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

- This is a group of mental disorders characterized by a change in the emotional state in the direction of depression or uplift. Includes various forms of depression and mania, manic-depressive psychosis, affective lability, increased anxiety, dysphoria. Mood pathology is accompanied by a decrease or increase in the overall level of activity, vegetative symptoms. Specific diagnostics includes a conversation and observation of a psychiatrist, an experimental psychological examination. For treatment, pharmacotherapy (antidepressants, anxiolytics, mood stabilizers) and psychotherapy are used.

Sufficient activity of dopamine provides switchability of attention and emotions, regulation of muscle movements. Lack is manifested by anhedonia, lethargy, apathy, excess - mental stress, excitability. An imbalance of neurotransmitters affects the functioning of the brain structures responsible for the emotional state. With affective disorders, it can be triggered by external causes, such as stress, or internal factors - diseases, hereditary characteristics of biochemical processes.

Classification

In psychiatric practice, the classification of emotional disorders in terms of the clinical picture is widespread. There are depressive, manic and anxiety spectrum disorders, bipolar disorder. The fundamental classification is based on different aspects of affective reactions. According to her distinguish:

1. Violations of the expression of emotions. Excessive intensity is called affective hyperesthesia, weakness is called affective hypoesthesia. This group includes sensitivity, emotional coldness, emotional impoverishment, apathy.
2. Violations of the adequacy of emotions. With ambivalence, multidirectional emotions coexist at the same time, 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 at tragic news.
3. Violations of stability of emotions. Emotional lability is manifested by frequent and unreasonable mood variability, explosiveness - increased emotional excitability with a vivid uncontrollable experience of anger, rage, 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 sense of hopelessness, meaninglessness of existence, a sense of their own failure and worthlessness. With a mild degree of the disease, there is a decrease in working capacity, increased fatigue, tearfulness, instability of appetite, problems with falling asleep.

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

Masked depression is isolated as a separate clinical form. Its peculiarity lies in the absence of external signs of emotional disorder, the denial of sickness and low mood. At the same time, various somatic symptoms develop - headache, joint and muscle pain, weakness, dizziness, nausea, shortness of breath, blood pressure drops, tachycardia, digestive disorders. Examinations by doctors of somatic profiles do not reveal diseases, drugs are often ineffective. Depression is diagnosed at a later stage than the classic form. By this time, patients begin to feel vague anxiety, anxiety, insecurity, and a decrease in interest in their favorite activities.

In a manic state, the mood is unnaturally elevated, the pace of thinking and speech is accelerated, hyperactivity is noted in behavior, facial expressions reflect joy, excitement. Patients are optimistic, constantly joke, make jokes, devalue problems, and cannot tune in to a serious conversation. They actively gesticulate, often change their position, get up from their seats. Purposefulness and concentration of mental processes are reduced: patients are often distracted, ask again, abandon the work they have just begun, replacing it with a more interesting one. The feeling of fear is dulled, caution is reduced, a feeling of strength and courage appears. All difficulties seem insignificant, problems are solvable. Sexual desire and appetite increase, the need for sleep decreases. With a pronounced disorder, irritability increases, unmotivated aggression appears, sometimes delusional and hallucinatory states. The alternating cyclical manifestation of phases of mania and depression is called bipolar affective disorder. With a weak manifestation of symptoms, they speak of cyclothymia.

Anxiety disorders are characterized by constant anxiety, a feeling of tension, and fears. Patients are in anticipation of negative events, the likelihood of which, as a rule, is very small. In severe cases, anxiety develops into agitation - psychomotor agitation, manifested by restlessness, "wringing" hands, walking around the room. Patients try to find a comfortable position, a quiet place, but to no avail. Increased anxiety is accompanied by panic attacks with autonomic symptoms - shortness of breath, dizziness, respiratory spasm, nausea. Obsessive thoughts of a frightening nature are formed, appetite and sleep are disturbed.

Complications

Prolonged affective disorders without adequate treatment significantly worsen the quality of life of patients. Mild forms interfere with full-fledged professional activity - with depression, the volume of work performed decreases, with manic and anxious states - quality. Patients either avoid communication with colleagues and clients, or provoke conflicts against the background of increased irritability and reduced control. In severe forms of depression, there is a risk of developing suicidal behavior with the implementation of suicide attempts. Such patients need constant supervision of relatives or medical personnel.

