mood disorders - bipolar and major depressive disorders . other mood disorders are also covered on the slides. enjoy your read feel free to comment.

1. MOOD DISORDERS
habakuk larry
Dr. Jaguga

2. • Mood is a pervasive and sustained feeling tone
that is experienced internally and that influences a
person’s behavior and perception of the world.
• Affect is the external expression of mood.
• Mood can be normal, elevated, or depressed.
• Healthy persons feel in control of their moods &
affects. Mood disorders are a group of clinical
conditions characterized by a loss of that sense of
control and a subjective experience of great
distress.

3. • Patients with elevated mood demonstrate
expansiveness, flight of ideas, decreased sleep,
and grandiose ideas.
• Patients with depressed mood experience a loss
of energy and interest, feelings of guilt, difficulty
in concentrating, loss of appetite, and thoughts of
death or suicide.
• Other s/sx of mood disorders include change in
activity level, cognitive abilities, speech, and
vegetative functions (e.g., sleep, appetite, sexual
activity, and other biological rhythms).
• These disorders result in impaired interpersonal,
social, and occupational functioning

4. Depression

5. Depressive disorders
• disruptive mood dysregulation disorder (<12 y),
• Major depressive disorder (including major depressive
episode),
• persistent depressive disorder (dysthymia),
• premenstrual dysphoric disorder,
• substance/medication-induced depressive disorder,
• depressive disorder due to another medical condition,
• other specified depressive disorder, and
• unspecified depressive disorder

6. • The common feature of all of these disorders is
the presence of sad, empty, or irritable mood,
accompanied by somatic and cognitive changes
that significantly affect the individual's capacity to
function
• Major depressive disorder is characterized by
discrete episodes of at least 2 weeks' duration
involving clear-cut changes in affect, cognition,
and neurovegetative functions and inter-episode
remissions

7. Epidemiology
• Incidence and Prevalence:
• Major depressive disorder has the highest lifetime
prevalence (~17%) of any psychiatric disorder
• Globally, over 300 million people are estimated to
suffer from depression, ~4.4% of the world’s
population (WHO, Global Health Estimates 2017)
• Depression ranked by WHO as the single largest
contributor to global disability (7.5%)
• Depression among uni students in Kenya: prevalence of
moderate depressive sx was 35.7% and severe
depression was 5.6% (Othieno, C. et al 2013)

8. • Sex: twofold greater prevalence of major
depressive disorder in women than in men.
• Reasons:
o hormonal differences
o the effects of childbirth
o differing psychosocial stressors for women and for
men and,
o behavioral models of learned helplessness

9. • Age: The mean age of onset for major
depressive disorder is about 40 years, with
50% of all patients having an onset between
the ages of 20 and 50 years
• incidence of MDD increasing among people
younger than 20 years of age. This may be
related to the increased use of alcohol and
drugs of abuse in this age group

10. • Marital status: MDD occurs most often in
persons without close interpersonal
relationships or in those who are divorced or
separated.
• Socioeconomic and Cultural Factors:
Depression is more common in rural areas
than in urban areas, and among lower
socioeconomic classes.

11. • Depression amongst the famous. A recent
study examined the lives of almost 300 world-
famous men and found that over 40% had
experienced some type of depression during
their lives.
• Highest rates (72%) were found in writers, but
the incidence was also high in artists (42%),
politicians (41%), intellectuals (36%),
composers (35%), and scientists (33%).

12. • Although depression can, and does affect
people of all ages, from all walks of life; the
risk of becoming depressed is increased by
poverty, unemployment, life events such as
the death of a loved one or a relationship
breakup, physical illness and problems caused
by alcohol & drug abuse.

13. Comorbidity
• Individuals with major mood disorders are at an
increased risk of having one or more additional
comorbid Axis I disorders.
• The most frequent disorders are alcohol abuse or
dependence, panic disorder, OCD, and social
anxiety disorder.
• Comorbid substance use disorders and anxiety
disorders worsen the prognosis of the illness and
markedly increase the risk of suicide among
patients who have major depressive disorder.

