AFFECTIVE

DISORDER
SAI PHALGUNA
5TH YEAR PHARM D
NP0219021
HAS ANYBODY WATCHED THIS
MOVIE
 AFFECTIVE DISORDER
MDP
MOOD
(MANIA DEPRESSIVE
DISORDER PSYSOSIS)

BIPOLAR UNIPOLAR
DISORDER DISORDER

MOOD AFFECTIVE MANIAC OR

DISORDER DEPRESSION
 WHAT IS AFFECTIVE DISORDER ?
• Affective disorders encompass all disorders of mood that are persistent and pervasive
and lead to socio-occupational dysfunction.
• Mood change is the primary dominant feature. It is severe disturbance of mood
characterised by two phases illation/excitement and depression
• Mood what you feel what you express AFFECT
(Happy/Sad) (Smile, laugh /Sad, Cry)

If its abnormal DISORDER

AFFECTIVE DISORDER
 TYPES
UNIPOLAR DISORDER BIPOLAR DISORDER
 DEPRESSION STAGES
 MANIAC (Maniac And Hypomaniac)  BIPOLAR-I
 BIPOLAR –II
 DEPRESSION
 disorder that presents with depressed mood, loss of interest or pleasure, feelings of
guilt or low self- worth, disturbed sleep or appetite, low energy, and
poor concentration.
 EPIDERMOLOGY
 Depression is one of the most common chronic mental illnesses globally and in India. It has been reported
that depression is twice as common in individuals with type 2 diabetes
 Gender: depression is higher in women than men (2:1)
 The World Health Organization (WHO) ranked depression as the fourth most common disease in 1990,
after lower respiratory tract infections, diarrheal diseases and perinatal infections. According to year 2020
reports , Depression is the second most common disease and it accounts nearly 15% of the disease burden
in the world population (340 million people globally).expected to move to the 1st place with reference to
global burden of disease by 2030
 India is home to the second largest number of adults with depression worldwide, after China .
 In the developed countries, depression is the most common psychiatric disorder, ranging from 10 to 37.7%
as reported in various studies, In developing countries 10–44% are reported to suffer from depression
 In 2014 under age group 25-65 Karnataka was reported to be high at 29.3% ,Maharashtra it was highest
31.4%.
 PATHOPHYSIOLOGY
 change in brain monoamine neurotransmitters in reduction or functional deficency
or Norepinephrine (Noradrenaline) and 5-HT receptors (Serotonin)
Etiology
Medications :
 CV Agents: Beta Blockers , CCB, Digoxin
 CNS Agents : Alcohol ,Benzodiazepines ,
Metoclopramide Etc
 Hormonal agents : Oestrogen, Androgens
Etc
 Others Like H2 Receptor Blocker,
Indomethacin
Physical Illness :
 Carcinoma, neurological Disorder, SLE,
Thyroid Disease, Viral Illness , Chronic
Inflammatory Disease
SIGNS AND SYMPTOMS RISK FACTORS
 Sadness  Female sex
 Loss of interest in life  Age <40 years
 Loss of interest in enjoyable activities  Impaired interpersonal
 Loss of appetite  Relationships
 Feelings of anxiety  Divorced, widowers
 Avoidance of people  Family history of depression
 Problems sleeping  Negative life events
 Low confidence level
 Feelings of unworthiness or guilt
 Thoughts of suicide
DIAGNOSIS
 Exclusion criteria :
 Transient depressed mood in reaction to negative experiences is normal
 Feeling sad is a normal reaction to experiences that are stressful or upsetting
 Most people, children as well as adults, feel low or 'blue' occasionally
 Depression becomes an illness when the depressed mood is serious and prolonged,
and is accompanied by other symptoms and disturbances of functioning
Test 1:
Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM5) criteria
 Depressed mood
 Insomnia / Hypersomnia
 Lack of concentration or interest
 Significant weight loss
 Fatigue
 Feeling worthless
 Suicidal thoughts
Test 2:
 For a depressive episode:
 Symptoms should be causing significant socio- occupational dysfunction.
 Rule out the possibility of bipolar depression. (Ask about prior episode of manic symptoms such as
elevated, expansive or irritable mood, increased activity and talkativeness, flight of ideas, decreased
need for sleep, grandiosity, distractibility, loss of social inhibitions and extreme optimism leading to
reckless behaviors.)
diagnostic criteria: For at least 2 weeks the person has at least 2 of the following
core symptoms
 Depressed mood (most of the day, almost every day), (for children and adolescents irritability
or depressed mood)
 Loss of interest or pleasure in activities that are normally pleasurable.
 Decreased energy or easily fatigued.
 Type 3 (severity):
 During the last 2 weeks has the person had at least 2 other features of depression:
1. Reduced concentration and attention
2. Reduced self-esteem and self-confidence
3. Ideas of guilt and unworthiness
4. Bleak and pessimistic view of the future (the state of mind of someone who always
expects the worst) (not hopeful or encouraging)
5. Ideas or acts of self-harm or suicide
6. Disturbed sleep
7. Diminished appetite ( to make less or cause to appear less)
 If 2 other features - mild depressive episode
 If 3 other features - moderate depressive episode
 If 3 of the core features and 4 other symptoms - Severe depressive episode.
It may be with or without psychotic features
CLINICAL FEATURES

