Mental mood disorders: causes and symptoms. Variety of forms and manifestations

is a group of mental disorders characterized by a change in the emotional state towards depression or upliftment. Includes various shapes depression and mania, manic-depressive psychosis, affective lability, increased anxiety, dysphoria. Mood pathology is accompanied by a decrease or increase general level activity, vegetative symptoms. Specific diagnostics includes conversation and observation by a psychiatrist, experimental psychological examination. Treatment uses pharmacotherapy (antidepressants, anxiolytics, mood stabilizers) and psychotherapy.

Sufficient dopamine activity ensures switching of attention and emotions, regulation of muscle movements. Deficiency is manifested by anhedonia, lethargy, apathy, excess - mental stress, excitability. An imbalance of neurotransmitters affects the functioning of brain structures responsible for emotional condition. In case of affective disorders it can be provoked external reasons, for example, stress, or internal factors– diseases, hereditary characteristics biochemical processes.

Classification

In psychiatric practice, the classification is widespread emotional disturbances from point of view clinical picture. There are depressive, manic and anxiety spectrum disorders, bipolar disorder. The fundamental classification relies on different aspects of affective reactions. According to it, they distinguish:

1. Disturbances in the expression of emotions. Excessive intensity is called affective hyperesthesia, weakness is called affective hypoesthesia. IN this group included sensitivity, emotional coldness, emotional impoverishment, apathy.
2. Violations of the adequacy of emotions. With ambivalence, multidirectional emotions coexist simultaneously, which prevents a normal response to surrounding events. Inadequacy is characterized by a discrepancy between the quality (orientation) of affect and the influencing stimuli. Example: laughter and joy in the face of tragic news.
3. Violations of emotional stability. Emotional lability is manifested by frequent and unreasonable mood swings, explosiveness is manifested by increased emotional excitability with a vivid uncontrollable experience of anger, rage, and aggression. With weakness, fluctuations in emotions are observed - tearfulness, sentimentality, capriciousness, irritability.

Symptoms of mood disorders

The clinical picture of disorders is determined by their form. The main symptoms of depression are depression, a state of prolonged sadness and melancholy, and a lack of interest in others. Patients experience a feeling of hopelessness, meaninglessness of existence, a sense of their own insolvency and worthlessness. At mild degree disease, there is a decrease in performance, increased fatigue, tearfulness, instability of appetite, problems falling asleep.

Moderate depression is characterized by the inability to perform professional activities and household duties in full - fatigue and apathy increase. Patients spend more time at home, prefer loneliness to communication, avoid any physical and emotional stress, women often cry. Periodically, thoughts of suicide arise, excessive drowsiness or insomnia develops, and appetite is reduced. At severe depression patients spend almost all their time in bed, are indifferent to current events, and are unable to make an effort to eat or perform hygiene procedures.

As a separate clinical form highlight masked depression. Its peculiarity is the absence external signs emotional distress, pain denial and low mood. At the same time, various somatic symptoms– headaches, joint and muscle pain, weakness, dizziness, nausea, shortness of breath, changes blood pressure, tachycardia, digestive disorders. Examinations by somatic doctors do not reveal diseases, medications often ineffective. Depression is diagnosed over late stage, how classic shape. By this time, patients begin to feel vague anxiety, anxiety, uncertainty, and decreased interest in their favorite activities.

At manic state the mood is unnaturally elevated, the pace of thinking and speech is accelerated, hyperactivity is noted in behavior, facial expressions reflect joy and excitement. Patients are optimistic, constantly joke, make wisecracks, devalue problems, and cannot tune in to a serious conversation. They gesticulate actively, often change their position, and get up from their seats. Focus and concentration mental processes reduced: patients are often distracted, ask questions again, abandon the task they have just started, replacing it with something more interesting. The feeling of fear is dulled, caution is reduced, a feeling of strength and courage appears. All difficulties seem insignificant, problems seem solvable. Rising sexual attraction and appetite, the need for sleep decreases. When the disorder is severe, irritability increases and unmotivated aggression, sometimes – delusional and hallucinatory states. The alternating cyclical occurrence of phases of mania and depression is called bipolar affective disorder. When symptoms are mild, they speak of cyclothymia.

