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Mood Disorders خلقی اختالالت
Bipolar Disorders دوقطبی اختالالت Depressive Disorders
افسردگی اختالالت
By : Dr SeddighHUMS
Episodes and Patternsها الگوها دوره و
Major depressive episode افسردگی عمده
Manic episode شیدایی دوره Mixed episode مختلط دوره Hypomanic episode هیبومانیک دوره Cycling patterns چرخشی الگوهای
Major depressive episodeعمده دوره افسردگی
Five or more of the following, most of the day and/or nearly every day, including at least symptom 1 or 2:
زیر 5 عالئم از بیشتر یا 1. Depressed mood افسرده خلق
– Sad, empty, weepy; irritable, angry 2. Loss of interest or pleasure in previously enjoyable
activities
لذت و عالقه فقدان 3. Change in weight or appetite اشتها و وزن تغییرات 4. Sleep changes خواب تغییرات
More depressive symptoms 5. Noticeable change in movement
حرکت در توجه قابل تغییرات 6. Fatigue خستگی 7. Feelings of worthlessness or guilt
گناه یا ارزشی بی احساس 8. Impaired cognition or volition
وتمرکز تفکر در اختالل 9. Repeated thoughts of death or suicide, or planned or
attempted suicide
خودکشی و مرگ مکرر افکار The five symptoms must occur in the same two weeks
باشد 5 داشته وجود هفته دو حداقل باید عالمت
Manic episode شیدایی دوره One week of persistently high, expansive, or irritable
mood, and 3 of:سه با پذیرهمراه تحریک یا و ،وسیع باال مستمرا خلق هفته یک
عالمت Grandiose self-esteem بینی خودبزرگ
Lower sleep need خواب به نیاز کاهش Overly talkative حرفی پر Racing thoughts افکار جویی سبقت Easily distracted پرتی حواس Increased activity or agitation
اژیتاسیون یا فعالیت افزایش High risk activities خطر پر فعالیتهای
Mixed episode مختلط دوره One week of both manic and major depressive
symptoms with rapidly alternating moods
سریع تغییر با شیدایی و افسردگی دودوره هر عالئم هفته یکخلق
Common symptoms: شایع عالئم
– Agitation آژیتاسیون – Insomniaبیخوابی – Irregular appetite (binge-fast) امساک و پرخوری– Delusions هذیان
– Thoughts of suicide خودکشی افکار
Hypomanic episode دوره هیپومانیک Four days of manic episode symptoms
4 شیدایی دوره عالئم روز Mood disturbance does not critically
نیست بحرانی خلقی آشفتگی impair ability to work or maintain social responsibilities
اجتماعی مسئولیت و کار انجام در عملکرد افت Response pattern is uncharacteristic
نیست منش به مربوط پاسخدهی الگوی Not euthymia نیست طبیعی خاق
Bipolar disorders دو اختالالت قطبی Bipolar I Disorder قطبی دو یک اختالالت تیپ
– One or more manic or mixed episodes– Usually one or more major depressive episodes– Subcategorized based on the character of the
most recent episode• Most recent episode depressed• Most recent episode manic• Most recent episode mixed
Bipolar I Disorder
Major Depressive
Episode
Manicor Mixed Episode
Manic or Mixed Episode
One or more manic episode
OR Depressed and manic episodes
OR
Bipolar disorders…
Bipolar II Disorder دو تیپ قطبی دو اختالالت – One or more major depressive episodes– One or more hypomanic episodes– NO manic or mixed episode
Cyclothymic Disorder سیکلوتایمیا اختالل– Two years of alternating hypomanic and depressive
symptoms – افسردگی عالئم و هیپومانیا متغییر های دوره سال دو
– No remission of more two months– NO major depressive, manic, or mixed episodes
Bipolar II Disorder
Major Depressive
Episode
Hypomanic Episode
Depressed and hypomanic episodes
Depressive disorders اختالالت افسردگی No history of manic, hypomanic, or mixed episodes
مختلط و مانیک،هیپومانیک های دوره قدان Major Depressive Disorder
عمده افسردگی اختالل– Current major depressive episode
Dysthymic Disorder دیستیمیا اختالل– Two years of chronically depressed mood– مزمن افسرده خلق سال دو– Two additional depression symptoms (appetite, sleep, energy,
concentration, low self-esteem, hopeless feelings)– درماندگی احساس و نفس به اشتها،خواب،انرژی،تمرکز،احترام
Likelihood of having another Major Depressive Episode if you’ve had…
Major Depressive
Episode
Major Depressive
Episode
Major Depressive
Episode
Major Depressive
Episode
Major Depressive
Episode
Major Depressive
Episode
1 episode 50%
2 episodes70%
3 episodes 90%
Patterns of mood disorders
-4
-3
-2
-1
0
1
2
3
4
1 2 3 4 5 6 7 8 9 10 11 12
MajorDepression
Bipolar I
Bipolar II
Manic
Hypo-manic
De-pressed
Weeks
Identify episodes:ManicMixedHypomanicMajor Depressive
More patterns...