14. Etiology
Biological factors: biogenic amines, other
neurotransmitter disturbances, hormonal
regulation alterations, alterations of sleep
neurophysiology, immunologic disturbance,
neuroanatomical considerations
Genetic Factors
Psychosocial Factors
Cognitive Theory
Learned Helplessness

15. Biological Factors
Biogenic Amines
• Norepinephrine. decreased sensitivity of β-adrenergic
receptors and clinical antidepressant responses indicates a
direct role for the noradrenergic system in depression.
– clinical effectiveness of antidepressant drugs with noradrenergic
effects e.g. Venlafaxine
• Serotonin. Depletion of serotonin may precipitate
depression, and some patients with suicidal impulses have
low CSF concentrations of serotonin metabolites and low
concentrations of serotonin uptake sites on platelets.
– SSRIs highly effective in treating depression
• Dopamine. dopamine activity may be reduced in depression.
Drugs that increase dopamine concentrations reduce sx of
depression.

16. Other Neurotransmitter disturbances
• Acetylcholine. Cholinergic agonists can exacerbate
sx in depression; can induce changes in
hypothalamic-pituitary-adrenal (HPA) activity and
sleep that mimic those associated with severe
depression.
• GABA has an inhibitory effect on ascending
monoamine pathways, esp the mesocortical and
mesolimbic systems. Reductions have been
observed in plasma, CSF, and brain GABA levels in
depression
• drugs that antagonize NMDA receptors (where
glutamate and glyicine bind) have antidepressant
effects.

17. Alterations of Hormonal Regulation: Lasting
alterations in neuroendocrine and behavioral
responses can result from severe early stress.
• Thyroid axis activity. Approximately 5 to 10%
of people evaluated for depression have
previously undetected thyroid dysfunction
• Growth Hormone. Decreased CSF GH levels
have been reported in depression. GH is
secreted from the anterior pituitary after
stimulation by norepinephrine and dopamine.

18. Alterations in sleep neurophysiology
• Depression is associated with a premature loss of
deep (slow-wave) sleep and an increase in
nocturnal arousal, with reduction in total sleep
time.
• Patients manifesting a characteristically abnormal
sleep profile have been found to be less
responsive to psychotherapy and to have a
greater risk of relapse or recurrence and may
benefit preferentially from pharmacotherapy.

19. Immunological Disturbance.
• Depressive disorders are associated with
several immunological abnormalities,
including decreased lymphocyte proliferation
in response to mitogens and other forms of
impaired cellular immunity

20. Psychosocial factors
Life events and environmental stress
• Stressful life events often precede episodes of
mood disorders
• the stress accompanying the first episode
results in long-lasting changes in the brain’s
biology
• the life event most often associated with
development of depression is losing a parent
before age 11 years.

21. • The environmental stressor most often
associated with the onset of an episode of
depression is the loss of a spouse.
• Another risk factor is unemployment;
unemployed persons are 3x more likely to
report sx of an episode of major depression

22. Personality factors
• Persons with certain personality disorders—
OCPD, histrionic, and borderline—may be at
greater risk for depression than persons with
antisocial or paranoid personality disorder.
• However, all humans, of whatever personality
pattern, can and do become depressed under
appropriate circumstances

23. Psychodynamic factors in Depression
Freud’s Theory: The classic view of depression; involves 4 key
points:
1. disturbances in the infant–mother relationship during
the oral phase predispose to subsequent vulnerability to
depression
2. depression can be linked to real or imagined object loss
3. introjection of the departed objects is a defense
mechanism invoked to deal with the distress connected
with the object’s loss
4. because the lost object is regarded with a mixture of love
and hate, feelings of anger are directed inward at the self

24. Other formulations of Depression
• Cognitive Theory: depression results from
specific cognitive distortions present in
persons susceptible to depression
• These distortions, are cognitive templates that
perceive both internal and external data in
ways that are altered by early experiences.
• Cognitive triad of depression (Aaron Beck)

25. I. views about the self—a negative self-precept
II. about the environment—a tendency to
experience the world as hostile and
demanding
III. about the future—the expectation of
suffering and failure.
Therapy consists of modifying these distortions

26. • Learned Helplessness.
• This theory of depression connects depressive
phenomena to the experience of uncontrollable
events.
• One learns that outcomes are independent of
responses, thus cognitive motivational deficits and
emotional deficits develop
• internal causal explanations are thought to
produce a loss of self-esteem after adverse
external events
• improvement of depression is contingent on the
patient’s learning a sense of control and mastery of
the environment.

