1. Mood disorders ( affective disorders ) prof. MUDr. Eva Češková, CSc. Dept. of Psychiatry, Dept. of Psychiatry, Masaryk University, Brno Masaryk University, Brno

2. Mood disorders ( affective disorders ) §epidemiology §etiology §classification.: major depressive disorder, bipolar I disorder, dysthymic disorder and cyclothymic disorder §diagnosis §differencial diagnosis §course and prognosis §treatment §literature

3. Mood disorders ( affective disorders ) Mood disorders - the critical pathology in those disorders is one of mood

4. Epidemiology Lifetime prevalence: major depressive disorder 15% (more in women) bipolar I disorder 1% Sex: major depressive disorder twofold often in women, Age: mean age of onset of depressive disorder 40 years, bipolar I disorder 30 years

5. Etiology 1.Biological factors: § the biological amines, noradrenaline (dopamine) and serotonin - neurotransmitters most implicated in the pathophysiology of mood disorders §neuroendocrine dysregulation (alteration of hypothalamic-hypophysis-adrenal and hypothalamic-thyreoid axis) 2. Genetic factors 3. Psychosocial factors 4. Other factors : alteration of circadian rhythms, neuroimmune dysregulation

6. Classification (DSM IV) 1. major depressive disorder 2. bipolar I disorder 3. dysthymic disorder 4. cyclothymic disorder Further classification major depressive disorder and bipolar I disorder: § according to the severity (mild, moderate, severe) §with and without psychotic features, congruent or incongruent (hallucinations and delusions) §according to the course (single episode, or recurrent, remission, further course specifiers)

7. Diagnosis: major depressive disorder Minim. 5 symptoms, change from functioning: §depressed mood §diminished interest or pleasure §significant weight loss, or decrease or appetite §insomnia ( or hypersomnia) §psychomotor agitation or retardation §fatigue or loss of energy §feelings of worthlessness or guilt §diminished ability to think or concentrate, indecisiveness §recurrent thought of death

8. Diagnosis: Bipolar I, manic episode At least 1 week of abnormally and persistently elevated, expansive or irritable mood, impairment in occupational functioning or social activities (not due to abuse or medical condition), min. 3 of the following symptoms: §grandiosity §decreased need for sleep, §more talkativeness §flight of ideas §distractibility §increase of goal directed activity §excessive involvement in pleasurable activities

9. Diagnosis : dysthymic disorder Dysthymic disorder: a chronic disorder, with the depressed mood that lasts most of the day on most days Symptoms: §depressed mood for more days than not, for at least 2 y. 2 or more further symptoms: §poor appetite or overeating §insomnia or hypersomnia §low energy or fatigue §low self esteem §poor concentration or difficulty making decisions §feelings of hopelessness

10. Diagnosis : Cyclothymic disorder §a mild form of bipolar II disorder, characterised by episodes of hypomania and episodes of mild depression §for at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous period with depressive symptoms that do not meet criteria for a major depressive episode

11. Differential diagnosis Depressive disorders: §medical disorders (neurological, endocrine, infectious) §pharmacological Bipolar I: §other mental disorders (schizophrenia) §pharmacological

12. Course and prognosis Depressive disorder: §untreated depression lasts 6-13 months § 5-10% have a manic episode §tends to be a chronic disorder §pts. tend to relapse Bipolar disorder: §most often starts with depression §is a recurring disorder §pts. have a poorer prognosis than do pts. with major depressive disorder § 50% have a second manic episode within 2 years

13. Treatment Acute treatment vs. long-term with recurrent episodes Major depressive disorder: §biological treatment - antidepressants, ECT, sleep deprivation, light therapy §psychotherapy - cognitive-behavioural therapy Mania: §mood stabilisers §antipsychotics §ECT

14. References :  Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997  Goodwin FK, Jamison KR.: Manic-depressive Illness. New York: Oxford University Press, 1990.