For anxiety disorders typical constant worry, feeling of tension, fears. Patients are in anticipation of negative events, the likelihood of which is usually very low. In severe cases, anxiety develops into agitation - psychomotor agitation, manifested by restlessness, “wringing” of hands, and pacing around the room. Patients are trying to find comfortable position, a calm place, but without success. Increased anxiety is accompanied by panic attacks with vegetative symptoms - shortness of breath, dizziness, respiratory spasm, nausea. Are being formed intrusive thoughts frightening in nature, appetite and sleep are disturbed.

Complications

Long-term affective disorders without adequate treatment significantly worsen the quality of life of patients. Light forms prevent full professional activity– with depression, the amount of work performed decreases, with manic and anxiety states- quality. Patients either avoid communication with colleagues and clients, or provoke conflicts in the background increased irritability and decreased control. At severe forms depression, there is a risk of developing suicidal behavior with suicide attempts. Such patients require constant supervision of relatives or medical personnel.

Diagnostics

A psychiatrist conducts a study of medical history and family predisposition to mental disorders. To accurately clarify symptoms, their onset, connections with traumatic and stressful situations A clinical interview is performed with the patient and his immediate family, who are able to provide more complete and objective information (patients may be uncritical of their condition or excessively weakened). In the absence of a pronounced psychogenic factor in the development of pathology, in order to establish true reasons An examination by a neurologist, endocrinologist, or therapist is prescribed. TO specific methods studies include:

• Clinical conversation. During a conversation with the patient, the psychiatrist learns about disturbing symptoms and identifies speech characteristics that indicate an emotional disorder. With depression, patients speak slowly, sluggishly, quietly, and answer questions in monosyllables. When manic, they are talkative, use bright epithets, humor, and quickly change the topic of conversation. Anxiety is characterized by confusion of speech, uneven tempo, and decreased focus.
• Observation. Natural observation of emotional and behavioral expression is often made - the doctor evaluates facial expressions, gestural features of the patient, activity and purposefulness of motor skills, autonomic symptoms. There are standardized expression monitoring schemes, such as the detailed Facial Expression Analysis Technique (FAST). The result reveals signs of depression - drooping corners of the mouth and eyes, corresponding wrinkles, a mournful expression on the face, stiffness of movements; signs of mania - smiling, exophthalmos, increased tone facial muscles.
• Psychophysiological tests. They are produced to assess mental and physiological stress, the severity and stability of emotions, their direction and quality. The color test of relations by A. M. Etkind, the method of semantic differential by I. G. Bespalko and co-authors, and the method of conjugate motor actions by A. R. Luria are used. Tests confirm psycho-emotional disorders through a system of unconscious choices - color acceptance, verbal field, associations. The result is interpreted individually.
• Projective techniques. These techniques are aimed at studying emotions through the prism of unconscious personal qualities, character traits, social relations. Thematic apperception test, Rosenzweig frustration test, Rorscharch test, “Drawing of a person” test, “Drawing of a person in the rain” test are used. The results make it possible to determine the presence of depression, mania, anxiety, a tendency towards aggression, impulsivity, asociality, frustrated needs that caused emotional deviation.
• Questionnaires. The methods are based on self-report – the patient’s ability to assess his emotions, character traits, health status, and characteristics of interpersonal relationships. The use of narrowly focused tests for diagnosing depression and anxiety (Beck questionnaire, Depressive Symptoms Questionnaire), complex emotional and personal techniques (Derogatis, MMPI (SMIL), Eysenck test) is widespread.

