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On Mood Disorder
On Mood Disorder
Department of Psychiatry
1st Faculty of Medicine
Charles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc.
Mood (Affective) Disorders
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:
1. those that are characterized by depression only
2. 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
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
F32 Depressive Episode
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.
relapse recurrence
severity of depression
no depression
relapse
response
symptoms
syndrome
time
Kupfer 1991
F33 Recurrent Depressive Disorder
F33 Recurrent depressive disorder
F33.0 Recurrent depressive disorder, current episode
mild
F33.1 Recurrent depressive disorder, current episode
moderate
F33.2 Recurrent depressive disorder, current episode
severe without psychotic symptoms
F33.3 Recurrent depressive disorder, current episode
severe with psychotic symptoms
F33.4 Recurrent depressive disorder, currently in
remission
F33.8 Other recurrent depressive disorders
F33.9 Recurrent depressive disorder, unspecified
F30 Manic Episode
F30 Manic episode
F30.0 Hypomania
F30.1 Mania without psychotic symptoms
F30.2 Mania with psychotic symptoms
F30.8 Other manic episodes
F30.9 Manic episode, unspecified
F30.0 Hypomania
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
F30.1 Mania without Psychotic
Symptoms
Mania without psychotic symptoms:
• last for at least 1 weak
• mood is elevated out of keeping with individual’s
circumstances and may vary from carefree joviality to
almost uncontrollable excitement
• elation is accompanied by increased energy, resulting in
overactivity, pressure of speech, and a decreased need for
sleep
• normal social inhibition are lost, attention cannot be
sustained, and there is often marked distractibility
• self-esteem is inflated, and grandiose or over-optimistic
ideas are freely expressed
• perceptual disorders may occur
• the individual may embark on extravagant and impractical
schemes, spend money recklessly, or become aggressive,
amorous, or factious in inappropriate circumstances.
F30.2 Mania with Psychotic
Symptoms
Mania with psychotic symptoms represents a
more severe form of mania:
• inflated self-esteem and grandiose ideas may develop into
delusions, and irritability and suspiciousness into delusions
of persecution
• in severe cases, grandiose or religious delusions of identity
or role may be prominent, and flight of ideas and pressure of
speech may result in the individual becoming
incomprehensible
• sustained physical activity and excitement may result in
aggression or violence, and neglect of eating, drinking, and
personal hygiene may result in dangerous states of
dehydration and self neglect
Mania with:
• mood-congruent psychotic symptoms
• mood-incongruent psychotic symptoms
Manic stupor
F31 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.
F31 Bipolar Affective Disorder
F31 Bipolar affective disorder
F31.0 Bipolar affective disorder, current episode hypomanic
F31.1 Bipolar affective disorder, current episode manic without
psychotic symptoms
F31.2 Bipolar affective disorder, current episode manic with
psychotic symptoms
F31.3 Bipolar affective disorder, current episode mild or
moderate depression
F31.4 Bipolar affective disorder, current episode severe
depression without psychotic symptoms
F31.5 Bipolar affective disorder, current episode severe
depression with psychotic symptoms
F31.6 Bipolar affective disorder, current episode mixed
F31.7 Bipolar affective disorder, currently in remission
F31.8 Other bipolar affective disorders
F31.9 Bipolar affective disorder, unspecified
F34 Persistent Mood (Affective)
Disorders
Persistent mood disorders are persistent and
usually fluctuating disorders of mood in which
individual episodes are not sufficiently severe to
warrant being described as hypomanic or even mild
depressive episodes.
Lasting more than 2 years
Supportive psychotherapy.
Treatment of Depression
First episode of depression - the drug should be
continued for another 16-20 weeks after the patient
is thought to be well (continuation treatment to
prevent recurrence).
The medication should be tapered gradually because
many patients experience some mild withdrawal
effects.
Patients with recurrent depression need long-term
maintenance therapy to prevent relapses.
Electroconvulsive therapy (ECT) is the treatment of
choice for some patients with very severe
depression, with high potential for suicide or other
selfdestroying behaviour and for pregnant women.
Other biological methods:
• phototherapy (seasonal affective disorder)
• sleep deprivation
• repetitive transcranial magnetic stimulation (rTMS).
Treatment of Mania
Mood stabilizers:
• lithium (0.6—1.2 mEq/L)
• carbamazepine (6—12 mg/L)
• valproate (50—125 mg/L)
Anticonvulsants:
• gabapentine
• topiramate
• lamotrigine
Agitated or psychotic patient –
coadministartion of
• antipsychotics of second generation
(olanzapine, risperidone)
• benzodiazepines (lorazepam, clonazepam)
ECT