27. Diagnosis
DSM-5 Criteria for Major Depressive Disorder
A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning: at least one
of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical
condition.
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by
others (e.g., appears tearful). (Note: In children and adolescents, can be
irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most
of the day, nearly every day (as indicated by either subjective account or
observation)
3. Significant weight loss when not dieting or weight gain (e.g., a change of
more than 5% of body weight in a month), or decrease or increase in
appetite nearly every day.
– (Note: In children, consider failure to make expected weight gain.)

28. 4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely self-
reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
others).
9. Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.

29. B. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas
of functioning.
C. The episode is not attributable to the physiological effects
of a substance or to another medical condition.
– Note: Criteria A-C represent a major depressive episode.
D. The occurrence of the major depressive episode is not
better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other
specified and unspecified schizophrenia spectrum and other
psychotic disorders.
E. There has never been a manic episode or a hypomanic
episode.

30. Specifiers:
• With anxious distress
• With mixed features
• With melancholic features
• With atypical features
• With mood-congruent psychotic features
• With mood-incongruent psychotic features
• With catatonia
• With peripartum onset
• With seasonal pattern

31. Clinical Features
• depressed mood and a loss of interest or pleasure are the
key symptoms of depression
• two thirds of all depressed patients contemplate suicide,
and 10 to 15% commit suicide
• withdrawal from family, friends, and activities that
previously interested them
• Almost all depressed patients (97%) complain about
reduced energy; they have difficulty finishing tasks, are
impaired at school and work, and have less motivation to
undertake new projects.
• trouble sleeping, especially early-morning awakening (i.e.,
terminal insomnia) and multiple awakenings at night
• Many patients have decreased appetite and weight loss,
but others experience increased appetite and weight gain

32. • The essential feature of a major depressive episode is a
period of at least 2 weeks during which there is either
depressed mood or the loss of interest or pleasure in
nearly all activities (Criterion A).
• In children and adolescents, the mood may be irritable
rather than sad.
• Other vegetative symptoms include abnormal menses
and decreased interest and performance in sexual
activities.
• Cognitive symptoms include subjective reports of an
inability to concentrate and impairments in thinking.

33. In Children and Adolescents
• School phobia and excessive clinging to
parents may be symptoms of depression in
children.
• Poor academic performance, substance abuse,
antisocial behavior, sexual promiscuity,
truancy, and running away may be symptoms
of depression in adolescents

34. Mental Status Examination
General description
• Generalized psychomotor retardation is the
most common symptom of depression,
although psychomotor agitation is also seen
• Hand-wringing and hair-pulling are the most
common symptoms of agitation.
• Classically, a depressed patient has a stooped
posture, no spontaneous movements, and a
downcast, averted gaze

35. • Mood and Affect. Depression is the key
symptom.
• Speech. Many depressed patients have
decreased rate and volume of speech; they
respond to questions with single words and
exhibit delayed responses to questions.
• Thought. Depressed patients customarily have
negative views of the world and of themselves.
Their thought content often includes non-
delusional ruminations about loss, guilt, suicide,
and death.

36. • Perceptual Disturbances. Depressed patients
with delusions or hallucinations are said to
have a major depressive episode with
psychotic features.
• Mood-congruent delusions in a depressed
person include those of guilt, sinfulness,
worthlessness, poverty, failure, persecution,
and terminal somatic illnesses e.g. Cancer

37. Sensorium and Cognition
• Orientation. Most depressed patients are
oriented to person, place, and time.
• Memory. About 50 to 75% of all depressed
patients have a cognitive impairment, sometimes
referred to as depressive pseudodementia.
• Judgment and Insight. Depressed patients’
description of their disorder is often hyperbolic;
they overemphasize their symptoms, their
disorder, and their life problems.