Inability to feel pleasure in normally

pleasurable activities.
Sex drive or the desire for
sex
A state of anxiety or nervous excitement.
TREATMENT :
Tricyclic antidepressants: TCA agents inhibit re-uptake of the amines
noradrenaline (norepinephrine) and 5-HT at synaptic clefts. The therapeutic
effect is noticeable within a week or two.
ADR : such as sedation, anticholinergic effects, postural hypotension,
lowering of the seizure threshold and cardiotoxicity, can be troublesome
during this period. TCAs may be dangerous in overdose and should be used
with caution in people who have coexisting heart disease, glaucoma and
prostatism
 Selective serotonin re-uptake inhibitors:SSRIs shows its action by inhibiting the serotonin
reuptake into the presynaptic cell and increase the levels of serotonin at post synaptic nerve.
 ADR : SSRIs are less cardiotoxic and less sedative than TCAs, and have fewer anticholinergic
effects. They are safer in overdose but can still cause QTe prolongation, headache, nausea,
anorexia and sexual dysfunction. They can also interact with other drugs increasing serotonin (5-
HT), to produce 'serotonin syndrome". This is a rare syndrome of neuromuscular hyperactivity,
autonomic hyperactivity and agitation, and potentially seizures, hyperthermia,
delirium and even death
Monoamine oxidase inhibitors: Monoamine oxidase inhibitors (MAOIs) increase the
availability of neurotransmitters at synaptic clefts by inhibiting metabolism of
noradrenaline (norepinephrine) and 5-HT. They are now rarely prescribed in the UK,
since they can cause potentially dangerous interactions with drugs such as
amphetamines and certain anaesthetic agents, and with foods rich in tyramine (such as
cheese and red wine). This is due to accumulation of amines in the systemic
circulation, causing a potentially fatal hypertensive crisis.
 Noradrenaline (norepinephrine) re-uptake inhibitors: These agents inhibit
noradrenaline uptake at the synaptic cleft but have additional pharmacological
effects. Venlafaxine and duloxetine also act as serotonin re-uptake inhibitors,
whereas mirtazapine also acts as an antagonist at 5-HT2a, 5-HT2c and 5-HT3
receptors. These drugs have similar efficacy to the agents listed below but a
different adverse-effect profile.
 PSYCHOTHERAPY
 Psychotherapy treatment is focused on improving positive changes in depressive patients. There are many
specific types of psychotherapy that are used to treat depression. Each works in a slightly different way, but
all have been proven to help improve the symptoms of depression.
 Cognitive-behavioural therapy (CBT): In CBT, the therapist is to identify and reshape the thought and
behavior patterns that contribute to depression.
 Interpersonal psychotherapy: In interpersonal psychotherapy, focus is on improvement of relationships, the
way that depressive patients interact with other people in their life.
 Family and couples therapy: In family and couples therapy, the therapist shall improve interaction of patient
with family members so that depressive patients can work together on the issues that are contributing
depression.
 Problem solving therapy: In problem solving therapy, the therapist have to develop practical and systematic
approach to the problems in life and find effective ways to solve them.
 Psychodynamic psychotherapy: In psychodynamic therapy, therapist might explore childhood or historic life
events and work to reduce their influence by gaining insight into how they may be shaping current behavior.
MANIAC :
 The word in derived from the Greek word (mania)
meaning "madness, frenzy“
 Mania is a state of extreme physical and emotional
elevation.
 It is a psychiatric medical condition In which patient
manifest a clinical syndrome characterized by;
extremely mood, energy, hyperactivity, unusual
thought process with flight of ideas and acceleration in
speaking purposes.
 TYPES
 Hypomania
 Mixed State (Agitated depression) (feeling or appearing troubled or nervous).
 Acute mania
 Delirium Mania
 ETIOLOGY
1) Genetic factors
2) Biochemical factors
3) Physiological factors
4) medications:- Levodopa , Antidepressants, Corticosteroids, Bromocriptine
 RISK FACTORS

