Affective disorders

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Affective disorders[edit | edit source]

  • DSM V: separation of bipolar and unipolar

Classification of affective disorders[edit | edit source]

  • According to..
    • ..Polarity
      • bipolar, unipolar
    • ..Cause
      • primary, secondary (e.g. hypothyroidism)
    • ..Intensity
      • mild, moderate or severe
    • ..Quality
      • psychotic, non-psychotic
    • ..Length
      • short-term fluctuations in mood
      • long-term decline in mood (dysthymia)

Depressive episode according to DSM-5 (F32, F33)[edit | edit source]

  • Have to meet 5 or more criteria for more than 2 weeks, while one of those have to be either depressed mood or anhedonia
  • They are classically called the "SIG E CAPS" criteria
  • Sleep disturbances, loss of Interest, Guilt, Loss of energy, Concentration problems, Appetite loss/gain, Psychomotor retardation/agitation, Suicidal ideation

Etiopathogenesis[edit | edit source]

  • various biological (monoamine hypothesis) and psychosocial factors
  • External factors: e.g. economic crisis in spain, corona-virus, cancer diagnosis

Epidemiology[edit | edit source]

  • w>m
  • incidence is increasing over the past years, as well as the consumption of antidepressants
  • relapse rate in 1 year: 30%, 5 years: 60% ... → in reality less (study was inpatient)
  • other data: 50% remission

subgroups at risk: family history, old age and loneliness, female gender, adverse life-events, certain life styles, serious physical condition (e.g. stroke)

  • Factors influencing the course of depression
    • age of onset
    • gender
    • sleep..

Phases of depression[edit | edit source]

  • 3 phases: acute (6-12 weeks), continuation (4-9 months), maintenance (> 1 year)

Treatment[edit | edit source]

  • Psychotherapy: mild-moderate symptoms
  • Antidepressants
    • in general: reuptake blockade (e.g. SSRIs, TCA(serotonin,Na)..), influence on receptors (newer drugs, serotonin, melatonin receptors...e.g. TCA on Ach)
  • Biological treatment
    • e.g. in acute treatment of patients with depression
    • ECT
    • Chronobiologic treatment
    • rTMS: comparable effectiveness with ECT

Complications[edit | edit source]

  • Serotonin syndrome
  • Failure of treatment
    • compliance? right diagnosis? right dose? time? (4-6 weeks!) → change, combination, dose, potentiation of antidepressant action
  • Side-effects related to medication
  • Suicide
    • majority of depressed patients think about suicide
    • 10% of depressed commit real suicide
  • drug-interactions: cave
    • [1]https://reference.medscape.com/drug-interactionchecker

Prognosis[edit | edit source]

  • 50-70% of antidepressants...?
  • residual symptoms (e.g. fatigue) are a negative prognostic factor

When to initiate maintenance treatment?

  • first depressive episode: no indication
  • two in past 5 years: any risk factors? (e.g. onset, genetic risk)
  • three+