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Mood Disorder ( Major Depressive and Bipolar disorder ) Dr. Vincent Wong MBBS, M.Med(Psych),CMIA Consultant Psychiatrist www.brainmindspecialist.com Dr. Vincent Wong, Consultant Psychiatrist 1

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Page 1: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Mood Disorder ( Major Depressive and Bipolar disorder ) Dr. Vincent Wong MBBS, M.Med(Psych),CMIA 王 忠 威 心 理 精 神 专 科 医 生 Consultant Psychiatrist www.brainmindspecialist.com

Dr. Vincent Wong, Consultant Psychiatrist 1

Page 2: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

1) What is normal ?

2) Signs and symptoms of Depressive disorder

3) Causes of Depressive disorder?

4) The Neurobiology of Depression

5) What is Bipolar Disorder

Contents

Dr. Vincent Wong, Consultant Psychiatrist 2

Page 3: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Interview ( The Callaghans )

Dr. Vincent Wong, Consultant Psychiatrist 3

Page 4: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Dr. Vincent Wong, Consultant Psychiatrist 4

Page 5: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

POPULAR MYTH ABOUT MENTAL ILLNESS

A sign of immaturity

If you can identify the cause of illness (e.g. break-up of relationship) then treatment is not necessary

Christians do not get mental illness

Dr. Vincent Wong, Consultant Psychiatrist 5

Page 6: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

POPULAR MYTH ABOUT MENTAL ILLNESS

Indicates a lack of faith

Indicates unconfessed sin

Mentally ill people tend to be lazy

Healing through medicine is not as good as healing by prayer

Taking medicine indicates a lack of real faith

Dr. Vincent Wong, Consultant Psychiatrist 6

Page 7: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Dr. Vincent Wong, Consultant Psychiatrist 7

Page 8: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

What is normal moods?

Dr. Vincent Wong, Consultant Psychiatrist 8

Page 9: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Emotions

Anger

Fear

Happy

Surprise

Disgust

Sadness

Dr. Vincent Wong, Consultant Psychiatrist 9

Page 10: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

“ To anyone with the kind of integrity that deeply feels the impact of life, the experience of being swept away by a flood of strong emotions is very real. At times like that, advice to rejoice anyway or to grab hold of responsibilities or to renew weakened commitments seem cruelly insensitive”

Dr. Larry Crabb

The validity and reality of human emotions

Dr. Vincent Wong, Consultant Psychiatrist 10

Page 11: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

They are like the tidal waves.

Most tides are normal.

But if it becomes a Tsunami, it is abnormal!

Unusually high or low moods are abnormal:

Low moods or Depression.

High moods or Mania.

Are moodswings normal?

Dr. Vincent Wong, Consultant Psychiatrist 11

Page 12: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

A mood which all of us experience from time to time, usually as a result of some distressing circumstance.

So, it is normal

It can become severe. then it is called: depressive illness

Normal Sadness vs DEPRESSION

Dr. Vincent Wong, Consultant Psychiatrist 12

Page 13: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Signs and symptoms of Depressive disorder?

Dr. Vincent Wong, Consultant Psychiatrist 13

Page 14: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Signs and Symptoms

Behavioural

Social withdrawal

Desire to escape

Crying without reason

Self harm

Physical

Sleep problems

Change of appetite

Tiredness

Painful symptoms ( Masking

Effect )

Emotional ( Less among Asians)

Depressed

Loss of interest / motivation

Iritable

Thinking

Guilt feelings

Loss of self confidence

Decreased concentration

Hopelessness

Dr. Vincent Wong, Consultant Psychiatrist 14

Page 15: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

3 NECESSARY CRITERIA ( 3 D )

DISTRESSING SYMPTOMS

DURATION – LASTS LONGER THAN USUAL

DYSFUNCTION – i.e. AFFECTS NORMAL FUNCTIONING IN PERSONAL, SOCIAL OR OCCUPATIONAL AREAS

Examples

CLINICAL DEPRESSION

Dr. Vincent Wong, Consultant Psychiatrist 15

Page 16: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Causes of Depressive disorder?

Dr. Vincent Wong, Consultant Psychiatrist 16

Page 17: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

CAUSES OF MENTAL ILLNESS

STRESS & COPING

COGNITIVE (THINKING)ERRORS BIOCHEMICAL

IMBALANCE

DETERIORATION OF

BRAIN CELLS

DRUG & ALCOHOL

FAMILY UPBRINGING

PERSONALITY/SPIRITUAL

DEVELOPMENT

GENETIC

Lack of Protective Factors

-Good Parenting -Spiritual Foundation -Healthy thinking/coping -Self Awareness -Social support

Dr. Vincent Wong, Consultant Psychiatrist 17

Page 18: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Neurobiology of depression

Dr. Vincent Wong, Consultant Psychiatrist 18

Page 19: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Dr. Vincent Wong, Consultant Psychiatrist 19

Page 20: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Chemicals in our brain

Dr. Vincent Wong, Consultant Psychiatrist 20

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Dr. Vincent Wong, Consultant Psychiatrist 21

Page 22: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Brain Scan changes ( comparison between Normal vs Depressed individuals

Dr. Vincent Wong, Consultant Psychiatrist 22

Page 23: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Complication of untreated depression.