Treatment of mood disorders

The treatment regimen for emotional disorders is determined by the doctor individually, depending on the etiology, clinical manifestations, the nature of the disease. General scheme treatment involves stopping acute symptoms, elimination of the cause (if possible), psychotherapeutic and social work aimed at increasing adaptive abilities. A complex approach includes the following areas:

• Drug treatment. Patients with depression are advised to take antidepressants - medications that improve mood and performance. Anxiety symptoms can be treated with anxiolytics. Drugs in this group relieve tension, promote relaxation, and reduce anxiety and fear. Normotimics have antimanic properties, significantly soften the severity of the next affective phase, and prevent its onset. Antipsychotic medications eliminate mental and motor agitation, psychotic symptoms(delusions, hallucinations). In parallel with psychopharmacotherapy, family meetings are held at which they discuss the need to maintain a rational regimen, physical activity, good nutrition, gradual involvement of the patient in household activities, joint walks, and sports. Sometimes there are pathological interpersonal relationships with household members who support the disorder. In such cases, psychotherapeutic sessions aimed at solving problems are necessary.

Prognosis and prevention

Exodus affective disorders relatively favorable for psychogenic and symptomatic forms, timely and complex treatment promotes reverse development diseases. Hereditary disorders of affect tend to chronic course, therefore, patients need periodic courses of therapy to maintain normal well-being and prevent relapses. Prevention includes avoiding bad habits, maintaining close, trusting relationships with relatives, observing correct mode days from good sleep, alternating work and rest, allocating time for hobbies and interests. In case of hereditary burden and other risk factors, regular examination is necessary. preventive diagnostics at the psychiatrist.

Recognition of any disease, including mental illness, begins with a symptom (a sign that reflects certain disorders of one or another function). However, the symptom-sign has many meanings and it is impossible to diagnose the disease on its basis. An individual symptom acquires diagnostic significance only in its aggregate and in relation to other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. The clinical picture of the disease and its development are formed from the syndromes and their sequential changes.

Neurotic (neurosis-like) syndromes

Neurotic syndromes are observed with neurasthenia, hysterical neurosis, obsessive-compulsive neurosis; neurosis-like - for diseases of an organic and endogenous nature and correspond to the mildest level of mental disorders. Common to all neurotic syndromes is the presence of criticism of one’s condition, the absence of pronounced phenomena of disadaptation to normal conditions life, the concentration of pathology in the emotional-volitional sphere.

Asthenic syndrome - characterized by a noticeable decrease in mental activity, increased sensitivity to ordinary irritations (mental hyperesthesia), rapid fatigue, difficulty in mental processes, incontinence of affect with quickly onset fatigue (irritating weakness). A number of somatic functional disorders with autonomic disorders are observed.

Obsessive Obsessive Syndrome (anankast syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.

Hysterical syndrome - a combination of egocentrism, excessive self-suggestion with increased affectivity and instability of the emotional sphere. An active desire for recognition from others by demonstrating one's own advantage or the desire to arouse sympathy or self-pity. The experiences of patients and behavioral reactions are characterized by exaggeration, hyperbolization (of the merits or severity of their condition), increased fixation on painful sensations, demonstrativeness, mannerisms, and exaggeration. This symptomatology is accompanied by elementary functional somatoneurological reactions, which are easily recorded in psychogenic situations; functional disorders of the motor system (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deaf-mute, aphonia).

Affective disorder syndromes

Dysphoria - grouchy-irritable, angry and gloomy mood with increased sensitivity to any external stimulus, aggressiveness and explosiveness. Accompanied by unfounded accusations of others, scandalousness, and cruelty. There are no disturbances of consciousness. Equivalents of dysphoria can be binge drinking (dipsomania) or aimless wandering (dromomania).

Depression – melancholy, depressive syndrome- a suicidal state, which is characterized by depressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). The structure of depression includes possible depressive delusional or overvalued ideas (of low value, worthlessness, self-blame, self-destruction), decreased desire, vital depression of self-feelings. Subdepression is a mild depressive affect.

