Mood symptoms

Schizophrenia and bipolar disorder often share certain symptoms, including psychosis in some patients. The prominence of mood symptoms and the history of mood episodes distinguish bipolar disorder and schizophrenia. In addition, the psychosis of schizophrenia occurs in the absence of prominent mood symptoms. 

Personality disorders are inflexible and maladaptive patterns of behavior that deviate markedly from expectations of society. These patterns are stable over time, pervasive and rigid, and lead to distress or impairment in the individual s life. Onset is in adolescence or early adulthood.1 Personality disorders and bipolar disorder may be comorbid, and patients with personality disorders may have mood symptoms. The two diagnoses are distinguished, however, by the predominance of mood symptoms and the episodic course of bipolar disorder, in contrast to the stability and persistence of the behavioral patterns of personality disorders. 

Comorbid conditions must be addressed in order to maximize desired outcomes. For comorbid bipolar disorder and attention-deficit/hyperactivity disorder when stimulant therapy is indicated, treatment of mania is recommended before starting the stimulant in order to avoid exacerbation of mood symptoms by the stimulant. 

Major depressive disorder causes the following mood symptoms ... 

Patients who have a partial response or nonresponse to therapy should be reassessed for an accurate diagnosis, concomitant medical or psychiatric conditions, and medications or substances that exacerbate mood symptoms. 

Management includes identifying the cause of insomnia, education on sleep hygiene, stress management, monitoring for mood symptoms, and elimination of unnecessary pharmacotherapy. 

Once it has been determined that a patient has been exposed to a trauma, the next step is to disentangle the anxiety and mood symptoms of PTSD from those of other syndromes. 

The significance of the effects of the TCAs on receptor sensitivity and subsequent antidepressant effects remains unclear. Other agents that possess similar receptor interactions to TCAs (such as cocaine and the tti receptor) are devoid of antidepressant activity. In addition, receptor blockade is seen with initial doses of medication, while changes in mood symptoms have considerable lag time. The lag phase of clinical effectiveness appears to be due to changes in receptor density and postsynaptic activity associated with chronic administration of TCAs (Sugrue, 1983). 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Younger children with manic symptoms tend to have severe functional impairment and comorbid psychopathology such as anxiety dysregulation, disruptive behaviors, and developmental delays that further complicate their clinical picture. In addition, these children may have mood symptoms that merge with other disorders, making manic episodes difficult to define. Irritability is part of the clinical picture of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). Poor concen-... 

Donovan et al. (1996, 1997) completed an open study evaluating the use of valproic acid (Depakote) in adolescent outpatients with marijuana abuse or dependence and explosive mood disorder (mood symptoms were not classified using the DSM FV Diagnostic System). Eight subjects were prescribed 1000 mg of valproic acid (Depakote) for 5 weeks, in addition to regular therapy sessions, but did not receive any other psychotropic medications. All subjects showed a significant improvement in their marijuana use (p <0.007) and their affective symptoms (p < 0.001), although both outcomes were measured only by self-report. The most common adverse events were nausea and sedation. No subjects discontinued because of these side effects, nor were there any reported interactions between the valproic acid (Depakote) and substances of abuse. 

Adolescents with SUD, ADHD, and mood symptoms in outpatient treatment... 

Schizoaffective (SA) disorder is characterized by both psychotic and mood symptoms, with patients meeting the inclusion diagnostic criteria for acute schizophrenia and a major mood disorder. They should also have had a period during the episode of at least 2 weeks when psychotic symptoms predominate in the relative absence of mood symptoms. In addition, mood symptoms should be present for a substantial portion of an episode. This disorder can be further divided into SA-bipolar or SA-depressed subtypes. Although this disorder is not well understood, it has been considered as ... 

A wide range of disorders can benefit from antipsychotic therapy. For example, since the introduction of antipsychotics, 25% fewer hospital beds are occupied by patients with schizophrenia. In particular, the newer antipsychotics hold the promise of benefitting patients once refractory to conventional treatment. Thus, negative, cognitive, and mood symptoms may improve with use of newer agents such as clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. 

