Affective disorders

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Affective disorders

• Shaul Lev-Ran, MD
• Shalvata Mental Health Center

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• Major Depressive disorder
• Dysthymic disorder
• Cyclothymia
• Bipolar II disorder
• Bipolar I disorder

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Major depressive disorder

• Prevalence15
• FgtM
• Mean age of onset40
• Genetic
• 1st degree relative of MDD 2-3 times the chance
  of suffering from MDD

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

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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

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Consequences

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

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Specifiers describing depressive episode

• With psychotic features
• With melancholic features
• With atypical features
• With catatonic features
• Postpartum onset

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Treatment - goals

• 5 X R
• (achieve) Response
• (achieve) Remission
• (achieve) Recovery
• (prevent) Relapse
• (prevent) Recurrence

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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

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• What Biopsychosocial approach
• Biomedication, 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
• Socialcouples, family, occupational, etc.

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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.
• 75recurrence in 5 yrs.

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Bipolar I disorder

• Prevalence1
• MF
• Mean age of onset30
• 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.

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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

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Mixed episode

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

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Specifiers describing recurrent episodes

• Rapid cycling -4 or more episodes in 1 yr.
• With seasonal pattern

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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

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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

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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

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Cyclothymia

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

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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

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• What Biopsychosocial approach
• Biomedication, 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
• Socialcouples, family, occupational, etc.