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Affective Disorders
( Mood Disorders )
Depression

Lowering of mood

Mania

Heightening of mood

Depression
A persistent pervasive feeling of
emptiness or hopelessness,
resulting in a loss of interest in every
thing that once gave a person pleasure.
It is not the occasional low mood or
sadness in response to a loss.
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Central features
1. Low mood:

The mood is one of misery.


It does not improve in pleasant company
or when hearing good news.

2. Lack of enjoyment:
No enthusiasm for activities and hobbies
that were normally enjoyed.
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3. Reduced energy:
The person finds every thing an effort.

Pessimistic thinking:
The person sees the unhappy side of every event.
The past - Guilt + Self blame
The present - a failure
The future - expects the worst.
Foresees the ruin of his finances and misfortune
for his family.
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Biological symptoms
Sleep disturbance - early morning awakening
- delay in falling asleep
Loss of appetite
Loss of weight
Constipation
Loss of libido
Amenorrhoea
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Psychiatric symptoms

Anxiety
Depersonalisation
Obsessional symptoms
Phobias eg. Social
Dissociative state eg. Paralysis of a limb
Poor memory ( pseudo-dementia )
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Delusion

A false belief
Firmly held
Not amenable to reason
Not in keeping with the
persons religious, cultural
or social background
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Hallucination
Perception without
a stimulus
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Psychotic symptoms
1. Delusions - mood congruent
(a) hypochondriacal eg. AIDS, CA
(b) poverty
(c) nihilistic eg. bowels not working
(d) persecutory
2. Hallucinations
usually auditory
rarely visual

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Classification
Mild
Moderate
Severe
* Reactive
* Neurotic

vs
vs

Endogenous
Psychotic
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ICD 10 Depressive episode

Duration of 2 weeks
Symptoms 2 of major symptoms
Depressed mood
Loss of interest/enjoyment
Reduced energy/fatigueability

2 other minor symptoms

Reduced concentration/attention
Reduced self confidence
Ideas of guilt
Bleack & pessimistic views of the future
Ideas/acts of self harm
Disturbed sleep

Categories
Minor episode 2 major + 2 minor
Moderate episode 2 major + 3-4 minor
Major episode 3 major + 4 minor
(with or without psychotic symptoms)
Recurrent depressive disorder 2 or more
episode
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Aetiology - Multifactorial
1. Genetic - family history
2. Early developmental - parental discord
- childhood abuse
2. Cognitive ( personality ) - outlook / thinking
2. Environmental factors - stressful life events
- lack of social support
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Illnesses associated with


Depression

Thyroid disorder - esp. hypothyroidism


Diabetes mellitus
Addisons disease
Carcinoma
Systemic lupus erythematosus
Neurological disorders eg. Parkinsonism
Cushings disease
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Other causes of depression


Alcohol
Drugs

blockers
-

beta blockers
methyldopa
calcium channel
cimetidine
oral contraceptive pills
corticosteroids

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Presentation
Physical complains eg. fatigue, burning
sensation of the body
Agitation - restlessness
Sleep disturbance
Anorexia and weight loss
Attempted suicide
Stupor
Pseudodementia
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Treatment

Chemotherapeutic antidepressants
a) Tricyclics eg. Imipramine, amitryptaline,
clomipramine

b) Selective serotonin reuptake inhibitors


eg. Fluoxetine, paroxetine
c) Monoamine oxidase inhibitors
d) others miratazpine, venalafaxine

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Treatment
Psycho-social intervention
Supportive psychotherapy
Marital therapy
Family therapy

Cognitive therapy
Interpersonnel therapy
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Treatment
In severe depression - electro convulsive
therapy ( ECT )
( For quicker recovery )
Eg: A patient with suicidal ideas
Drugs take 2 - 3 weeks to show a response
Drug treatment should be continued for
at least 6 months after recovery.
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