Chapter 6 Mood Disorders

Mood disorders
• Affect : short –lived emotional response to an idea
/event
• Mood : sustained & pervasive emotional response
which colors the whole psychic life
 Classification
Ⅰ. Manic episode
Ⅱ. Depressive episode
Ⅲ. Bipolar mood (affective) disorders
Ⅳ. Recurrent depressive disorders
Ⅴ. Persistent mood disorder (cyclothymia ,dysthymia)
Ⅵ.Other mood disorders(mixed affective episode &
recurrent brief depressive disorder)
ⅰ.Elevated,expansive or irritable mood
ⅱ.Psychomotor activity goal- oriented
ⅲ.Speech & thought
ⅳ.Goal-directed Activity
ⅴ.Other features sleeping
ⅵ.Absence of underlying organic causes
ⅰ. Euphoria hypomania
ⅱ. Elation confidence & enjoyment
ⅲ.Exaltation delusion of grandeur
ⅳ. Ecstasy rapture of blissfullness
delirious / stuporous mania
ⅰ.Depressed mood
ⅱ.Depressive ideation /cognition
ⅲ.Psychomotor activity ＜ 40y
ⅳ.Physical symptoms hypochondriacal (ill)
ⅴ.Biological functions sleeping
ⅵ.Psychotic features delusion
ⅶ.Suicide
ⅷ.Absence of underlying organic causes
 BipolarⅠ & Ⅱ
ⅰ. Hypomanic
ⅱ. Manic without psychotic symptoms
ⅲ. Manic with psychotic symptoms
ⅳ. Mild or moderate depression
ⅴ. Severe depression , wtihout psychotic symptoms
ⅵ. Severe depression , wtih psychotic symptoms
ⅶ. mixed
ⅷ. In remission
ⅰ. mild
ⅱ. moderate
ⅲ. Severe,without psychotic symptoms
ⅳ. Severe,with psychotic symptoms
ⅴ. In remission
 Courses & prognosis
• Bipolar mood disorders early onset than recurent
depressive
• Manic episode 3~4 mon 2w
• Depressive episode 4~6mon 6~8w
• Unipolar depression longer than bipolar
depression
• Rapid cyclers 4episodes/y F 70·80%
(Bipolar )
 Etiology
• Ⅰ. Biological theories
• Ⅱ. Psychosocial theories
 Biological theories
• Genetic hypothesis monozygotic 65% ,46% dizygotic
• Biochemical theories
• Neuroendocrine
• Sleeping studies
• Brain imaging
 Psychosocial theories
• Psychoanalytic theories self-love
• Stress
• Cognitive & behavioral theories
Depressive negative cognition, learned helplessness
Anger directed inward
 Differential diagnosis
• Organic , drug-induced
• Acute & transient psychotic disorders/
schizoaffective disorder & schizophrenia
obsessive compulsive disorder
 Management

Ⅰ. Somatic treatment
Ⅱ. Psychosocial treatment
 Somatic treatment
• Antidepressants
• ECT(Electroconvulsive therapy)
• Lithium (Li) manic episode
• Antipsychotics
• Other mood stabilizers
• Other treatment
 Electroconvulsive therapy
• psychosis or a risk of suicide
• major depression :manic delirium, or catatonia
• schizoaffective or schizophreniform disorder
 Common antipsychotics
First generation

* Butyrophenones
Haloperidol (Haldol) (Serenace) Droperidol
(Droleptan)
* Phenothiazines
*Thioxanthenes
Chlorprothixene
Flupenthixol (Depixol and Fluanxol)
Thiothixene (Navane)
Zuclopenthixol (Clopixol & Acuphase)
 Common antipsychotics 2nd &3rd generation

2nd Clozapine (Clozaril)

Risperidone (Risperdal)
Quetiapine (Seroquel)

3rd Aripiprazole (Abilify) 1 mg ~ 30 mg

Mechanism of action is thought to reduce susceptibility to
metabolic symptoms seen in some other atypical
antipsychotics
 Psychosocial treatment
• Cognitive behavior therapy
• Interpersonal therapy
• Psychoanalytic psychotherapy
• Behavior therapy
• Group therapy
• Family & marital therapy
 Other syndromes of depression & mania
• Involutional melancholia
• Mixed anxiety –depressive disorder
• Masked depression
• Depressive equivalents compulsion
• Atypical depression(s)
• Agitated depression impulsive
• Seasonal mood disorder
• Secondary depression & secondary mania
• Neurotic depression
•
Chapter 7 Other Psychotic Disorders
 Other Psychotic Disorders
• Persistent delusional disorders
• Induced delusional disorder (2)
• Acute & transient psychotic disorders
• Schizoaffective disorder
• Capgras ‘ syndrome (The delusion of doubles)
• Reactive psychosis
•
 PERSISTENT DELUSIONAL DISORDER
• Delusional disorder
• Other persistent delusional disorders
 Differential diagnosis
• Paranoid schizophrenia delusion
• Mania
• Depression
• Paranoid personality disorder
• Organic delusional disorder
 Treatment
• Antipsychotics MHP
• Supportive psychotherapy
• Antidepressants fluoxetine & ECT
•