38. • Impulse Control.
• 10 to 15% of all depressed pts commit suicide,
and about two thirds have suicidal ideation.
• Depressed patients with psychotic features
occasionally consider killing a person as a result
of their delusional systems.
• Patients with depressive disorders are at
increased risk of suicide as they begin to improve
and regain the energy needed to plan and carry
out a suicide (paradoxical suicide).

39. Differential Diagnosis
• Manic episodes with irritable mood or mixed
episodes.
• Mood disorder due to another medical condition.
E.g. multiple sclerosis, hypothyroidism
• Substance/medication-induced depressive or
bipolar disorder.
• Attention-deficit/hyperactivity disorder;
Distractibility and low frustration tolerance can
occur in both attention-deficit/ hyperactivity
disorder and MDE

40. Management
• Goals:
The patient’s safety must be guaranteed.
A complete diagnostic evaluation of the patient is
necessary.
A treatment plan that addresses not only the
immediate symptoms but also the patient’s
prospective well-being should be initiated.
• Mainstay of tx: pharmacotherapy and
psychotherapy addressed to the individual patient

41. • Hospitalization
• Clear indications for hospitalization are the
risk of suicide or homicide, a patient’s grossly
reduced ability to get food and shelter, and
the need for diagnostic procedures
• Mild depression can be safely treated as out
pt

42. • Pharmacotherapy
• antidepressants may take up to 3 to 4 weeks to
exert significant therapeutic effects
• Antidepressant treatment should be maintained
for at least 6 months or the length of a previous
episode, whichever is greater.
SSRIs; fluoxetine, sertraline, SNRIs; venlafaxine,
Norepinephrine/Dopamine Reuptake inhibitors;
Bupropion, MAOi, Alpha-2 adrenergic antagonist

43. Psychosocial Therapy
• Cognitive therapy. The goal of cognitive therapy is to
alleviate depressive episodes and prevent their
recurrence by helping patients identify and test
negative cognitions; develop alternative, flexible, and
positive ways of thinking; and rehearse new cognitive
and behavioral responses.
• Behavior therapy. By addressing maladaptive behaviors
in therapy, patients learn to function in the world in
such a way that they receive positive reinforcement.
– based on the hypothesis that maladaptive behavioral
patterns result in a person’s receiving little positive
feedback and perhaps outright rejection from society.

44. • Interpersonal therapy. consists of 12 to 16
weekly sessions and is characterized by an
active therapeutic approach. Discrete
behaviors - such as lack of assertiveness,
impaired social skills, and distorted thinking -
may be addressed but only in the context of
their meaning in, or their effect on,
interpersonal relationships.

45. • Psychoanalytically oriented therapy
• The goal of psychoanalytic psychotherapy is to
effect a change in a patient’s personality
structure or character, not simply to alleviate
symptoms.
• Improvements in interpersonal trust, capacity for
intimacy, coping mechanisms, the capacity to
grieve, and the ability to experience a wide range
of emotions are some of the aims of
psychoanalytic therapy.

46. Prognosis
• MDD tends to be chronic, and patients tend to
relapse.
• Patients who have been hospitalized for a first
episode of major depressive disorder have
about a 50% chance of recovering in the first
year.
• 25% of patients experience a recurrence of
major depressive disorder in the first 6
months after release from a hospital

47. Prognostic Indicators
• Good: Mild episodes, the absence of psychotic
symptoms, and a short hospital stay. A history of
solid friendships during adolescence, stable
family functioning, and generally sound social
functioning for the 5 years preceding the illness.
• absence of a comorbid psychiatric disorder and of
a personality disorder, no more than one
previous hospitalization for major depressive
disorder
• an advanced age of onset.

48. Poor prognostic indicators:
• coexisting dysthymic disorder
• abuse of alcohol and other substances
• Anxiety disorder symptoms
• history of more than one previous depressive
episode.
• Men are more likely than women to
experience a chronically impaired course

49. • depressive disorder has significant potential
morbidity and mortality.
• Suicide is the second leading cause of death in
persons aged 20–35yrs and depressive disorder is
a major factor in around 50% of these deaths.
• Depressive disorder also contributes to higher
morbidity and mortality when associated with
other physical disorders (e.g. myocardial
infarction [MI]) and its successful diagnosis and
treatment has been shown to improve both
medical and surgical outcomes.

