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Mood Disorder

Mood Disorders

Mood disorders encompass several disorders that cause some form of emotional disturbances. Depressive, bipolar, manic and anxiety-related disorders fall into this category. The diagnosis mandates a thorough and meticulous patient history.


Presentation

Mood changes may be a constitutive feature of several psychiatric disorders and a broad classification based on the nature of the disorder (sadness or elation) can be made into depressive and manic mood changes, each presenting with distinct clinical features [1] [2]:

  • Depressive disorders - Numerous subtypes have been described in literature - major depressive disorder, persistent depressive disorder, substance or medication induced, depression occurring as a result of another disease, premenstrual dysphoric disorder and unspecified forms [3] [4]. The presence of irritable or sad mood that substantially influences everyday life of affected individuals due to somatic and cognitive disturbances is a common finding in all of them, but their distinction can be made according to the duration, onset or the underlying etiology [2]. For example, major depressive disorder is diagnosed when mood changes last for at least two weeks, while persistent depression is suspected if symptoms last for two years in adults and one year in children [2]. Moreover, patients may suffer from psychotic, melancholic or catatonic episodes that can mislead the physician from depression as the underlying disorder.
  • Mania and hypomania - Abnormally irritable and expansive mood present for one week accompanied by symptoms such as elevated self-esteem, decreased need for sleep, psychomotor agitation, racing thoughts, increased goal-directed activity and a propensity for distraction by irrelevant or unimportant stimuli are hallmarks of a manic episode [2] [5]. A fast rate of speech, verbosity, accelerated mental and physical activity, and personal belief that he/she is at an excellent mental state is often encountered, which can be dangerous or even life-threatening. A hypomanic state is described as a milder form of mania, lasting at least four days and presenting with less severe clinical symptoms than that observed in manic patients [5].
  • Bipolar disorders - When manic episodes, depression, and/or hypomania are all seen in one individual, the diagnosis of a bipolar disorder should be suspected. Like in depressive disorders, several clinical types are recognized - type I, type II, drug-induced, etc. [1], while cyclothymia denotes a less severe form.
Family History of Depression
  • It is not clear whether people who have had depression before, or have a family history of depression, are more prone to this complication, and its causes are not understood.[benzo.org.uk]
  • However, it can also occur in people who have no family history of depression. [0005] Major depressive disorder is prevalent in a large number of elderly patients, resulting in a significant increase in the number of suicides in this population.[faqs.org]
Family History of Suicide
  • From a clinical perspective, our study proposes several clinical characteristics, such as increased depressive symptomatology, anxiety comorbidity, functional disability and family history of suicidality, as correlates associated with suicide.[ncbi.nlm.nih.gov]
  • ., 1999), as well as among those who have experienced stressful life events, who have medical illnesses, and who have a family history of suicidal behavior (Blumenthal, 1988).[webspace.ship.edu]
Gaucher Disease
  • Gaucher disease (GD) is a lysosomal storage disorder with a wide spectrum of phenotypic presentations. We report the case histories of two adult brothers with GD who developed both parkinsonism and psychiatric symptoms.[ncbi.nlm.nih.gov]
Hypoxemia
  • Abstract Hypoxemia is a common complication of the diseases associated with the central nervous system, and neurons are highly sensitive to the availability of oxygen.[ncbi.nlm.nih.gov]
Heart Disease
  • Mood disorders can increase a person's risk for heart disease, diabetes, and other diseases. Treatments include medication, psychotherapy, or a combination of both. With treatment, most people with mood disorders can lead productive lives.[medlineplus.gov]
  • More specifically, Ketter says, just as heart disease sometimes presents itself for the first time as a fatal heart attack, mental illness sometimes presents itself for the first time as a suicide. All About Depression • Bipolar Disorder[cnn.com]
  • Chronic medical conditions associated with depression include heart disease, cancer, vitamin deficiencies, diabetes, hepatitis, and malaria.[mentalhealthamerica.net]
Skin Lesion
  • ., a 57 years-old woman presenting with mood disorder with psychotic symptoms developing strange skin lesions, ultimately leading to the suspected diagnosis of varicella-zoster encephalitis.[ncbi.nlm.nih.gov]
Feeling of Worthlessness
  • Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive (dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of worthlessness[britannica.com]
  • […] of worthlessness or guilt Difficulty concentrating Recurrent thoughts about suicide Major depressive disorder is much more common in women than in men.[sparknotes.com]
  • Major hallmarks of depression include a persistent low or sad mood, decreased or absent interest in almost all activities, loss of self-confidence, and a feeling of worthlessness.[healthcommunities.com]
  • The two main types of mood disorders are: depressive disorders – symptoms include persistent and severe feelings of sadness, accompanied by lack of motivation, inability to experience joy as well as feelings of worthlessness bipolar disorder – extreme[sjog.org.au]
Low Self-Esteem
  • Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem.[healthychildren.org]
  • These mood disorders share some common symptoms: Slowness in motor behavior/speech Slowed thought processes Blunted emotions Poor grooming Social withdrawal Weight loss/gain Early morning awakening Excessive sleeping Low self-esteem Agitation In addition[bhevolution.org]
  • In contrast, during an episode of depression, a person can suffer from feelings of worthlessness, loss of interest, low self-esteem, and lack of energy.[pamf.org]
  • A teen may also have low self-esteem and sleep problems. Take symptoms of suicide seriously. Call your teen’s healthcare provider right away if he or she shows signs of suicidal thinking or behavior. Treatment includes medicines and therapy.[urmc.rochester.edu]
  • A teen may also have low self-esteem and sleep problems. Take symptoms of suicide seriously. Call 911 if your teen has suicidal thoughts, a suicide plan, and the means to carry out the plan. Treatment includes medicines and therapy.[urmc.rochester.edu]
Suicidal Ideation
  • OBJECTIVE: To examine the associations between personality traits and suicidal ideation (SI) and attempt (SA) in mood disorder patients and community controls.[ncbi.nlm.nih.gov]
  • At symptom level, elated mood, decreased need of sleep, racing thoughts, suicidal ideation, and middle insomnia were significantly associated with BD conversion.[ncbi.nlm.nih.gov]
  • Across different assessments, patients with FH showed consistently elevated depressive symptoms, such as lower concentration and energy, higher suicidal ideation, as well as increased racing thoughts and distractibility within the manic spectrum of symptoms[ncbi.nlm.nih.gov]
  • Suicidal ideation was weakly but significantly associated with suicide among studies of patients with mood disorders over periods of follow-up of CONCLUSION: Although our findings suggest that the association between suicidal ideation and later suicide[ncbi.nlm.nih.gov]
  • Graham, Factors associated with suicidal ideation in OEF/OIF veterans, Journal of Affective Disorders, 130, 1-2, (231), (2011).[doi.org]
Suicidal Depression
  • Learn the facts about teen suicide. Depression and You Learn the symptoms and signs of depression. Seek help today. About Bipolar Disorder Learn about the symptoms and behaviors associated with bipolar disorder.[lindnercenterofhope.org]
Euphoric Mood
  • Mood disorders exist at these extremes of thought and feeling. They have two additional characteristics. First, they are characterized by mood states that are more intense than people normally experience in their daily lives.[cnn.com]
Organic Psychosis
  • The best described neuropsychiatric alterations are dementia and an organic psychosis. Organic mood disorder has been reported less often, and mania secondary to idiopathic basal ganglia calcification has not been noted previously.[ncbi.nlm.nih.gov]

