Psychotic and Mood Disorders

Transcription

1 Psychotic and Mood Disorders د ر ا ر با ی کلاس د یاران سال اول روا پ ز ش ی وه روا پ ز ش ی دا ه ع وم زپ ش ی ا ان 93/6/16

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3 Symptoms Mood Anxious Psychotic Non-specific Depressed mood Anxiety/Worry Delusion Aggression Loss of interest Phobia Hallucination Agitation/Restlessness Elevated mood Rumination Disorganized speech Irritability Hopelessness Avoidance Disorganized behavior Impulsivity Worthlessness Safety behaviors Mood swing Helplessness Hypervigilance Talkativeness Guilt feeling Panic attack Grandiosity Attempted suicide Safety behaviors Difficulty concentrating Overactivity it Restlessness Self-injury Overfamiliarity Exaggerated startle response Insomnia Being easily fatigued

4 Symptom Syndrome Depressed mood + Loss of interest + Insomnia + Low self-esteem + Hopelessness Major Depressive Episode 4

5 Symptom Syndrome GAD Talkativeness Anxiety Adjustment Disorder Substance-induced Compulsion OCD Organic Manic Episode Hyperthyroidism Bipolar Disorder Schizoaffective Disorder Substance-induced Substance-induced/Abuse Organic 5

6 Mood Depressed mood/ Loss of interest Elevated/ Expansive mood Irritable mood (Less specificity) Affective instability (Less specificity) 6

7 Adjustment MDD Dysthymic y Rec Brief Minor dep Bip dep 0% 20% 40% 60% 80% 100%

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9 دوقطبي نشانههاي كليدي اختلال Depressed mood Loss of finterest t Euphoria Irritability Overactivity 9

10 دوقطبي ويژگيهاي اختلال Highly recurrent Familial [etiology] Hypo/mania: Hallmark Depression: Predominant affect Profound disability Suicide: a major outcome Subsyndromal symptoms: Predominant features Comorbidity is the rule rather than exception. 10

11 In the clinic: i depression/anxiety symptoms > mania/hypomania i/ i symptoms 11

12 Bipolar I Disorder Mania Major Depression

13 Bipolar I Disorder Major Mania Depression Mixed

14 Bipolar I Disorder

15 Mania Hypomania Psychosis Dysfunction Significant aggression Duration 7 days or any if aggression 4 days

16 Bipolar II Disorder Hypomania Major Depression

17 Bipolar II Disorder

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19 Psychosis Delusion Hallucination Disorganized speech Disorganized behavior 19

20 Bryan Charnley,

21 Mania whose author is Florencio Yllana, a contemporary artist of Philippine origin (born 1977), presently living in Brazil. The painting was done in 2001 following the acute manic episode in the course of BD in the artist. (Rybakowski JK, 2010) 21

22 Psychotic Disorders Schizophrenia Schizoaffective Disorder Delusional Disorder Brief Psychotic Disorder Another Medical Condition Substance-induced 22

23 Psychotic+Affective Psychotic+ Affective Remission Psychotic+ Affective Psychotic+ Affective Psychotic Psychotic+Affective Psychotic+ Affective Affective Psychotic+ Affective Psychotic+ Affective Psychotic Affective Psychotic +Affective

24 Treatment Options Placebo; Sham ECT Medications Psychotherapy ECT rtms VNS

25 Antidepressants: 1) TCAs (imipramine) 2) Atypical TCAs (mianserin) 3) MAOIs (tranylcypromine) 8) NDRIs (bupropion) 10) NASSAs (mirtazapine) 11) MASSAs (agomelatine) 12) SSREs (tianeptine) 4) RIMAs (moclobemide) 13) Serotonin Modulator and Stimulator (vortioxetine) 5) SSRIs (fluoxetine) 14) SRI+5HT 1a PA (vilazodone) 6) SNRIs (venlafaxine) 7) NRIs (reboxetine) 15) Herbal: St. John's wort 16) SNDRIs (amitifadine)( ) 8) SARIs (trazodone)

26 Treatment algorithm Remission New drug Partial remission Poop out Increase OR Augmentation/ Combination No Response Switch Poop out = losing the efficacy

27 Augmentation agents: 1) Folic acid 2) Omega-3 fatty acids 3) Buspirone 4) SGAs 5) Stimulants 6) Liothyronine 7) Lithium 8) Wake-promoting agents: modafinil 9) Dopamine agonists: pramipexole

28 Major side effects Lithium Renal failure Toxicity Diabetes insipidusi id Valproate Teratogenicity Hepatotoxicity Lamotrigine Serious rash Atypical Diabetes mellitus Hyperlipidemia id i Weight gain antipsychotics 28

29 Strengths Weaknesses Lithium ihi Antisuicide i id Toxicity ii Valproate High tolerance For women in fertility ages Lamotrigine High tolerance Titration No weight gain Low teratogenicity No antimanic Serious rash Atypical Antipsychosis py Metabolic antipsychotics syndromes 29

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