my presentation was about mood disorder. it could help understand patient deeply.

1. MOOD DISORDERS
DEPRESSIVE EPISODE

2. Introduction:
In these disorders, which include depressive
episodes, bipolar mood disorder and
persistent mood disorder, there is a
disturbance of mood that is not secondary
to organic causes, psychoactive substance
use or another psychia-
Tric disorder such as schizophrenia or
schizoaffective disorder.

3. DEFINITION:
This model shown in mental disorder after
sepe
Cific accident example :
1.delivery.
2.Surgical operation .
It become appearance suddenly . sometime
slide gradual from depression into acute
depression or psychotic depression.

4. CLINICAL FEATURES:
Characteristic features of a depressive episode
include depression of mood , anhedonia, reduced
attention and concentration ,ideas of guilt and
worthlessness, lowered self-esteem and reduced
energy, which in turn causes tiredness and
reduced activity. In turn ,these can lead to
hopelessness and a belief that life is not worth
living , which can cause suicidal thoughts
.biological symptoms occur frequently. The type of
sleep disturbance that may occur in depressive
episodes are shown diagrammatically.

5. MENTAL STATE EXAMINATION
1.Appearance:
Depressive facies include down turned eyes sagging
of the corners of the mouth and a vertical furrow
between the eyebrows . There is typically poor eye
contact . There may be direct evidence of weight
loss, with the patient appearing emaciated and
dehydrated .indirect evidence of recent weight loss
may be indicated by the clothing appearing to be
too large. Evidence of poor self-care and general
neglect may include an unkempt appearance ,poor
personal hygiene and dirty clothing.

6. CONT.
2.Behaviour: psychomotor retardation typically
occurs.
3.Speech : the
patient's speech is typically slow, with long delays
before questions are answered.
4.Mood : it is low and sad , with feeling of
hopelessness. The future seems bleak. Anxiety,
irritability and agitation may also occur. The
patient may complain of reduced energy and
drive, and an inability to feel enjoyment
(anhedonia). There is a loss of interest in normal
activities and hobbies.

7. CONT.
5.Thought content:
Pessimistic thoughts occur concerning the past
,present and future. Suicidal and homicidal
thoughts may occur and should be checked for.
Obsessions may occur secondary to depression
6. Abnormal beliefs and interpretation of events:
Ideas or delusions of a hypochondriacally or
nihilistic nature may be present .

8. CONT.
7. Abnormal experiences:
In severe depressive episodes auditory
hallucination may occur which are typically
in the second person and derogatory in
content.
8. Cognition :
Concentration is characteristically poor.

9. DSM-IV CRITERIA FOR MAJOR
DEPRSSIVE EPISODE
A-at least five of the following symptoms have been
present during the same 2-week period represent a
symptoms is either (1) or (2):
1-depressive mood most of the day ,nearly every day,
as indicated by either subjective report (e.g. feels
sad or empty) or observation by others (e.g.
appears tearful) . In children and adolescents this
can be irritable mood.
2- markedly diminished interest or pleasure in all

10. CONT.
Or almost all, activities most of the day , nearly
every day.
3-significant weight loss when not dieting or weight
gain (e.g. a change of>5% body weight in a
month), or a decrease or increase in appetite
nearly every day . In children consider failure to
make expected weight gain .
4-Insomnia or hypersomnia nearly every day .
5-Psychomotor agitation or retardation

11. CONT.
(observable by others) nearly every day .
6-fatigue or loss energy nearly every day.
7-feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional)
Nearly every day.
8-diminished ability to think or concentrate
,or indecisiveness, nearly every day .
9-recurrent thoughts of death (not just fear of

12. CONT.
Dying), recurrent suicidal ideation without a
specific plan , or a suicide attempt or a
specific plan for committing suicide.
B-Exclude a mixed episode (in which a manic
episode also occurs).
C-The symptoms cause clinically significant
distress or impairment in social ,occupational
Or other important areas of functioning.

13. CONT.
D-The symptoms are not caused either by a
direct physiological action of a substance (e.g.
Drug of abuse ,or medication), or by general
medical condition (e.g. hypothyroidism) .
E-The symptoms are not better accounted for
by bereavement.

