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Disturbance of mood


Affective frustration (Frustration of mood) - the mental disorder connected with disturbances in the emotional sphere. Combines several diagnoses in classifications of DSM IV TR when the main sign supposes disturbance of an emotional state.

Most widely two types of frustration between which distinction is based on whether the person ever had a maniacal or hypomaniacal episode admit. Thus, there are depressive frustration among which the most known and studied is big depressive frustration which is called still a clinical depression, and the bipolar affective disorder earlier known as maniac-depressive psychosis and described by the alternating periods maniacal (lasting from 2 weeks to 4-5 months) and depressive (average duration of 6 months) episodes.

Symptoms of Disturbances of mood:

Depressive frustration.
The big depressive frustration which is often called by a clinical depression when the person endured not less than one depressive episode. The depression without the mania periods often is called a unipolar depression as the mood remains in one emotional state or "pole". At diagnosis allocate several subtypes or specifications for a course of treatment:

- The atypical depression is characterized by reactivity and positivity of mood (a paradoxical angedoniya [paradoxical anhedonia]), significant increase in weight or the increased appetite ("to eat to remove concern"), excess quantity of a dream or drowsiness (hypersomnia), heavy feeling in extremities and considerable shortage of socialization as consequences of hypersensitivity to the seeming social rejection. Difficulties in assessment of this subtype led to the fact that its validity and its distribution is called into question.

- The melancholic depression (cafard) is characterized by loss of pleasure (angedoniya) from the majority or from all affairs, inability to react to the incentives giving pleasure, the feeling of the lowered mood is expressed more accurately, than feeling of a regret or loss, deterioration in symptoms in the morning, prosypany early in the morning, psychomotor block, excessive loss of weight (not to confuse to nervous anorexia), or strong feeling of fault.

- The psychotic depression - the term for the long depressive period, in particular at melancholic nature when the patient tests such psychotic symptoms as the crazy ideas, or is more rare than a hallucination. These symptoms almost always correspond to mood (contents matches depressive subjects).

- The depression stiffening - involutional - the rare and severe form of a clinical depression including disorder of motive functions and other symptoms. In this case the person is silent and almost is in a condition of a stupor, and either is immovable, or makes aimless or even abnormal movements. Similar catatonic symptoms are also shown at schizophrenia, maniacal episodes, or are a consequence of a malignant antipsychotic syndrome.

- The puerperal depression is noted how the specifying term in DSM-IV-TR; it belongs to excessive, steady and sometimes the capacity of the depression endured by women after the child's birth leading to loss. The puerperal depression which probability is estimated at 10-15% is usually shown within three working months and proceeds not longer than three months.

- Seasonal affective frustration is a specifying term. The depression at some people has seasonal nature, with a depression episode in the fall or in the winter, and return to norm in the spring. The diagnosis is made if the depression was never shown at least twice in cold months and in other season within two years or any more.

- A dysthymia - chronic, moderate disturbance of mood when the person complains of almost daily bad mood for, at least, two years. Not so heavy symptoms, as at a clinical depression though people with a dysthymia are at the same time subject to periodic episodes of a clinical depression (sometimes the called "double depression").

- Other depressive frustration  (DD-NOS) are designated by a code 311 and include depressive frustration which cause damage, but do not approach under officially certain diagnoses. According to DSM-IV, DD-NOS cover "all depressive frustration which I do not correspond to criteria of any concretized frustration". They include a research of diagnoses

The repeating fulminating depression [Recurrent brief depression], and the Small depression provided below:
- The repeating fulminating frustration  [Recurrent brief depression] (RBD) is distinguished from big depressive frustration preferential because of distinction in duration. People with RBD test depressive episodes of times a month, with the separate episodes lasting less than two weeks, and usually less than 2-3 days. It is necessary for diagnosing of RBD that episodes were shown for at least one year and if the patient is a woman, then irrespective of a menstrual cycle. At people with a clinical depression RBD, as well as on the contrary can develop.

