mood disorder ( major depressive and bipolar disorder )€¦ · mood disorder ( major depressive...
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Mood Disorder ( Major Depressive and Bipolar disorder ) Dr. Vincent Wong MBBS, M.Med(Psych),CMIA 王 忠 威 心 理 精 神 专 科 医 生 Consultant Psychiatrist www.brainmindspecialist.com
Dr. Vincent Wong, Consultant Psychiatrist 1
1) What is normal ?
2) Signs and symptoms of Depressive disorder
3) Causes of Depressive disorder?
4) The Neurobiology of Depression
5) What is Bipolar Disorder
Contents
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Interview ( The Callaghans )
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POPULAR MYTH ABOUT MENTAL ILLNESS
A sign of immaturity
If you can identify the cause of illness (e.g. break-up of relationship) then treatment is not necessary
Christians do not get mental illness
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POPULAR MYTH ABOUT MENTAL ILLNESS
Indicates a lack of faith
Indicates unconfessed sin
Mentally ill people tend to be lazy
Healing through medicine is not as good as healing by prayer
Taking medicine indicates a lack of real faith
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What is normal moods?
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Emotions
Anger
Fear
Happy
Surprise
Disgust
Sadness
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“ To anyone with the kind of integrity that deeply feels the impact of life, the experience of being swept away by a flood of strong emotions is very real. At times like that, advice to rejoice anyway or to grab hold of responsibilities or to renew weakened commitments seem cruelly insensitive”
Dr. Larry Crabb
The validity and reality of human emotions
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They are like the tidal waves.
Most tides are normal.
But if it becomes a Tsunami, it is abnormal!
Unusually high or low moods are abnormal:
Low moods or Depression.
High moods or Mania.
Are moodswings normal?
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A mood which all of us experience from time to time, usually as a result of some distressing circumstance.
So, it is normal
It can become severe. then it is called: depressive illness
Normal Sadness vs DEPRESSION
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Signs and symptoms of Depressive disorder?
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Signs and Symptoms
Behavioural
Social withdrawal
Desire to escape
Crying without reason
Self harm
Physical
Sleep problems
Change of appetite
Tiredness
Painful symptoms ( Masking
Effect )
Emotional ( Less among Asians)
Depressed
Loss of interest / motivation
Iritable
Thinking
Guilt feelings
Loss of self confidence
Decreased concentration
Hopelessness
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3 NECESSARY CRITERIA ( 3 D )
DISTRESSING SYMPTOMS
DURATION – LASTS LONGER THAN USUAL
DYSFUNCTION – i.e. AFFECTS NORMAL FUNCTIONING IN PERSONAL, SOCIAL OR OCCUPATIONAL AREAS
Examples
CLINICAL DEPRESSION
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Causes of Depressive disorder?
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CAUSES OF MENTAL ILLNESS
STRESS & COPING
COGNITIVE (THINKING)ERRORS BIOCHEMICAL
IMBALANCE
DETERIORATION OF
BRAIN CELLS
DRUG & ALCOHOL
FAMILY UPBRINGING
PERSONALITY/SPIRITUAL
DEVELOPMENT
GENETIC
Lack of Protective Factors
-Good Parenting -Spiritual Foundation -Healthy thinking/coping -Self Awareness -Social support
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Neurobiology of depression
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Chemicals in our brain
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Brain Scan changes ( comparison between Normal vs Depressed individuals
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Complication of untreated depression.
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Suicidal Risk
Mnemonics
( SAD PERSON )
S : Sex
A : Age
D : Depressive illness
P : Previous attempts
E : Ethanol
R : Rational thinking loss
S : Sickness
O : Organized Plan
N : No spouse / support
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Slide on the Kupfer curve
Natural Pattern for treatment of Depression
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Treatment stages In
cre
ase
d
seve
rity
Time
Euthymia
Symptoms
Syndrome
TREATMENT STAGES Acute
(6 to 12 wk) Maintenance (1 y)
RECOVERY Relapse
Relapse
REMISSION Recurrence
+
RESPONSE
Adapted from: Kupfer DJ, Long-Term Treatment of Depression, The Journal of Clinical Psychiatry. 52, 28-34, 1991. Copyright 1991.
Relapse
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Q and A for Depression.
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What is Bipolar Disorder
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Bipolar Disorder
Lifetime risk: perhaps as high as 2.1%
Peak onset: late teens and early 20s 25% of first episodes occur before age 20
Recurrence in almost all cases
Bipolar Disorder is an inheritable illness
High morbidity and mortality
American Psychiatric Association. Practice Guideline for
the Treatment of Patients with Bipolar Disorder. 2nd ed. Washington, DC; 2002.
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Sever
e
Severe
Mild
Mild
Moderat
e
Moderate
Euthymic
Man
ia
Dep
ress
ion
Time
Bipolar Disorder:
Slide courtesy of MP DelBello.
Euthymic
Man
ia
D
epre
ssio
n
Time
Bipolar Disorder: Depression Followed by Mania
Sever
e
Severe
Mild
Mild
Moderat
e
Moderate
Slide courtesy of MP DelBello.
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Manic States: Symptoms
Mood Thinking Speech
Mood Swings Fast thinking Talkative
Feeling “High” Grandiose
Irritable Suspicious
Behaviour
Reckless
Overspending
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Bipolar Disorder: Untreated vs Treated Standardized Mortality Ratios
Neoplasm Cardio- vascular
Cerebro- vascular
Accidents Suicide Other All Causes
Untreated
Treated
29.2*
6.4
1.4* 0.6
2.2* 1.7 1.6† 1.3 1.6 2.0 2.0* 1.3 2.2*
1.3
Adapted from Angst F et al. J Affect Disorder. 2002;68:167-181. Dr. Vincent Wong, Consultant Psychiatrist 33
Suicide Risk: Various Conditions
1.8
0 5 10 1
5
20 2
5
30 3
5
40
38.4
20.3
15.0
8.5
19.2
5.9
7.1
History of Suicide Attempt
Major Depression
Bipolar Disorder
Schizophrenia
Mixed Drugs
Alcohol
Personality Disorder
Cancer
Inskip H et al. Br J Psychiatry. 1998;172:35-37.
5 10 15 20 25 30 35 40 0 Percentage
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The Close sisters
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For more information, please visit
www.brainmindspecialist.com
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