Affective (mood)Disorders XIE Guang-rong M.D
Affective (mood) Disorders XIE Guang-rong M.D
Definition Affective disorders are characterized by obvious and persistent elation or depression of mood The mood disturbance is commonly associated with cognitive and behavioral changes.In severe cases,psychotic symptoms,such as hallucination and delusion,may be observed.There is a recurrent tendency.In certain cases,an episode may become chronic and residual symptoms are observed
Definition ⚫ Affective disorders are characterized by obvious and persistent elation or depression of mood . The mood disturbance is commonly associated with cognitive and behavioral changes. In severe cases,psychotic symptoms,such as hallucination and delusion,may be observed.There is a recurrent tendency. In certain cases,an episode may become chronic and residual symptoms are observed
The Classification of Affective Disorders Manic episode (mania) Depression single episode (unipolar) recurrent episode with or ●Affective without ●Disorders Bipolar-I(with mania) Psychotic Bipolar Bipolar-II(with hypomania) symptom disorders Mixed type Rapid-cycling bipolar disorder Dysthymia Cyclothymia disorder
The Classification of Affective Disorders ⚫ Manic episode ⚫ (mania) ⚫ Depression single episode ⚫ (unipolar) recurrent episode with or ⚫ Affective without ⚫ Disorders Bipolar-I(with mania) Psychotic ⚫ Bipolar Bipolar-II(with hypomania) symptom ⚫ disorders Mixed type ⚫ Rapid-cycling bipolar disorder ⚫ Dysthymia ⚫ Cyclothymia disorder ⚫
Clinical description of mood disorders ●The episode ● Severity Mild,moderate,or severe Type Depressive,manic,mixed Special features With melancholic symptoms With neurotic symptoms With psychotic symptoms With agitation ● With retardation or stupor ●The course Unipolar or bipolar ● Aetiology Predominantly reactive Predominantly endogenous
Clinical description of mood disorders ⚫ The episode ⚫ Severity Mild, moderate, or severe ⚫ Type Depressive, manic, mixed ⚫ Special features With melancholic symptoms ⚫ With neurotic symptoms ⚫ With psychotic symptoms ⚫ With agitation ⚫ With retardation or stupor ⚫ The course Unipolar or bipolar ⚫ Aetiology Predominantly reactive ⚫ Predominantly endogenous
Etiology ●Genetic Causes ●Family Studies In a study at the National Institute of Mental Health,25%of relatives of bipolar probands were found to have bipolar disorder or unipolar illness (depression)themselves,compared to 20%of relatives of unipolar probands and 7%of relatives of control subjects
Etiology ⚫ Genetic Causes ⚫ Family Studies: ⚫ In a study at the National Institute of Mental Health, 25% of relatives of bipolar probands were found to have bipolar disorder or unipolar illness (depression) themselves, compared to 20% of relatives of unipolar probands and 7% of relatives of control subjects
Some data have supported multifactorial models These models imply multiple factors: genetic,environmental,or both.An alternative explanation is heterogeneity.In other words single major genes are important in at least some families,but it is not the same gene in each family
Some data have supported multifactorial models , These models imply multiple factors: genetic, environmental, or both. An alternative explanation is heterogeneity. In other words , single major genes are important in at least some families, but it is not the same gene in each family
Twin studies: On average,MZ twin pairs show concordance 65%of the time,and DZ twin pairs show concordance 14%of the time
Twin studies: On average, MZ twin pairs show concordance 65% of the time, and DZ twin pairs show concordance 14% of the time
Adoption Studies: In one study the risk for affective disorder in the biological relatives of bipolar probands was 31%as opposed to 2%in the relatives of control probands.The risk in biological relatives of adopted bipolar probands was similar to the risk in relatives of bipolar probands who were not adopted away (26%).Adoptive relatives did not show increased risk
Adoption Studies: In one study , the risk for affective disorder in the biological relatives of bipolar probands was 31% as opposed to 2% in the relatives of control probands. The risk in biological relatives of adopted bipolar probands was similar to the risk in relatives of bipolar probands who were not adopted away (26%). Adoptive relatives did not show increased risk
Adoption studies that used a broader class of affective probands showed evidence for genetic factors but also possible environmental influences
Adoption studies that used a broader class of affective probands showed evidence for genetic factors but also possible environmental influences
Molecular Genetics ●Linkage Studies ● Chromosomal Location Reference 18p Berrettini et al 19 Stine et al 1995 21q Straub et al 1994 Detera-Wadleigh et al 1996 Xq26 Pekkarinen et al 1995 11pl5 Egeland et al 1987 Kelsoe et al1991 Gurling et al1995 5q Coon et al 1993 4p Blackwood et al 1996 18q Freimer et al 1996 Stine et al1995 Other (including 10p,12q)Craddock et al1994 Ewald et al 1995 Ginns et al 1996 NIMH Genetics Initiative 1997
Molecular Genetics ⚫ Linkage Studies ⚫ ⚫ Chromosomal Location Reference ⚫ 18p Berrettini et al 19 ⚫ Stine et al 1995 ⚫ 21q Straub et al 1994 ⚫ Detera-Wadleigh et al 1996 ⚫ Xq26 Pekkarinen et al 1995 ⚫ 11p15 Egeland et al 1987 ⚫ Kelsoe et al1991 ⚫ Gurling et al1995 ⚫ 5q Coon et al 1993 ⚫ 4p Blackwood et al 1996 ⚫ 18q Freimer et al 1996 ⚫ Stine et al1995 ⚫ Other (including 10p,12q) Craddock et al1994 ⚫ Ewald et al 1995 ⚫ Ginns et al 1996 ⚫ NIMH Genetics Initiative 1997