(精神病学ppt课件)mood-disorder-and-suicide

MoodDisordersandSuicideBy Yixiao FuDepartment of PsychiatryMoodDisordersandSuicideByY1OutlineMooddisorders,depressionandmaniaDepressivedisordersBipolardisordersCausesofmooddisordersTreatmentofmooddisordersSuicideDepressivedisorderMAJOROutlineMooddisorders,depress2Mooddisorders,depressionandmaniaMooddisordersGroupofdisordersinvolvingsevereandenduringdisturbancesinemotion(mood)(prevalenceinpopulationbetween8%and19%)MajordepressiveepisodeExtremelydepressedmoodstatethatlastsatleast2weeksandincludescognitivesymptoms(worthlessness,indecisiveness)andphysicalsymptoms(alteredsleepingpattern,changesinappetiteandweight,lossofenergy)ManiaEpisodeofjoyandeuphoriamarkedbyindividualsextremepleasureineveryactivity,hyperactivity,littlesleepHypomanialesssevereversionofamanicepisodethatdoesnotcausemarkedimpairmentinsocialoroccupationalfunctioningDysphoricmanicormixedepisodetheindividualexperiencesbothelationanddepressionoranxietyatthesametimeMooddisorders,depressionand3(精神病学ppt课件)mood-disorder-and-suicide4(精神病学ppt课件)mood-disorder-and-suicide5DepressivedisordersMajordepressivedisorder,singleepisodeInvolvesonlyonemajordepressiveepisodeinlifetime(veryrare85%ofsingleepisodesarefollowedbyrepeatedepisodes)(12%suicidalattempts)Majordepressivedisorder,recurrentY-BarbaraInvolvesrepeatedmajordepressiveepisodesseparatedbyaperiodofatleast2monthsduringwhichtheindividualwasnotdepressedDysthymicdisorderthesamesymptomsasmajordepressivedisorderbutpresentedinmilderform,thedepressedmoodcontinuesforatleast2yearsDoubledepressionCombinationofmajordepressionepisodesanddysthymicdisorderDepressivedisordersMajordep6DepressivedisordersUsualonsetis25yearsbutisdecreasingDepressiveepisodeslastfrom2weeksuptoyearsAdultpatientswithdysthymicdisorderaremorelikelytocommitsuicidethanpatientswithmajordepressivedisorderDepressioncanresultfromgriefPathologicalgriefreactioninvolvespsychoticfeatures,suicidalideation,severelossofweightorenergythatpersistsmorethan2monthsTherapyinvolvesreexperiencingthetraumaundersupervisionandfindingmeaninginthelossDepressivedisordersUsualons7BipolardisordersBipolarIdisorderY-MaryDepressiveepisodesalternatewithfullmanicepisodes(17%suicidalattempts)(onsetatage18)BipolarIIdisorderDepressiveepisodesalternatewithhypomanicepisodes(24%suicidalattempts)(onsetatage22)CyclothymicdisorderChronicalternationofmoodelevati+onanddepressionthatdoesnotreachtheseverityofmanicormajordepressiveepisodesSeasonalaffectivedisorder(SAD)Mooddisorderinvolvingacyclingofepisodescorrespondingtotheseasonsoftheyear,typicallywithdepressionoccurringinthewinter(10%inNewHampshireand2%inFlorida)BipolardisordersBipolarIdi8Causesofmooddisordersbiologicalfactorsifonetwinpresentswithamooddisorder,anidenticaltwinisapproximatelythreetimesmorelikelythanafraternaltwintohaveamooddisorder(heritabilityapprox.40%forwomen)psychologicalfactorsstressfullifeevents,hopelessness,negativecognitivestyles-overgeneralizationsocialandculturalfactorsmaritaldissatisfaction70%ofpeoplesufferingwithmajordepressivedisorderordysthymiaarewomenCausesofmooddisordersbiolo9CausesofmooddisordersCausesofmooddisorders10TreatmentofmooddisordersMedicationsAntidepressants(numberofsideeffects)Monoamineoxidase(MAO)inhibitors(negativeinteractionswithtyramine)Selectiveserotonergicreuptakeinhibitors(SSRIs)(sideeffects)Lithium(weightgain,dangerofpoisoning)Electroconvulsivetherapy(ECT)andtranscranialmagneticstimulation(TMS)asanalternativetoECTPsychosocialtreatmentsCognitivetherapyInterpersonaltherapyCombinedtreatmentsV-Bipolarindepression(medicationandpsychosocialtreatments)inbipolardisorders(combiningmedicationandfamilyand/orCBTiscrucial)TreatmentofmooddisordersMed11Suicide8thleadingcauseofdeathintheUSA(30000peopleayear)forpeopleaged25-34Amongteenagers,suicideisthe3rdleadingcauseofdeathThesuiciderateforyoungmenintheUSAisthehighestintheworldMalesarefourtofivetimesmorelikelytocommitsuicidethanfemales90%ofsuicidesarecommittedbypeoplesufferingfrompsychologicaldisorder60%areassociatedwithmooddisorders25%-50%withalcoholuseandabuse10%borderlinepersonalitydisorderSuicide8thleadingcauseofde12SuicideSuicidalattemptSuicidalideationTypesofsuicide(formalizedsuicidealtruisticsuicide,egoisticsuicide,fatalisticsuicideetc.)Psychologicalautopsy(postmortempsychologicalprofileofasuicidevictim)Imitationofsuicide(teenagerorcelebrity)Suicidepreventioncognitive-behavioralproblem-solvingapproachstrongsocialsupportandhopefulnesstreatmentofpsychiatricandpersonalitydisordersSuicideSuicidalattempt13MAJORDEPRESSIVEDISORDERMAJOR14One Thing in Common-DepressionGreat writer Hemingway Scientist DarwinArtist van goghPrime Minister ChurchillSuperstar Marilyn MonroeOneThinginCommon-Depressi15Depression is CommonThe WHO identified depression as the fourth leading cause of worldwide disease in 1990,and depressive illness is projected to be the second leading cause of disability worldwide in 2020.Murray CJ,Lopez AD.The global burden of disease:a comprehensive assessment of mortality and disability from diseases,injuries,and risk factors in 1990 and projected to 2020.Cambridge,Mass.:Harvard University Press,1996.DepressionisCommonTheWHOid16Depressionisanillnessinvolvesthebody,mood,andthoughts.Itaffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Itisnotthesameasunhappinessandisnotastatepeoplecansnapoutof.Whatisdepression?Depressionisanillnessinvol17DEPRESSIONDEPRESSION18(DSM-IV-TR):MajorDepressiveDisorderDiagnostic and Statistical Manual of Mental DisordersBy:AmericanPsychiatricAssociation(ICD-10):DepressiveEpisodeInternational Statistical Classification of Diseases and Related Health ProblemsBy:WorldHealthOrganizationDepression(informal)Scholarfield:Diagnosticcriteria:(DSM-IV-TR):MajorDepressiveD19MDD/DEPRESSIONMDD/DEPRESSION20(精神病学ppt课件)mood-disorder-and-suicide21(精神病学ppt课件)mood-disorder-and-suicide22EpidemiologyThelifetimeriskisabout15%Outofvery100peopleabout13menand21womendevelopthedisorder（MDDoccursmoreonwoman)TeenagersaremostlikelytodevelopMDDduetodevelopingthesymptomsofsadness,loneliness,stress.Upto15%ofpeoplewithMDDdiebysuicideEpidemiologyThelifetimerisk23(精神病学ppt课件)mood-disorder-and-suicide2425genetic predispositionFamilyandTwinstudiesshowthatMDDhasadefinitegeneticcomponent.the risk rate among first-degree relatives of individuals suffering from MDD is about two to three times the risk in the general population.There is a higher concordance rate(about 40%)in monozygotic compared with dizygotic(about 11%）twins.Nosinglemajorgenehasyetbeenshowntobeinvolved(polygenicinheritance).GeneshavenotyettobeidentifiedEtiology25geneticpredispositionFamily2526Social and Environmental Influences historical factors:earlymaternaldeath,parentalneglect,alongperiodofseparationfromaparentduringchildhood,childhoodsexualabuse experiencespersonalitycurrent factors（stress）unemployment,DisappointedInLove.（losslifeevents）Etiology26SocialandEnvironmentalInf2627Biochemical factorsNeurotransmitterEtiology5-HTDANAACH27BiochemicalfactorsNeurotra27Etiology;Bio-Psycho-SocialEtiology;Bio-Psycho-Social2829.Etiology29.Etiology29(精神病学ppt课件)mood-disorder-and-suicide30ofMDD?Whatarethesymptoms31DSM-IV-TR1 DEPRESSED MOOD(SAD.HOPELESS)2 FATIGUE,ENERGY LOSS3 THOUGHTS OF DEATH/SUICIDE4 DIFFICULTY5LACK OF INTEREST6INSOMNIA(WAKING UP IN THE MIDDLE OF THE NIGHT/NOT BEING ABLE TO GO BACK TO SLEEP)7RETARDATION8UNINTENTIONAL WIGHT LOSS/APPETITTE DECREASE OR INCREASE9DISTRESS/IMPAIRMENTClinical FeatureBiological symptomsCognitive symptoms Mood and motivation symptomsDSM-IV-TRClinicalFeatureBiolo32Mood and motivation symptoms(core feature)1.Mood symptomsSadness,anhedonia,unhappiness irritability Anxiety symptoms,panic attacks Clinical FeatureMoodandmotivationsymptoms(c33Mood and motivation symptoms(cord feature)2.motivation symptoms loss of