心境障碍牧案 Subject:Psychiatry Teacher:XIE Guang-rong Target:Clinical Medicine Teaching place:The second classroom Chapters:Chapter 5,section 2 Teaching hour:100 minutes Content:Mood disorders Date:2004 【Purpose and requirement】 1.To master the concepts,the classification,the main clinical manifestation, diagnosis and differential diagnosis, treatment principles of mood disorders. 2.To understand the etiology&pathogenesis of mood disorder. 【Key points of teaching】 The concepts,the main clinical manifestation,diagnosis and treatment principles of mood disorders. 【Difficult points of teaching】 The etiology,diagnosis and differential diagnosis of mood disorders. 【Type of teaching】 New knowledge teaching 【Teaching method】 Bilinguistic teaching,I ecture and heuristic method. 【Teaching aid】 Multimedia mix and lantern slide. 【Content and step of teaching】 1.Definition and the classification of mood disorders.(10min) 2.Etiology and epidemiology of mood disorders.(10min) 3.Clinical manifestation of mood disorders.(35min)
心境障碍教案 Subject ： Psychiatry Teacher ：XIE Guang-rong Target ： Clinical Medicine Teaching place ：The second classroom Chapters : Chapter 5, section 2 Teaching hour ： 100 minutes Content ： Mood disorders Date ： 2004 【Purpose and requirement 】 1. To master the concepts, the classification, the main clinical manifestation, diagnosis and differential diagnosis, treatment principles of mood disorders. 2. To understand the etiology & pathogenesis of mood disorder. 【Key points of teaching】 The concepts, the main clinical manifestation, diagnosis and treatment principles of mood disorders. 【Difficult points of teaching 】 The etiology, diagnosis and differential diagnosis of mood disorders. 【Type of teaching 】 New knowledge teaching. 【Teaching method 】 Bilinguistic teaching, l ecture and heuristic method. 【Teaching aid 】 Multimedia mix and lantern slide. 【Content and step of teaching】 1. Definition and the classification of mood disorders. (10min) 2. Etiology and epidemiology of mood disorders . (10min) 3. Clinical manifestation of mood disorders . (35min)
4.The diagnosis and differential diagnosis of mood disorders.(15min) 5.Course and prognosis of mood disorders.(I0nin) 6.Treatment of mood disorders.(15min) 7.Summry and discussion.(5min) CHAPTER 5 SECTION 2 MOOD DISORDERS 1.Definition and the classification 1.1 Definition 1.2 The classification 2.Etiology and Epidemiology 2.1 Etiology Genetie causes Changes of neurochemistry:Neurotransnitters Neuroendocrine factors Psychosocial factors:Stressful events,economic status or lower social class, et al. 2.2 Epideniology 3 Clinical manifestation 3.I Depressive episode L0w00d出 Lack of enjoynent Reduced energy Impaired efficiency Psychonotor retardation Slowing of thought Biological symptoms: Sleep disturbance Diurnal variation of nood Loss of appetite
4. The diagnosis and differential diagnosis of mood disorders. (15min) 5. Course and prognosis of mood disorders . (10min) 6. Treatment of mood disorders . (15min) 7. Summary and discussion. (5min) CHAPTER 5 SECTION 2 MOOD DISORDERS 1. Definition and the classification 1.1 Definition 1.2 The classification 2. Etiology and Epidemiology 2.1 Etiology Genetic causes Changes of neurochemistry: Neurotransmitters Neuroendocrine factors Psychosocial factors: Stressful events, economic status or lower social class, et al. 2.2 Epidemiology 3. Clinical manifestation 3.1 Depressive episode Low mood: Lack of enjoyment Reduced energy Impaired efficiency Psychomotor retardation Slowing of thought Biological symptoms: Sleep disturbance Diurnal variation of mood Loss of appetite
