1. Mood disorders
Department of Psychology P.G. Govt. College for Girls Sector-11, Chandigarh

2. Introduction
Affect: A short lived emotional response to an idea or an event
Mood: A sustained and pervasive response which colors the whole psychic life.

3. Introduction contd…
Depression and mania are the opposite ends of same spectrum
These are the two poles apart , thus generating the terms unipolar depression and bipolar disorder.
It can also occur as a mixed state , hypomania or rapid cycling

4. Major depressive disorder
Prevalence rate -
DIAGNOSIS
RATE
Major depressive disorder
Female : %
Male 7-12%
Dysthymic disorder 6%
Bipolar disorder - I
0.4-6%
Bipolar disorder - II
0.5%

5. Mood [affective] disorders
According to ICD –10 :
Chapter F : F30-F39

6. ICD –10 Classification……..
F30 : Manic episode
F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
.20 With mood-congruent psychotic symptoms
.21 With mood-incongruent psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode, unspecified

7. ICD –10 Classification
F31 : Bipolar affective disorder
F31.0: Bipolar affective disorder, current episode hypomania
F31.1 : Bipolar affective disorder, current episode mania without psychotic symptoms
F31.2 : Bipolar affective disorder, current episode mania with psychotic symptoms
.20 With mood-congruent psychotic symptoms
.21 With mood-incongruent psychotic symptoms

8. ICD –10 Classification…….
F31.3 : Bipolar affective disorder, current episode mild or moderate depression
.30 Without somatic syndrome
.31 With somatic syndrome
F31.4: Bipolar affective disorder, current episode severe depression without psychotic symptoms

9. ICD –10 Classification…….
F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms
.50 With mood-congruent psychotic symptoms
.51 With mood-incongruent psychotic symptoms
F31.6 Bipolar affective disorder, current episode mixed
F31.7 Bipolar affective disorder, currently in remission
F31.8 Other bipolar affective disorders
F31.9 Bipolar affective disorder, unspecified

10. ICD –10 Classification……..
F32 : Depressive episode
F32.0 : Mild depressive episode
.00 Without somatic syndrome
.01 With somatic syndrome
F32.1 : Moderate depressive episode
.10 Without somatic syndrome
.11 With somatic syndrome

11. ICD –10 Classification……..
F32.2 : Severe depressive episode without psychotic symptoms
F32.3: Severe depressive episode with psychotic symptoms
.30 With mood-congruent psychotic symptoms
.31 With mood-incongruent psychotic symptoms
F32.8 : Other depressive episodes
F32.9 :Depressive episode, unspecified

12. ICD –10 Classification………
F33 : Recurrent depressive disorder
F33.0 :Recurrent depressive disorder, current episode mild
.00 Without somatic syndrome
.01 With somatic syndrome
F33.1 : Recurrent depressive disorder, current episode moderate
.10 Without somatic syndrome
.11 With somatic syndrome

13. ICD –10 Classification
F33.2 : Recurrent depressive disorder, current episode severe without psychotic symptoms
F33.3 :Recurrent depressive disorder, current episode severe with psychotic symptoms
.30 With mood-congruent psychotic symptoms
.31 With mood-incongruent psychotic symptoms
F33.4 :Recurrent depressive disorder, currently in remission
F33.8 :Other recurrent depressive disorders
F33.9 :Recurrent depressive disorder, unspecified

14. ICD –10 Classification F34 : Persistent mood [affective] disorders
F34.0 Cyclothymia
F34.1 Dysthymia
F34.8 Other persistent mood [affective] disorders
F34.9 Persistent mood [affective] disorder, unspecified

15. ICD –10 Classification F38 : Other mood [affective] disorders
F38.0 Other single mood [affective] disorders
.00 Mixed affective episode
F38.1 Other recurrent mood [affective] disorders
.10 Recurrent brief depressive disorder
F38.8 Other specified mood [affective] disorders
F39 : Unspecified mood [affective] disorder

16. Clinical features of depression
Sad mood: Persistent and pervasive sadness of mood- Patient not responsive to external environment
Lack of interest
Diminished activity
Weakness leading to fatigability
Depressed mood
Complete anhedonia: lack of pleasure

17. Clinical features depression….
Depressive ideations: Helplessness, hopelessness, worthlessness
Guilt feelings
Difficulty in concentration
Indecisiveness
Slowed thinking
Lack of energy and initiative
Suicidal ideations with nihilism

18. Clinical features depression…. Psychomotor activity
Slowness in thinking and activity
Depressive stupor

19. Clinical features depression….
Physical features:
Multiple physical complaints
(heaviness of head, vague body aches & paines)
Easy fatigability

20. Clinical features Depression….
Biological features:
Insomnia
Reduced appetite
Reduced weight
Loss of libido

21. Clinical features depression…..
Psychotic features:
Nihilistic delusions
Delusions of guilt
Delusions of poverty

22. Clinical features for mania
Elevated , expansive or irritable mood which may pass through following stages:
Euphoria: Mild elevation of mood
Elation: Moderate elevation
Exaltation: Severe elevation
Ectasy

23. Clinical features for mania…
OVERACTIVITY
RESTLESSNES
MANIC EXCITEMENT

24. Clinical features for mania…
Speech and thought:
Over talkativeness
Pressure of speech
Flight of ideas
Delusions of grandeur:
Ability, Identity, Role