50. DEFINITION
-Common mood disorder, the hallmark of which
is elevated mood(mania/ hypomania)
Bipolar I d/order is characterized by episodes of
mania with or without major depressive episode
Bipolar II disorder is characterized by
hypomanic episodes and major depressive
disorders

51. Other bipolar disorders
• Cyclothymic disorder
• Substance/medication induced bipolar
d/order
• Bipolar d/order due to another medical
condition
• Other specified bipolar d/order
• Unspecified bipolar d/order

52. EPIDIEMOLOGY
Lifetime prevalence in adults 1-3% for bipolar d/order
bipolar I -0.6-2.4%
bipolar II -0.3-4.8%
M:F-1:1
Median age of onset is 18yrs for bipolar I and 20yrs for
bipolar II d/order
More common in the high socio-economic status
More common in divorced and single persons than
married pple(early age of onset)
No racial predilection

53. comorbidity
• Substance/alcohol abuse
• Panic d/order
• OCD
• Social anxiety d/order
• These worsen prognosis and increase risk of
suicide in patients with bipolar d/order

54. etiology
• Etiology is unknown
Theories have been put forward to explain the
etiology of Bipolar disorder
BIOLOGIC -
Genetics,Neurotransmitters,neuroendocrine,n
europathology
Psychological factors
Environmental factors

55. genetics
• Family studies-increased risk of bipolar
d/order in 1st degree relatives of bipolar
proband 5-10 times that of general population
• Twin studies-monozygotic twin of a bipolar
proband has 45-75% chance of having bipolar
d/order
16-35% risk in dizygotic same sex twin
Adoption studies-biological relatives have higher
risk of developing bipolar disorder compared to
adoptive relatives.

56. • Biochemical
• Implicates several neurotransmitters
Catecholamine hypothesis (reserpine)
Antidepressants and psychoactive drugs e.g.
cocaine which increase levels of monoamines(
serotonin, NE, dopamine)can potentially trigger
mania implicating these neurotransmitters

57. Neuroendocrine
• Hormonal imbalances-increased cortical levels
subclinical
hypothyroidism
Neuropathology
MRI studies-volumetric changes i.e. reduced
volumetric changes in the prefrontal cortex and
anterior cingulate cortex

58. Psychosocial factors
Freud-loss results in turning against self
in depression this results in anxiety, guilt
and possibly suicidality
in mania ego is released from oppressive
domination by super
ego
Manic defense(Melanie Klein)-mania as a
defense reaction to depression, using manic
defenses such as omnipotence in which a person
develops delusion of grandeur

59. ENIRONMENTAL FACTORS
• Stressful life events often precede mood
episodes in bipolar disorder.
These induce brain pathological changes and
thus a person experiences mood episodes
without a trigger
examples-childhood maltreatment
obstetric complications in females

60. Diagnosis. Manic episodes
• Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or
irritable mood
and abnormally and persistently increased goal-directed activity or energy,
lasting at
least 1 week and present most of the day, nearly every day (or any duration
if hospitalization
is necessary).
B. During the period of mood disturbance and increased energy or activity,
three (or
more) of the following symptoms (four if the mood is only irritable) are
present to a significant
degree and represent a noticeable change from usual behavior:

61. 1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external
stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., puposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful
consequences
(e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).

62. C. The mood disturbance is sufficiently severe to cause marked impairment in social
or
occupational functioning or to necessitate hospitalization to prevent harm to self or
others,
or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a
drug
of abuse, a medication, other treatment) or to another medical condition.

