Mood disorders

The emotions can be described as two main types:

1. Affect: It is a short lived emotional response to an idea or an event

2. Mood: It is a sustained and pervasive emotional response which colors the whole psychic life.

ICD 10 Classification of Mood Disorders:

According to ICD 10 mood disorders are classified as follows:

F30 : Manic Episode

F31: Bipolar affective disorder

F32: Depressive episode

F33: Recurrent depressive disorder

F34: Persistent mood disorders

F38: Other mood disorders

F39: Unspecified mood disorders

Epidemiology of Mood disorders:

 Major depression affects almost 10% of the population
 During life time 10-25% of women and 5-12% of men will become clinically depressed.
 Gender: Incidence of depressive disorders is higher in women than in men by about 2:1. The incidence
of bipolar disorder is roughly equal (1.2:1).
 Age: Incidence of depression is higher in young women and has a tendency to decrease with age. The
opposite has been found in men with the prevalence of depressive symptoms being lower in younger
men and increasing with age.
 Social class: Bipolar disorders appears to occur more frequently among the higher social classes,
especially professional and the highly educated.
 Marital status: The highest incidence of depressive symptoms has been indicated in individuals
without close interpersonal relationships and in persons who are divorced or separated. Lowest rates of
depressive symptoms among married men and the highest by married women and single men.

1. Manic Episode:
Incidence:
 The life time risk of manic episode is about 0.8 -1%.
 This disorder tends to occur episodes lasting usually 3-4 months followed by complete recovery.

Clinical features:
1. Elevated, expansive or irritable mood.

The elevated mood can pass through following four stages depending on the severity of disease:
a. Euphoria (Stage I): Mild elevation of mood. Increased sense of psychological well being and
happiness not in keeping with ongoing events.
b. Elation (Stage II): Moderate elevation of mood. Feeling of confidence and enjoyment along with
increased psychomotor activity.
c. Exaltation (Stage III): Severe elevation of mood. Intense elation with delusions of grandeur.
d. Ecstasy (Stage IV): Very severe elevation of mood.
2. Psychomotor activity: there is increased psychomotor activity ranging from overactiveness
restlessness to manic excitement.
3. Speech and Thought: More talkative, racing thoughts, pressure of speech and speaks loudly. Flights
of ideas and incoherent speech.
Delusion of gradeur with marked inflated self esteem and hallucinations with religious content can
occur.
4. Goal directed activity: In hypomania, ability to function becomes much better and there is a marked
increase in productivity and creativity.
 In mania, there is marked increase in activity with excessive planning and at times execution of
multiple activities.
 There is marked increase in sociability even with previously unknown people.
 The person becomes impulsive and hypersexual.
 Due to grandiose ideation, increased sociability, overactivity and poor judgement, the manic
person is involved in high risk activities like reckless driving, foolish business investments,
distributing money and personal articles to unknown persons.
5. Other features:
 Decreased sleep
 Increased appetite
 Insight into the illness is absent etc
6. Absence of underlying organic cause.
Depressive episode:
Incidence:
The life time risk of depression in males is 8-12% and in females is 20-26%.

Clinical features:
a. Depressed mood:
 Sadness of mood or loss of interest or pleasure in almost all activities and it presents throughout
the day
 The depressed mood varies little from day to day and is often not responsive to environmental
stimuli.
 Social withdrawal, decreased ability to function and decreased involvement in previous
pleasurable activities.

b. Depressive ideation:
 Hopelessness (There in no hope in future due to pessimism)
 Helplessness (no help is possible)
 Worthlessness ( feeling of inadequacy and inferiority)

c. Psychomotor activity
 In younger patients psychomotor retardation is more common which is characterized by slowed
thinking and activity, decreased energy and monotonous voice.
 In older patients agitation is commoner with marked anxiety, restlessness and subjective feeling
of unease.

d. Physical symptoms
Multiple physical symptoms are common in depressive patients.
Ex – Heaviness of head, vague body aches, reduced energy, easy fatiguability etc.

e. Biological functions:
Disturbance of biological function is common with insomnia, loss of appetite and weight and loss of
sexual drive.

f. Psychotic features (15-20% Patients)

 Delusions – Nihilistic delusions, delusions of guilt, delusions of poverty etc
 Hallucinations – Auditory and visual etc

g. Suicide: There is a risk of suicide in every depressed patient with suicidal ideation, presence of certain
factors like hopelessness, written or verbal communication of suicidal intent, early stage of depression,
divorced or widowed increases risk of suicide.

h. Absence of an underlying organic cause

Bipolar Mood disorder
 This disorder is characterized by recurrent episodes of mania and depression in the same patient
at different times.
 These episodes can occur in any sequence.

a.

b.

c.