interest,low energy and social withdrawal(keep themselves in the room,low-esteem,have no confidence)Clinical FeatureMoodandmotivationsymptoms(c34Biological symptomsloss of appetite and weightloss of sex drive(libido)Sleep disturbance most days:either initial insomnia or early morning waking and being unable to get back to sleep.Diurnal variation of mood,such that mood is worse in the morning and slowly lifts in the evening.non-specific physical symptoms,such as tension headache,back pain and atypical chest Psychomotor retardation (mute and stupor)Clinical FeatureBiologicalsymptomslossofapp35Biologicalsymptomsa.Loss of appetite and weightBiologicalsymptomsLossofapp36b.Loss of sex drive BiologicalsymptomsLossofsexdriveBiologicals37c.Early morning wakingBiologicalsymptomsEarlymorningwakingBiological38d.Diurnal variation of mood123456789101112131415161718192021222324BiologicalsymptomsDiurnalvariationofmoodBiolo39e.Non-specificphysicalsymptomsBiologicalsymptomsNon-specificphysicalsymptoms40Psychomotor41Cognitive symptoms negative thoughts To the past(guilt,regrets and self-blame)To the present(low self-esteem,worthlessness)To the future(pessimism,hopelessness,thoughts of dying and suicidal ideas)Psychotic depression Delusions(persecutory,hypochondriacal,guilt)hallucinations(Auditory)Clinical FeatureCognitivesymptomsnegativeth42SuicideSuicide43DEPRESSIONOccasionalsadnessMe44(精神病学ppt课件)mood-disorder-and-suicide45DiagnoseDiagnose46DiagnoseCriteria for Major depressive Episode(DSM-)it includes four aspects:symptom criteria,course criteria severity criteria exclusion.these symptoms must persist continuously for at least 2 weeks.Symptoms cause clinically impairment in social,occupational,or other important areas of functioningSymptomsareNOTduetotheeffectsofasubstance(e.g.,drug of abuse,or medication)orageneralmedicalcondition(e.g.,hyperthyroidism)5 or more of the total 9 symptoms must be met.at least 1 of those must be either depressed mood or loss of interest or pleasure.DiagnoseCriteriaforMajorde47(精神病学ppt课件)mood-disorder-and-suicide48Management1.Preparation2.Treament .Pharmacotherapy .Electroconvulsive therapyManagement1.Preparation49 1.PreparationHistory-taking will include alcohol and drug use and psychosocial history with evidence for supportive relationships.Suicidal risk assessment is important.Physical investigations will include eosinophil sedimentation rate(ESR)and thyroid function and,in older patients,chest X ray and computed tomographic(CT)scan.Management1.PreparationManagement502.Treament.PharmacotherapyA.Major depression is usually treated with antidepressant drugs/medication Selective Serotonin Reuptake Inhibitors(SSRIs):fluoxetin,citalopram,paroxetine;Serotonin/Norepinephrine Reuptake Inhibitors(SNRIs):venlafaxineTricylic Antidepressants(TCAs):amitryptine,imipramine,dosulepin;Monoamine Oxidase Inhibitors(MAOIs)these will be effective in about 70%.Management2.TreamentManagement51B.If there is no response to first-line treatment with full dosage antidepressant for 6 weeks,the next step is to change to another class of antidepressant drug or adding lithium.ManagementB.Ifthereisnoresponseto52C.Psychotic depression will also need antipsychotic drug treatment.Risperidon,Olanzapine,QuetiapineManagementManagement53.Electroconvulsive therapy For severe depression or high suicidal risk,inpatient admission may be needed and should be given ECT.Management.ElectroconvulsivetherapyMan54.Psychotherapy Cognitive behaviour therapy,psychodynamic therapy are also used,if available.Management.PsychotherapyManagement55Questions1.What is the difference between depression and MMD?2.What are the causes of the depression?3.What are the main symptoms of a MMD?4.What are the most important issues related to diagnostic criteria(DSM-)for MMD？5.How do we manage/treat MMD?Questions1.Whatisthediffere56THANKS！THANKS！57