MOOD DISORDERS

The two main mood disorders are the Major Depressive Disorder (also called the Unipolar Disorder) and Bipolar Disorder.

Major Depressive Disorder. This is characterised by an emotional state of great sadness and apprehension, feelings of guilt, abulia (see glossary), social isolation, insomnia or hypersomnia, an alteration in the individual’s level of activity (in the direction of a slowing-down of psycho-motor activity or agitation), loss of appetite and consequent weight loss or an increase of appetite and a corresponding gain in weight, the waning or loss of libido, lack of energy, feelings of exhaustion, a negative conception of the self, self-blame, disapproval of the self, self-devaluation, the sensation that nothing has any value any more, the loss of interest in activities that were previously performed, an incapacity to derive pleasure from any type of activity, thoughts of death or suicide.

Depressed people cannot concentrate their attention on anything: for these patients such a task requires extenuating and almost unbearable effort. They cannot recall what people have said to them or what they might have learnt through reading and, similarly, they find it particularly difficult to engage in conversation. They generally use very few words to communicate their feelings or ideas, making long pauses, speaking very slowly and adopting a low, monotonous tone of voice. Their motor behaviour may vary: some patients will sit on their own for hours on end, remaining totally silent, while others may be very agitated and cannot remained seated for very long, preferring to walk about, wringing their hands, sighing and expressing dismay or complaining. The disorder also affects an individual’s capacity to cope with problems. Depressed patients will tend not to have any ideas or strategies regarding their solution and live each moment with a feeling of oppression. They may eventually reach a point where they are neglecting themselves so utterly and fully that they no longer pay any attention to their appearance and personal hygiene.

These patients occasionally express lamentations in a manner that can be defined as hypochondriacal (see Somatoform Disorders) and may denounce fears concerning pains they are suffering from that are then found to derive from no apparent organic cause. Symptoms of depression vary in accordance with the age of the patient. In children they tend to assume the form of somatic disorders, while in older people they will be generally associated with poor attention and amnesia. In most cases, depression tends to dissipate in time but it may also become a chronic condition in those cases where the subject is incapable of recovering a normal mental state in the intervals between one depressive episode and the next. Major Depression is one of the most widespread mental disorders and would appear to be more frequent amongst women than men, and more frequently presents in people belonging to the lower socio-economic groups (1). The disorder occurs more frequently in early adulthood but in recent years it has been noted that the age of onset is gradually getting lower.

Bipolar Disorder. This condition is characterised by an emotional state, referred as 'mania', consisting of an intense but unjustified euphoria accompanied by irritability, logorrhea (see glossary), hyperactivity, poor capacity to remain focused or concentrate and the planning of grandiose plans which could never be carried out. A manic state may present in persons that suffer from episodes of depression and has been rarely found in subjects not affected by the disorder. A manic episode can continue for a period lasting from just a few days to various months and manifests with an incessant flow of comments expressed out loud in a very high tone of voice and with speech coloured by ironical comments, puns, play on words, rhymes and exclamations. It is quite an arduous task to interrupt this kind of speech and the disturbance leads to a further symptom, the ‘flight of ideas’, which is an incapacity to talk about a specific topic without jumping from one topic to another, and where the subject reveals a certain degree of coherence in only a few fragments of his or her discourse.

In persons suffering from a manic episode the ‘maniacal need’ to be involved in an activity also presents in the form of an inopportune and invasive kind of sociability or through the tendency to be ‘busy’ without really having any specific goal in mind. In this state the patient is incapable of realising that all of his or her ideas are destined to fail. Attempts made to repress an impetus of this nature provoke anger and occasionally even furious reactions. During the appearance of this pathological state there is also an increase in the levels of activity in the person’s occupational, social and/or sexual life, a decrease in the need to sleep, hypertrophic self-esteem, which involves the conviction of possessing extraordinary skills and powers, and excessive involvement in activities perceived as pleasant, which however generally result in unpleasant consequences (e.g., overspending or wild shopping sprees).

Besides manic episodes, the Bipolar Disorder may also present mixed episodes, which include both the symptoms of mania and those of depression. Most individuals affected by the condition experience both types of episode. The disorder generally first appears between the ages of 20 and 30, and the same frequency has been recorded for both sexes. It moreover has the tendency to reappear on various occasions. It would seem that the euphoric episodes themselves play a fundamental role in the generation of these great quantities of energy and rapid successions of thoughts which allow the person to establish links between ideas that would normally not appear to be connected (2).

In both the Unipolar and Bipolar Disorders, the seasonal depressive disorder or Seasonal Affective Disorder (SAD) sub-category is provided for in cases in which it is evident that there is a systematic relation between the appearance of the pathological episodes and a particular season of the year.

The DSM refers to two other chronic disorders: the Cyclothymic Disorder and Dysthymic Disorder. People suffering from Cyclothymia present frequent periods of depression and other periods of hypomania. Hypomania is a milder condition with respect to mania; however, it presents the same symptoms as the latter, only these are slightly less evident. These periods can be mixed or alternated with periods of normal mood lasting up to two months. In the phases of depression and hypomania, Cyclothymic patients present pairs of diametrically-opposed symptoms, passing for example from a sense of inadequacy typical of depression to the excessive degree of self-esteem typical of hypomania.

Unlike Major Depression, Dysthymia is characterised by a chronic depressive mood lasting for at least two years, which will be present almost every day and for most of the day. This type of depressed state may be associated with one or more of the following symptoms: insomnia or hypersomnia, low self-esteem, difficulty in concentrating, feelings of desperation, poor or excessive appetite and low energy (3). Dysthymic Disorder is often also associated with Substance Dependency Disorder and the Borderline, Histrionic, Narcissistic, Avoidant and Dependent Personality Disorders. In children, the disturbance can be associated with Conduct Disorders, Anxiety Disorders, Learning Disorders, Mental Retardation and also Attention Deficit and Hyperactivity Disorder (ADHD).

>>> (Somatoform Disorders)


Bibliographical references:

(1) Blazer, D.G., Kessler, R.C., & McGonagle, K.A. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. American Journal of Psychiatry, 151, 979-986.

(2) Jamison, K., (1992). Touched with Fire: Maniac-Depressive Illness and the Artistic Temperament.

(3) Klein, D.N., Taylor, E.B., Dickstein, S., & Harding, K. (1988). Primary early-onset dysthymia: Comparison with primary nonbipolar nonchronic major depression on demographic, clinical, familial, personality, and socioenvironmental characteristics and short-term outcome. Journal of Abnormal Psychology, 97, 387-398.

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