Classification:
Bipolar Mood disorder is classified in to Bipolar I and Bipolar II disorder.

Bipolar I disorder: It is characterized by episodes of severe mania and severe depression.

Bipolar II Disorder: Is characterized by episodes of hypomania and severe depression

Recurrent Depressive disorder:
This disorder is characterized by recurrent (at least two) unipolar depressive episodes. These are further
classified as-

 Mild, moderate or severe: according to number and severity of symptoms.

 Severe with psychotic features: the individual experiences delusions and hallucinations.
 Sever without psychotic features: Severe depression without presence of psychotic
symptoms.

Persistent Mood disorder:

These disorders are characterized by persistent mood symptoms which last for more than 2 years (1 year
in children and adolescents) but are not severe enough to be labelled as even hypomanic or mild depressive
episode.

Common persistent mood disorders are-

a. Dsythymic Disorder:
The essential feature is a chronically depressed mood for most of the day, for at least 2 years.
It is further classified as
1. Early onset: When the onset occurs before age 21 years.
2. Late onset: When the onset occurs at age 21 years or above.

b. Cyclothymic disorder:
The essential feature of this disorder is chronic mood disturbance of at least 2 year duration,
involving numerous episodes of hypomania and mild depression.

Other mood disorders:

These includes-

 Mood disorder due to a general medical condition

 Substance induced mood disorders

Prognosis:
The good and poor prognostic factors in mood disorders are-

Good prognostic factors

 Acute or abrupt onset

 Typical clinical features
 Severe depression
 Well adjusted Premorbid personality
 Good response to treatment

Poor Prognostic factors:

  Co-morbid medical disorders, personality disorders or alcohol dependence
 Chronic ongoing stress
 Unfavourable early environment
 Poor drug compliance

Etiology of mood disorders:

1. Genetic theories
 The life time risk for the first degree relatives of bipolar disorder patients is 25%
 The life time risk for the children of one parent with mood disorder is 27% of both parents with
mood disorder is 74%
 The concordance rate in bipolar disorders for monozygotic twins is 65% and for dizygotic
twings is 20%.
These data indicates that genetic factors are very important in causation of mood disorders.

2. Biochemical Theories:
Mood disorders may be related to a abnormality of the neurotransmitters norepinephrine,
serotonin and dopamine at functionally important receptor sites in the brain.
 Decrease level of neurotransmitters leads to depression.
 Increase level of neurotransmitters leads to mania

3. Neuroendocrine theories:
Mood symptoms are present in many endocrine disorders, like hypothyroidism, Cushing disease,
addisons disease etc.

4. Physiological influences:
 Mood symptoms may be related to some of following physiological factor-
 Medication side effects : Ex-Anxiolytics, antipsychotic drugs, sedatives, antihypertensive drugs
etc.
 Neurological disorders: Ex- CVA, brain tumors, ventricular dilatation, Degenerative nerve
disorders etc
 Electrolyte disturbances:
 Hormonal disturbances
 Nutritional deficiency
5. Psychosocial theories:

Psychoanalylytical theory:
According to this theory mood disorders occur after loss of a loved object, actually by death or
emotionally by rejection.
Freud Postulated that individual predisposed to depression experience ambivalence in love
relationships. Therefore, that once the loss has been incorporated, the hostile part of the ambivalence
that had been felt for the lost object is then turn inward against the ego.

Stress: Increased stressful life events may predispose for mood disorders.
Learning theory:
This theory explains that learned helplessness predisposes individuals to depression by imposing a
feeling of lack of control over their life situations. They become depressed because they feel helpless.

Cognitive theories:
It believes that depression is the product of negative thinking. These includes negative expectations
of the environment, negative expectations of the self and negative expectations of the future. Because of
this individual feel inadequate, worthless and rejected by others.