Affective (mood) disorders.

Lesson 2
Epidemiological features of mood
disorders
 Depressive episodes are more common in females
 There is a raised incidence in those who are not
married.
 The average age of onset of depressive episodes is
around the late thirties; however, they can start at
any age.
 About 15% of urban women had severe depressive
symptoms, and there was a higher prevalence in
working-class than in middle-class women.
Biopsychosocial model of etiology and
pathogenesis of mood disorders
 Biological factors (genes, twin studies, family studies,
candidate genes, neuroedocrine changes and
neurotransmitter dysfunction)
 Psychological factors (EQ, thinking, self-esteem,
coping, capacity, personality)
 Social factors (martial, family, gender, age, culture,
social environment)
Classification of affective (mood)
disorders according to ICD-10
 F30-F39 Mood [affective] disorders
 F30 Manic Episode
 F31 Bipolar affective disorder
 F32 Depressive episode
 F33 Recurrent depressive disorder
 F34 Persistent mood [affective] disorders
 F38 Other mood [affective] disorders
 F39 Unspecified mood [affective] disorder

Depressive episode classification
 F32 Depressive episode
 F32.0 Mild depressive episode
 .00 Without somatic syndrome
 .01 With somatic syndrome
 F32.1 Moderate depressive episode
 .10 Without somatic syndrome
 .11 With somatic syndrome
 F32.2 Severe depressive episode without psychotic
symptoms
 F32.3 Severe depressive episode with psychotic symptoms
 F32.8 Other depressive episodes
 F32.9 Depressive episode, unspecified
F33 Recurrent depressive disorder
 F33.0 Recurrent depressive disorder, current episode mild
 .00 Without somatic syndrome
 .01 With somatic syndrome
 F33.1 Recurrent depressive disorder, current episode moderate
 .10 Without somatic syndrome
 .11 With somatic syndrome
 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
F32.0 Mild depressive episode symptoms
 The main symptoms:
 depressed mood,
 slowing of thinking,
 psychomotor retardation,
 increased fatigability and loss of interest and
enjoyment
Mild depressive episode symptoms
 Additional symptoms are:

 reduced concentration and attention;

 reduced self-esteem and self-confidence;
 ideas of guilt and unworthiness (even in a mild type of
episode);
 bleak and pessimistic views of the future;
 ideas or acts of self-harm or suicide;
 disturbed sleep
 diminished appetite.
Mild depressive episode symptoms
 Without somatic syndrome
 With somatic syndrome (tachycardia, spastic
constipation, diarrheal disorders, disturbance of
menstruation, increased blood pressure, headaches,
decreased libido, weight loss, loss of appetite)

 Diagnosis: at least two of typical symptoms of

depression, plus at least two of the other symptoms.
 Minimum duration of the whole episode is about 2
weeks.
F32.1 Moderate depressive episode
 At least two of the three most typical symptoms noted for
mild depressive episode (F32.0) should be present, plus at
least three (and preferably four) of the other symptoms.
 Without somatic syndrome
 With somatic syndrome (tachycardia, spastic
constipation, diarrheal disorders, disturbance of
menstruation, increased blood pressure, headaches,
decreased libido, weight loss, loss of appetite)

 Minimum duration of the whole episode is about 2 weeks.

F32.2 Severe depressive episode
without psychotic symptoms
 All three of the typical symptoms noted for mild and
moderate depressive episodes (F32.0, F32.1) should be
present, plus at least four other symptoms, some of
which should be of severe intensity.
 The depressive episode should usually last at least 2
weeks, but if the symptoms are particularly severe and
of very rapid onset, it may be justified to make this
diagnosis after less than 2 weeks.
F32.3 Severe depressive episode with
psychotic symptoms
 A severe depressive episode which meets the criteria
given for F32.2 above and in which delusions,
hallucinations, or depressive stupor are present.
 The delusions usually involve ideas of sin, poverty,
or imminent disasters, responsibility for which may be
assumed by the patient.
 Auditory or olfactory hallucinations are usually
of defamatory or accusatory voices or of rotting
filth or decomposing flesh.
 Severe psychomotor retardation may progress to
stupor.
Bipolar affective disorder
 This disorder is characterized by repeated (i.e. at least
two) episodes in which the patient's mood and activity
levels are significantly disturbed, this disturbance
consisting on some occasions of an elevation of mood
and increased energy and activity (mania or
hypomania), and on others of a lowering of mood and
decreased energy and activity (depression).
 Characteristically, recovery is usually complete
between episodes, and the incidence in the two sexes is
more nearly equal than in other mood disorders.
ICD-10 classifications
BIPOLAR AFFECTIVE DISORDER
bipolar affective disorder with:
 current episode hypomanic,
 or current episode manic without psychotic symptoms,
 or current episode manic with psychotic symptoms
bipolar affective disorder with:
 current episode having mild/moderate depression,
 or current episode having severe depression without
psychotic symptoms,
 or current episode having severe depression with psychotic
symptoms
bipolar affective disorder with:
 urrent episode mixed.
Bipolar affective disorder
 Manic episodes usually begin abruptly and last for
between 2 weeks and 4-5 months (median duration
about 4 months).
 Depressions tend to last longer (median length about 6
months)
Manic episode
 The main symptoms:
 increase mood,
 increase mental activity
 increase in the quantity and speed of physical activity
Manic episode
 The fundamental disturbance is an elevation of mood
to elation, with concomitant increase in activity level.
 Three degrees of manic episode are specified by
ICD-10, all used for a single manic episode only:
 Hypomania.
 Mania without psychotic symptoms
 Mania with psychotic symptoms
Hypomania
 There is persistent elevated mood, increased energy
and activity, feelings of wellbeing, and reduced need
for sleep.
 Irritability may replace elation.
 Work is considerably disrupted.
 There are no hallucinations or delusions.
Mania without psychotic symptoms
 Mood is elevated, with almost uncontrollable
excitement.
 There is over-activity, pressured speech, reduced sleep,
distractible, inflated self-esteem, and grandiose
thoughts.
 Perceptual heightening may occur.
 The person may spend excessively, become aggressive,
amorous, or facetious.
Mania with psychotic symptoms
 The symptoms are as above, but with delusions and
hallucinations, usually grandiose.
 There may be sustained physical activity, aggression
and self neglect.
Persistent mood disorders: dysthymia
 Dysthymia
 This is a chronic, less severe depression, usually with
an insidious onset.
 Symptoms include excessive guilt, difficulty in
concentrating, loss of interest, pessimism, low self-
esteem, low energy, irritability and reduced
productivity.
 For the diagnosis it must be present for at least 2 years.
ICD-10 and DSMIV-TR criteria are similar.
Persistent mood disorders:
cyclothymia

 cyclothymia
 This is characterized by persistent instability of mood
with numerous periods of mild depression and mild
elation.
 It may predispose to bipolar disorder.

 Severity slight drop in mood and light of mood

elevation not consistent with depression or mania.
The duration of mood swings is not less than 2
years