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Mood Disorder

Mood Disorder

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Published by Vaibhav Krishna

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Published by: Vaibhav Krishna on May 18, 2010
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01/24/2013

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SCHIZOPHRENIA

Schizophrenia is a common mental disorder it is mainly characterized by

Disturbances in

Thinking Feeling Behavior

Epidemiology
Incidence .05 - .25% Prevalence .2 - 1% Sex - Equal Age - 15-25yrs (Could be any age) Socio-economic - No difference Status

Etiology
A) Genetics i) close relatives show much higher risk of schizophrenia compared to general population. ii) MZ twin have a high concordance rate for schizophrenia iii) The biological parents of a schizophrenic shown higher prevalence of this disorder then the adopted parents B) Biogenic Amines Schizophrenia is presently thought to be probably due to increase of dopamine at the post synaptic receptor. Other neurotransmitters like serotonin, GABA and AC are also presumably involved.

Etiology
C) Neuropathology Carnial CT Scan, MRI and post-mortem studies show enlarged lateral and third ventricles, and mild cortical atrophy PET - shows hypofrontality and decreased glucose utilisation in dominant temporal lobe. D) Psycho Social i) Socio-economic status. ii) Family psychopathology Inappropriate communication amongst the family members Unhealthy parent - child interaction

Etiology
iii) StressSchizophrenia commonly develops during adolescence and or in post-partum phase and both these periods are of intense endocrine disturbances as well as psychological stress. It is possible that some biological or psychological stress may be associated with the precipitation of the disorders in vulnerable individual.

Summary of ethological Theories of schizophrenia
1. Genetic 2. Biochemical 3.Brati Pathology 4. Endocrinal Abnormalities 5. Psychosocial - family pathology and stress.

Clinical Features (A) General Behavior Withdrawal Overactivity, aggressive, aversive or destructive Catatonic stupor Waxy flexibility Posturing Negativism Automatic obedience echolalia Echopraxia

Clinical Features (B) Disorders of thinking a) Disturbance of thought process i) Irrelevant speech ii) Incoherent speech iii) Loosening of association iv) Circumstantiality v) Tangentially vi) Neologism vii) Verbigeration viii) World salad ix) Poverty of thought x) Thought block xi) Perseveration xii) thought being read xiii) thought control xiv) Thought withdrawal

Clinical Features (B) Disorders of thinking b) Disturbance of thought content i) Delusion Delusion of control Delusion of persecution Delusion of reference Delusion of Grandeur (C) Disorders of perception Hallucination - Auditory, visual, Tactile, gustatory and olfactory (D) Disorders of Affect Apathy Blunting Incongruity

Clinical Features (E) Attention and concentration Attention - difficult to arouse concentration - generally poor. (F) Impulse control Usually poor Behaviors is unpredictable (G) Orientation and consciousness Conscious and oriented to time, place and person. (H) Intelligence and memory Usually not affected. (I) Insight and Judgement Insight is often poor and can not make proper Judgement

Sub types of schizophrenia
Paranoid Hebephrenic Catatonic Undifferentiated Residual Simple Post- Schizophrenic depression

Management
a) Management of acute episode b) Maintenance treatment c) Rehabilitation d) Prevention

Mood Disorder
Classification:
1. 2. 3. 4. 5. Manic episode Depressive episode Bipolar mood disorder Recurrent depressive disorder Persistent mood disorder (Cyclothymia and dysthymia) 6. Other mood disorder

Life time prevalence 0.8 to 1% F:M:: 2:1

Etiology:
1. Genetic Theory Life-time risk for the first degree relative of bipolar mood disorders is 25% Children of one parent with mood disorder is 27% Both parent with mood disorder is 74% Concordance rate in MZ twin is 65% DZ twin is 20%

2.

Biochemical Theory Relative deficiency of non epinephrine or 5 Hydroxytryptamine or Dopamine is associated with depression. with mania Neuroendocrine Mood disorders are prominently present in many endocrine disorders eg. Hypothyroidism, Cushing’s disease, Addison’s disease. Endocrine function is often disturbed in depression with hypersecretion of cortisol blunted TSH response to TRH and blunted GH production.

3.

4.

Brain Structure:

Brain imagining techniques have shown decrease in blood flow and glucose metabolism in frontal lobes.

Manic Episode:
3 areas are mainly affected. Onset – Acute 1. Elevated mood 2. Psychomotor activity 3. Speech and thought
1. Elevated Mood:

Euphoria – Sense of well being and happiness Elation – Feeling of confidence and enjoyment along with psychomotor activity Exaltation – Intense elation with delusion of grandeur Ecstasy – Very severe elation of mood.

2. 3.

Psychomotor Activity Speech and thought More talkative, describes thoughts racing in mind. Pressure of speech Flight of ideas Grandeur delusion Delusion of grandeur identity Delusion of grandeur ability Depending on the severity of the symptoms, the Manic episode has been classified as: a) Hypomania b) Mania without psychotic features c) Mania with psychotic symptoms

4. Other Features: Person becomes impulsive, Shows disinhibition Sexual indiscretion Hypersexual and promiscuous Buying sprees Reckless driving Distributing money, personal articles Dressed up in gaudy and flamboyant clothes Sleep Appetite Insight - absent

Treatment: a) Drugs: Antipsychotic Haloperidol 10 – 30mg Olanzapine 10 – 30mg Mood Stabilizer Lithium Sodium Valporate Carbamezapine Anxiolytics Clonazepam b) ECT c) Nursing management

Depressive Episode:
Most common mental disorder 2 – 4% of the population are suffering from Depression. Onset – gradual 1. Depressed Mood: Sadness of mood – present throughout the day Should last at least for 2 weeks Loss of interest in daily activities Painful and agonising -> crying Anhedonia

2.

Depressive Ideation / Cognition: a. Hopelessness b. Helplessness c. Worthlessness -> guilt feeling Psychomotor Activity: Difficulty in thinking, in concentration Indecisiveness Lack of initiative and energy Suicidal ideas may be present Slow and retarded Agitation, Irritability Anxiety – frequent accompaniment

3.

4. Physical Symptoms: Heaviness in head Vague body action fatigue 5. Biological Function: Insomnia Loss of appetite Weight loss Loss of libido

* Depressed mood * Loss of interest * Loss of energy * Inappropriate guilt * Recurrent thoughts of death or suicidal ideas * Diminished concentration * Psychomotor agitation or retardation * Insomnia * Loss of appetite

Major depression: Emotional Psychomotor Negative beliefs Question to be asked:* Do you feel depressed? * Is there any change in your self esteem * Are you being more self critical

Three key features: Depressed mood Lowered self esteem Increased self criticism

Treatment: a) Drugs: Antipsychotic Tricyclic antidepressant Irripramine Amitryptyline Nortryptyline SSRI Fluoxetine Sertaline Citalopram Escitalopram Paroxetine Fluvoxamine

Treatment: b) ECT c) Psychosocial treatment Cognitive behaviour therapy Interpersonal therapy Group therapy Family and marital therapy d) Nursing management

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