Cotard's syndrome – nihilistic-hypochondriacal delirium combined with ideas of enormity. It is most common in involutional melancholia, much less common in recurrent depression. There are two variants of the syndrome: hypochondriacal – characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriacal delirium; depressive – characterized by anxious melancholy with predominantly depressive delusions and ideas of denial of the outside world of a megalomaniac nature.

Masked (larvated) depression - characterized by a feeling of general vague diffuse somatic discomfort, vital senestopathic, algic, vegetodystonic, agrypnic disorders, concern, indecision, pessimism without clear depressive changes in affect. Often found in somatic practice.

Mania (manic syndrome) - a painfully elevated joyful mood with increased drives and tireless activity, accelerated thinking and speech, inadequate joy, cheerfulness and optimism. A manic state is characterized by distractibility of attention, verbosity, superficiality of judgment, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one’s own personality, and lack of fatigue. Hypomania is a mildly expressed manic state.

Affective syndromes (depression and mania) are the most common mental disorders and are noted in the onset of mental illnesses; they may remain the predominant disorders throughout the course of the disease.

When diagnosing depression, it is necessary to focus not only on the complaints of patients: sometimes complaints of decreased mood may be absent, and only targeted questioning reveals depression, loss of interest in life (“satiety with life” - taedium vitae), decreased overall vital activity, boredom, sadness, anxiety, etc. In addition to targeted questioning about actual mood changes, it is important to actively identify somatic complaints that can mask depressive symptoms, signs of sympathicotonia (dry mucous membranes, skin, tendency to constipation, tachycardia - the so-called “Protopopov’s sympathicotonic symptom complex”), characteristic of endogenous depression. A large number of diagnostically significant signs can be detected when studying the appearance and behavior of patients by observation: motor retardation or, conversely, fussiness, agitation, neglected appearance, characteristic physical phenomena - a frozen expression of melancholy, depressive "omega" (the fold between eyebrows in the shape of the Greek letter “omega”), Veragut fold (oblique fold on the upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Biological tests such as therapy with tricyclic antidepressants and the dexamethasone test allow paraclinical clarification of the nature of depression. Clinical and psychopathological studies using standardized scales (Zung and Spielberger scales) make it possible to quantify the severity of depression and anxiety.

Affective or mood disorders are common name for a group of mental disorders that are associated with a violation of the internal experience and external expression of a person’s mood (affect).

The disorder is expressed in changes in the emotional sphere and mood: excessive elation (mania) or depression. Along with the mood, the individual’s activity level also changes. These conditions have a significant impact on human behavior and social function, can lead to maladjustment.

Modern classification

There are two main mood disorders that are polar in their manifestation. These conditions are depression and mania. When classifying affective disorders, the presence or absence of a patient's history is taken into account. manic episode.

The most widely used classification is distinguishing three forms of the disorder.

Depressive spectrum disorders

Depressive disorders – mental disorders, in which motor retardation, negative thinking, depressed mood and the inability to experience a feeling of joy are manifested. The following types of depressive disorders are distinguished:

Also a separate item Seasonal affective disorder stands out, more about it in the video:

Manic spectrum disorders

Manic disorders:

1. Classic mania – pathological condition, which is characterized by high mood, mental agitation, increased physical activity. This condition differs from the usual psycho-emotional upsurge, and is not due to visible reasons.
2. Hypomania –light form classic mania, characterized by a less pronounced manifestation of symptoms.

Bipolar spectrum disorders

(outdated name - manic-depressive psychosis) - mental disorder, in which alternating manic and depressive phases occur. Episodes replace each other, or alternate with “bright” intervals (states of mental health).

Features of the clinical picture

Manifestations of affective disorders vary and depend on the form of the disorder.

