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09.11.2014

Mood disorder definition, homeopathic tinnitus treatment - Review

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In addition to the adverse psychosocial, vocational, and societal impacts of BPD, the lifetime suicide rate associated with BPD (15.6%) is higher than corresponding rates in any other psychiatric disorder.
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting throughout at least 1 week (or any duration if hospitalization is necessary). The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others, or the mood disturbance has psychotic features. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The mood symptoms in the first two criteria are not better accounted for as schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Figures 4 through 6 graphically illustrate common courses of mood episodes in patients with different subtypes of BPD. If an active mood episode is identified, rule out mood disorder due to a general medical condition or one that is substance-related. If psychosis accompanies a mood episode, rule out schizophrenia, schizoaffective disorder, delusional disorder, or psychosis due to a general medical condition. Treatment strategies must be individualized and adjusted at different phases of the mood disorder.


Olanzapine-fluoxetine combination (OFC) and mood stabilizers are first-line treatments for bipolar depression. Ryan MM, Lockstone HE, Huffaker SJ, et al: Gene expression analysis of bipolar disorder reveals downregulation of the ubiquitin cycle and alterations in synaptic genes. Valtonen HM, Suominen K, Mantere O, et al: Suicidal behaviour during different phases of bipolar disorder.
The disturbance of mood in BPD is episodic and recurrent, cycling at varying intervals from one mood state to another. A higher rate of mood and anxiety disorders exists in the first-degree relatives of persons with BPD than in the general population. A diagnosis of bipolar I disorder is given if there has been at least one lifetime episode of mania or a true mixed episode; a diagnosis of bipolar II disorder depends on at least one lifetime episode of hypomania, with none of the episodes achieving criteria for mania. An atypical antipsychotic or a mood stabilizer is typically administered to stabilize the manic behavior, and depression is addressed with standard antidepressant treatment.
Once this mood disorder has declared itself, the patient should be counseled regarding the chronic risk for relapse and recurrence; lifetime treatment is recommended. The Bipolar Spectrum Diagnostic Scale (BSDS) involves an easy-to-read, one-page story that depicts typical mood swing experiences.
Traditionally, classic BPD has been depicted as mood episodes alternating from mania to depression and back, but the variable course depicted in Figure 3 is more common.
This may have led to an overdiagnosis of BPD, which until recently was underdetected or misdiagnosed as recurrent major depressive disorder (MDD).


Treatment of acute mood episodes during pregnancy requires a careful consideration of the potential teratogenic effects of medications versus the harmful effects of an ill mother on the unborn child. The natural course of bipolar disorder is for episode frequency to gradually increase and for an ever-increasing percentage of episodes to be characterized by depression.
In addition to mood elevation, the symptoms of mania include inflated self-esteem, decreased need for sleep, pressured and often loud speech, flight of ideas, distractibility, and increased goal-directed behavior often focused on pleasurable activities that have a high potential for becoming reckless and self destructive. This is an error that is easily committed even by experienced clinicians, because MDEs and dysthymia constitute the predominant mood disturbance in BPD, especially BPD type II.
These include simultaneously administering an antidepressant and an antipsychotic, administering mood-stabilizing medication, or administering the combination formulation of olanzapine and fluoxetine (OFC, Symbyax). In general, late-onset mania suggests drug toxicity or an underlying medical disorder until proved otherwise.
Mild mania and hypomania often respond to one antimanic drug, whereas acute manic crises often require two or more agents to stabilize the mood. Pharmacologic management of mania in HIV-infected persons often includes a combination of an anticonvulsant mood stabilizer plus an antipsychotic. Patients with primary BPD who are also HIV seropositive should receive recommended treatment for acute mood episodes, although careful attention must be paid to an increased risk for drug interactions in this population.




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