Mood Disorders

The editors of Diagnostic Manual-Intellectual Disability (DM-ID) have set out to complete the difficult task of compiling the evidence base on mental disorders in the field of intellectual disability (ID) into one reference book while modifying DSM-IV diagnostic criteria for use in persons with the disorder who present with mental and behavioral disorders.

The fact that treatment with interferon (IFN)-α has become the world’s foremost human model for studying how the innate immune system promotes depression points to a disturbing clinical truth: patients who elect to receive (IFN)-α therapy for any of the several disease states to which it is applied face a high likelihood of experiencing a multitude of psychiatric symptoms severe enough to affect their social and occupational functioning and overall well-being.1

Depression complicates medical illnesses and their management, and it increases health care use, disability, and mortality. This article focuses on the recent research data on diagnosis, etiopathogenesis, treatment, and prevention in unipolar, bipolar, psychotic, and subsyndromal depression.

The loss of a loved one is one of the most traumatic events in a person’s life. In spite of this, most people cope with the loss with minimal morbidity. Approximately 2.5 million people die in the United States every year, and each leaves behind about 5 bereaved people.

There is substantial comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in children with attention-deficit/hyperactivity disorder (ADHD). It is important to determine the effect of comorbid ODD and CD on the clinical course in youth with ADHD. Biederman and associates1 recently published clinical findings from a 10-year prospective, longitudinal study of boys with ADHD, following them into early adulthood.

Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.

What is the effectiveness (if any) of antidepressants in bipolar depression? What is the risk of manic switching? How effective are antidepressants in preventing relapse of bipolar depression? Insights here.

Although several antimanic agents are available to treat individuals with bipolar disorder (BD), many patients have a less than satisfactory response or experience adverse effects.1 With the exception of lithium, all of the current antimanic agents are either anticonvulsant or antipsychotic drugs. It is remarkable that no drug has been developed specifically for BD, especially because this illness was conceptualized more than a century ago.

An international team of experts recently proposed expanding the diagnostic criteria for several subtypes of bipolar disorder, adding a pediatric bipolar disorder category and eliminating the schizoaffective disorder category.

For many years, research on mood disorders has focused on neurotransmitters, particularly on the monoamines (serotonin, norepinephrine, and dopamine) and their action at the neuronal junction, or synapse. Although the monoamine theory helps explain the action of tricyclics, monoamine oxidase inhibitors, and SSRIs, it fails to account for many other things.

Panic disorder with or without agoraphobia is a chronic, debilitating psychiatric illness that affects about 4.7% of the general US population.

In May 2007, the novelist Ann Bauer went public with the tribulations of her autistic son. When catatonia developed, a diagnosis of schizophrenia was made, and antipsychotic medications were prescribed, but with little benefit. When the catatonia syndrome was recognized as independent of schizophrenia and successfully treated, her son returned to a more normal life.1,2

Patients with chronic pain and head injury frequently have comorbid anxiety and depressive disorders, with depressive disorders appearing to be more predominant. A number of studies show that depressive spectrum illness develops in 40% to 80% of patients with chronic pain; in a majority of these cases, the mood disorder is caused by chronic pain.

Comorbidity of psychiatric syndromes is quite common-in a 12-month period, almost 50% of adults in the United States with any psychiatric disorder had 2 or more disorders.

Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.

A recent analysis that found a 40-fold increase in the diagnosis of bipolar disorder in youth has highlighted diagnostic dilemmas and prompted calls for more research studies.

Parkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.

Depression is primarily a mood disorder, but it can also be viewed as a cognitive disorder for many older adults.

Early relapse is a limiting defect in electroconvulsive therapy (ECT). Although more than 80% of patients with a severe depressive illness who complete an acute course of ECT are relieved within three weeks, up to 60% relapse within six months, despite continuation treatments with antidepressant medications.1,2 In a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments--placebo, nortriptyline (Aventyl, Pamelor) alone, or the combination of nortriptyline and lithium (Eskalith, Lithobid). The patients were monitored for adequacy of blood levels.1 Within the six-month follow-up period, 84% of patients treated with placebo, 60% of patients treated with nortriptyline, and 39% of patients treated with the combination medications had relapsed.

Suicide is the third leading cause of death in younger (10- to 14-year-old) adolescents in the United States and the leading cause of death in this age group in other countries, including China, Sweden, Ireland, Australia, and New Zealand.

Child and adolescent psychosomatic medicine, usually in the realm of the pediatric psychiatric consultation-liaison service, seeks to address the complex relationship between a child's physical illness and affective state with the goal of improving the child's emotional well-being.

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection.

Mood disorders are among the most prevalent forms of mental illness. Serious depression is especially common; based on a face-to-face survey conducted from December 2001 to December 2002, the past-year prevalence rate of clinically significant major depressive disorder (MDD) was estimated to be 6.6%, affecting at least 13.1 to 14.2 million Americans.

The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.

Successfully weaving together the long and complex history of melancholic depression as a severe mood disorder with strong biological underpinnings and a distinctive clinical profile.

According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).

Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.

Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other nonconsenting persons that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS).

Panic disorder occurs in about 1 in 5 individuals who have bipolar disorder. Anxiety amplifies the distress caused by depression and mania, but pharmacological approaches are tricky and under-studied. Frequent comorbidity and evidence of a possible genetic relationship of bipolar and panic disorders are suggestive of a causal relationship between the 2. Thus, it may be fruitful to look more closely at evidence for common biological abnormalities in both disorders to find a pathophysiological mechanism that links mania, depression, and panic attacks. Mood episodes and panic attacks can both be modeled as the result of deficits in amygdala-mediated emotional conditioning. From this model, some insight may be gained for potentially helpful treatment strategies for the 2 disorders when they occur together.

The construct of bipolar spectrum disorder remains a work in progress. Its precise boundaries are still a matter of considerable debate. Some psychiatrists are convinced that it is widely overdiagnosed. It is possible that depending on the clinician and the clinical setting both views are correct.