Goodwin and Jamison (9) summarized the incidence of typical mood symptoms during a manic phase from 14 studies that included 751 patients as follows ... 

Schizoaffective disorder, characterized by concurrent symptoms of both schizophrenia (criterion A) and a mood disorder, meeting full criteria for a mood disorder, manic or mixed episode, can also pose a difficult diagnostic dilemma. Other criteria include a period of psychosis (2 weeks) in the absence of significant mood symptoms and mood symptoms should be present for a substantial proportion of an episode. Schizoaffective probands often have family members with both affective and schizophrenic disorders. 

Janicak et al. (113, 283) recently reported the results of a double-blind, randomized trial of risperidone monotherapy versus haloperidol monotherapy for controlling both psychotic and mood symptoms in 62 patients with schizoaffective disorder (bipolar or depressed subtype). These authors observed that, in comparison with haloperidol, risperidone was as follows ... 

Bupropion was approved in 1997 as a treatment for smoking cessation. Approximately twice as many people treated with bupropion as with placebo have a reduced urge to smoke. In addition, patients taking bupropion appear to experience fewer mood symptoms and possibly less weight gain while withdrawing from nicotine dependence. Bupropion appears to be about as effective as nicotine patches in smoking cessation. The mechanism by which bupropion is helpful in this... 

Mood symptoms of depression are associated with many conditions in addition to major depressive disorder, including mood and anxiety symptoms in schizophrenia, schizoaffective disorder, bipolar manic/depressed/mixed/rapid cycling states, organic mood disorders, psychotic depression, childhood and adolescent mood disorders, treatment-resistant mood disorders, and many more (see Chapter 10, Fig. 10-6). Atypical antipsychotics are enjoying expanded use for the treatment of symptoms of depression and anxiety in schizophrenia that are troublesome but not severe enough to reach the diagnostic threshold for a major depressive episode or anxiety disorder in these cases the antipsychotics are used not only to reduce such symptoms but hopefully also to reduce suicide rates, which are so high in schizophrenia (Fig. 11 — 53). Atypical antipsychotics may also be useful adjunctive treatments to anti-... 

Mood stabilizers, such as lithium, lamotrigine, and carba-mazepine, may be effective in treating glucocorticoid-induced mood symptoms. In an open trial, 12 patients with glucocorticoid-induced manic or mixed symptoms were treated with olanzapine 2.5 mg/day initially, increasing to a maximum of 20 mg/day 11 of the 12 patients had significant improvement (505). 

Brown ES, Chamberlain W, Dhanani N, Paranjpe P, Carmody TJ, Sargeant M. An open-label trial of olanzapine for corticosteroid-induced mood symptoms. J Affect Disord 2004 83(2-3) 277-81. 

Lane JD. Effects of brief caffeinated-beverage deprivation on mood, symptoms, and psychomotor performance. Pharmacol Biochem Behav 1997 58(l) 203-208. 

Troisi A, Moles A, Panepuccia L, Lo Russo D, Palla G, Scucchi S. Serum cholesterol levels and mood symptoms in the postpartum period. Psychiatry Res 2002 109 213-219. 

A number of other factors, including genetic or biological factors, that are possibly associated with the development of psychiatric disorders, have been explored. In a retrospective study of 110 patients with chronic hepatitis C, those with the apolipoprotein E e4 allele, the inheritance of which may be associated with several neuropsychiatric outcomes, were more likely than those without this allele to have psychiatric referrals and neuropsychiatric symptoms, in particular irritability, anger, anxiety, or other mood symptoms, during interferon alfa treatment... 

In addition to the presumed antidepressant mechanism of these drugs, they exert a multiplicity of effects on other neurotransmitters and neuron receptors, both in the areas that control mood symptoms and elsewhere in the central and peripheral nervous systems. Because medications have effects not only in the areas thought to be related to the disorder being treated but also in other areas in the brain and peripheral nervous system,... 

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