MOOD DISORDERS

April 2, 2012

Hypomania Manic ep. - moderate - with or without psychotic symptoms (congruent/incongruent) Seasonal Postpartum

Onset duration evolution

BIPOLAR DISORDER

Only manic episode Manic or depressive ep: I or II Rapid cycling Circular course Mixed states Rapidly alternating states

Dysthymic disorder

Depressive mood for more than a two-years period

Accompanied by:

Loss of appetite or overeating Insomnia/hypersomnia Fatigue loss of energy Low self-esteem Poor concentration Feelings of hopelesness

Cyclothymic disorder

Over two years (at least) of oscillations between depressive and hypomanic mood

Differential diagnosis of mood disorders

Dysthymia depressive disorder Cyclothimia

Major Bipolar disorder

Depressive or Manic ep. organic induced (substance misuse/somatic or brain lesions) E.g: depression - dementia

Mood episodes Schizoaffective disorders Secondary mood disturbances (of other psychiatric disorders)

TREATMENT

Depression

Where to treat? PSYCHOTHERAPY Supportive Interpersonal Cognitive-behavioural MIND OVER MOOD! Evaluate Identify Arguments Replacing Logotherapy - existential therapy - giving meaning sense

Pharmacotherapy Antidepressant drug therapy 1. Tricyclic

Imipramin 100-200 mg/day Amitryptiline Doxepine 200 mg/day Trimipramine Clomipramine Nortriptiline 100-150 mg/day

100-

2. Tetracyclic Maprotiline (Ludiomil) 100-200 mg/day Mianserine 90-120 mg/day

Side-effects: Anticholinergic effects Sedation (for some) Stimulation (for others) Cardio-vascular: hTA diziness; tachycardia; arrhythmias; Conduction modifications: prolongation of PR and QTc intervals (EKG)

Sexual dysfunction Weight gain Allergic reactions Neurological symptoms: tremor, risk for seizures

Risk of suicide ! Latency effect Over dosage

2. SSRIs

See Anxiety

3. Mono-Amin Oxydase Inhibitors (MAOI)

Reduce catabolism Irreversibly restriction for food containing tyramine (!!) could induce HTA Selective reversible inhibitors of MAO

Moclobemid Washout period is mandatory!

4. New generation AD

Mirtazapine (Remeron) 30-45 mg/day

Venlafaxin (Efexor) 75-150 mg/day

Basic rules
Acute phase: - explain the delay in action - analyse: clinical picture past response (if) - One or two AD? - Increase slowly - Sufficient period

Continuation phase +/- concomitant medication: antipsychotic, anxiolytic, hypnotic

Maintenance therapy

Gradually tapering for AD Mood stabilizer: carbamazepine, lamotrigine

Other therapies:

ECT Light therapy Sleep deprivation

Mania
Episode treatment sedation bz: diazepam, clonazepam, lorazepam Diminishing mania and psychosis antipsychotic drugs: haloperidol, olanzapine Antimanic (mood stabilizer): Lithium carbonate: monitoring lithemia 0.81.2 mEq/l (900-1800 mg/day) Thyroid function (hTY) Renal fct. Hematology EKG Neurological lithium intoxication

CARBAMAZEPINE 200-400 mg/day VALPROIC ACID 20 mg/kg

Side-effects: gastro-intestinal, liver toxicity, thrombocytopenia

Maintenance treatment: mood stabilizer Lithium or Valproic Acid or Carbamazepine

OBSESSIVE-COMPULSIVE DISORDER

ETIOLOGY

1. Neurotransmitters: - Serotonin dysregulation - Dopamine hyperfunction 2. Neuroanatomy alterations: - PET: functional alterations (frontal lobe, basal ganglia) - CT, MRI: structural alterations 3. Genetics

4. Behavioural factors - Respondent conditioning - Strategies to control aux fixed equivalents of avoidance 5. Personality factor - obsessive-compulsive traits 6. Early experiences - obsessional mother 7. Psychoanalytical theory - repressed impulses - regression to the anal stage

Symptomatology

Obsessional Obsessional Obsessional Obsessional

thoughts images ruminations impulses

Compulsion: A. mental activities - counting - repeating - lucky/unlucky no.

Compulsion

B. Behavioural: - Hand washing - Ordering - Checking - Need: ask, symmetry, precision - Hoarding - Collection

Obsessive phobias Obsessive slowness

Associated conditions

Depression suicide Body dysmorphic disorder Derealization/depersonalization Hypochondria Tourette disorder Impulse disorder Psychosis

Treatment 1. Pharmacotherapy

Psychotherapy
Cognitive-behavioural individual

Self-exposure and response prevention Flooding S O R C Situation Organism Reaction Consequence Day structuring Homeworks

Group therapy - patients - families

Psycho-education Supportive