Workup

The diagnosis of a mood disorder can be quite challenging, having in mind the diverse clinical presentation and its variable appearance in patients. In addition, concomitant presence of anxiety disorders (social phobias, obsessive-compulsive disorders, or even panic attacks) may be noted, creating an even bigger issue to discern between the disorders [5]. For this reason, physicians must bear in mind that a long and carefully obtained patient history is the essential component during workup, as the majority of symptoms may not be evident during the hospital visit, but more importantly, because the diagnosis is made almost solely on clinical criteria [2] [5]. Not all patients will be able to describe typical changes seen in mood disorders, and some will not even admit that anything extraordinary is happening, which is why parents, close friends or even relatives can be interviewed as well. Apart from determining symptoms related to mood changes, physicians must inquire about recent use of drugs or substances that can induce such changes [3] [4], but also exclude some organic diseases that may mimic depression [5]. Thyroid hormone levels should be measured to exclude hypothyroidism, while folate, B12 and a complete blood count are recommended in the diagnostic workup as well [5].

Dyslipidemia
  • Based on dyslipidemia ( 40mg/dL), low level of HDL-C was associated with the risk of mood disorder in both male and female, however, only females showed statistically significant (HR: 1.097, 95% CI: 1.012-1.189).[ncbi.nlm.nih.gov]
Sinus Arrhythmia
  • Infant respiratory sinus arrhythmia (RSA) was measured in a laboratory stressor paradigm.[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: There is suggestive evidence that prior illness history may have little association with response to long-term treatment in bipolar disorder (BD) or recurrent major depressive disorder (MDD), but relationships of illness-history to treatment-response[ncbi.nlm.nih.gov]
  • OBJECTIVE: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system.[ncbi.nlm.nih.gov]
  • METHODS: Within small areas (2840 meshblocks, mean size 0.05 km(2)) in the city of Auckland, New Zealand, counts of adults receiving anxiety/mood disorder treatment (2008-9) were identified and the proportions of these individuals also receiving treatment[ncbi.nlm.nih.gov]
  • Anxiety and personality disorders may worsen prognosis and treatment outcome. Lacosamide has been recently introduced as adjunctive treatment for partial epilepsy.[ncbi.nlm.nih.gov]
  • Given the existence of chronobiological disturbances in depression and evidence regarding their treatment in improving depression, a chronobiological approach, including timely use of light and melatonin agonists, could complement the treatment of MDD[ncbi.nlm.nih.gov]