-4
-3
-2
-1
0
1
2
3
1 2 3 4 5 6 7 8 9 10 11 12
CyclothymiaDysthymia
Manic
Hypo-manic
De-pressed
Depressive Disorders NOS
Premenstrual dysphoric disorder
قاعدگی از پیش اختالل Minor depressive disorder
جزئی افسردگی اختالل– Fewer than five symptoms
Recurrent brief depressive disorder
گذرا کننده عود افسردگی اختالل– Monthly episodes lasting <2 weeks
Postpsychotic depressive disorder of Schizophrenia
اسکیزوفرنیا سایکوز از پس افسردگی اختالل– Residual phase phenomenon
Mood Disorder Specifiersترین تازه کننده توصیف های شاخص
دوره These specifiers may be applied to mood disorder diagnoses,
where appropriate:– Mild/moderate/severe w/o psychotic features
– / / سایکوتیک/ ویژگیهای بدون یا با شدید متوسط خفیف– With:psychotic/ catatonic/ melancholic/ atypical features (m-
older, a-younger)– / / / آتیپیکال : مالنکولیک کاتاتونیک سایکوزیس ویژگیهای با
– In remission/chronic/seasonal pattern– فصلی / / مزمن بازگشت الگوی با
– With postpartum onset زایمان از پس شروع با– Rapid cycling for Bipolar I or II Disorder تندچرخ سیر با
Etiology of mood disordersخلقی اختالالت شناسی سبب
Psychoanalytic theory: Evaluation of experiences گذشته تجارب بررسی Cognitive theories: Thought patterns تفکر الگوهای Interpersonal theory: Rejectionطرد Biological theories: Genes and NTs نوروترانسمیترها و ژنها Existential theory: Loss of meaning معنا از بودن خالی
Psychoanalytic theory
Oral fixation: در دهانی تثبیت مرحله
Depends on others for self-esteem
Super ego کننده انتقاد فراخود
Cognitive theories
Beck’s theory:
بدبینانه (NegativeTriad) منش
گرایی منفی (Negative schemas) تکرار
شده تحریف (Characteristic biases) تفکر
DEPRESSION
Characteristic biases
Arbitrary inference دلخواه استنباطکافی قرائن بدون خاص استنتاج
Selective abstraction ویژه انتزاعواحد جزئی روی تمرکز
Overgeneralization مفرط تعمیموباریک کوتاه ای تجربه بر مبتنی استنتاج
Magnification and minimizationنمایی کوچک و بزرگنمایی
رخدادها اهمیت افزایش یا کاهش
Assessment of Beck’s theory
Depressed people do show cognitive biases in their thinking
Their apparent pessimism, however, is accurate
The theory is correlational, not causal The model is multidimensional Treatment based on the theory is helpful
Helplessness/hopelessness theories / ناامیدی درماندگی تئوری Learned helplessness (Seligman & Maier,
1967) شده آموخته درماندگی Attributional reformulation (Abramson,
Seligman & Teasdale, 1978) اسنادی اصالح– Personal/Environmental (a.k.a. Internal/External)
– محیطی/ فردی– Stable/Unstable ناپایدار / پایدار– Global/Specific / محدود گیر همه
Hopelessness: Add diatheses of low self-
esteem and hopelessness
Interpersonal theory بین تئوری فردی Reduced interpersonal support Experiences of rejection
– Due to social structure• Inadequate social networks• Others may dislike them
– Elicited by patient• Consequences of behavioral choices• Critical comments by spouse
– Poor social skills and seeking reassurance
Behavioral theories
Learned helplessness/hopelessness is a behavioral theory with a cognitive twist.
Reduction in reinforcement leads to a reduction in activity.
Depressive behaviors are reinforced. Depressed people have taken part in
fewer pleasant events.
Biological theories زیست تئوری شناختی
Genetics:ژنتیک – Bipolar MZ concordance = 43% to 72%– Bipolar DZ concordance = 6% to 25%– Unipolar MZ concordance = 46%– Unipolar DZ concordance = 20%
Linkage analysis: Mixed results– Multiple genes?– Chromosomes 13 and 22
Brain chemistry theoriesمغز شیمیایی تئوری
Serotonin and norepinephrine Drug treatments: Tricyclics, MAOIs, and
SSRIs But the time course doesn’t match Current hypothesis: Antidepressant
drugs change the density or sensitivity of postsynaptic serotonin receptors
Neuroendocrine theory
Hypothalamus-pituitary-adrenocortical axis
High levels of cortisol correlate with depression
Dexamethasone Suppression Test identifies major depressive episodes
Existential theory
Frankl and the search for meaning A spiritual approach: Logotherapy Suffering has meaning: What is it? Reversing helplessness?