Diagnostic and Statistical Manual

of Mental Disorder ( DSM- IV)

MOOD
MOOD DISORDER
DISORDER

MAJOR
MAJOR DEPRESSIVE
DEPRESSIVE BIPOLAR

DYSTHYMIC CYCLOTHYMIC

SCHIZOAFFECTIVE
 DEPRESSION

Depression is an illness
It is common and treatable

It is a medical disorder like Hypertension or

diabetes that requires medical treatment
 Major Depression

In Major Depression, as a medical

disorder, sad feeling are felt much
more intensely and for longer period
of time.
Disruptive to work
Disruptive to social
Disruptive to the family
Signs
Signs and
and symptoms
symptoms Endokrine
• Tyroxin
• Antibody

Heart
•BP HR , T
•Arryththmias
Muscle atropy
Reproduktif
•Amenorrhea
•FSH
 Clinical Features of Depression

Mood : Depressed most of the day

Talk : Monotonous, incomplete

Energy: Retarded, apathetic

Ideation: feeling of guilty, worrying,

suicidal thoughts, delusion of guilty

Cognition: Verbal memory impaired.

Physical: Early waking, appetite and weight loss

Constipation, loss of libido, impotence
 Behavior:
Retardation,
poverty of movement
and expression

Hallucinations
Auditory
Etiology

1. Biochemical
imbalance in neurotransmitter
e.g : Serotinin
Monoamine
Epinephrine
2. Environment

`- Divorce
- Death of a loved one
- Long term alcohol use
- Chronic Physical illness
- Serious injury
- Low self – esteem
- Loss of job
- Marital Problem
3. Physical illness

• Chronic illness Hpt, DM, ESRF

• Cancer
• Hepatitis
• HIV, AIDS
 MANAGEMENT
• Outpatient in most cases, only necessary when
there is strong risk of suicide
and social support are inadequate

Antidepressant Drugs
GROUP DRUG DOSE
Amitriptyline 75-150mg dly
TRICYCLIC
Imipramine 75-150mg dly
Dothiepin 75-150mg dly
Clomipramine 75-150mg dly
 Antidepressent Drug

GROUP DRUG DOSE

5-HT Fluxentine 20mg dly
reuptake
Fluvoxamine 100-200mg
Inhibator dly
Tetracylics Mianserin 30-90mg dly
Monoamines Phenelzine 60-90mg dly
oxidase
Inhibitors Tranycypromine 20-40mg dly
ECT

Indication
• Severe depression with paranoid
• High suicidal risk
• failure to response to
anti depression drugs
• depressive stupor
Psychological Support
a. Psychotherapy
• interacts between patient and
therapist
• increase insight .
• Decreased symtoms.

b. Counseling