Module Three Mood Disorders

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Module ThreeMood Disorders

• Lesson 1What is disorder and how it is
  manifested
• Lesson 2 What are the causes of Depression
• Lesson 3 Which is the treatment of Depression
  
• Lesson 4 What is Bipolar Disorder
• Lesson 5 Which is the therapeutical treatment of
  Bipolar Disorder

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Lesson 1

• WHAT IS DEPRESSION AND HOW IT IS MANIFESTED

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Step 1 Introduction

• The emotion of sadness is a common experience of
  all people.
• Depression is mental disorder, where the normal
  emotion of sadness has over passed the usual
  limits of sadness.
• This disorder is extremely common. One in ten
  people is attacked by it in any time of his life
  and one in five will experience it some time
  during his life.
• Women are more prone to suffer Depression than
  men.
• It can often lead to suicide.

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Step 2 Brainstormin

• How does it feel and what is the behavior of a
  person that suffers from Depression?

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Step 3 Slide Projection

• Slide 3.1.1 Symptoms of Depression
• Emotion of intense sadness that does not subside
• Lack of pleasure
• Tendency to avoid other people.
• uneasiness and anxiety
• Irritability
• Difficulties to sleep (insomnia)
• Very early waking up
• Anorexia and weight loss (some times the
  opposite)
• Decrease of sexual desire
• Sense of fatigue and lack of energy.

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Step 3 (continued)

• Difficulty to accomplish his everyday tasks.
• Difficulty to take major or minor decisions
• Loss of interest
• Thoughts of committing suicide
• Guilt
• Difficulties in paying attention and in
  concentration
• Loss of self esteem
• Psychotic symptoms (aberrant depressive ideas,
  delusions)
• Physical disturbances

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Step 4 Theory Presentation

• Verbal and no verbal communication
• Communication between people is usually made
  through exchange of verbal messages. This
  requires
• Listening and paying attention,
• Understanding of the content,
• Knowledge of the language structure (grammar and
  syntaxes),
• Creating new sentences,
• Using common vocabulary with others,
• Remembering,
• Thinking,
• Putting his thoughts in words,
• Following social rules, as for example when to
  answer and in what way so that the answer
  responds to the question.

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Step 5 (continued)

• Verbal messages are either completed, or replaced
  by no verbal. These include
• Body posture
• Physical distance from the interlocutor
• Face expression
• Eye threat or its absence
• Various gestures
• Other elements of the persons behavior
• People with serious mental disorders some times
  have difficulties in verbal expression.

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Step 6 Questions and comments (5?)

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Lesson 2

• WHICH ARE THE CAUSES OF DEPRESSION
•  

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Step 1 Brainstorming

• What do you think that are the causes of
  Depression ?

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Step 3 Slide projection

• Slide 3.2.1 Factors related to the causes of
  Depression
• Genetic
• Neurochemical
• Traumatic experiences
• Hard social situations
• Stressful situations
• Physical diseases
• Substance use especially alcohol and cocaine
• Perperium (after birth recovery)

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Step 4 Slide Projection

• Slide 3.2.2 Clinical course (progress) of
  Depression
• 1 Case long , gentle and insidious start
•  
•  
•  

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Step 4 (continued)

• 2nd case long gentle and insidious start, plus
  acute symptoms for a period of time.

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Step 4 (continued)

• 3rd Case Sudden start and total subsiding of
  symptoms after a period of time.

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Step 4 (continued)

• 4th Case Sudden start, partial subsiding,
  relapses.

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Step 4 (continued)

• 5th Case Sudden or insidious start and chronic
  duration.

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Step 5 Questions and comments (5?)

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Lesson 3

• WHAT IS THE THERAPEUTICAL TREATMENT OF DEPRESSION

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Step 1 Slide Projection

• Slide 3.3.1 Therapeutic interventions to
  depressive patient
• Antidepressants
• Therapy with Lithium
• Psychotherapy
• Electrospasmic therapy
• Social interventions

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Step 3 Slide Projection

• What antidepressants do you use in your practice?

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Step 4 (continued)

• Slide 3.3.2 Common antidepressants
• Tricycles
• Imipramine (Tofranil)
• Amitriptyline (Saroten)
• Clomipramine (Anafranil)
•  New
• Fluoxetine (Ladose)
• Paroxetine (Seroxat)
• Fluvoxamine (Dumyrox)
• Venlafaxine (Efexor)
• Nefazodone (Nefirel)

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Step 5 Slide Projection

• Slide 3.3.3 Antidepressants side effects
• dry mouth, constipation, blurred vision
• drowsiness and fatigue
• Standing hypotension (low blood pressure)
• rapid heart rate excessive sedation or
  uncoordinated movements while taking this
  medicationTachycardia, arrhythmias and
  palpitation
• Sexual dysfunction
• Weight gain
• From newer antidepressants nausea, migraine
  headaches and insomnia.