- A small depression which does not correspond to all criteria of a clinical depression, but at which at least two symptoms are present within two weeks.

Bipolar disorders
- The bipolar affective disorder earlier known as "maniac-depressive psychosis", is described as the alternating periods of maniacal and depressive states (sometimes very quickly replacing each other or mixing up in one state at which at the patient symptoms of a depression and mania at the same time are observed).

Subtypes include:
- Bipolar disorder of I  [Bipolar I] is defined if there was one or more maniacal episode to existence or lack of episodes of a clinical depression earlier. The diagnosis on DSM-IV-TR, requires not less than one maniacal or mixed episode. For diagnosis of Bipolar disorder the I depressive episodes though are not obligatory, but are shown quite often.

- Bipolar disorder of II  [Bipolar II] consists of the repeating hypomaniacal and depressive episodes alternating with each other.

- The cyclotymia is softer form of bipolar disorder which is shown in the hypomaniacal and dysthymic episodes which are shown from time to time, without any more severe forms of a mania or depression.

The main disturbance consists in change of affect or mood, level of motor activity, activity of social functioning. Other symptoms, for example change of rate of thinking, psychosensorial disorders, statements of self-accusation or revaluation, are secondary in relation to these changes. The clinic is shown in the form of episodes (maniacal, depressive) bipolar (two-phase) and rekkurentny disorders, and also in the form of chronic frustration of mood. Between psychoses intermissiya without psychopathological symptoms are noted. Affective frustration are almost always reflected in the somatic sphere (physiological departures, weight, turgor of skin, etc.).

Treat a range of affective frustration seasonal change of weight (usually increase of weight in the winter and its decrease in the summer within 10%), evening thirst for carbohydrates, in particular to sweet before going to bed, the premenstrual syndromes which are expressed in decrease mood and alarm before monthly, and also "a northern depression" to which migrants on northern latitudes are subject, it is noted more often during polar night and is caused by a lack of photons.

Reasons of Disturbances of mood:

The reasons of affective frustration it is unknown, however also psychosocial hypotheses are offered biological.

Biological aspects. Noradrenaline and serotonin - two neurotransmitters which are most causing pathophysiological manifestations of frustration of mood. On the models created at animals it is shown that effective biological treatment by antidepressants (ABP) is always connected from ingibitsiy sensitivity postsynaptic b-adrenergic and 5HT2-receptors after a long course of therapy. It, perhaps, corresponds to decrease in functions of serotoninovy receptors after chronic influence on them of the ABP who reduce number of zones of the return serotonin reuptake and to the increase in concentration of serotonin found in a brain of the patients who made a suicide. There are data indicating that dofaminergichesky activity is reduced in a condition of a depression and increases at a mania. In recently conducted researches it was shown that the number of muskarinovy receptors on culture of fabric of fibrinogens, urine, blood and cerebrospinal fluid at patients with frustration of mood increases. Apparently, frustration of mood are connected with heterogeneous disturbances of regulation of system of biogenic amines.

It is supposed that systems of secondary regulation, such as adenylatecyclase, calcium, inositol fosfatidit - can also be etiological factors.

It is considered that neyroendokriiny frustration reflect disturbances of regulation of an input of biogenic amines in a hypothalamus. Deviations on лимбико-гипоталамо-питуитарно-адреналовой axes are described. At some patients hypersecretion of cortisol, thyroxine, reduction of night secretion of melatonin, decrease in the FSG and LG main level takes place.

Sleep disorders are one of the strongest markers of a depression. The main frustration consist in decrease in stage of latency of a REM sleep, increase in duration of the first period of a REM sleep and volume of a REM sleep in the first phase. It was suggested that the depression is disturbance of chronobiologic regulation.
Decrease in a brain blood-groove, especially in basal gangliya, decrease in metabolism, disturbance of late components of visual evoked potential are found.
It is supposed that at the heart of a sleep disorder, gait, mood, appetite, sexual behavior, - disturbance of functions of limbiko-hypothalamic system and basal ганглиев lies.