14. DIFFERENTIATION
FROM BEREAVEMENT
1- Guilt about things other than action taken
or not taken by the survive at the time of
death.
2-Thoughts of death other than the survive
feeling that he or she would be better off dead
,or should have died with the deceased .
3-Morbid preoccupation with worthlessness.
4-Marked psychomotor retardation .

15. ATYPICAL TYPES OF
DEPRESSION
DEPRESSIVE STUPOR:
This is rare these days because of effective
treatment.
MASKED DEPRESSION:
Depressive patients may present with somatic
or other complain instead of a depressed
mood.
SEASONAL AFFECTIVE DISORDER(SAD)

16. CONT.
The onset depressive episodes is related to a
particular time or season .
AGITATED DEPRESSION:
This occur in the elderly .
INVESTIGATION:
The physical examination should include a
careful inspection for any evidence of self-
harm, such as scars on the wrists.

17. TYPE OF DEPRESSION
SEVERE
DEPRESSION.
MODERATE
DEPERSSION.
MILD
DEPRESSION.
TRANSIENT
DEPRESSION
Major
depressive
disorder.
Dysthymic
disorder.
Normal grief
response.
Life's
everyday
disappointme
nts.

18. EPIDEMIOLOGY
INCIDENCE:
In males ,80-200 new cases per 100000 popul-
Ation per year . In females ,250-7800 new
cases per 100000 population per year.
POINT PREVALENCE:
In the west ,1.8-3.2%of males ,and 2.0-9.3%
of females . The point prevalence of
depressive symptom in western population is
up to 20%.

19. CONT.
LIFETIME RISK:
In the general population of western countries
5-12% in males and 9-26% in females .
AGE OF ONSET:
On average , around the late 30s. However ,it
can start any where from childhood to old
age.
SEX RATIO:

20. CONT.
Commoner in females .
MARRIAGE:
Higher incidence in those who are not
married , including the divorced and
separated.
SOCIAL CLASS:
1)Have three or more children under the age
of 14 to look after.

21. CONT.
2)Do not work outside the home.
3)Do not have somebody to confide in, that is ,
There is a lack of intimacy.
4)Lost their own mother before the age of11,
through death or separation.
AETIOLOGY:
#Women may be more likely to admit to
feeling depressed.

22. CONT.
#Depression may be underdiagnosed in man ,
who may be more likely to engage in
excessive alcohol consumption and therefore
be diagnosed rather than depression.
MANAGEMENT:
1)HOSPITALIZATION:
Less severe episodes can be treated by GPs in
the community or by psychiatrists in out
clinics.

23. CONT.
2)DRUG TREATMENT:
Antidepressant medication is the mainstay of
treatment for moderate and severe depressive
episodes . Mild depressive symptoms can also
benefit from such treatment.
3)ELECTROCONVULSIVE THERAPY
(ECT):
This may used as a first line of treatment in
the following relatively rare condition:

24. CONT.
*Very low fluid intake ,resulting in oliguria.
*Depressive stupor.
*A dangerously high risk of suicide.
PSYCHOSURGERY:
This is considered only extremely rarely
,when all other treatment for severe chronic
handicapping depression have failed.
PHOTOTHERAPY:

25. CONT.
SAD with an autumn or winter onset can be
treated with high- intensity light.
PSYCHOTHERAPIES:
@Cognitive therapy.
@Group therapy.
@Psychoanalytic Psychotherapy.
@Family therapy.
@Marital therapy.

26. SOCIAL MILIEU:
Increased activity and social contact should be
encouraged. The development of confiding
relationships has a protective function in
preventing relapse.
PROGNOSIS:
The outcome in general is better the greater
the length of follow-up. The risk of relapse is
reduced if antidepressant medication is
continued for 6 months after the end of the
depressive episode .over all, the suicide rate
is around 9%.

28. REFERENCE
PSYCHIATRY FOR:
Basant k.puri.
Name of student:
SAMIAH AL-JHANY.
SAMIAH AL-HARBY.