25. Clinical features for mania…
Goal directed activity:
Increased activity
Over planning
Poor judgment
Other features:
Decreased sleep
Increased appetite

26. Bipolar mood disorder
It is characterized by recurrent episodes of mania and depression in same patient at different times
SUBTYPES :
Bipolar I
Bipolar II

27. Bipolar mood disorder……….
Bipolar I Disorder
One or more manic episodes usually alternating with major depressive episodes
Manic episodes – periods of abnormally and persistently elevated, expansive or irritable mood
Bipolar II Disorder
Major depressive episode and at least one hypomanic episode
No manic episode

28. Bipolar mood disorder………..
The current episode can be specified as :
Hypomania
Mania without psychotic symptoms
Mania with psychotic symptoms
Mild or moderate depression
Mixed or remission
Severe depression with/ without psychotic symptoms

29. Recurrent depressive disorder
It is characterized by recurrent depressive episodes:
The current episode can be specified as :
Mild Depression
Moderate Depression
Severe depression with / without psychotic symptoms

30. Persistent mood disorder
It is characterized by persistent mood symptoms for more than 2 years :
Dysthymia
Cyclothymia

31. Dysthymia…….. Milder form of depressive illness Criteria
Symptoms less severe but chronic
Criteria
Depressed or irritable mood most of the day, occurring more days than not for at least 2 years
No more than 2 months in which s/s not present
No manic or depressive episode
Important because of chronic nature

32. Cyclothymia…… Resembles Bipolar I Disorder with less severe symptoms
Repeated episodes of nonpsychotic depression and hypomania for at least 2 years
Diagnosed only if a major depressive or manic episode has never been present

33. Other mood disorders
The full clinical picture of ,mania and depression are present either:
at same time intermixed or
alternates rapidly with each other without a normal intervening period of euthymia

34. Course and prognosis
BMD has early age of onset ( 3rd decade ) than RDD
UNIPOLAR DEPRESSION is common in 3rd decade and 5th to 6th decade
Average manic episode lasts for 3-4 months
Average depressive episode lasts for 4–6 months
Nearly 40% of depressives with episodic course improve in 3 months
60% of which may last for two or more years improve in 6 months
80% improve in one year
15-20 % develop a chronic course

35. Prognosis Good prognostic factors: Acute onset
Typical clinical features
Severe depression
Well adjusted pre morbid personality
Good response to treatment

36. Prognosis Poor prognostic factors: Co-morbid medical disorder, PD
Double depression
Chronic stress
Unfavorable environment
Mood incongruent psychotic features
Hypochondriacal features
Poor drug compliance

37. Etiology: 1. Genetic Hypothesis: life time risk for
First degree relatives of Bipolar Mood Disorder is 25%
Recurrent Depressive Disorder is 20%
Children of one parent with Bipolar Mood Disorder is 27%
Both parents with Bipolar Mood Disorder is 74%

38. Etiology contd……. 2. Biochemical theories: The monoamine hypothesis
Postsynaptic alteration in receptors number and function
Decrease in serotonergic function

39. Etiology contd……. 3. Brain Imaging (MRI, PET scan):
Ventricular dilatation
Changes in blood flow and metabolism

40. Etiology contd…….
4. Learned Helplessness: Seligman Experiment of dogs

41. Predisposing Factors Genetic Physiological
Endocrine system (HPA axis and HPT axis)
Cortisol (hyper-secretion)
Neurotransmission
Dysregulation hypothesis
Abnormal transmission of serotonin
Biological rhythms
Periodic variations in physiological and psychological functions

42. Predisposing Factors Psychological Psychodynamic factors
Anger turned inward
Learned helplessness
Passivity, negative expectations, feelings of helplessness, hopelessness, and powerlessness
Cognitive
Errors in thinking and unrealistic attitudes
Errors precede mood changes

43. Precipitating Stressors
Stress due to major or minor life events
Loss of attachment
Disruptions of patterns
Loss of self-esteem
Interpersonal discord
Physical conditions
Impairment of social role performance
Certain events more predictive than others
Abuse, multiple family disadvantages

44. Management/ Treatment
Acute phase treatment:
To achieve euthymia and thereby current episode to conclusion
Continuation phase treatment:
Maintainance phase treatment:
To prevent the future episodes

45. Acute phase treatment Choose the venue for treatment
Select the appropriate mood stabilizer: Medicines
Manage the agitation and psychosis
Optimize the patient’s sleep

46. Mood stabilizers Lithium Valporate Carbamazepine
Atypical antipsychotics

47. Management of agitation and psychosis
Benzodiazapines
Anti psychotics
Optimizing sleep: Bedtime dose of benzodiazepine or anti psychotic

48. Maintainance phase It is indicated in following cases:
Partial response to acute treatment
Poor symptom control during continuation treatment
More than 3 episodes
More than 2 episodes with early age of onset or reoccurrence within 2 years of stopping anti depressants
chronic depression

49. Electrconvulsive Therapy(ECT)
Indications for ECT :
Severe depression with suicidal risk
Severe depression with stupor
Catatonia
Treatment refractory depression
Delusional depression
Intolerance to drugs

50. Psychosocial treatment
Cognitive behavior therapy
Behavior therapy
Group therapy
Family and marital therapy

51. THANK YOU