 First degree relatives

Twin studies:- Identical twins>fraternal twins.
Family studies:- more chances if any family member is suffering from manic
disorders.
 Biogenic amines:- increased level of nor-epinephrine and dopamine.
Electrolyte imbalance:-increased level of intracellular sodium and calcium.
 Brain lesions:-lesion in right fronto-temporal or left parieto- occipital is associated
with Mania.
 Neurological disorders:-Brain tumours , Head injuries, encephalitis,
Multiple sclerosis. (inflammation of the active tissues of the brain caused by an infection or
an autoimmune response.)
 Periods of high stress> Drug or alcohol abuse
 Major life changes, such as the death of a loved one> Being in your early 20s
  Social embarrassing behavior.

Sign and symptoms Difficulties at work or social relationship. Increase stress in



personal relationship.
 Distribute money to unknown person.
 Euphoria. (intense feelings of well-being and
 Hallucination (a false perception of objects or events
happiness.)
involving your senses: sight, sound, smell,)
 Irritable mood.
 Delusion. (affected person's content of thought.
 Grandiosity.
 Increased in sexual interest.
 Decrease need for sleep
 Word salad.
 Flight of ideas.
 Distractibility and attention deficit.
 Pressured speech;
 Rapid talking.
 Speaks louder.
 Poor judgement.
 Suicidal tendency.
 Over active.
 Diagnosis
 Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM5)
criteria
 Mental status examination.
 History collection.
 Physical examination.
 TREATMENT
 MOOD STABILIZERS :
LITHIUM (low to moderate doses : 600mg/day ; high doses : 900-1200 mg/day )
 ANTICONVULSANT: clonazepam (2mg -16mg)
valproic acid (500mg -750mg)
 CALCIUM CHANNEL BLOCKER: verapamil(160mg -480mg)
 ANTIPSYCHOTICS : Olanzapine (10mg -15mg ), Risperidone (6mg-8mg),
Quetiapine (200mg-800mg),Chlorpromazine(500mg-2g),
Haloperidol (5mg-10mg)
 SEDTIVES/HYPNOTICS: Benzodiazepines.[diazepam (20-40mg),clonazepam(20-
40mg)]
 ➤ Often hospitalisation is required for someone who is experiencing acute mania. Both mood-
stabilising agents such as lithium carbonate or sodium valproate and an antipsychotic may be
needed to treat psychotic symptoms, agitation, thought disorder and sleeping difficulties.
Benzodiazepines may be useful to reduce hyperactivity.
 ➤ Treatment with lithium alone may have a relatively slow response rate (up to two weeks after
a therapeutic blood level is established), so that adjunctive medication such as sodium valproate
is usually required.
 ➤ Regular monitoring of blood levels for lithium and valproate is essential because of the
potential for toxicity.
 ➤ Hypomania may be managed with lithium or valproate and benzodiazepines. Doses can be
lower than for mania, and may prevent progression to a manic episode.
 ➤ Maintenance therapy needs to be based on an assessment of severity, recurrences and risks of
ongoing use of medication.
 ➤ Psychosocial strategies including education, counselling and support for the person and his or
her family can help with understanding, stress management and compliance with medication.
 psychotherapy
 Marital therapy.
