Diagnosis and Treatment of Affective Disorders
Published on Thursday, August 4th, 2011 at 11:56 pm and is filed under Mental Disorders
The main symptoms are mood changes, or affect, the other symptoms are derivable from these changes and are secondary.
Affective disorders occur in many endocrine diseases (thyrotoxicosis and hypothyroidism), Parkinson’s disease, vascular brain pathology. In organic mood disorders are present symptoms of cognitive deficits or disorders of consciousness, which are not typical for endogenous affective disorders. It should also differentiate between them in schizophrenia, but in this disease there are other specific productive or negative symptoms, in addition, manic and depressive states are usually atypical and closer to the manic-hebephrenia or apathetic depression. The greatest difficulties and disputes arise in the differential diagnosis of schizoaffective disorder, if in the structure of affective disorders occurs secondary ideas of revaluation or self-incrimination. However, the true mood disorders disappear as soon as possible to normalize the affect and determine the clinical picture.
Treatment of affective disorders:
Therapy of affective disorders is made up of proper treatment of depression and mania, as well as preventive therapy. Treatment of depression includes, depending on depth, a wide range of drugs fluoxetine lerivona, Zoloft, mianserin to tricyclic antidepressants and ECT. They are also used sleep deprivation therapy and photon therapy. Manias therapy consists of treatment with increasing doses of lithium to control blood, the use of neuroleptics or carbamazepine, and sometimes beta-blockers. Supportive treatment is lithium carbonate, carbamazepine or sodium valpratom.
Treatment begins with psychogenic depression antidepressants. Depression, as mentioned above, may be a component of anxiety or, conversely, can be a asthenic syndrome. Depending on this, the treatment will be based treatment. Dose is titrated as needed.
In the presence of asthenic syndrome it is prescribed SSRIs such as fluoxetine, Luvox, Paxil.
In the presence of anxiety it is prescribed SSRIs such as tsipramil, Zoloft. Additionally it is prescribed alprazolam (Xanax) or mild neuroleptics – Chlorprothixene, sonapaks.
Patient as a cure can go to the elated state, in vetom case should be prescribed mood stabilizers, such as finlepsin of 200 mg and above. Assign as psychotherapy (cognitive therapy, behavioral, interpersonal therapy, group and family therapy).
From the moment it continues to improve treatment with antidepressants for at least 6 weeks, then it is reduced the dose, if necessary, it is prescribed supportive therapy.
Treatment of endogenous depression with antidepressants begins. The most effective selective and nonselective erotonin reuptake inhibitors are serotonin and norepinephrine.
Since the improvement of treatment continued for 6 months (as recommended by WHO). 2-3 weeks before reducing the dose are prescribed mood stabilizers (finlepsin 1000 mg). Reduce by 25 mg of amitriptyline per week, and after the abolition of mood stabilizer treatment continues for 1-2 weeks. If necessary maintenance therapy is applied.
In that case, if the patient gives an allergic reaction to all anti-depressants or therapy is ineffective – it is prescribed ECT (electroconvulsive therapy). It is possible for up to 15 sessions in elderly patients with endogenous depression.