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Chapter 11. Mood Disorders

John A. Joska, M.D., M.Med.(Psych.), F.C.Psych.(S.A.); Dan J. Stein, M.D., Ph.D.
DOI: 10.1176/appi.books.9781585623402.331278

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Excerpt

Mood critically affects perception and appraisal of the self and the environment. Changes in mood occur as part of everyday experience, in response to multiple factors. In a proportion of people, mood states can become distressing, and psychopathology ensues. In this chapter, we describe the clinical features of mood disorders, summarize knowledge of their pathogenesis, and outline current approaches to management.

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FIGURE 11–1. Summary of mood disorders, specifiers, and relationships.

FIGURE 11–2. Strategies for the treatment of major depression (nonpsychotic).Note. SSRI = selective serotonin reuptake inhibitor (fluoxetine, sertraline, paroxetine, citalopram); BUPSR = bupropion sustained release; NEF = nefazodone; VLFXR = venlafaxine extended release; MRT = mirtazapine; TCA = tricyclic antidepressant; MAOI = monoamine oxidase inhibitor; ECT = electroconvulsive therapy.*Consider TCA/VLF if not tried. **Lithium, thyroid, buspirone. ***Skip if lithium augmentation has already failed.Most studied combination.Source.  Trivedi et al. 2004. Algorithms are revised as new data become available; consult the Texas Implementation of Medication Algorithms (TIMA) Web site (http://www.dshs.state.tx.us/mhprograms/TIMA.shtm) for the most recent versions.

FIGURE 11–3. Strategies for the treatment of bipolar disorder (hypomanic/manic episode).Note. AC = anticonvulsant; AAP = atypical antipsychotic; CONT = continuation treatment; DVP = divalproex; ECT = electroconvulsive therapy; Li = lithium; OLZ = olanzapine; OXC = oxcarbazepine; QTP = quetiapine; RIS = risperidone; TPM = topiramate; VPA = valproate; ZIP = ziprasidone.Source.  Suppes et al. 2001. Algorithms are revised as new data become available; consult the Texas Implementation of Medication Algorithms (TIMA) Web site (http://www.dshs.state.tx.us/mhprograms/TIMA.shtm) for the most recent versions.
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TABLE 11–1. DSM-IV-TR diagnostic criteria for major depressive episode
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TABLE 11–2. DSM-IV-TR diagnostic criteria for dysthymic disorder
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TABLE 11–3. DSM-IV-TR criteria for seasonal pattern specifier
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TABLE 11–4. DSM-IV-TR research criteria for premenstrual dysphoric disorder
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TABLE 11–5. Some medical conditions that may cause depression
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TABLE 11–6. Some substances and medications that may cause depression
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TABLE 11–7. DSM-IV-TR diagnostic criteria for manic episode
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TABLE 11–8. DSM-IV-TR diagnostic criteria for bipolar I disorder, single manic episode
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TABLE 11–9. DSM-IV-TR diagnostic criteria for bipolar II disorder
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TABLE 11–10. DSM-IV-TR diagnostic criteria for cyclothymic disorder
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TABLE 11–11. Some conditions that may cause mania
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TABLE 11–12. Some substances and medications that may cause mania
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TABLE 11–13. Studies of current and lifetime prevalence of mood disorders
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TABLE 11–14. Currently available antidepressants: activity, indications, adverse effects, and dosing
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TABLE 11–15. Selective serotonin reuptake inhibitors (SSRIs): activity, prescribing notes, and dosing
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Depression is a symptom of a syndrome that may have many causes.

Bipolar disorders can be difficult to diagnose because of the inability to detect past and future episodes.

The clinical features of depression across cultures may vary, including expressions such as loneliness and somatic complaints.

Major depression is common, with a lifetime prevalence of about 10%. It also causes about twice as much disability as any other medical condition.

Major depression is a chronic and recurring illness, with relapses occurring in at least half of patients.

The causes of depression are multifactorial and usually include genetic and environmental contributions.

Treatment of major depression consists of selecting an appropriate antidepressant and giving consideration to an effective psychotherapy.

Bipolar disorders should be treated with mood stabilizers first, with the addition of other agents if response is unsatisfactory.

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Which of the following types of mood disorder episodes requires a symptom duration of 4 days?
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Four recent epidemiological studies published over a 10-year period in the mid-1990s to mid-2000s, all using the Composite International Diagnostic Interview (CIDI) in general populations, found 1-year prevalence rates of major depression of. . .
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Which of the following statements concerning sociodemographic correlates of mood disorders is false?
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