Genetic aspects. About 50% of bipolar patients have at least one parent suffering from frustration of mood. Level of a konkrodantnost sotavlyat 0,67 for bipolar disorders at monozygotic twins and 0,2 for bipolar disorders at dizygotic twins. It was revealed that the dominant gene localized on a short limb 11 gives strong predisposition to bipolar disorders in one family. This gene perhaps participates in regulation of a tyrosinehydroxylase, enzyme which is necessary for synthesis of catecholamines.

Psychosocial aspects. Events of life and stresses, premorbidal personal factors (inspired in the personality), psychoanalytic factors, cognitive theories (a depression in connection with the wrong understanding of events in life).

Treatment of Disturbances of mood:

Therapy of affective frustration consists of treatment actually of depressions and manias, and also preventive therapy. Therapy of depressions includes, depending on depth, a wide range of drugs from fluoxetine, a lerivon, a zoloft, a mianserin to tricyclic antidepressants and EST. Are applied also therapy by a deprivation of a dream and photon therapy. Therapy of manias consists of therapy by the increasing lithium doses at their control in blood, use of neuroleptics or carbamazepine, sometimes beta-blockers. The supporting treatment is performed by lithium carbonate, carbamazepine or valpraty sodium.

Treatment of a psychogenic depression is begun with prescription of antidepressants. The depression as it was told above, can be with a component of alarm or, on the contrary, the asthenic syndrome can be the leader. Depending on it treatment will be based. Doses as required titrate.

In the presence of an asthenic syndrome appoint SIOZS such as: fluoxetine, феварин, paksit.

In the presence of alarm appoint SIOZS such as: tsipramit, золофт. In addition appoint to alprazola (ксанакс) or soft neuroleptics - chlorprothixene, сонапакс.
The patient on a measure can pass cure into a hypomaniacal state, a vety case it is necessary to appoint mood stabilizers, for example Finlepsinum from 200 mg and above. Appoint also psychotherapy (cognitive therapy, behavioural, interpersonal therapy, group and family therapy).

From the moment of improvement continue treatment by antidepressants within not less than 6 weeks, then reduce a drug dose, if necessary appoint a maintenance therapy.

Treatment of an endogenous depression is begun with prescription of antidepressants. The selection and non-selective inhibitors of the return serotonin reuptake and noradrenaline are most effective.

In the presence of alarm appoint amitriptyline, and other sedative antidepressants. From the selection inhibitors - ludiomit, desipramine, and also ремерон (central alpha 2 - adrenoblocker), моклобемид, perhaps additional purpose of anxiolytics or neuroleptics. At inefficiency non-selective IMAO, but it is obligatory in a complex with anxiolytics, or neuroleptics since IMAO have the activating effect expressed only.

At a melancholy prevalence, anafranit lack of alarm of a naznachayua, протриптилин, нортриптилин - the activating antidepressants. At inefficiency it is also possible to appoint IMAO - traniltsipramit (negidrozirovanny) - positive effect in 2-3 days. At use of gidrozirovanny - Nialamidum - in 2-3 weeks.
From the moment of improvement treatment is continued within 6 months (under the WHO recommendation). In 2-3 weeks prior to a dose decline appoint mood stabilizers (Finlepsinum from 1000 mg). Lower by 25 mg of amitriptyline a week, and after cancellation continue treatment by mood stabilizers within 1-2 weeks. If necessary - a maintenance therapy.

If the patient gives allergic reaction to all antidepressants or treatment is inefficient - appoint EST (electroconvulsive therapy). Perhaps carrying out prior to 15 sessions at elderly patients with an endogenous depression.

Treatment of manias comes down to purpose of neuroleptics of buterofenonovy or fenotiazinovy ranks, mood stabilizers, psychotherapy. EST - 10-15 sessions.

Treatment of cyclotymias comes down to prescription of antidepressants (from small doses, because of a possibility of reversion of phases), mood stabilizers, psychotherapy - see an endogenous depression.

Drugs, drugs, tablets for treatment of Disturbances of mood:

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