<prompt> Which of the following has to be present for diagnosis of manic-depressive psychosis?Loss of interest or pleasureRecurrent suicidal ideationIndecisivenessInsomnia  <response>: Ans. a Loss of interest or pleasure Ref. Hs medicine 18thch. 391QBipolar DisorderA mood disturbance in patient that experiences manic symptoms for 1 week causes significant impairment in hisher functioning levelQDysthymiaA milder form of depression lasting at least 2 years.QCyclothymic DisorderA chronic mood disorder mild Bipolar II Disorder characterized by many periods of Depressed Mood many periods of Hypomanic Mood for 2 years.MAJOR DEPRESSIVE DISORDER MAJOR DEPRESSION Mood disorder that presents with at least a 2-week course of symptoms that is a change from the patients previous level of functioning. Must have depressed mood or anhedonia absence of pleasure Risk FactorsEpidemiology- Women Men 2:1 due to several factors, such as hormonal differences- Onset is 40 years Biology:- Neurotransmitters abnormalities: Serotonin, Norepinephrine Dopamine Q- Serotonin metabolites 5 HOIAA in suicide aggression0- Other risk factors include family history, exposure to stressors behavioral reasons, such as learned helplessness. Symptoms- Typical Features Vegetative Changes of Depression It is characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedonia: mnemonic - SIGECAPS Sleep disturbance Loss of Interest anhedonia Guilt or feelings of worthlessness Loss of Energy Loss of Concentration Change in Appetiteweight Psychomotor retardation or agitation Suicidal ideations Depressed mood Lifetime prevalence of major depressive episode--5-12 male, 10-25 female. Major depressive disorder, recurrent--requires 2 or more episodes with a symptom-free interval of 2 months.- Atypical Features Appetite, Weight Sleep Hypersomnia May Also Include Psychotic features: Worse prognosis Treatment:- Antidepressants: Selective Serotonin Reuptake Inhibitors SSRI, Tricyclic Antidepressants TCA Monoamine Oxidase Inhibitors MOI- Electro-Convulsive Therapy ECT may be indicated if patient is suicidal or worried about side effects from medications. 0- Individual Psychotherapy: To help the patient deal with conflicts sense of loss- Cognitive Therapy: To change the patients distorted thoughts about self world.Mood disorder subtypesTypesCharacteristicsDysthmia Depressed mood Loss of interest or pleasure Chronic at least 2 yearsCyclothymia nonpsychotic Alternating states Chronic Often not recognized by affected personSeasonal affective disorder SAD Depressive symptoms during winter months shortest days, so least amount of light Caused by abnormal melatonin metabolism Treat with bright light therapyUnipolar depressionmajor depression Symptoms for at least 2 weeks Must be a change from previous functioning May be associated with anhedonia, no motivation, feelings of worth lessness, reduced concentration, weight loss or gain, depressed mood, recurrent thoughts, insomnia or hypersomnia, psychomotor agitation or retardation, somatic complaints, delusions or hallucinations mood congruent, loss of sex drive Diurnal improvement as day progresses Suicide: 60 of depressed patients have suicidal ideation; 15 die by suicide Neurochemistry: biogenic amine theory of depression- caused by decreased NE5HT Sleep: REM in first half of sleep, REM consistency, stage 4 sleep, REM time overall, early morning wakeningBipolar disordermanic-depression Symptoms of major depression and symptoms of mania period of abnormal and persistent elevated, expansive, or irritable mood Subtype- Bipolar I: Mania more prominent- Bipolar II: recurrent depressive episodes, plus hypomanic episodes- Rapidly cycling bipolar disorder: If alternates within 48-72 hours Manic symp: self-esteenmor grandiosity, low frustration tolerance, need for sleep, fight of ideas, excessive involvement in activities, weight loss,anorexia, erratic and uninhibited behavior, libido 