Elmeida Effendy

Psychiatric Department
Medical Faculty- USU

=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

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

Patients with elevated mood :

Expansiveness
Flight

of ideas
Decreased sleep
Heightened self-esteem
Grandiose ideas

Patients with depressed mood :

Loss

of energy & interest

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

Other signs & symptoms :

Changes

in activity level
Cognitive abilities
Speech
Vegetative functions (sleep, sexual activities)

Result

in impaired interpersonal, social and

functioning

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

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

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

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-4hydroxyphenylglycol (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 longlasting changes in the brains 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 objects 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 patients 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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