Mood disorder

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

Principles of Psychopharmacology for Mental Health Professionals By Jeffrey E. Kelsey, D. Jeffrey Newport, and Charles B. Nemeroff Copyright 2006 John Wiley Sons, Inc. 

Mood disorders represent a major public health concern around the globe. In the United States alone, the annual cost of major depression is over 40 billion dollars. Less than 30% of the total cost of depression is incurred through direct treatment. The remainder consists of the indirect hidden costs of lost productivity due to absenteeism and poor work efficiency, premature death from suicide or medical illness, and the uncounted losses related to a poor quality of life. 

These disorders should concern all physicians and mental health professionals for several reasons. First, mood disorders are very common and will be encountered on a daily basis in most clinical settings (see Table 3.1). Second, they disrupt life in numerous ways. During an episode of depression or mania, sleep patterns change, appetite and eating are affected, family life is disrupted, work efficiency suffers, substance abuse rates soar, and physical illness is exacerbated. Thus, comprehensive treatment of mood disorders routinely requires the work of nutritionists, social workers, family therapists, vocational rehabilitation counselors, substance abuse counselors and 12 step groups, primary care physicians, and others. 

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The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

Roth BL, Sheffler DJ, Kroeze WK (2004) Magic shotguns versus magic bullets selectively non-selective drugs for mood disorders and schizophrenia. Nat Rev Drug Discov 3 353-359... 

Ogren SO, Koteeva E, Hokfelt T et al (2006) Galanin receptor antagonists a potential novel pharmacological treatment for mood disorders. CNS Drugs 20 633-654... 

In noncancer-related pharmacology, GSK3 is inhibited by lithium at therapeutic concentrations, implying that the long-established effectiveness of lithium in the treatment of psychiatric mood disorders (and more recently as a neuroprotective agent) may be linked to GSK3 inhibition. Antipsychotics such as haloperidol... 

Monophasic Preparations Monoxide Mood Disorders Mood Elevators Mood-stabilising Drugs Morbus Alzheimer Morphogens Morpholines Motilin... 

Alcohol Health Res World 22 122-123, 1998 Solhkhah R, Finkel J, Hird S Possible risperidone-induced visual hallucinations. J Am Acad Child Adolesc Psychiatry 39 1074-1073, 2000 Solhkhah R, Wilens TE, Prince JB, et al Bupropion sustained release for substance abuse, ADHD, and mood disorders in adolescents (NR31), in New Research Absrracts, Annual Meeting of the American Psychiatric Associarion. Washington, DC, American Psychiatric Associarion, 2001... 

Inhalant-Induced Mood Disorder and Inhalant-Indueed Anxiety Disorder... 

Cookson JC, Sachs GS (1999). Lithium clinical use in mania and prophylaxis of affective disorders. In Buckley PF, Waddington JL, eds, Schizophrenia and Mood Disorders The New Drug Therapies in Clinical Practice. Oxford Butterworth Heinemann. 

Schizoaffective and mood disorder exclusion Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. 

Bipolar disorder is a mood disorder characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is a chronic illness with a course characterized by relapses and improvements or remissions. Mood episodes can be manic, depressed, or mixed. They can be separated by long periods of stability or can cycle... 

A mood disorder questionnaire is completed by the patient that asks about common symptoms of bipolar disorder, problems caused by the symptoms, and family history in a yes-or-no answer format. It is then scored by the clinician. 

Bipolar disorder can be conceptualized as a continuum or spectrum of mood disorders and is not comprised solely of bipolar I disorder.9 They include four subtypes bipolar I (periods of major depressive, manic, and/or mixed episodes) bipolar II (periods of major depression and hypomania) cyclothymic disorder (periods of hypomanic episodes and depressive episodes that do not meet all criteria for diagnosis of a major depressive episode) and bipolar disorder, NOS. The defining feature of bipolar disorders is one or more manic or hypomanic episodes in addition to depressive episodes that are not caused by any medical condition, substance abuse, or other psychiatric disorder.1... 

Mood disorders, hypochondriasis, personality disorders, alcohol/ substance abuse, alcohol/substance withdrawal, other anxiety disorders... 

Premenstrual dysphoric disorder Severe psychiatric mood disorder with marked affective symptoms causing significant interference in work or relationships that is temporally associated with the luteal phase and not caused by an underlying psychiatric disturbance. 

Kunugi, H., Kato, T., Fukuda, R. el al. (2002). Association study of C825T polymorphism of the G-protein beta3 subunit gene with schizophrenia and mood disorders. /. Neural Transm. 109, 213-18. 

Lin, C. N., Tsai, S. J. Hong, C. J. (2001a). Association analysis of a functional G protein beta3 subunit Gene polymorphism (C825T) in mood disorders. Neuropsychobiology, 44, 118-21. 

Serretti, A., Lilli, R., Lorenzi, C., Franchini, L. Smeraldi, E. (1998). Dopamine receptor D3 gene and response to lithium prophylaxis in mood disorders. Ini. J. Neuropsychopharmacol., 1, 125-9. 

Serretti, A., Malitas, R N., Mandelli, L. etal. (2004). Further evidence for a possible association between serotonin transporter gene and lithium prophylaxis in mood disorders. Pharmacoge-nomics /., 4(4), 267-73. 

Smeraldi, E., Benedetti, F. Zanardi, R. (2002). Serotonin transporter promoter genotype and illness recurrence in mood disorders. Eur. Neuropsychopharmacol. 12, 73-5. 

The clinical significance of this ethnic difference for psychiatry was found later. A study examining lithium tolerability found more side effects in African American patients with high RBC/plasma ratio even when the lithium levels were in the therapeutic range (Strickland etal., 1995). It is not known whether African Americans require lower doses and will respond with lower plasma levels. We do know that African Americans with mood disorders are less likely to be prescribed lithium either as primary treatment or adjunctive therapy (Valenstein etal., 2006 Kilbourne 8c Pincus, 2006). It is unknown as to whether the lack of tolerability at usual therapeutic doses is a factor. 

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