Diagnostics

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

• clinical conversation. In the course of a conversation with a patient, a psychiatrist learns about disturbing symptoms, reveals speech features that indicate an emotional disorder. When depressed, patients speak slowly, sluggishly, quietly, and answer questions in monosyllables. With mania, they are talkative, use bright epithets, humor, quickly change the topic of conversation. Anxiety is characterized by inconsistency in speech, uneven pace, and a decrease in focus.
• observation. Often a natural observation of emotional and behavioral expression is made - the doctor evaluates facial expressions, features of the patient's gestures, activity and purposefulness of motor skills, vegetative symptoms. There are standardized expression monitoring schemes, such as the Detailed Expression Analysis Method (FAST). The result reveals signs of depression - lowered corners of the mouth and eyes, corresponding wrinkles, a mournful facial expression, stiffness of movements; signs of mania - smile, exophthalmos, increased tone of facial muscles.
• Psychophysiological tests. They are produced to assess mental and physiological stress, the severity and stability of emotions, their orientation and quality. The color test of relations by A. M. Etkind, the method of semantic differential of I. G. Bespalko and co-authors, the method of conjugated motor actions of 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 methods. These techniques are aimed at the study of emotions through the prism of unconscious personal qualities, character traits, social relations. The Thematic Apperception Test, Rosenzweig's Frustration Test, Rorscharch's Test, "Drawing of a Man" test, "Drawing of a Man in the Rain" test are used. The results make it possible to determine the presence of depression, mania, anxiety, a tendency to aggression, impulsivity, asociality, frustrated needs that caused emotional deviation.
• Questionnaires. Methods are based on self-report - the patient's ability to assess their emotions, character traits, health status, features of interpersonal relationships. It is common to use narrowly focused tests for diagnosing depression and anxiety (the Beck questionnaire, the questionnaire for symptoms of depression), complex emotional and personal methods (Derogatis, MMPI (SMIL), Eysenck test).

Treatment of Mood Disorders

The treatment regimen for emotional disorders is determined by the doctor individually, depending on the etiology, clinical manifestations, and the nature of the course of the disease. The general treatment regimen involves the relief of acute symptoms, elimination of the cause (if possible), psychotherapeutic and social work aimed at increasing adaptive abilities. An integrated approach includes the following directions:

• Medical treatment. Patients with depression are shown taking antidepressants - drugs that improve mood and performance. Anxiety symptoms are relieved with anxiolytics. Preparations of this group relieve stress, promote relaxation, reduce anxiety and fear. Normotimics have anti-manic properties, significantly soften the severity of the next affective phase, and prevent its onset. Antipsychotic drugs 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, gradually involving the patient in household chores, joint walks, playing sports. Sometimes there are pathological interpersonal relationships with household members that support the disorder. In such cases, psychotherapeutic sessions aimed at solving problems are needed.

Forecast and prevention

The outcome of affective disorders is relatively favorable in psychogenic and symptomatic forms, timely and comprehensive treatment contributes to the regression of the disease. Hereditary disorders of affect tend to be chronic, so patients need periodic courses of therapy to maintain normal well-being and prevent relapses. Prevention includes giving up bad habits, maintaining close trusting relationships with relatives, observing the correct daily routine with good sleep, alternating work and rest, allocating time for hobbies and hobbies. With hereditary burden and other risk factors, regular preventive diagnostics by a psychiatrist is necessary.

Recognition of any disease, including mental, 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 value only in the aggregate and in interrelation with other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. From the syndromes and their successive changes, the clinical picture of the disease and its development are formed.

Neurotic (neurosis-like) syndromes

Neurotic syndromes are noted in neurasthenia, hysterical neurosis, obsessive-compulsive disorder; neurosis-like - in 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 maladjustment to ordinary living conditions, the concentration of pathology in the emotional-volitional sphere.

Asthenic syndrome - characterized by a noticeable decrease in mental activity, increased sensitivity to ordinary stimuli (mental hyperesthesia), rapid fatigue, difficulty in the flow of mental processes, incontinence of affect with rapidly onset fatigue (irritating weakness). There are a number of somatic functional disorders with vegetative disorders.

obsessive-compulsive disorder (anancastic syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.

hysterical syndrome - a combination of egocentrism, excessive self-suggestion with increased affectation and instability of the emotional sphere. Actively seeking recognition from others by demonstrating one's own superiority or seeking 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, exaggerations. This symptomatology is accompanied by elementary functional somato-neurological reactions, which are easily fixed in psychogenic situations; functional disorders of the motor apparatus (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deafness, aphonia).

