1. Shaul Lev-Ran, MD Shalvata Mental Health Center
Affective disorders
Shaul Lev-Ran, MD
Shalvata Mental Health Center

2. Major Depressive disorder
Dysthymic disorder
Cyclothymia
Bipolar II disorder
Bipolar I disorder

3. Major depressive disorder
Prevalence=15%
F>M
Mean age of onset=40
Genetic
1st degree relative of MDD – 2-3 times the chance of suffering from MDD

4. Depression is 2nd only to IHD as major cause of disability and early death in industrialized countries

5. Major Depressive Episode
5 of the following for at least 2 wks:
1. depressed mood
2. markedly diminished interest or pleasure
3. psychomotor disturbances
4. fatigue/loss of energy
5. feelings of worthlessness or guilt
6. suicidal thoughts or attempt
7. weight loss
8. sleep disturbances
9. difficulty concentrating, thinking, or deciding

6. Consequences Functional impairment Morbidity and mortality self family
occupational
financial
Morbidity and mortality
Worse outcome of disease than control
Cardiac – independent prognostic factor
Sudden death
suicide

7. Specifiers describing depressive episode
With psychotic features
With melancholic features
With atypical features
With catatonic features
Postpartum onset

8. Treatment - goals 5 X R (achieve) Response (achieve) Remission
(achieve) Recovery
(prevent) Relapse
(prevent) Recurrence

9. Treatment-strategies
What, where & how?
(focus, locus, modus):
What – major concerns, type of depression
Where?
Suicidal risk
Support system
Compliance
Psychosocial stressors
Level of functional impairment

10. What= Biopsychosocial approach:
Bio=medication, others (ECT, TMS, VNS…)
Psycho=
Explaining the diagnosis
Treatment plan and objectives
Assessment
Advantages: deals with secondary consequences (marital discord, occupational difficulties), adherence to medication
Social=couples, family, occupational, etc.

11. Prognosis Untreated episode – 6-13 months Treated episode – 3 months
Tends to be chronic –
25% recurrence in 6 m. after discharge
50% recurrence in 2 yrs.
75%recurrence in 5 yrs.

12. Bipolar I disorder Prevalence=1% M=F Mean age of onset=30
At least 1 manic episode
Most often starts with depressive episode
10-20% - only manic episodes
Genetic
1st degree relative with BP – 8-18 times the chance for BP
1 parent with BP – 25% chance of affective dis.
2 parents with BP – 50-75% chance of affective dis.

13. Manic episode
Abnormally elevated, expansive or irritable mood lasting 1 wk. or requiring hospitalization.
At least 3 of the following:
Inflated self esteem or grandiosity
More talkative/pressure to keep on talking
Flight of ideas (including subjective feeling)
Distractability
Increase in goal directed activity
Excessive involvement in pleasurable activity with high potential for painful consequence

14. Mixed episode
The criteria for both manic episode and MD episode are met nearly every day for at least one week

15. Specifiers describing recurrent episodes
Rapid cycling -4 or more episodes in 1 yr.
With seasonal pattern

16. Affective disorders Major Depressive disorder (unipolar)
Major depressive episodes
Dysthymic disorder
Milder & more chronic depression
Cyclothymia
Hypomanic episodes and milder depression
Bipolar II disorder
Hypomanic episodes and major depressive episodes
Bipolar I disorder
Manic episodes and major depressive episodes

17. Bipolar II disorder Includes at least one hypomanic episode:
Lasting at least 4 days
Criteria similar to manic episode
The episode is not severe enough to cause marked impairment in functioning and there are no psychotic features

18. Dysthymic disorder At least 2 years
No major depressive episode for first two years
2 of the following
Eating disturbances
Sleeping disturbances
Fatigue/low energy
Low self esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness

19. Cyclothymia
At least two years of hypomanic and minor depressive episodes
No major depressive, manic or mixed episode for first two years

20. Treatment-strategies
Where, what & how?
(focus, locus, modus):
Where?
Danger to self and others
Significant harm to self or others
Support system
Compliance
Psychosocial stressors
Level of functional impairment

21. What= Biopsychosocial approach:
Bio=medication, others (ECT, TMS, VNS…)
Psycho=
Explaining the diagnosis
Treatment plan and objectives
Assessment
Advantages: deals with secondary consequences (marital discord, occupational difficulties), adherence to medication
Social=couples, family, occupational, etc.