Depressive disorders

Major depressive affective disorder is characterized by the following symptoms:

Symptoms of other types of affective disorders of the depressive spectrum:

1. At melancholic depression there is a vitality of affect - physical sensation pain in solar plexus, which are caused by deep melancholy. Observed heightened sensation guilt.
2. At psychopathic depression, hallucinations and delusions are present.
3. At involutionary The patient's depression is impaired motor functions. This manifests itself in either aimless or abnormal movements.
4. Symptoms postpartum depression are similar to the symptoms of major depressive disorder. The criterion for assessing the condition is postnatal depression, which indicates the development of pathology in the postpartum period.
5. At small depression, symptoms of major depressive disorder are observed, but they are less intense and do not have a significant impact on the patient’s social function and life activities.
6. Similar symptoms are observed with recurrent disorder, the main difference is the duration of the condition. Episodes of depression occur periodically and last from 2 days to 2 weeks. During the year, episodes are repeated several times and do not depend on menstrual cycle(among women).
7. At atypical form of mood disorder symptoms clinical depression are supplemented emotional reactivity, increased appetite, weight gain, increased drowsiness.

The patient experiences alternating periods of low mood (depression) and increased activity (mania). Phases can replace each other quite quickly.

The average duration of one period is about 3-7 months, however, it can be several days and several years, with depressive phases often three times longer than manic ones. Manic phase may be an isolated episode against the background of a depressive state.

In cases of the organic nature of affective disorder, patients experience a decrease mental abilities And .

Health care

The choice of therapeutic course depends on the form of affective disorder, but in any case, patients are recommended to undergo outpatient treatment.

Patients are given an appointment medications and psychotherapy sessions. The selection of drugs is carried out depending on the existing symptoms.

Treatment of depressive affective disorders

The main course of treatment includes taking selective and non-selective norepinephrine and serotonin uptake inhibitors.

Anxiety is relieved with:

At increased manifestation melancholy is prescribed:

• activating antidepressants (Nortriptyline, Protriptyline);
• non-selective monoamine oxidase inhibitors (Tranylcipramil);

Almost every one of us at least once in our lives says that we are not in the mood today.

However, most have no idea what that same mood is and why it is good today and bad tomorrow. There are people who are constantly out of sorts and live with this depressive state for years. Moreover, quite often a person does not even think that he has some problems with mental state. But actually it is not.

Causes

In the dictionary, the term “mood” is defined as follows by experts in the field of psychology. So, mood is a certain emotional state of a person, in which life activity takes on a special color, and vitality flows in a certain channel. If a person is in good mood, then he is cheerful, active and enjoys what he has done.

If a person Bad mood, then he is passive and everything around him is not at all pleasing, and familiar things can even cause some despondency. Moreover, the mood does not depend on the person himself, but rather on surrounding factors and situations in which he finds himself. For example, an individual experiences fear before doing something, feels unprepared for a certain job. All this causes depression, and the person experiences a general loss of strength and decreased vitality.

Almost everyone faces such problems. But if mood swings occur too often, a mood disorder is diagnosed.

Mood disorders are psychological illness, which occurs quite often. In this case, a violation of affect occurs. This term means strong but short-term excitement, in which a person simply cannot control his emotional state. Concerning specific examples, then this is anger, strong fear and anger.

There are two types of affective disorder - a rapid rise (mania) or, conversely, a strong decline emotional background(depression). Naturally, when one of the types manifests itself, a change in human activity occurs, which is expressed very clearly.

Affective disorders, in turn, are also divided into several types. It all depends on what affective state prevails in him. Varieties:

• depressed;
• bipolar;
• manic.

As for the manifestation of such disorders, a person can sometimes experience severe depression and mania, and sometimes experience mania and then depression. If we talk about depression, it can occur without mania, but mania without depression is usually not observed.

Also, affective disorders look like an abnormal manifestation of various emotions. For example, severe fear, anxiety, rage, and even ecstasy may suddenly arise. As for more serious manifestations, this is nonsense.