Mood Disorder Syndromes

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

Depression - melancholy, depressive syndrome - a suicidal state, which is characterized by an oppressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). In the structure of depression, there are possible depressive delusional or overvalued ideas (of low value, worthlessness, self-accusation, self-destruction), a decrease in attraction, a vital oppression of self-perceptions. Subdepression is a mild depressive affect.

Cotard's syndrome - nihilistic-hypochondriac nonsense combined with ideas of enormity. It is most common in involutional melancholia, much less often in recurrent depression. There are two variants of the syndrome: hypochondriacal - characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriac 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 indefinite diffuse somatic discomfort, vital senestopathic, algic, vegetodistonic, agripnic disorders, anxiety, 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, acceleration of thinking and speech, inadequate joy, cheerfulness and optimism. The manic state is characterized by distractibility of attention, verbosity, superficiality of judgments, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one's own personality, lack of fatigue. Hypomania is a mildly pronounced manic state.

Affective syndromes (depression and mania) are the most common mental disorders and are noted in the onset of mental illness, 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 there may be no complaints about a decrease in mood, and only targeted questioning reveals depression, loss of interest in life (“satisfaction with life” - taedium vitae), a decrease in overall vital activity, boredom, sadness, anxiety, etc. , signs of sympathicotonia (dryness of mucous membranes, skin, a tendency to constipation, tachycardia - the so-called "Protopopov's sympathicotonic symptom complex"), characteristic of endogenous depression. "omega" (fold between the eyebrows in the form of the Greek letter "omega"), Veraguta fold (oblique fold on the upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Paraclinically clarify the nature of depression allow such biological tests as therapy with tricyclic antidepressants, dexamethasone test. Clinical and psychopathological examination using standardized scales (Zung scale, Spielberger scale) makes it possible to quantify the severity of depression and anxiety.

Affective disorders, or mood disorders, is the general 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).

Violation is expressed in a change in the emotional sphere and mood: excessive elation (mania) or depression. Along with the mood, the level of activity of the individual also changes. These conditions have a significant impact on a person's behavior and his social function, and 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 manic episode in the patient's history is taken into account.

The most widely used classification with the allocation of three forms of violation.

Depressive Spectrum Disorders

Depressive disorders are psychiatric disorders characterized by motor retardation, negative thinking, low mood, and inability to experience feelings of joy. There are two types of depressive disorders:

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

Manic Spectrum Disorders

Manic disorders:

1. classic mania- a pathological condition, which is characterized by increased mood, mental arousal, increased motor activity. This state differs from the usual psycho-emotional upsurge, and is not due to visible reasons.
2. Hypomania- a mild form of classic mania, characterized by a less pronounced manifestation of symptoms.

Bipolar Spectrum Disorders

(obsolete name - manic-depressive psychosis) - a mental disorder in which there is an alternation of manic and depressive phases. Episodes succeed each other, or alternate with "light" intervals (mental health conditions).

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:

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

1. At melancholic depression, there is a vitality of affect - a physical sensation of pain in the solar plexus, which are caused by deep longing. There is an increased sense of guilt.
2. At psychopathic depression present hallucinations and delusions.
3. At involutionary depression in a patient impaired motor functions. This is manifested in either aimless and anomalous movements.
4. Symptoms postpartum depression are similar to those 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 of lesser intensity and do not significantly affect the patient's social function and life.
6. Similar symptoms are seen with recurrent disorder, the main difference is the duration of the condition. Episodes of depression occur intermittently and last from 2 days to 2 weeks. During the year, the episodes are repeated several times and do not depend on the menstrual cycle (in women).
7. At atypical form of mood disorder, the symptoms of clinical depression are complemented by emotional reactivity, increased appetite, weight gain, increased drowsiness.

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

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

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

Health care

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

Patients are prescribed medication and psychotherapy sessions. The selection of drugs is carried out depending on the symptoms present.

Therapy for depressive affective disorders

The main course of treatment includes the use of selective and non-selective norepinephrine and serotonin reuptake inhibitors.

Anxiety is relieved by:

With an increased manifestation of longing, they prescribe:

• activating antidepressants (nortriptyline, protriptyline);
• non-selective inhibitors of monoamine oxidase (Tranylcipramil);

Almost every one of us at least once in his life says the phrase that he is not in the mood today.

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

Causes

In the dictionary, such a term as "mood", experts in the field of psychology give the following definition. So, mood is a certain emotional state of a person, in which life activity acquires a special color, and vitality flows in a certain direction. If a person is in a good mood, then he is cheerful, active and enjoys what he has done.