Loss of weight Constipation,et al. Pessimistic thoughts:present.future,past Others: Delusions and hallucinations Depressive stupor Suicide 3.2 Manic episode Elevation of mood Flight of thought Inereased activity: Overactive Feeling lively and energetic Physical exhaustion Expansive ideas:grandiose delusions Other symptons: Hallucinations (nood-congruent) Insight is invariably impaired Sleep is often reduced 3.3 Cyelothymie disorder Consisting of cyeling episodes of hypomania and less severe episodes of depression. It is often difficult to ascertain any regular pattern of mood switching. Individuals appear self-assured,energetic,and often impulsive. 3.4 Dysthymic disorder Mild depression predominated by persistent low mood. Never presenting mania Commonly accompanied by anxiety,physical upset and sleep disturbance. Social function is not severely impaired,but demanding treatment. 4.Diagmosis and differential diagnosis
Loss of weight Constipation, et al. Pessimistic thoughts: present, future, past Others: Delusions and hallucinations Depressive stupor Suicide 3.2 Manic episode Elevation of mood Flight of thought Increased activity: Overactive Feeling lively and energetic Physical exhaustion Expansive ideas: grandiose delusions Other symptoms: Hallucinations (mood-congruent) Insight is invariably impaired Sleep is often reduced 3.3 Cyclothymic disorder Consisting of cycling episodes of hypomania and less severe episodes of depression. It is often difficult to ascertain any regular pattern of mood switching. Individuals appear self-assured, energetic, and often impulsive. 3.4 Dysthymic disorder Mild depression predominated by persistent low mood. Never presenting mania. Commonly accompanied by anxiety, physical upset and sleep disturbance. Social function is not severely impaired, but demanding treatment. 4. Diagnosis and differential diagnosis
4.1 The diagnostie criteria of mood disorders in COD-3 A:Symptom criteria Depressive episode [F32] (Depressed mood lasting for at least two weeks) (At least 4 of the following) Loss of interest or enjoyment: Lack of energy or fatigability: Psychonotor retardation or apparent hypoactivity: Reduced self-esteen,worthlessness,self-blame.or preoccupation with guilt: Feel thinking retardation,or thinking efficiency reduced; Repeated ideas or attempts of self-harm or suicide: Disturbed sleep,e.g.,insomnia.early morning wakening,or hypersomnia: Poor appetite or obvious weight loss: Decreased libido. Manic episode [F30] (At least 3 of the following are required) Impaired concentration or distractibility: Over-talkativeness: Racing thoughts or flight of ideas: Inflated self-esteen or grandiosity: overactivity,or psychoeotor excitement: Reckless behavior: Decreased need for sleep: Inereased libido. B:Severity criteria Impairment of social function
4.1 The diagnostic criteria of mood disorders in CCMD-3 A: Symptom criteria ____________________________________________________________________ Depressive episode [F32] (Depressed mood lasting for at least two weeks) (At least 4 of the following) Loss of interest or enjoyment; Lack of energy or fatigability; Psychomotor retardation or apparent hypoactivity; Reduced self-esteem,worthlessness,self-blame.or preoccupation with guilt; Feel thinking retardation, or thinking efficiency reduced; Repeated ideas or attempts of self-harm or suicide; Disturbed sleep,e.g.,insomnia,early morning wakening,or hypersomnia; Poor appetite or obvious weight loss; Decreased libido. ----------------------------------------------- Manic episode [F30] (At least 3 of the following are required) Impaired concentration or distractibility; Over-talkativeness; Racing thoughts or flight of ideas; Inflated self-esteem or grandiosity; overactivity, or psychomotor excitement; Reckless behavior; Decreased need for sleep; Increased libido. ____________________________________________________________________ B: Severity criteria Impairment of social function
