be able to differentiate them from other disorders. To identify different types of affective disorders:
Unipolar Bipolar
To be able to draw a management plan for affective disorders To be able to discuss the prognosis of affective disorders
Definition
Affective Disorders are disorders of the mood. i.e. elation or depression of the mood.
Classification
Unipolar
Bipolar
Only Depressive episodes patient never had manic hypomanic or hypomanicphases episode)
Had at least one manic or episode (or mixed
Epidemiology Epidemiology of Bipolar and Unipolar disorder (Major Depression Bipolar Disorder
Unipolar Disorder
Lifetime Risk
About 1%
10-20 %
Sex Ratio (M:F)
1:1
1:2
Lifetime risk for Bipolar Disorder
About 10%
About 2%
Lifetime risk for Unipolar Disorder
10-15%
10-15%
Average age of onset
21 Years
27 Years
First Degree relatives:
Depression Symptoms needed to meet criteria for ' depressive episode' in ICD-10
A. Depressed mood Loss of interest and enjoyment Reduced energy and decreased activity B Reduced concentration Reduced self-esteem and confidence Ideas of guilt and unworthiness Pessimistic thoughts Ideas of self-harm Disturbed sleep Diminished appetite Mild depressive episode: at least 2 of A and at least 2 of B Moderate depressive episode: at least 2 of A and at least 3 of B Severe depressive episode: all 3 of A and at least 4 of B Severity of symptoms and degree of functional impairment also guide classification
Differential Diagnosis
Normal Sadness Anxiety Disorder Schizophrenia Organic Brain Syndrome
Course & Prognosis
The age of onset of unipolar disorders varies widely; it is generally agreed to be later than for bipolar cases.
The average length of a depressive episode is about 6 months.
About 80% of patients with major depression will experience further episodes.
As with bipolar patients, the interval between episodes becomes progressively shorter.
About one third of depressed patients do not achieve complete symptom remission between episodes.
The longer-term prognosis of depression may be a little better in some ways than that of bipolar disorder but is still modest.
The assessment of depressive disorder
The steps in assessment are:
To decide whether the diagnosis is depressive disorder. To judge the severity of the disorder, including the risk of suicide. To form an opinion about the causes. To assess the patient's social resources. To gauge the effect of the disorder on other people
Management
In- patient Vs Out-patient:
- depends on severity
* Mild – moderate : Out- patient is possible
* Moderate – Severe : In Patient.
Psychotherapy:- Psycho + Drug therapy- better than either alone - In selected mild cases Psychotherapy alone could be enough - C.B.T is the most reliable form. - is very helpful in preventing relapses.
Drug therapy:-
- First line : SSRI's or SNRI's -Second line: TCA's -Third line: MAOI's
ECT:-
- Severe cases: were severe physical deterioration is evident - Suicidal patient - Treatment resistant cases.
Mania
* Mood:- Elevated - Irritable
* Appearance + Behaviour - Clothes brightly coloured - Untidy and disheveled - Over active - Food intake - Sexual desire + activity - Disinhibition - Sleep reduced
* Speech and thoughts: - Rapid - Flight of Ideas - Expensive Ideas - Grandiose Delusions * Perceptual Disturbances : - Hallucinations also occur.
Deferential diagnosis
-
Anxiety Schizophrenia Drug induced Psychosis Physical Condition . Thyrotoxicosis - Organic Brain Syndrome
Course & Prognosis
The age of onset of Bipolar Disorder is typically about 21 Years. Late-onset Bipolar Disorder is rare and may be participated by organic brain disease. The average length of a manic episode (treated or untreated ) is about 6 months. At least 90% of patients with mania experience further episodes of mood disturbance. The interval between episodes becomes progressively shorter with both age and the number of episodes. Nearly all bipolar patients recover from acute episodes but the long-term prognosis is rather poor.
The Assessment of Mania
Decide the diagnosis Assess the severity of the disorder Form an opinion about the causes Assess the patient's social resources Judge the effects on other people.
Management
In-patient Vs Out-patient - All cases of mania requires admission. - Cases of hypomania can be managed on out-patient bases with frequent assessments.