Dr. Vincent Wong, Consultant Psychiatrist 23

Page 24: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Suicidal Risk

Mnemonics

( SAD PERSON )

S : Sex

A : Age

D : Depressive illness

P : Previous attempts

E : Ethanol

R : Rational thinking loss

S : Sickness

O : Organized Plan

N : No spouse / support

Dr. Vincent Wong, Consultant Psychiatrist 24

Page 25: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Slide on the Kupfer curve

Natural Pattern for treatment of Depression

Dr. Vincent Wong, Consultant Psychiatrist 25

Page 26: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Treatment stages In

cre

ase

d

seve

rity

Time

Euthymia

Symptoms

Syndrome

TREATMENT STAGES Acute

(6 to 12 wk) Maintenance (1 y)

RECOVERY Relapse

Relapse

REMISSION Recurrence

+

RESPONSE

Adapted from: Kupfer DJ, Long-Term Treatment of Depression, The Journal of Clinical Psychiatry. 52, 28-34, 1991. Copyright 1991.

Relapse

Dr. Vincent Wong, Consultant Psychiatrist 26

Page 27: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Q and A for Depression.

Dr. Vincent Wong, Consultant Psychiatrist 27

Page 28: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

What is Bipolar Disorder

Dr. Vincent Wong, Consultant Psychiatrist 28

Page 29: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Bipolar Disorder

Lifetime risk: perhaps as high as 2.1%

Peak onset: late teens and early 20s 25% of first episodes occur before age 20

Recurrence in almost all cases

Bipolar Disorder is an inheritable illness

High morbidity and mortality

American Psychiatric Association. Practice Guideline for

the Treatment of Patients with Bipolar Disorder. 2nd ed. Washington, DC; 2002.

Dr. Vincent Wong, Consultant Psychiatrist 29

Page 30: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Sever

e

Severe

Mild

Mild

Moderat

e

Moderate

Euthymic

Man

ia

Dep

ress

ion

Time

Bipolar Disorder:

Slide courtesy of MP DelBello.

Page 31: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Euthymic

Man

ia

D

epre

ssio

n

Time

Bipolar Disorder: Depression Followed by Mania

Sever

e

Severe

Mild

Mild

Moderat

e

Moderate

Slide courtesy of MP DelBello.

Dr. Vincent Wong, Consultant Psychiatrist 31

Page 32: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Manic States: Symptoms

Mood Thinking Speech

Mood Swings Fast thinking Talkative

Feeling “High” Grandiose

Irritable Suspicious

Behaviour

Reckless

Overspending

Dr. Vincent Wong, Consultant Psychiatrist 32

Page 33: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Bipolar Disorder: Untreated vs Treated Standardized Mortality Ratios

Neoplasm Cardio- vascular

Cerebro- vascular

Accidents Suicide Other All Causes

Untreated

Treated

29.2*

6.4

1.4* 0.6

2.2* 1.7 1.6† 1.3 1.6 2.0 2.0* 1.3 2.2*

1.3

Adapted from Angst F et al. J Affect Disorder. 2002;68:167-181. Dr. Vincent Wong, Consultant Psychiatrist 33

Page 34: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

Suicide Risk: Various Conditions

1.8

0 5 10 1

5

20 2

5

30 3

5

40

38.4

20.3

15.0

8.5

19.2

5.9

7.1

History of Suicide Attempt

Major Depression

Bipolar Disorder

Schizophrenia

Mixed Drugs

Alcohol

Personality Disorder

Cancer

Inskip H et al. Br J Psychiatry. 1998;172:35-37.

5 10 15 20 25 30 35 40 0 Percentage

Dr. Vincent Wong, Consultant Psychiatrist 34

Page 35: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

The Close sisters

Dr. Vincent Wong, Consultant Psychiatrist 35

Page 36: Mood Disorder ( Major Depressive and Bipolar disorder )€¦ · Mood Disorder ( Major Depressive and Bipolar disorder ) ... Mentally ill people tend to be lazy ... Normal Sadness

For more information, please visit

www.brainmindspecialist.com

Dr. Vincent Wong, Consultant Psychiatrist 36