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=affective disorders Mood disorders is preferred cause it refers to sustained emotional states, not merely to the external (affective) expression of a transitory emotional state Mood may be normal, elevated or depressed

Normal persons experience a wide range of mood have an e!ually large repertoire of affective expressions " they feel in control, more or less, of their moods and effects #n mood disorders the sense of control is lost, there is a sub$ective experience of great distress

&atients with elevated mood '

(xpansiveness )light

of ideas *ecreased sleep +eightened self,esteem -randiose ideas

&atients with depressed mood '

/oss

of energy interest )eelings of guilt *ifficulty concentrating /oss of appetite 0hought of death or suicide

2ther signs
3hanges

symptoms '

in activity level 3ognitive abilities 4peech 5egetative functions (sleep, sexual activities)

6esult

in impaired interpersonal, social and functioning

ma$or depressive episode ' M**= unipolar depression Manic depressive episode ' bipolar disorder Manic episodes alone ' bipolar disorder Manic episode alone = unipolar mania = pure mania=euphoric mania

9 ma$or depressive disorder(M**=unipolar depression)occurs without a history of a manic, mixed or hypomanic episode M** must last at least 2 wee:s 9 manic episode is a distinct period of an abnormally persistently elevated, expansive or irritable mood lasting for at least 1 wee:

9 hypomanic ' last at least . days similar to a manic episode except that is not severe enough to cause impairment in social or occupational functioning no psychotic features are present <oth mania
#nflated

hypomania are associated with

self,esteem *ecreased need for sleep *istractibility -reat physical mental activity 2verinvolvement in pleasureable behavior

<ipolar # disorder ' 1 or more manic episodes, sometimes ma$or episodes episode 9 mixed episode is a period of at least 1 wee: in which both manic episode a ma$or depressive episode occur almost daily <ipolar ## disorder ' episodes of ma$or depression hypomania

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*ysthymic disorder' at least 2 years of depressed mood that is not severe enough to fit the diagnosis of ma$or depressive epidode 3yclothymic disorder ' at least 2 years of fre!uently occurring hypomanic symptoms that cannot fit the diagnosis of manic episode of depressive symptoms that cannot fit the diagnosis of ma$or depressive episode

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<iological )actors
9bnormalities

in biogenic amine metabolites such as 1 hydroxy indole acetic acid (1,+#99), homovanilic acid (+59) %,methoxy,., hydroxyphenylglycol (M+&-) in blood, urine 34) Neuroendocrine 6egulation 4leep 9bnormalities 3ircadian rhytms

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-enetic )actors &sychososial )actors

/ife

events

environmental 4tress

4tress accompanying the first episode results in long, lasting changes in the brain?s biology /ong lasting changes may alter the functional states of various neurotransmitter intra neuronal signaling systems ' loss of neuron excessive reduction in synaptic contacts

&ersonality

)actors

No single personality trait predispose a person to depression 2bsessive,compulsive disorder, histrionic borderline' greater ris:

&sychodynamic

)actors 3ognitive 0heory

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 &sychodynamic

)actors

&sychodynamic )actors in *epression )reud 9braham

*isturbance in the infant,mother relationship during oral,phase /in:ed to real or imagined ob$ect #ntro$ection of the departed ob$ects, defens mechanism invo:ed to deal with ob$ect?s loss /oss ob$ect is regarded with a mixture of love hate, feelings of anger are directed inward at the self

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&sychodynamic )actors in Mania 9braham ' manic episode may reflect an inability to tolerate a developmental tragedy, such as loss of a parent 6esult from a tyrannical superego,which produces intolerable self criticism that is then replaced by euphoric self satisfaction /ewin ' manic patient?s ego as overwhelmed by pleasurable impulses such as sex or by feared impulses such as aggression @lein ' defensive reaction to depression, using manic defenses such as omnipotence, the person develops delusion grandeur

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3ognitive 0heory 9aron <ec: 'cognitive triad of depression '

1A views about the self, a negative self,precept 2A(nvironment B a tendency to experience the world as hostile demanding %A )uture 'expectation of suffering failure

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*epressed mood Mar:edly diminished interest or pleasure in all 4ignificant weight loss when not dieting or weight gain (change of more than 1 C of body weight in amonth) #nsomnia or hypersomnia &sychomotor agitation or retardation

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)atigue or loss of energy )eelings of worthlessness or excessive or inappropriate guilt *iminished ability to thin: or concentrate 6ecurrent thoughts of death

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#nflated self esteem or grandiosity *ecreased need for sleep (feels rested after only % hours sleep) More tal:ative than usual or pressure to :eep tal:ing )light of ideas or sub$ective experience that thoughts are racing *istractibility

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#ncrease in goal directed activity ( socially, wor:, school, sexually) (xcessive involvement in pleasurable activities that have a high potential for painful conse!uences

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