If a person is in a bad mood, then he is passive and everything around him does not please him at all, and the usual things can even cause some despondency. At the same time, the mood does not depend on the person himself, but rather on the surrounding factors and situations in which he finds himself. For example, an individual is afraid of some business, feels unprepared for a certain job. All this causes a depressed state, and a person experiences a general breakdown and a decrease in vitality.

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

Mood disorders are a psychological illness that is quite common. In this case, there is a violation of affect. This term means a strong, but short-term arousal, in which a person simply cannot control his emotional state. As for specific examples, these are anger, intense fear and anger.

There are two types of affective disorder - it is a rapid rise (mania) or, conversely, a strong decrease in the emotional background (depression). Naturally, with the manifestation of one of the types, 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:

• depressive;
• bipolar;
• manic.

With regard to 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, then it can manifest itself without mania, but mania without depression is usually not observed.

Also, affective disorders look like an abnormal manifestation of different emotions. For example, strong fear, anxiety, rage, and even ecstasy can 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. Consider the main options:

Symptoms of mood disorders

As for the symptoms of a mood disorder, they depend entirely on the type of disorder. A person can be depressed for a long time, he has a decrease in activity. Even after frivolous loads, severe fatigue and loss of strength appear. Then, a sleep disturbance appears: a person falls asleep badly or constantly wakes up during sleep. Some people experience a decrease in appetite. Low self-esteem leads to constant thoughts that he is characterized by a certain worthlessness and even the guilt of his existence. All of these are characteristic of depression.

The symptoms of a manic episode are exactly the opposite. A person constantly feels a certain vital upsurge, which is absolutely not typical for this situation. For some people, this condition is accompanied by increased activity, increased appetite, reassessment of their personality, and the like.

chronic type disorder

Certain symptoms can be attributed to this type of mood disorder.

Affective emotional disorders include a complex of mental pathologies characterized by a predominant change in the emotional sphere, as well as mood, either in the direction of depression or in the direction of elation. At the same time, the level of activity of a person often also changes. Virtually all other symptoms are secondary or due to changes in mood and activity.

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

Reasons for the development of mood disorders

For certain, all the reasons why affective disorders develop are unknown, but presumably there are three groups of them:

1. Biological causes associated with brain metabolism.
2. genetic. The high probability that this pathology is based on gene mutations is evidenced by the fact that in about half of patients with bipolar syndrome, at least one parent suffers from a mood disorder.
3. Psychosocial factors.

Symptoms of the disease

The symptoms of pathology depend on which types of the disease develop in patients. Mood disorders are divided into several main varieties:

1. . It is characterized by at least two episodes of a significant disturbance in the mood and activity of the patient. They are expressed either in mood ups, bursts of energy, increased activity (mania), or in its fall, decrease in activity and energy (depression). In other words- .
2. (unipolar disorder). In the case of the development of this disorder, the patient's mood and energy decrease, activity decreases. The patient is no longer able to receive joy and pleasure, to concentrate and be interested. He gets tired quickly, sleeps poorly and loses his appetite. The patient is haunted by thoughts of his guilt in what is happening and uselessness.
3. Recurrent depressive disorder is characterized by depression without manic episodes.
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 disability.
5. Affective psychosis NOS.
6. Chronic mood disorders, - cyclothymia, represented by alternating light depression and elevation of mood, dysthymia, a state of chronic subdepression.
7. Seasonal affective disorder is one of the variants of bipolar disorder or recurrent depression, aggravated either in late autumn or early spring.
8. Bipolar disorder, with fast cycles. In this case, the patient experiences during the year from four episodes of the disease.
9. postpartum depression.
10. Secondary disorders accompanying other mental or somatic diseases.

Diagnosis of pathology

Syndromes of affective disorders can be observed during exacerbation of many endocrine diseases, pathological changes in cerebral vessels, parkinsonism. In such cases, there are manifestations of a disorder of consciousness or cognitive deficit, uncharacteristic of endogenous mood disorders. Also performed with, and schizoaffective disorder.

Therapy of affective disorders should be based on a set of measures aimed at both combating mania and depression itself and preventing exacerbations. Treatment depression carried out using a wide range of drugs - Lerivon, Fluoxetine, Zoloft, ECT, tricyclic antidepressants. Sleep deprivation is used, as well as photon therapy. Mania is 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