13. R.Vrasti - Dihotomia primar secundar in tulburarile depresive
TULBURAREA AFECTIVA BIPOLARA - Psihiatrie Timisoara · 2014. 12. 23. · TAB – tip II...
Transcript of TULBURAREA AFECTIVA BIPOLARA - Psihiatrie Timisoara · 2014. 12. 23. · TAB – tip II...
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TULBURAREA AFECTIVA
BIPOLARA
Conf.Dr. Ienciu Monica
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-Studii familiale Psihanaliza - Noerepinefrina (R.ß2 presinaptic)
↙senzitivitatii
-Studii adoptive Tb.cogn.-comp. - Serotonina (depletie)
-Studii pe gemeni (DEPRESIE) - SUICID
-Predispozitie - DOPAMINA ↙ Depresie
-Vulnerabilitate ↗ Manie
-Studii linkage - ACETYLCOLINA
- CR.18, 21q, 22q - GAMA SI ACID GLUTAMIC
- Reg.CORTEX PREFRONTAL
-Zona CINGULARA (T.virala)
-HIPOCAMP
-AMIGDALA
- PERT.RITM.CIRCADIAN
-HIPOTALAMUS-HIPOFIZA-TIROIDA-PROLACTINA - PERT.ARHITECTURA SOMNULUI
GENETICA BIOLOGIE PSIHOLOGIE
TAB
NEURO -ANATOMIE EV.DE VIATA IMUNOLOGIE
NEURO-ENDOCRINA
CRONOBIOLOGIE
TRASATURI DE PERSONALITATE
ETIOLOGIE
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Tristete Expansivitate, elatie, eufo Iritabilitate Iritabilitate
Tulb. de atentie - Hipoprosexie - Hiperprosexie Tulb. de memorie - Selectiva univoc negativa - Selectiva univoc
pozitiva Tulb. de gandire Cantitative - Continut - Continut ↗ Fuga de idei, - Viteza - Viteza ↗ incoerenta Calitative Teme negative Teme pozitive (Schemate disfunct. tema mortii – SUICID) Intensitate deliranta – congruenta afectiv - incongruenta afectiv PIERDERE – interes CASTIG – interes - placeri - placeri - bucurie -
bucurie - prezent negativ prezent si viitor =
superbe Modificarea perceptiei subiective - viitor inexistent a timpului STIMA DE SINE SCAZUTA CRESCUTA
EP.DEPRESIV EP.MANIACAL
MODIF.ALE DISPOZITIEI
SIMPT.COGNITIVE
DESCRIERE
CLINICA
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- APARITIE - Stearsa - Incarcata
- MIMICA – GESTICA - Hipo; plange - Hiper; rade
- VORBIRE - Lenta - Rapida
- PSIHOMOTOR - Inhibitie-stupor - Neliniste
Agitatie Agitatie – furor
- PULSIONAL - Inhibitie - Dezinhibitie
- SOMN - Insomnie/Hipersomnie - Nevoie scazuta
- ACTIVITATE - Scazuta, saraca - Crescuta, bogata
retragere hiperimplicare,
hiposociabilitate hipersociabilite
Excese
Consecinte!
SIMPTOME COMPORTAMENTALE
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- APETIT
GREUTATE : -SCAZUTE - DECENZURARE
-CRESCUTE - NU IL PREOCUPA
- TRAIREA PRAG DUREROS FARA
CORPORALITATII SIMPTOME DIGESTIVE SIMPTOME
SOMATICE
- ENERGIE SCAZUTA CRESCUTA
SIMPTOME
SOMATICE
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USOR HIPOMANIE
EP.DEPRESIV MEDIU MANIE - FARA
SEVER (MAJOR) SIMPT.PSIH.
- CU S.PSIH.
DEPR.MASCATA
DEPR.SEZONIERA MANIE SEZONIERA
DEPR.POSTPARTUM MANIE POSTPARTUM
MELANCOLIE FUROR MANIACAL
EPISOD (STARE) MIXTA
DEBUT
DURATA
CRONICIZARE
FORME CLINICE
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EP.DEPRESIVE EP.MANIE RECURENTA
ALTERNANTA
TAB – tip I - episoade depresive clinice
maniacale anterior
- episod actual………
EP.MANIACAL UNIC (DSM IV)
NUMAI EP.MANIACALE
TAB – tip II EP.DEPRESIVE CLINICE + HIPOMANIE
TAB - tip III cel putin 2 ep.clinice DEPRESIVE +
istorie familiala de TAB
TULBURAREA AFECTIVA
BIPOLARA
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FORMA CU CICLURI RAPIDE : - cel putin 4 episoade in
ultimele 12 luni
FORMA SEZONIERA
FORMA CIRCULARA
SPECTRUL BOLII BIPOLARE :
- CICLOTIMIE
- DISTIMIE
- TEMPERAMENT IRITABIL
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DG.POZITIV
Nu ridica probleme
DG.DIFERENTIAL
Determinism – Organic
- Alcool – Droguri
EP.AFECTIV CU
SIMPTOME PSIHOTICE EP. SCHIZO-AFECTIV
EP. SCHIZOFREN
EVOLUTIE – PROGNOSTIC
- REMISIUNEA EPISODULUI
- EVOLUTIE PE TERMEN LUNG
- Nr.episoade, frecv.episoade
- Calitatea remisiunii interepisodice
- Functionalitate premorbida
- Varsta la debut
- Genetica
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COMORBIDITATI CU :
- TULBURARI ANXIOASE (DEPRESIE)
- ALCOOL – DROGURI
- GAMBLING (MANIE)
- TULBURARE HIPERKINETICA CU DEFICIT DE ATENTIE
- AFECTIUNI SOMATICE (CARDIO-VASCULARE,
TIROIDIENE)
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EPISODUL AFECTIV
DEPRESIV MANIACAL
ANTIDEPRESIVE ANTIPSIHOTICE
?? +
LAMOTRIGINA
?
ANTIPSIHOTICE LITHIU VALPROAT CARBAMAZEPINA
TRATAMENT
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TRATAMENT DE INTRETINERE
TIMOSTABILIZATOARE
- LAMOTRIGINA
(profilaxia depresiei)
- LITHIU
- VALPROAT
- CARBAMAZEPINA
±
ANTIPSIHOTICE
CAT TIMP ???
PSIHOTERAPIE PSIHOEDUCATIE
TERAPIE SUPORTIVA REABILITARE