Mood Disorder ( Major Depressive and Bipolar disorder )

Transcription

1 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 Dr. Vincent Wong, Consultant Psychiatrist 1

2 Contents 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 Dr. Vincent Wong, Consultant Psychiatrist 2

3 Interview ( The Callaghans ) Dr. Vincent Wong, Consultant Psychiatrist 3

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5 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 Dr. Vincent Wong, Consultant Psychiatrist 5

6 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 Dr. Vincent Wong, Consultant Psychiatrist 6

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8 What is normal moods? Dr. Vincent Wong, Consultant Psychiatrist 8

9 Emotions Anger Fear Happy Surprise Disgust Sadness Dr. Vincent Wong, Consultant Psychiatrist 9

10 The validity and reality of human emotions 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 Dr. Vincent Wong, Consultant Psychiatrist 10

11 Are moodswings normal? 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. Dr. Vincent Wong, Consultant Psychiatrist 11

12 Normal Sadness vs DEPRESSION 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 Dr. Vincent Wong, Consultant Psychiatrist 12

13 Signs and symptoms of Depressive disorder? Dr. Vincent Wong, Consultant Psychiatrist 13

14 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 Dr. Vincent Wong, Consultant Psychiatrist 14

15 CLINICAL DEPRESSION 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 Dr. Vincent Wong, Consultant Psychiatrist 15

16 Causes of Depressive disorder? Dr. Vincent Wong, Consultant Psychiatrist 16

17 CAUSES OF MENTAL ILLNESS DRUG & ALCOHOL GENETIC FAMILY UPBRINGING PERSONALITY/SPIRITUAL DETERIORATION OF BRAIN CELLS DEVELOPMENT Lack of Protective Factors -Good Parenting -Spiritual Foundation -Healthy thinking/coping -Self Awareness -Social support BIOCHEMICAL IMBALANCE Dr. Vincent Wong, Consultant Psychiatrist 17 STRESS & COPING COGNITIVE (THINKING)ERRORS

18 Neurobiology of depression Dr. Vincent Wong, Consultant Psychiatrist 18

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20 Chemicals in our brain Dr. Vincent Wong, Consultant Psychiatrist 20

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22 Brain Scan changes ( comparison between Normal vs Depressed individuals Dr. Vincent Wong, Consultant Psychiatrist 22

23 Complication of untreated depression. Dr. Vincent Wong, Consultant Psychiatrist 23

24 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 Dr. Vincent Wong, Consultant Psychiatrist 24

25 Natural Pattern for treatment of Depression Slide on the Kupfer curve Dr. Vincent Wong, Consultant Psychiatrist 25

26 Increased severity Treatment stages Euthymia Symptoms Relapse RESPONSE REMISSION RECOVERY Relapse Recurrence + Syndrome TREATMENT STAGES Acute (6 to 12 wk) Time Relapse Maintenance ( 1 y) Adapted from: Kupfer DJ, Long-Term Treatment of Depression, The Journal of Clinical Psychiatry. 52, 28-34, Copyright Dr. Vincent Wong, Consultant Psychiatrist 26

27 Q and A for Depression. Dr. Vincent Wong, Consultant Psychiatrist 27

28 What is Bipolar Disorder Dr. Vincent Wong, Consultant Psychiatrist 28

29 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. Dr. Washington, Vincent Wong, Consultant DC; Psychiatrist

30 Depression Mania Bipolar Disorder: Sever e Moderat e Mild Euthymic Mild Moderate Severe Slide courtesy of MP DelBello. Time

31 Depression Mania Bipolar Disorder: Depression Followed by Mania Sever e Moderat e Mild Euthymic Mild Moderate Severe Slide courtesy of MP DelBello. Time Dr. Vincent Wong, Consultant Psychiatrist 31

32 Manic States: Symptoms Mood Thinking Speech Mood Swings Fast thinking Talkative Feeling High Irritable Grandiose Suspicious Behaviour Reckless Overspending Dr. Vincent Wong, Consultant Psychiatrist 32

33 Bipolar Disorder: Untreated vs Treated Standardized Mortality Ratios 29.2* Untreated Treated * 2.2* * 2.2* Neoplasm Cardiovascular Cerebro- Accidents Suicide Other All Causes vascular Dr. Adapted Vincent Wong, from Consultant Angst Psychiatrist F et al. J Affect Disorder ;68:

34 Suicide Risk: Various Conditions Cancer Personality Disorder History of Suicide Attempt Alcohol Mixed Drugs Schizophrenia Bipolar Disorder Major Depression Percentage Inskip H et al. Br J Psychiatry ;172: Dr. Vincent Wong, Consultant Psychiatrist

35 The Close sisters Dr. Vincent Wong, Consultant Psychiatrist 35

36 For more information, please visit Dr. Vincent Wong, Consultant Psychiatrist 36