Elmeida Effendy

Psychiatric Department
Medical Faculty- USU

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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

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 Normal persons experience a wide range of
mood & have an equally large repertoire of
affective expressions ; they feel in control,
more or less, of their moods and effects

 In mood disorders the sense of control is lost,

& there is a subjective experience of great
distress

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 Patients with elevated mood :

 Expansiveness
 Flightof ideas
 Decreased sleep
 Heightened self-esteem
 Grandiose ideas

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 Patients with depressed mood :

 Loss of energy & interest

 Feelings of guilt
 Difficulty concentrating
 Loss of appetite
 Thought of death or suicide

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 Other signs & symptoms :
 Changes in activity level
 Cognitive abilities
 Speech
 Vegetative functions (sleep, sexual activities)

 Resultin impaired interpersonal, social and

functioning

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 major depressive episode : MDD= unipolar
depression

 Manic & depressive episode : bipolar

disorder
 Manic episodes alone : bipolar disorder
 Manic episode alone = unipolar mania =
pure mania=euphoric mania

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 A major depressive disorder(MDD=unipolar
depression)occurs without a history of a
manic, mixed or hypomanic episode
 MDD must last at least 2 weeks

 A manic episode is a distinct period of an

abnormally & persistently elevated,
expansive or irritable mood lasting for at
least 1 week

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 A hypomanic : last at least 4 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

 Both mania & hypomania are associated with

 Inflated self-esteem
 Decreased need for sleep
 Distractibility
 Great physical & mental activity
 Overinvolvement in pleasureable behavior

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 Bipolar I disorder : 1 or more manic episodes,
& sometimes major episodes episode

 A mixed episode is a period of at least 1

week in which both manic episode & a major
depressive episode occur almost daily

 Bipolar II disorder : episodes of major

depression & hypomania

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 Dysthymic disorder: at least 2 years of
depressed mood that is not severe enough to
fit the diagnosis of major depressive epidode

 Cyclothymic disorder : at least 2 years of

frequently occurring hypomanic symptoms
that cannot fit the diagnosis of manic
episode & of depressive symptoms that
cannot fit the diagnosis of major depressive
episode

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 Biological Factors
 Abnormalities in biogenic amine metabolites
such as 5 hydroxy indole acetic acid (5-HIAA),
homovanilic acid (HVA) & 3-methoxy-4-
hydroxyphenylglycol (MHPG) in blood, urine &
CSF
 Neuroendocrine Regulation
 Sleep Abnormalities
 Circadian rhytms

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 Genetic Factors
 Psychososial Factors
 Life events & environmental Stress
 Stress accompanying the first episode results in long-
lasting changes in the brain’s biology
 Long lasting changes may alter the functional states of
various neurotransmitter & intra neuronal signaling
systems : loss of neuron & excessive reduction in
synaptic contacts
 Personality Factors
 No single personality trait predispose a person to
depression
 Obsessive-compulsive disorder, histrionic &
borderline: greater risk
 Psychodynamic Factors
 Cognitive Theory

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 Psychodynamic Factors
 Psychodynamic Factors in Depression
 Freud & Abraham
 Disturbance in the infant-mother relationship during
oral-phase
 Linked to real or imagined object
 Introjection of the departed objects, defens mechanism
invoked to deal with object’s loss
 Loss object is regarded with a mixture of love & hate,
feelings of anger are directed inward at the self

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 Psychodynamic Factors in Mania
 Abraham : manic episode may reflect an inability to
tolerate a developmental tragedy, such as loss of a
parent
 Result from a tyrannical superego,which produces
intolerable self criticism that is then replaced by
euphoric self satisfaction
 Lewin : manic patient’s ego as overwhelmed by
pleasurable impulses such as sex or by feared
impulses such as aggression
 Klein : defensive reaction to depression, using
manic defenses such as omnipotence, the person
develops delusion grandeur

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 Cognitive Theory
 Aaron Beck :cognitive triad of depression :
 1. views about the self- a negative self-precept
2.Environment – a tendency to experience the world as
hostile & demanding
3. Future :expectation of suffering & failure

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 Depressed mood
 Markedly diminished interest or pleasure in
all
 Significant weight loss when not dieting or
weight gain (change of more than 5 % of body
weight in amonth)
 Insomnia or hypersomnia
 Psychomotor agitation or retardation

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 Fatigue or loss of energy
 Feelings of worthlessness or excessive or
inappropriate guilt
 Diminished ability to think or concentrate
 Recurrent thoughts of death

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 Inflated self esteem or grandiosity
 Decreased need for sleep (feels rested after
only 3 hours sleep)
 More talkative than usual or pressure to keep
talking
 Flight of ideas or subjective experience that
thoughts are racing
 Distractibility

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 Increase in goal directed activity ( socially,
work, school, sexually)

 Excessive involvement in pleasurable

activities that have a high potential for
painful consequences

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