Individual subjective distress or dangerous/harmful outcomes on oneself or others C:Course criteria Depressive:at least 2 weeks Manic:at least one week D:Exclusion 4.2 Differential diagnosis Depressive episode: Medical conditions Neuroses Schizophrenia Organic syndromes (dementia) Manic episode: Medical disorders Schizophrenia Organie brain diseases Personality disorders Substance abuse 5.Course and prognosis Disorders Non-Bipolar Disorders Bipolar Disorders Age of onset Middle age Early or■iddle age Duration of episode Average about 6 months Average about 3 months (manic episode) Recovery 5-105 do not recover fron index episode
Individual subjective distress or dangerous/harmful outcomes on oneself or others C: Course criteria Depressive: at least 2 weeks Manic: at least one week D: Exclusion 4.2 Differential diagnosis Depressive episode: Medical conditions Neuroses Schizophrenia Organic syndromes (dementia) Manic episode: Medical disorders Schizophrenia Organic brain diseases Personality disorders Substance abuse 5. Course and prognosis Disorders Non-Bipolar Disorders Bipolar Disorders Age of onset Middle age Early or middle age Duration of episode Average about 6 months Average about 3 months (manic episode) Recovery 5-10% do not recover from index episode
5-10%do not recovery from index episode Long-term outcone Nearly two third of patients are good More chronic course.more episodes.length of cycle shortens with nore frequent episodes Mortality suicide Up to 15%comnit suicide Completed suicide occurs in 10-15%of patients 6.Treatnent 6.I Treatnent of depressive disorders Antidepressant drugs: Selective serotonin reuptake inhibitors (SSRIs,fluoxetine,paroxetine,etc) Tricyelic antidepressants ECT:(6-12 times each course,3-4tines/week) Psychotherapy 6.2 Treatnent of manic disorders Medications: Lithium carbonate:600 ~2000ng/day:Plasm concentration is 0.8 1.2mol/L;Toxic effects my appear with concentrations above 1.4nmol/L Anticoeulsant drugs carbamazepine Antipsychotics:chlorpromzine,clozapine,olanzapine.risperidone.et al. Electroconvulsive therapy (ECT) 7.Surnary and discussion 【Reference naterial】 1.Michael Gelder,Dennis Gath,Richard Mayou,te al.Oxford Textbook of Psychiatry.3th edition.Oxford Nedical Publications.1996. 2.Sadock,B.J.,Sadock,V.A:Kaplan Sadock's Comprehemsive Textbook of Psychiatry.7 th.edition. Lippincott Villians Nilkins.Philadelphia.2000
5-10% do not recovery from index episode Long-term outcome Nearly two third of patients are good More chronic course, more episodes, length of cycle shortens with more frequent episodes Mortality & suicide Up to 15% commit suicide Completed suicide occurs in 10-15% of patients 6. Treatment 6.1 Treatment of depressive disorders Antidepressant drugs: Selective serotonin reuptake inhibitors (SSRIs, fluoxetine, paroxetine, etc) Tricyclic antidepressants ECT: (6-12 times each course, 3-4times/week) Psychotherapy 6.2 Treatment of manic disorders Medications: Lithium carbonate: 600 ～ 2000mg/day;Plasma concentration is 0.8 ～ l.2mmol/L;Toxic effects may appear with concentrations above 1.4mmol/L. Anticonvulsant drugs carbamazepine Antipsychotics:chlorpromazine, clozapine, olanzapine, risperidone,et al. Electroconvulsive therapy (ECT) 7. Summary and discussion 【Reference material】 1. Michael Gelder, Dennis Gath, Richard Mayou, te al. Oxford Textbook of Psychiatry.3th edition. Oxford Medical Publications.1996. 2. Sadock, B. J., Sadock, V. A: Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 7 th . edition. Lippincott Williams & Wilkins, Philadelphia, 2000
【riting design】 See the lantern slide. 【Summary after class】 1.Question:What are the maim features of manie episode? 2.What are the main features of depressive episode?
【Writing design】 See the lantern slide. 【Summary after class】 1. Question: What are the main features of manic episode? 2. What are the main features of depressive episode?