 Family therapy.
 Behaviour therapy.
 Cognitive behaviour therapy.
 BIPOLAR
• Bipolar affective disorder is a
chronic and complex mental
illness, characterized by mania and
hypomania episodes, alternating
with periods of depression.
• Bipolar disorder causes extreme
shifts in mood, energy, thinking,
and behavior-from the highs of
mania on one extreme, to the lows
of depression on the other.
 ETIOLOGY
 Genetics
Bipolar disorder tends to run in families. Children with a parent or sibling who has
bipolar disorder are four to six times more likely to develop the illness, compared with
children who do not have a family history of bipolar disorder.
Studies of identical twins have shown that the twin of a person with bipolar illness
does not always develop the disorder. The study results suggest factors besides genes
are also at work.
It is likely that many different genes and a person's environment are involved.
 RISK FACTORS
 Age below 25 years who has chronic  Hopelessness
episodes of unipolar alternatively  Previous suicide attempts
 Depressive, mixed dysphoric-irritable  Substance or alcohol abuse
states  Impulsivity (the tendency to act without
 Caucasian ethnicity thinking.)
 Being unmarried  Stressful life events (deaths, divorce,
 Previous depression separations, scandals, etc)
 Previous dysphoric-agitated states
 Suicidal ideation
 Limited access to support or
clinical services
 TYPES
 TYPE I : (depression +maniac) defined by manic or mixed episodes that last at least seven days, or by manic
symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive
episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the
person's normal behavior.
 TYPE II : (depression + hypomanic) defined by a pattern of depressive episodes shifting back and forth with
hypomanic episodes, but no full-blown manic or mixed episodes.
 OTHERS : CYCLOTHYMIA (minor epi. Of depression + hypomanic)
bipolar-spectrum (depression + other complexities)
Rapid cycling bipolar. ( rapid shifting of episodes )
Bipolar with mixed features.
Bipolar with seasonal pattern. (Bipolar only specific duration)
Unspecified bipolar.
SIGNS AND SYMOTOMS
 EPIDEMIOLOGY
Characteristics BPD I BPD II

Prevalence ≤1.6% 0.5%

Ethnic/racial differential None None

Gender differential M=F F>M (?)

Course Recurrent in >90% of cases Hypomanic episodes in BPD II

immediately precede or follow
MDEs in 60% to 70% of cases

Familial pattern First-degree relatives have First-degree relatives may have

increased rates of BPD I, BPD II, increased rates of BPD I, BPD II,
and MDDA and MDD
 DIAGNOSIS
BPD I Recurrent major depression with
BPD II hypomania and/or cyclothymic
temperament

BPD NOS Recurrent major depression without

spontaneous hypomania but often with
hyperthymic temperament and/or family
history of BPD
 TREATMENT
 LITHIUM (low to moderate doses : 600mg/day ; high doses : 900-1200 mg/day )
 ANTICONVULSANT: Clonazepam (2mg -16mg)
Valproic acid (500mg -750mg)
 ANTIPSYCHOTICS : Olanzapine (10mg -15mg ), Risperidone (6mg-8mg),
Quetiapine (200mg-800mg),Chlorpromazine(500mg-2g),
Haloperidol (5mg-10mg)
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