Prognosis

  • This change is of concern because a large proportion of patients with mixed features are now unspecified, and this may influence treatment planning and prognosis.[ncbi.nlm.nih.gov]
  • Anxiety and personality disorders may worsen prognosis and treatment outcome. Lacosamide has been recently introduced as adjunctive treatment for partial epilepsy.[ncbi.nlm.nih.gov]
  • Its identification in adolescents may provide the opportunity for adequate intervention to improve global functioning and long-term prognosis.[ncbi.nlm.nih.gov]
  • Like cancer, "mood disorder" is a general term for a group of disorders that can vary widely in terms of symptoms, prognosis and treatment.[cnn.com]
  • Such differentiation might be important for establishing prognosis and optimal treatment.[ajp.psychiatryonline.org]

Etiology

  • The etiology of the mental illness could be related to the processes contributing to the development of parkinsonism.[ncbi.nlm.nih.gov]
  • Recent progress in defining the molecular mechanisms of the human circadian clock and retinal phototransduction of light will provide important new directions for future studies of the etiology and pathophysiology of SAD.[ncbi.nlm.nih.gov]
  • CONTEXT: Understanding the temporal sequencing of alcohol use disorders (AUDs) and comorbid mood and anxiety disorders may help to disentangle the etiological underpinnings of comorbidity.[ncbi.nlm.nih.gov]
  • Abstract Suicidality is a continuum ranging from ideation to attempted and completed suicide, with a complex etiology involving both genetic heritability and environmental factors.[ncbi.nlm.nih.gov]
  • […] irritable or sad mood that substantially influences everyday life of affected individuals due to somatic and cognitive disturbances is a common finding in all of them, but their distinction can be made according to the duration, onset or the underlying etiology[symptoma.com]

Epidemiology

  • Centers for Disease Control and Prevention National Center for Health Statistics Office of Analysis, Epidemiology & Health Promotion, Room 6433 Hyattsville USA 2. National Institute of Mental Health Bethseda USA 3.[doi.org]
  • This paper reviews the literature on the epidemiological, biological and clinical features of benzodiazepine dependence and withdrawal syndrome, focusing on clinical problems associated with the long-term use of benzodiazepine (BZs) in mood and anxiety[ncbi.nlm.nih.gov]
  • 2007-979558 Review Georg Thieme Verlag Stuttgart · New York Institute of Psychiatry, School of Medicine, University of Pisa, Italy Further Information Publication History Publication Date: 23 April 2007 (online) This paper reviews the literature on the epidemiological[doi.org]
  • Keywords: age of onset, mood disorders, anxiety disorders, alcohol use disorders, comorbidity, NESARC, epidemiology 1.[ncbi.nlm.nih.gov]
  • BACKGROUND: The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Adverse impacts of early life sexual abuse (ESA) on adult attachment, affective regulation, and pain sensitivity suggest ESA-related OT dysregulation in MRMD pathophysiology.[ncbi.nlm.nih.gov]
  • This paper reviews the studies on the pathophysiology of SAD with emphasis on circadian, neurotransmitter, and genetic hypotheses.[ncbi.nlm.nih.gov]
  • The proposed pathophysiology of this syndrome is also discussed.[ncbi.nlm.nih.gov]
  • Corticosteroids often induce steroid psychosis, a collection of heterogeneous syndromes with different pathophysiologic mechanisms.[ncbi.nlm.nih.gov]
  • OBJECTIVE: Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol (E2) and progesterone (P4) have been implicated in the pathophysiology of menstrually related mood disorder (MRMD).[ncbi.nlm.nih.gov]

Prevention

  • […] dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention[ncbi.nlm.nih.gov]
  • Author information 1 Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2 Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea. 3 Department of Literary Arts, Brown University[ncbi.nlm.nih.gov]
  • Elucidating psychobiological mechanisms of risk early in development is critical to inform prevention and early intervention efforts.[ncbi.nlm.nih.gov]
  • Further epidemiological and clinical studies of RBD are warranted in order to develop specific treatments and prevention strategies.[ncbi.nlm.nih.gov]
  • Family therapy is helpful during the mood episode for both crisis resolution and prevention. Unresolved problems may induce relapse. Dysfunctional family interaction patterns include rigidity, polarizations, and using the child as a go-between.[ncbi.nlm.nih.gov]

References

Article

  1. Marvel CL, Paradiso S. Cognitive and neurological impairment in mood disorders. Psychiatr Clin North Am. 2004;27(1):19-viii.
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
  3. Quello SB, Brady KT, Sonne SC. Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science & Practice Perspectives. 2005;3(1):13-21.
  4. Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. Dialogues Clin Neurosci. 2015;17(2):181-190.
  5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.

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Last updated: 2019-07-11 22:09