Mood (Affective) Disorders

Posted by e-Medical PPT
Mood disorders are very common, their life prevalence is up to 20 %, and they have a high level of morbidity and mortality as well as an immense impact on disabilities worldwide.
The fundamental disturbance is a change in mood or affect, usually to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity.
Most of these disorders tend to be recurrent, and the onset of individual episodes is often related to stressful events or situations.
The mood disorders may be subdivided into unipolar and bipolar types:
those that are characterized by depression only
those that are characterized by manic episode either alone or in combination with depression

Classification of Mood Disorders
International Classification of Diseases (ICD-10) came into use in WHO Member States as from 1994

F30   Manic episode
F31   Bipolar affective disorder
F32   Depressive episode
F33   Recurrent depressive disorder
F34   Persistent mood (affective) disorders
F38   Other mood (affective) disorders
F39   Unspecified mood (affective) disorder

Depressive episode:
depressed mood
loss of interest and enjoyment
reduced energy leading to increased fatigability and diminished activity
marked tiredness after only slight effort
reduced concentration and attention
reduced self-esteem and self-confidence
ideas of guilt and unworthiness
bleak and pessimistic views of the future
ideas or acts of self-harm or suicide,
disturbed sleep and diminished appetite

Clinical presentation shows marked individual variations
in some cases, anxiety, distress, and motor agitation may be more prominent at times than the depression
the mood change may also be masked (masked depression) by added features such as irritability, excessive consumption of alcohol, histrionic behaviour, and exacerbation of pre-existing phobic or obsessional symptoms, or by hypochondriacal preoccupations.

Depressive episode should last at least 2 weeks (typically several months), but shorter periods may be reasonable if symptoms are unusually severe and of rapid onset.
The lifetime prevalence: 17%; risk of recurrence >50%.

The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called „somatic“ symptoms:
loss of interest or pleasure in activities that are normally enjoyable (anhedonia)
lack of emotional reactivity to normally pleasurable surroundings and events
waking in the morning 2 hours or more before the usual time
depression worse in the morning
objective evidence of definite psychomotor retardation or agitation
loss of appetite
weight loss
loss of libido

Manic Episode
Hypomania is characterized by
persistent mild elevation of mood for at least several days
increased energy and activity
usually marked feelings of well-being and both physical and mental efficiency
Increased sociability, talkativeness, overfamiliarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. There are no hallucinations or delusions

Bipolar Affective Disorder
Bipolar affective disorder is characterized by repeated, at least two episodes in which the patient’s mood and activity levels are significantly disturbed (manic or depressive syndromes, patients who suffer only from repeated episodes of mania are comparatively rare).
The first episode may occur at any age from childhood to old age.
The frequency of episodes and the pattern of remissions and relapses are both very variable.
The lifetime prevalence is between 0,5 an 1 %. Suicidality – about 19%. Comorbidity with alcohol and drug abuse
The rapid-cycling specifier identifies those patients who have had at least four episodes of a major depressive, manic, or mixed episode during the past 12 months.

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