Acute Phase:a) Anti Psychotic Medications - Typical - Atypical
b) Mood Stabilizers - Lithium - Sodium Valproate - Carbamazepine
c) Benzodiazepines
Objectives
To understand Affective disorder and be able to differentiate them from other disorders. To identify different types of affective disorders:
Unipolar Bipolar
To be able to draw a management plan for affective disorders To be able to discuss the prognosis of affective disorders
Definition
Affective Disorders are disorders of the mood. i.e. elation or depression of the mood.
Classification
Unipolar
Bipolar
Only Depressive episodes patient never had manic hypomanic or hypomanicphases episode)
Had at least one manic or episode (or mixed
Epidemiology Epidemiology of Bipolar and Unipolar disorder (Major Depression Bipolar Disorder
Unipolar Disorder
Lifetime Risk
About 1%
10-20 %
Sex Ratio (M:F)
1:1
1:2
Lifetime risk for Bipolar Disorder
About 10%
About 2%
Lifetime risk for Unipolar Disorder
10-15%
10-15%
Average age of onset
21 Years
27 Years
First Degree relatives:
Depression Symptoms needed to meet criteria for ' depressive episode' in ICD-10
A. Depressed mood Loss of interest and enjoyment Reduced energy and decreased activity B Reduced concentration Reduced self-esteem and confidence Ideas of guilt and unworthiness Pessimistic thoughts Ideas of self-harm Disturbed sleep Diminished appetite Mild depressive episode: at least 2 of A and at least 2 of B Moderate depressive episode: at least 2 of A and at least 3 of B Severe depressive episode: all 3 of A and at least 4 of B Severity of symptoms and degree of functional impairment also guide classification
Differential Diagnosis
Normal Sadness Anxiety Disorder Schizophrenia Organic Brain Syndrome
Course & Prognosis
The age of onset of unipolar disorders varies widely; it is generally agreed to be later than for bipolar cases.
The average length of a depressive episode is about 6 months.
About 80% of patients with major depression will experience further episodes.
As with bipolar patients, the interval between episodes becomes progressively shorter.
About one third of depressed patients do not achieve complete symptom remission between episodes.
The longer-term prognosis of depression may be a little better in some ways than that of bipolar disorder but is still modest.
The assessment of depressive disorder
The steps in assessment are:
To decide whether the diagnosis is depressive disorder. To judge the severity of the disorder, including the risk of suicide. To form an opinion about the causes. To assess the patient's social resources. To gauge the effect of the disorder on other people
Management
In- patient Vs Out-patient:
- depends on severity
* Mild – moderate : Out- patient is possible
* Moderate – Severe : In Patient.
Psychotherapy:- Psycho + Drug therapy- better than either alone - In selected mild cases Psychotherapy alone could be enough - C.B.T is the most reliable form. - is very helpful in preventing relapses.
Drug therapy:-
- First line : SSRI's or SNRI's -Second line: TCA's -Third line: MAOI's
ECT:-
- Severe cases: were severe physical deterioration is evident - Suicidal patient - Treatment resistant cases.
Mania
* Mood:- Elevated - Irritable
* Appearance + Behaviour - Clothes brightly coloured - Untidy and disheveled - Over active - Food intake - Sexual desire + activity - Disinhibition - Sleep reduced
* Speech and thoughts: - Rapid - Flight of Ideas - Expensive Ideas - Grandiose Delusions * Perceptual Disturbances : - Hallucinations also occur.
Deferential diagnosis
-
Anxiety Schizophrenia Drug induced Psychosis Physical Condition . Thyrotoxicosis - Organic Brain Syndrome
Course & Prognosis
The age of onset of Bipolar Disorder is typically about 21 Years. Late-onset Bipolar Disorder is rare and may be participated by organic brain disease. The average length of a manic episode (treated or untreated ) is about 6 months. At least 90% of patients with mania experience further episodes of mood disturbance. The interval between episodes becomes progressively shorter with both age and the number of episodes. Nearly all bipolar patients recover from acute episodes but the long-term prognosis is rather poor.
The Assessment of Mania
Decide the diagnosis Assess the severity of the disorder Form an opinion about the causes Assess the patient's social resources Judge the effects on other people.
Management
In-patient Vs Out-patient - All cases of mania requires admission. - Cases of hypomania can be managed on out-patient bases with frequent assessments.
Acute Phase:a) Anti Psychotic Medications - Typical - Atypical
b) Mood Stabilizers - Lithium - Sodium Valproate - Carbamazepine
c) Benzodiazepines
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