MOOD DISORDERS

All of us experience fluctuation of mood from depression to elation, and

AFFECT: is what the people perceive of patient’s mood considering the patient’s external display of his mood

Mood: patient’s own description of his inner state of being

Fluctuations are normal. It is considered a disorder when it doesn’t resolve itself by itself, gets long-term and impairs daily life.

Types

Bipolar I Disorder:

  • The symptoms alternate between mania (DIG FAST≥ 1 week)
SYMPTOMS OF MANIA

– DIG FAST –

D-distractibility

I-insomnia

D-delusions of grandeur

F-flight of ideas

A-increase in Activity

S- reduced Sleep

T-talkativity

And major depression (SIG E CAPS ≥ 2 WEEKS)

Bipolar II Disorder:

●           at least one episode of current or past hypomania (DIG FAST for 1 week or more) and at least one episode of current or past major depression

(SIG E CAPS for 2 weeks or more), with no history of an episode of mania.

●           treatment options for both bipolar 1 and 2 disorders include mood stabilisers to prevent fluctuations of mood, antipsychotics for manic episodes and antidepressants when depressive symptoms supervene.

Cyclothymic Disorder:

●           cyclical mood swings lasting for at least 2 years

●           multiple bouts of depression (<of 5 sig e caps) and hypomania (dig fast) occur on and off chronically

●           hypomanic or depressive symptoms must be present at least half of the time during the required two-year period

●           it is treated similarly as bipolar disorder 2

Major Depressive Disorder:

  • SIG E CAPS (≥5) for 2 weeks or more

●           Treatment of the disorder requires to assure the security of patient prior to all as risk of suicidal ideation is quite high that is, 60{d1272f9be01bb360d2e08f42defc794b644e1298a474496e050da4509a809c3c}

●           Options for treatment include pharmacotherapy (selective serotonin reuptake inhibitors are are considered as 1st line therapy), cognitive therapy, may be that’s the only thing required by a person with mild depression. Hypericum (st john’s wort), omega 3 supplements may reduce suicidal ideation.

Persistent Depressive Disorder (Dysthymia):

●            two or more years of depression

●           Periods of depression are mild (<5 sig e caps)

●            Managed by providing cognitive behavioral therapy and selective serotonin reuptake inhibitors (if pharmacotherapy is required)

Premenstrual Dysphoric Disorder:

●           Presence of depressive or other mood symptoms (marked affective lability, irritability or anger, depressed mood or hopelessness, and anxiety or tension,)  in the week before onset of menses followed by resolution of the symptoms after onset.

●           Confirmed by prospective daily ratings during at least two symptomatic cycles

Seasonal affective disorder:

  • Symptoms of depression initiate in winter and remit in spring or summer
  • Sunlight acts as pace maker for the biological clock via serotonin and melatonin secretion
  • Causes abnormal melatonin metabolism which plays a role in sleep patterns and mood
  • Treated with light therapy +/- antidepressants

POST PARTUM MOOD DISORDERS

  • POSTPSRTUM BLUES: in the first 2 weeks after delivery, the patients experience fatigue, short temperedness, difficulty sleeping, depressed mood and tearfulness. The symptoms resolve spontaneously in majority.
  • POSTPARTUM DEPRESSION: in the first year after delivery, the patients experience excessive guilt, anxiety, anhedonia, depressed mood, fatigue, sleep disturbance and suicidal ideation
  • POSTPARTUM PSYCHOSIS: in first 3 months after delivery the patients experience psychotic episodes including hallucinations and delusions, agitation, disorganised behavior and cognitive impairment

Treatment options include short term fluoxetine and cognitive therapy. Lithium, Antidepressants and antipsychotics are also prescribed depending upon the severity of symptoms. Evidence of estrogen is conflicting.

 

References:

  • Videos of paul bolin on youtube
  • Kaplan
  • Oxford hand book of clinical specialities
  • http://jaapl.org/content/42/2/182#xref-ref-1-1
  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Arlington, VA: American Psychiatric Association, 2013
  • OBSTETRICS BY TEN TEACHERS