Affective Mood Disorders

Definition | Types of Affective Mood Disorders | Aetiology | Risk Factors | Clinical Presentation | Investigations | Management | When to Refer | References

Definition

Affective Mood Disorders refer to a group of mental health conditions characterised by significant disturbances in a person’s mood. These disorders can lead to periods of extreme sadness or overly elevated moods, significantly impacting daily functioning, relationships, and quality of life. The two main types of affective mood disorders are depression and bipolar disorder.

Types of Affective Mood Disorders

Affective mood disorders encompass a range of conditions, including:

• Major Depressive Disorder (MDD): Characterised by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in most activities.
• Bipolar Disorder: Involves episodes of mania or hypomania (elevated mood) alternating with episodes of depression. There are two main types:
  • Bipolar I Disorder: Defined by at least one manic episode, with or without depressive episodes.
  • Bipolar II Disorder: Characterised by hypomanic episodes and at least one major depressive episode, without full-blown manic episodes.
• Dysthymia (Persistent Depressive Disorder): A chronic form of depression with less severe symptoms than major depression but lasting for at least two years.
• Cyclothymia: A milder form of bipolar disorder, involving periods of hypomanic and depressive symptoms that are not severe enough to meet the criteria for Bipolar I or II.
• Seasonal Affective Disorder (SAD): A type of depression that occurs at a specific time of year, usually in the winter, when there is less natural sunlight.

Aetiology

The exact cause of affective mood disorders is not fully understood, but it is believed to result from a combination of genetic, biological, environmental, and psychological factors:

• Genetic Factors: A family history of mood disorders increases the risk, suggesting a genetic predisposition.
• Neurochemical Imbalance: Dysregulation of neurotransmitters such as serotonin, norepinephrine, and dopamine is thought to play a key role in mood regulation.
• Hormonal Changes: Hormonal fluctuations, such as those related to pregnancy, menopause, or thyroid conditions, can contribute to mood disorders.
• Stressful Life Events: Traumatic experiences, loss of a loved one, financial difficulties, or chronic stress can trigger or exacerbate mood disorders.
• Psychosocial Factors: Personality traits, such as low self-esteem or perfectionism, and adverse childhood experiences can increase vulnerability to mood disorders.

Risk Factors

Several factors increase the likelihood of developing an affective mood disorder:

• Family History: Having a first-degree relative with a mood disorder, such as depression or bipolar disorder, increases the risk.
• Gender: Women are more likely to be diagnosed with depressive disorders, whereas bipolar disorder affects both genders equally.
• Previous Episodes: A history of previous mood episodes increases the risk of recurrence.
• Chronic Medical Conditions: Conditions such as diabetes, heart disease, or chronic pain can contribute to the development of mood disorders.
• Substance Abuse: The use of drugs or alcohol can trigger or worsen mood disorders and complicate treatment.
• Childhood Trauma: Early life experiences, such as abuse, neglect, or significant loss, can increase vulnerability to mood disorders later in life.

Clinical Presentation

Affective mood disorders present with a range of psychological and physical symptoms, depending on the specific disorder:

Depressive Symptoms

• Low Mood: Persistent feelings of sadness, emptiness, or hopelessness.
• Anhedonia: Loss of interest or pleasure in most activities, including those previously enjoyed.
• Guilt and Worthlessness: Excessive feelings of guilt, worthlessness, or self-blame.
• Cognitive Impairment: Difficulty concentrating, making decisions, or thinking clearly.
• Suicidal Thoughts: Thoughts of death, suicide, or self-harm.
• Fatigue: Persistent tiredness and lack of energy, even after adequate rest.
• Sleep Disturbances: Insomnia (difficulty falling asleep or staying asleep) or hypersomnia (excessive sleeping).
• Appetite Changes: Significant weight loss or gain due to changes in appetite.

Manic or Hypomanic Symptoms

• Euphoric or Irritable Mood: A period of abnormally elevated, expansive, or irritable mood.
• Increased Energy: Unusually high levels of energy, decreased need for sleep, and hyperactivity.
• Grandiosity: Inflated self-esteem or unrealistic beliefs in one's abilities or importance.
• Racing Thoughts: Rapid, disorganised thinking and difficulty focusing.
• Impulsivity: Engaging in risky behaviours, such as reckless spending, sexual indiscretions, or substance abuse.
• Increased Talkativeness: Pressured speech, talking more than usual, or feeling a need to keep talking.

Investigations

The diagnosis of affective mood disorders is primarily clinical, based on a detailed history and mental health assessment. Additional investigations may be necessary to rule out other conditions:

• Psychiatric Assessment: A thorough mental health evaluation, often using structured interviews and diagnostic tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression.
• Medical History and Physical Examination: A complete medical history and physical examination to rule out underlying medical conditions that could mimic mood symptoms.
• Laboratory Tests: Blood tests such as thyroid function tests, full blood count (FBC), and electrolyte levels to exclude physiological causes of mood symptoms, such as hypothyroidism.
• Imaging Studies: MRI or CT scans may be considered if there are neurological symptoms or if there is a need to rule out brain lesions or structural abnormalities.

Management

The management of affective mood disorders involves a combination of pharmacological treatments, psychological therapies, and lifestyle modifications:

Pharmacological Treatments

• Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline, fluoxetine, and citalopram are commonly prescribed for depression. Other options include Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), and Atypical Antidepressants.
• Mood Stabilizers: Lithium, valproate, and carbamazepine are commonly used in bipolar disorder to stabilise mood and prevent episodes of mania and depression.
• Atypical Antipsychotics: Medications such as olanzapine, quetiapine, and aripiprazole are used in the treatment of bipolar disorder and can also be used adjunctively in depression.
• Psychotherapy: Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT), and Mindfulness-Based Cognitive Therapy (MBCT) are effective in treating both depression and bipolar disorder.

Lifestyle Modifications

• Regular Exercise: Physical activity can help alleviate depressive symptoms by releasing endorphins and improving overall well-being.
• Healthy Diet: A balanced diet with adequate hydration can support mental health. Reducing caffeine, sugar, and alcohol intake may help minimise symptoms.
• Sleep Hygiene: Establishing a regular sleep routine and creating a restful environment can improve sleep quality and reduce symptoms of mood disorders.
• Stress Management: Techniques such as mindfulness, meditation, and relaxation exercises to manage stress and improve mood.
• Social Support: Encouraging patients to seek support from friends, family, or support groups can be beneficial in managing mood disorders.

When to Refer

Referral to a specialist mental health service or psychiatrist is necessary in the following situations:

• Severe or treatment-resistant mood disorder that does not respond to initial therapies or requires more intensive management.
• Presence of co-occurring mental health conditions, such as anxiety disorders, substance use disorders, or personality disorders.
• Risk of suicide, self-harm, or harm to others, necessitating urgent intervention and possible hospitalisation.
• Need for specialised psychological therapies, such as CBT or IPT, that are not available in primary care settings.

References

1. NHS (2024) Mood Disorders. Available at: https://www.nhs.uk/conditions/mood-disorders/ (Accessed: 26 August 2024).
2. National Institute for Health and Care Excellence (2024) Bipolar Disorder: Assessment and Management. Available at: https://www.nice.org.uk/guidance/cg185 (Accessed: 26 August 2024).
3. British Medical Journal (2024) Depression and Bipolar Disorder: Clinical Review. Available at: https://www.bmj.com/content/350/bmj.h379 (Accessed: 26 August 2024).

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