The depressive or manic symptoms should be of atleast 15 days duration. Types of depressive disorders. 1. Endogenous depression - is characterised by

Recurring episodes of depression only. (The term unipolar mania is not used because nearly all patients who have mania eventually experience a depressive disorder). These two disorders ware earlier referred to as manic depressive disorder. The depressive or manic symptoms should be of atleast 15 days duration. Types of depressive disorders. 1. Endogenous depression - is characterised by the classical triad of depressive symptoms, sadness of mood, poverty of ideation and psychomotor retardation. The onset of this type of depression can occur even in the absence of a significant stressor. 2. Reactive (or neurotic) depression - The onset of this disorder is usually precipitated by an environmental stressor. In addition to the depressive symptoms, concurrent symptoms of anxiety may be present. 3. Dysthymic disorder - This type of depression is characterised by chronic depressive signs and symptoms which are not as severe as those in major depressive disorder. Depressive symptoms should be present for atleast two years during which time symptom-free periods, if any, should be less than two months at a time. DIFFERENCE BETWEEN ENDOGENOUS AND NEUROTIC DEPRESSION: Endogenous depression Neurotic depression 1. Significant stress situation preceeding the 1. Significant stress situation preceding 1. Hypomania - Milder form of manic disorder characterised by euphoria and over-estimation of personal abilities and importance. If the symptoms are not disruptive, the patient's work efficiency may be relatively unimpaired and he may be socially acceptable. 2. Delirious mania - A severe form of mania with concurrent symptoms suggestive of delirium i.e. Clouding of consciousness, disorientation, illusions, hallucinations, incoherence. This form of mania is usually precipitated by emotional or physical stress and frequently results in deterioration of physical health. 3. Chronic mania - Continuous occurrence of manic symptoms in an attenuated form for a prolonged period of time Prognosis of mood disorders: Suicidal tendencies and attempts are unpredictable, hence caution is always needed while determining the prognosis. 1. Duration of illness - Shorter duration carries better prognosis. 2. Type of depression - Reactive depression has better long-term prognosis than endogenous depression. 3. Personality - Well adjusted personality carries better prognosis than maladjusted, neurotic (i.e. obsessive, inadequate or anxious) personality. 4. Type of onset - Acute onset carries better prognosis than gradual onset. 5. Precipitating factors - Presence of precipitating factors carries better prognosis than absence of precipitating factors. 6. Number of attacks - Repeatedepisodes couldresult in chronicity Management of depressive episodes - 1. Hospitalization - Indicated in (a) severe attack of depression, (b) suicidal and homicidal tendencies, and (c) stuporose condition of the patient. 2. ECT - About G to 8 convulsions spread out over a period of 2 to 3 weeks give excellent results in endogenous depression (90 to 95% success rate). Indications: (a) Severe attack, (b) Suicidal and homicidal tendencies, (c) Stupor and (d) Poor response to the other treatments. (e) Patients non-compliant with drug treatment. 3. Drug therapy - (a) Ant i depress ants I Anxiety disorder II Phobic disorder. III. Obsessive compulsive disorder IV Hysteria (a) Conversion disorder. (b) Dissociation disorder. V. Somatisation Disorder VI. Psychogenic Pain Disorder VII. Hypochondriasis. I. Anxiety disorder Definition: Anxiety disorder is characterised by an anxious and apprehensive overconcern often extending to panic and frequently associated with somatic symptoms. Etiology. 1. Genetic factors - Role of genetic factors in anxiety disorder is controversial and higher incidence in relatives of patients with the disorder could be the result of upbringing rather than inheritance. 2. (Biochemical and endocrine factors) - In anxious patients there is increased secretion of adrenaline and noradrenaline. Also post-exercise serum lactate levels are higher in patients with anxiety states than in normal subjects. But these disturbances have been shown to be accompaniments of anxiety rather than its cause. 3. Psychological theories -regard anxiety to be the result of a failure of an individual to successfully repress unwanted thoughts, ideas and feelings into the subconscious mind. Anxiety is also regarded as a fear response to another stimulus through the process of conditioning. 4. Age -Although the disorder can occur any age, it is most common in young adults. 5. Sex - Equal incidence in both sexes. 6. Personality - Persons with anxious, dependent and obsessive traits are more likely to suffer from anxiety states. Clinical manifestations: These are broadly grouped into: 1. PHYSICAL - They are referable to autonomic nervous system imbalance and commonly include palpitations, shortness of breath, tremulousness, unsteadiness, dryness of mouth, headache or heaviness of head, giddiness, blurring of vision, frequency of micturition, diarrhoea, and excessive sweating particularly in palms and soles, etc. On examination, one finds tachycardia, elevation of blood pressure, increase in depth and frequency of respiration, exaggerated deep reflexes 2 PSYCHOLOGICAL - Worries, nervousness, apprehension, irritability and a morbid fear as ifRecurring episodes of depression only. (The term unipolar mania is not used because nearly all patients who have mania eventually experience a depressive disorder). These two disorders ware earlier referred to as manic depressive disorder. The depressive or manic symptoms should be of atleast 15 days duration. Types of depressive disorders. 