There are many different classifications of mood disorders. It all depends on how long the moments of mania and depression last. Let's look at the main options:

Symptoms of Mood Disorders

As for the symptoms of a mood disorder, they depend entirely on the type of disorder. Human can for a long time be in a depressed state, he has a decrease in activity. Even after light loads, it appears extreme fatigue and loss of strength. Then, a sleep disorder appears: the person has difficulty falling asleep or constantly wakes up during sleep. Some experience a decrease in appetite. Low self-esteem leads to constant thoughts that he is characterized by a certain worthlessness and even guilt of his existence. All this is characteristic of a depressive state.

The symptoms of a manic episode are the complete opposite. A person constantly feels a certain uplift in life, which is absolutely not typical for a given situation. For some people this condition is accompanied by increased activity, increased appetite, reassessment of one’s personality and the like.

Chronic type disorder

This type of mood disorder may include certain symptoms.

Affective emotional disorders include a complex mental pathologies, characterized by a predominant change in the emotional sphere, as well as mood, either towards depression or towards elation. At the same time, the level of human activity often changes. Almost all other symptoms are secondary or explained by changes in mood and activity.

Mood disorders tend to recur, and exacerbations may be caused by various kinds stress.

Causes of mood disorders

All the reasons why affective disorders develop are not known for certain, but presumably there are three groups of them:

1. Biological reasons associated with metabolism in the brain.
2. Genetic. ABOUT high probability that this pathology is based on gene mutations, says that approximately half of patients with bipolar syndrome have at least one parent suffering from a mood disorder.
3. Psychosocial factors.

Symptoms of the disease

Symptoms of the pathology depend on what types of disease develop in patients. Mood disorders are divided into several main types:

1. . Characterized by at least two episodes of significant disturbance in the patient’s mood and activity. They are expressed either in high mood, bursts of energy, increased activity (mania), or in its fall, decreased activity and energy (depression). In other words- .
2. (unipolar disorder). If this disorder develops, the patient's mood and energy decrease, and activity decreases. The patient is no longer able to experience joy and pleasure, focus and be interested. He gets tired quickly, sleeps poorly and loses his appetite. The patient is haunted by thoughts about his guilt in what is happening and uselessness.
3. Recurrent depressive disorder characterized by the presence of depression without episodes of transition to mania.
4. Persistent affective disorders. This pathology can continue for many years, but almost all episodes are mild enough that they cannot be described as either depression or mania. Gradually they lead to constant malaise and loss of ability to work.
5. Affective psychoses NOS.
6. Chronic mood disorders - cyclothymia, represented by alternating mild decreases and increases in mood, dysthymia, a state of chronic subdepression.
7. Seasonal affective disorder is one option bipolar disorder or recurrent depression, worsening either in late autumn or early spring.
8. Bipolar disorder, with rapid cycles. In this case, the patient experiences four episodes of the disease within a year.
9. Postpartum depression.
10. Secondary disorders accompanying other mental or physical illnesses.

Diagnosis of pathology

Affective disorder syndromes may occur during exacerbation of many endocrine diseases, pathological changes cerebral vessels, parkinsonism. In such cases, there are manifestations of a disorder of consciousness or cognitive deficit that is not characteristic of endogenous mood disorders. Also carried out with, and schizoaffective disorder.

Therapy for affective disorders should be based on a set of measures aimed both at combating mania and depression themselves, and at preventing exacerbations. Treatment depression carried out with the help wide range drugs – "Lerivon", "Fluoxetine", "Zoloft", "EST", tricyclic antidepressants. Sleep deprivation is used, as well as photon therapy. Manias are treated gradually increasing doses of lithium salts, antipsychotics and carbamazepine. Prevention of exacerbations is carried out by taking sodium valprate, lithium carbonate or carbamazepine.

Video: Mood disorders: the influence of heredity and environment