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AFFECTIVE DISORDERS

Dr. Adel Alzayed


Kuwait university – medical
college
Department of Psychiatry
Objectives

 To understand Affective disorder and be able to
differentiate them from other disorders.
 To identify different types of affective disorders:
 Unipolar
 Bipolar
 To be able to draw a management plan for
affective disorders
 To be able to discuss the prognosis of affective
disorders

Definition


 Affective Disorders are disorders of the mood.
 i.e. elation or depression of the mood.

 Classification
 
 

 

 

 

 Unipolar Bipolar
 

 Only Depressive episodes Had at least one


 patient never had manic manic or
hypomanic
 or hypomanicphases episode (or mixed
episode)
  

Epidemiology
Epidemiology of Bipolar and Unipolar disorder (Major Depression

Bipolar Disorder Unipolar Disorder

Lifetime Risk About 1% 10-20 %

Sex Ratio (M:F) 1:1 1:2

First Degree relatives:

Lifetime risk for Bipolar Disorder About 10% About 2%

Lifetime risk for Unipolar Disorder 10-15% 10-15%

Average age of onset 21 Years 27 Years


Depression
Symptoms needed to meet criteria for ' depressive episode' in ICD-10

A. Depressed mood
Loss of interest and enjoyment
Reduced energy
and decreased activity

B Reduced concentration
Reduced self-esteem and confidence
Ideas of guilt and unworthiness
Pessimistic thoughts
Ideas of self-harm
Disturbed sleep
Diminished appetite

Mild depressive episode: at least 2 of A and at least 2 of B


Moderate depressive episode: at least 2 of A and at least 3 of B
Severe depressive episode: all 3 of A and at least 4 of B
Severity of symptoms and degree of functional impairment also guide classification
Differential Diagnosis

- Normal Sadness
- Anxiety Disorder
- Schizophrenia
- Organic Brain Syndrome

Course & Prognosis
 The age of onset of unipolar disorders varies widely; it is generally
agreed to be later than for bipolar cases.
 The average length of a depressive episode is about 6 months.
 About 80% of patients with major depression will experience further
episodes.
 As with bipolar patients, the interval between episodes becomes
progressively shorter.
 About one third of depressed patients do not achieve complete symptom
remission between episodes.
 The longer-term prognosis of depression may be a little better in some
ways than that of bipolar disorder but is still modest.

The assessment of depressive disorder


 The steps in assessment are:
 To decide whether the diagnosis is depressive disorder.
 To judge the severity of the disorder, including the risk
of suicide.
 To form an opinion about the causes.
 To assess the patient's social resources.
 To gauge the effect of the disorder on other people
Management

 In- patient Vs Out-patient:

 - depends on severity

 * Mild – moderate : Out- patient is possible


 * Moderate – Severe : In Patient.




 Psychotherapy:-
 - Psycho + Drug therapy- better than either
alone
 - In selected mild cases Psychotherapy
alone could be enough
 - C.B.T is the most reliable form.
 - is very helpful in preventing relapses.


 Drug therapy:-
  
 - First line : SSRI's or SNRI's
 -Second line: TCA's
 -Third line: MAOI's

 ECT:-
  
 - Severe cases: were severe physical
deterioration is evident
 - Suicidal patient
 - Treatment resistant cases.

Mania

 * Mood:-
 - Elevated
 - Irritable
 

 * Appearance + Behaviour
 - Clothes brightly coloured
 - Untidy and disheveled
 - Over active
 - Food intake
 - Sexual desire + activity
 - Disinhibition
 - Sleep reduced
 


 * Speech and thoughts:-


 - Rapid
 - Flight of Ideas
 - Expensive Ideas
 - Grandiose Delusions
 

* Perceptual Disturbances :-

 - Hallucinations also occur.



Deferential diagnosis

- Anxiety
- Schizophrenia
- Drug induced Psychosis
- Physical Condition
 . Thyrotoxicosis
- Organic Brain Syndrome
Course & Prognosis

 The age of onset of Bipolar Disorder is typically


about 21 Years.
 Late-onset Bipolar Disorder is rare and may be
participated by organic brain disease.
 The average length of a manic episode (treated
or untreated ) is about 6 months.
 At least 90% of patients with mania experience
further episodes of mood disturbance.
 The interval between episodes becomes
progressively shorter with both age and the
number of episodes.
 Nearly all bipolar patients recover from acute
episodes but the long-term prognosis is
rather poor.
The Assessment of Mania

 Decide the diagnosis
 Assess the severity of the disorder
 Form an opinion about the causes
 Assess the patient's social resources
 Judge the effects on other people.

Management

 In-patient Vs Out-patient
 - All cases of mania requires admission.
 - Cases of hypomania can be managed on
out-patient bases with frequent
assessments.
  

 Acute Phase:-
 a) Anti Psychotic Medications
 - Typical
 - Atypical
 

 b) Mood Stabilizers
 - Lithium
 - Sodium Valproate
 - Carbamazepine
 

 c) Benzodiazepines