Depression and Mania are the most serious of the mood disorders. Depression and Mania are often referred to as affective disorders, however the critical pathology in these disorders is one of the moods, the internal emotional state of a person and the external expression of emotional content.
Mood may be normal, elevated or depressed. Normal persons experience a wide range of moods and have an equally large repertoire of affective expressions. They feel in control of their moods and affects. Mood disorders are a group of clinical conditions characterized by a loss of that sense of control and a subjective experience of great distress. Patients with depressed mood have a loss of energy and interest, feeling of guilt, difficulty in concentrating, loss of appetite and thoughts of death or suicide.
Other signs and symptoms of mood disorders include changes in activity level, cognitive abilities, speech and vegetative functions such as sleep, appetite, sexual activity and other biological rhythms.
Patients with elevated mood demonstrate expansiveness,decreased sleep, heightened self -esteem and grandiose ideas. These disorders virtually always result in impaired- interpersonal, social and occupational functioning. Patients who are affected with only major depressive episodes are said to have major depressive disorder or unipolar depression. Patients with both manic and depressive episodes or patients with manic episodes alone are said to have bipolar disorder. The term unipolar mania or pure mania are sometimes used for bipolar patients who do not have depressive episodes.
Three additional categories of mood disorders are hypomania, cyclothymia and dysthymia. Hypomania is an episode of manic symptoms that does not meet the full DSM – IV R criteria (Diagnostic and statistical manual of mental disorders) for mania. Cyclothymia and dysthymia are DSM – IV R, defined disorders that represent less severe forms of bipolar disorders and major depression respectively. Diagnostic Criteria for depression
A .At least five of the following symptoms have been present during the same twoweek period and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest (Do not include symptoms that are clearly due to physical illness)
- Depressed mood most of the day, nearly every day
- Markedly diminished interest in all activities most of the day.
- Significant weight loss or weight gain when not dieting.
- Insomnia or hypersomnia nearly every day.
- Psychomotor retardation or agitation – nearly every day
- Fatigue or loss of energy nearly every day.
- Feeling of worthlessness or excessive guilt nearly every day.
- Diminished ability to think or concentrate nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without specific plan or a suicidal attempt.
B.1.It cannot be established that an organic factor has initiated.
2.The disturbance is not a normal reaction to the death of a loved one.
At no time during the disturbance have there been delusions or hallucinations.
C. Not superimposed on schizophrenia or psychotic disorders.
Diagnostic Criteria for Mania
A. A distinct period of abnormality and persistently elevated or irritable mood
B. During the period of mood disturbance at least three of the following symptoms have persisted and have been present to a significant degree
- Inflated self- esteem or grandiosity.
- Decreased need for health.
- More talkative than usual or pressure to keep talking.
- Flight of ideas.
- Increase in goal directed activity or psychomotor agitation.
- Excessive involvement in pleasurable activities.
C. No evidence of delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms.
D. Not superimposed on schizophrenia or psychotic disorder not otherwise specified.
E. It cannot be established that an organic factor initiated and maintained the disturbance