63. • Note: A full manic episode that emerges
during antidepressant treatment (e.g.,
medication,electroconvulsive therapy) but
persists at a fully syndromal level beyond the
physiological effect of that treatment is
sufficient evidence for a manic episode and,
therefore, a bipolar I diagnosis.
• Note: Criteria A-D constitute a manic
episode. At least one lifetime manic episode
is required for the diagnosis of bipolar I

64. Hypomanic episode
• A. A distinct period of abnormally and persistently elevated, expansive,
or irritable mood
and abnormally and persistently increased activity or energy, lasting at least
4 consecutive
days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity,
three (or
more) of the following symptoms (four if the mood is only irritable) have
persisted, represent
a noticeable change from usual behavior, and have been present to a
significant
degree:

65. 1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative th4. Flight of ideas or subjective experience that thoughts
are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or
sexually) or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments
an usual or pressure to keep talking

66. • C. The episode is associated with an unequivocal change in functioning
that is uncharacteristic
of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by
others.
E. The episode is not severe enough to cause marked impairment in social
or occupational
functioning or to necessitate hospitalization. If there are psychotic features,
the
episode is, by definition, manic.

67. • F. The episode is not attributable to the physiological effects of a
substance (e.g., a drug
of abuse, a medication, other treatment).
• Note: A full hypomanic episode that emerges during antidepressant
treatment (e.g.,
medication, electroconvulsive therapy) but persists at a fully syndromal
level beyond
the physiological effect of that treatment is sufficient evidence for a
hypomanic episode
diagnosis. However, caution is indicated so that one or two symptoms
(particularly increased
irritability, edginess, or agitation following antidepressant use) are not
taken
as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative
of a bipolar
diathesis.
• Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes

68. Bipolar I Disorder
• A. Criteria have been met for at least one
manic episode (Criteria A-D under “Manic
Episode”above).
• B. The occurrence of the manic and major
depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional
disorder,or other specified or unspecified
schizophrenia spectrum and other psychotic
disorder.

69. Bipolar ii disorder
• A. Criteria have been met for at least one hypomanic episode (Criteria A-
F under “Hypomanic
Episode” above) and at least one major depressive episode (Criteria A-C
under
“Major Depressive Episode” above).
• B. There has never been a manic episode.
• C. The occurrence of the hypomanic episode(s) and major depressive
episode(s) is not
better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder,
delusional disorder, or other specified or unspecified schizophrenia
spectrum and
other psychotic disorder.
• D. The symptoms of depression or the unpredictability caused by
frequent alternation between
periods of depression and hypomania causes clinically significant distress or
impairment

70. ddx
• Major depressive disorder
• Other bipolar disorders
• Schizophrenia spectrum d/orders
ADHD
Personality d/orders

71. investigations
• Biologic
CBC-antipsychotics cause bone marrow suppression
Fasting glucose-antipsychotics associated with
weight gain &impaired glucose regulation
Lipid profile-lipid derangements due to
antipsychotics
LFTs-valproate
Creatinine /Bun-lithium needs proper kidney fxn
Electrolytes
ECG-effects of lithium on heart conduction
TFTs-R/o hyperthyroidism, hypothyroidism

72. psych diagnostic
• Young mania scale

73. mgmt.
Pharmacotherapy
Lithium
Anticonvulsants-valproate,
carbamezapine,lamotrigine
Antipsychotics-haloperidol,
chlorpromazine,olanzapine,quetiapine,risperido
ne
Benzodiazepines-
clonazepam,lorazepam(adjunctive treatment for
insomnia,agitation or anxiety)

74. Psychosocial mx
Psychoeducation
CBT
Family therapy
Interpersonal therapy
Occupational therapy

75. prognosis
• Bipolar I
• Poor prognosis compared to major depression
d/order
• 40-50% go on to develop a 2nd manic episode
• Good prognosis-short duration of manic
episodes
advanced age of onset
few suicidal thoughts
few comorbid psychiatric or

76. • Poor prognosis-premorbid poor occupational
status
alcohol dependence
psychotic fx
depressive fx
male gender
interepisode depressive fx

77. Bipolar ii disorder
• Good prognosis-more education
fewer years of illness
being married
• Poor prognosis-rapid cycling pattern
prolonged illness

78. • Reference
• Kaplan and Sadock's Synopsis of
Psychiatry: Behavioral Sciences/Clinical
Psychiatry 10th edition
• Core psychiatry
• Dsm v

79. References
• Kaplan and Sadocks Concise Textbook of
Psychiatry
• Kaplan and Sadocks Synopsis of Psychiatry
• DSM-5