Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Manifestations of Mental Illness: Disturbances of Mood
Most of us have an immediate and intuitive understanding of the notion of mood. We readily comprehend what it means to feel sad or happy. These concepts are nonetheless very difficult to formulate in a scientifically precise and quantifiable way; the challenge is greater given the cultural differences that are associated with the expression of mood. In turn, disorders that impact on the regulation of mood are relatively difficult to define and to approach in a quantitative manner. Nevertheless, dysregulation of mood and the expression of mood, or affect, represent a major category among mental disorders.
Disturbances of mood characteristically manifest themselves as a sustained feeling of sadness or sustained elevation of mood. As with anxiety and psychosis, disturbances of mood may occur in a variety of patterns associated with different mental disorders. The disorder most closely associated with persistent sadness is major depression, while that associated with sustained elevation or fluctuation of mood is bipolar disorder. The most common signs of these mood disorders are listed in Table 2-4. Along with the prevailing feelings of sadness or elation, disorders of mood are associated with a host of related symptoms that include disturbances in appetite, sleep patterns, energy level, concentration, and memory.
Table 2-4. Common signs of mood disorders
|
Symptoms Commonly Associated With Depression |
| • Persistent sadness or despair |
| • Insomnia (sometimes hypersomnia) |
| • Decreased appetite |
| • Psychomotor retardation |
| • Anhedonia (inability to experience pleasure) |
| • Irritability |
| • Apathy, poor motivation, social withdrawal |
| • Hopelessness |
| • Poor self-esteem, feelings of helplessness |
| • Suicidal ideation |
|
Symptoms Commonly Associated With Mania |
| • Persistently elevated or euphoric mood |
| • Grandiosity (inappropriately high self-esteem) |
| • Psychomotor agitation |
| • Decreased sleep |
| • Racing thoughts and distractibility |
| • Poor judgment and impaired impulse control |
| • Rapid or pressured speech |
It is not known why diverse functions such as sleep and appetite should be altered in disorders of mood. However, depression and mania are typically associated with characteristic changes in these basic functions. Mood appears to represent a complex group of behaviors and responses that undergo precise and tightly controlled regulation. Higher organisms that must adapt to changing environments depend on optimal control of basic functions such as sleep, appetite, sex, and physical activity. This regulation must adapt to diurnal and seasonal changes in the environment. In addition, more complex behaviors such as exploration, aggression, and social interaction must also undergo a similar, perhaps closely linked, regulation. In humans, these complex behaviors and their regulation are believed to be associated with the expression of mood. A depressed mood appears to reflect a kind of global damping of these functions, while a manic state may result from an excessive activation of these same functions. The mechanisms underlying the diverse changes associated with the mood disorders are largely unknown, but their appearance as clusters in specific disorders along with their collective response to specific therapeutics suggests a common mechanistic basis.
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