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Step 6 Questions and comments (5?)

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Lesson 4

• WHAT IS BIPOLAR DISORDER

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Step 1 Introduction

• Depression might appear in combination with an
  opposite emotional state, euphoria which
  characterizes Mania. It is then called
  Manio-Depressive Disorder or Bipolar Disorder
  as it is named nowadays.
• Bipolar Disorder, like Schizophrenia, is
  considered as a psychotic disorder with long and
  serious course
• Patients with this disorder appear Depressive
  episodes as well as manic episodes. Either one
  might appear first.

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Step 1 (continued)

• It is possible that some patients appear severe
  episodes of Depression only, while the
  characteristics of euphoric behavior and
  hyperactivity are really mild and do not cause
  any problem. Other might appear only manic
  episodes, but it is not very common.
• The time in between the episodes the person might
  feel perfectly well.
• In some patients episodes alternate in high rate.

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Step 1 (continued)

• Some times at the beginning of the disease, if
  there are intense psychotic characteristics, it
  is difficult to distinguish a manic from a
  schizophrenic episode.
• The depressive episodes manifested in Bipolar
  Disorder are usually serious.
• Bipolar Disorder affects about 1 every 100
  persons, men as well as women.
• Depends on genetic background.
• Difficult social situations and stressful
  every-day situations worsen the development
  (progress) of this disorder.

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Step 2 Brainstorming

• What is the behavior of a manic patient?

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Step 3 Slide projection

• Slide 3.4.1 Manic Symptoms
• Symptoms related to mood
• Assiduous euphoric mood
• Irritability
• Temporary depression
• Symptoms related to concentration, speech and
  thinking
• Easy distraction of attention
• Pressurized talking, loss of ideas
• High self esteem

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Step 3 (continued)

• Somatic/ Biological/ Behavior symptoms
• High mobility and activity (physical, social,
  working, sexual)
• Dangerous or socially improper behavior
• Insomnia with no feeling of fatigue
• Good appetite, but loss of weight because of
  hyperactivity.

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Step 4 Questions and comments (5?)

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Lesson 5

• WHICH IS THE THERAPEUTICAL TREATMENT OF BIPOLAR
  DISORDER

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Step 1 Introduction

• Bipolar Disorder, without therapeutical
  treatment, has the tendency to manifest
  successive manic and depression episodes, which
  as the time pass become more often and more
  severe, while the intermediate free of symptoms
  periods become shorter.

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Step 2 Slide Projection

• Slide 3.5.1 Development of Bipolar Disorder with
  and without treatment.

one year?

Many years


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therapy of acute phase
 
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Step 3 Brainstorming

• Leaflet 3.5.1 Clinical case
• What are the needs of a patient that should be
  attended and in what way during his/ her
  treatment ?

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Step 4 Slide projection

• Slide 3.5.2 Therapeutical treatment for Bipolar
  Disorder
• Episode treatment
• Depression episode
• Antidepressants medication
• Other psychosocial interventions.
•  Manic episode
• Hospitalisation
• Medical treatment (with antipsychotic and
  tranquilizers)
• Limitation of manic behavior.
•  

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Step 4 (continued)

• Continued therapy from preventing relapses
• Continuation of the medication
• Supporting psychotherapy
• Other psychosocial interventions
•  Preservation therapy
• Administration of lithium or other drugs that
  stabilize mood
• Psychosocial interventions

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Step 5 Theory presentation

• Lithium
• Lithium is a chemical substance like sodium and
  potassium it is used as a simple salt.
• It is useful for the treatment and the prevention
  of manic episodes.
• Common Lithium drugs are Milithin, Priadel,
  Lithiofor.
• Before the patient starts the lithium treatment
  he undergoes urine, blood tests and an
  electrocardiograph. With these tests the function
  of the kidneys, liver, thyroid are checked out.

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Step 5 (continued)

• measuring the lithium levels in the blood (at
  first very often and later onevery1-2 months) is
  essential as the level at which the drug is
  efficient is not far from the toxicity level.
• Person in lithium medication should have a low in
  salt diet.
• It needs extra care when a person on lithium
  medication shows vomiting, diarrhea or
  dehydration.
• It shouldnt be administered in pregnant women or
  in people with kidney failure.

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Step 5 (continued)

• Slide 3.5.3 Lithium side effects
• Early signs
• Nausea, vomiting, diarrhea
• Fear at voluntary movements
• Dry mouth, thirst
• Fatigue
• congested nose, metallic taste
• Later signs
• hypothyroid
• Weight gain
• ataxia, joint dysfunction
• Arrhythmias
• Kidney disease

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Step 5 (continued)

• Lithium poisoning
• Terror (phobias)
• Ataxia
• Uncoordinated movements
• Rushed speech
• Confusion
• Loss of orientation
• Spasms (convulsion)
• Coma

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Step 7 Questions and comments (5?)