1. Endogenous depression - is characterised by the classical triad of depressive symptoms, sadness of mood, poverty of ideation and psychomotor retardation. The onset of this type of depression can occur even in the absence of a significant stressor. 2. Reactive (or neurotic) depression - The onset of this disorder is usually precipitated by an environmental stressor. In addition to the depressive symptoms, concurrent symptoms of anxiety may be present. 3. Dysthymic disorder - This type of depression is characterised by chronic depressive signs and symptoms which are not as severe as those in major depressive disorder. Depressive symptoms should be present for atleast two years during which time symptom-free periods, if any, should be less than two months at a time. DIFFERENCE BETWEEN ENDOGENOUS AND NEUROTIC DEPRESSION: Endogenous depression Neurotic depression 1. Significant stress situation preceeding the 1. Significant stress situation preceding 1. Hypomania - Milder form of manic disorder characterised by euphoria and over-estimation of personal abilities and importance. If the symptoms are not disruptive, the patient's work efficiency may be relatively unimpaired and he may be socially acceptable. 2. Delirious mania - A severe form of mania with concurrent symptoms suggestive of delirium i.e. Clouding of consciousness, disorientation, illusions, hallucinations, incoherence. This form of mania is usually precipitated by emotional or physical stress and frequently results in deterioration of physical health. 3. Chronic mania - Continuous occurrence of manic symptoms in an attenuated form for a prolonged period of time Prognosis of mood disorders: Suicidal tendencies and attempts are unpredictable, hence caution is always needed while determining the prognosis. 1. Duration of illness - Shorter duration carries better prognosis. 2. Type of depression - Reactive depression has better long-term prognosis than endogenous depression. 3. Personality - Well adjusted personality carries better prognosis than maladjusted, neurotic (i.e. obsessive, inadequate or anxious) personality. 4. Type of onset - Acute onset carries better prognosis than gradual onset. 5. Precipitating factors - Presence of precipitating factors carries better prognosis than absence of precipitating factors. 6. Number of attacks - Repeatedepisodes couldresult in chronicity Management of depressive episodes - 1. Hospitalization - Indicated in (a) severe attack of depression, (b) suicidal and homicidal tendencies, and (c) stuporose condition of the patient. 2. ECT - About G to 8 convulsions spread out over a period of 2 to 3 weeks give excellent results in endogenous depression (90 to 95% success rate). Indications: (a) Severe attack, (b) Suicidal and homicidal tendencies, (c) Stupor and (d) Poor response to the other treatments. (e) Patients non-compliant with drug treatment. 3. Drug therapy - (a) Ant i depress ants I Anxiety disorder II Phobic disorder. III. Obsessive compulsive disorder IV Hysteria (a) Conversion disorder. (b) Dissociation disorder. V. Somatisation Disorder VI. Psychogenic Pain Disorder VII. Hypochondriasis. I. Anxiety disorder Definition: Anxiety disorder is characterised by an anxious and apprehensive overconcern often extending to panic and frequently associated with somatic symptoms. Etiology. 1. Genetic factors - Role of genetic factors in anxiety disorder is controversial and higher incidence in relatives of patients with the disorder could be the result of upbringing rather than inheritance. 2. (Biochemical and endocrine factors) - In anxious patients there is increased secretion of adrenaline and noradrenaline. Also post-exercise serum lactate levels are higher in patients with anxiety states than in normal subjects. But these disturbances have been shown to be accompaniments of anxiety rather than its cause. 3. Psychological theories -regard anxiety to be the result of a failure of an individual to successfully repress unwanted thoughts, ideas and feelings into the subconscious mind. Anxiety is also regarded as a fear response to another stimulus through the process of conditioning. 4. Age -Although the disorder can occur any age, it is most common in young adults. 5. Sex - Equal incidence in both sexes. 6. Personality - Persons with anxious, dependent and obsessive traits are more likely to suffer from anxiety states. Clinical manifestations: These are broadly grouped into: 1. PHYSICAL - They are referable to autonomic nervous system imbalance and commonly include palpitations, shortness of breath, tremulousness, unsteadiness, dryness of mouth, headache or heaviness of head, giddiness, blurring of vision, frequency of micturition, diarrhoea, and excessive sweating particularly in palms and soles, etc. On examination, one finds tachycardia, elevation of blood pressure, increase in depth and frequency of respiration, exaggerated deep reflexes 2 PSYCHOLOGICAL - Worries, nervousness, apprehension, irritability and a morbid fear as if