Skip to main content
SpringerLink
Log in
Book cover

The Medical Basis of Psychiatry pp 403–417Cite as

Mood Disturbances

  • Chapter

abstract

Mood or affective disturbances are common expressions of mental and systemic diseases. We distinguish normative emotions such as grief, sadness, joy, anger, and fear from their elaboration into depressive, manic, and mixed syndromes in unipolar and bipolar disorders.

We then differentiate normative anxiety disorders from depressive illness along clinical and biologic parameters. The differential diagnosis of mood disorders from dementia and schizophrenia is taken up next in terms of natural history and biology. In-depth descriptions of the signs and symptoms of mood disorders are covered under emotional, cognitive, psychomotor, and vegetative subheadings. We finally give coverage to the chronic and subthreshold mood disorders, including dysthymia and cyclothymia. Knowledge of the psychopathology of mood disorders and their variants is of immense public health significance in light of their consequences in educational, conjugal, vocational, and physical health areas, and, more seriously, in their potential for suicidality.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Psychiatric Association. DSM-IV: Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Press, 1994 and DSM-IV-TR; 4th ed. text revision. Washington DC: American Psychiatric Press, 2000.

    Google Scholar 

  2. Winokur G, Clayton P, Reich T. Manic-Depressive Illness. St. Louis: CV Mosby, 1969.

    Google Scholar 

  3. Akiskal HS. Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. J Affect Disord 2001;62:17–31.

    Article  PubMed  CAS  Google Scholar 

  4. Akiskal HS. The bipolar spectrum: New concepts in classification and diagnosis. In: Grinspoon L, ed. Psychiatry Update: The American Psychiatric Association Annual Review, vol 2. Washington, DC: American Psychiatric Press, 1983:271–292.

    Google Scholar 

  5. Akiskal HS, Pinto O: The evolving bipolar spectrum: Prototypes I, II, III, IV. Psychiatr Clin North Am 1999;22:517–534.

    Article  PubMed  CAS  Google Scholar 

  6. Akiskal HS, Walker PW, Puzantian VR, King D, Rosenthal TL, Dranon M. Bipolar outcome in the course of depressive illness: Phenomenologic, familial and pharmacologic predictors. J Affect Disord 1983;5:115–128.

    Article  PubMed  CAS  Google Scholar 

  7. Akiskal HS, Maser JD, Zeller P, Endicott J, Coryell W, Keller M, Warshaw M, Clayton P, Goodwin FK: Switching from “unipolar” to bipolar II: An 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry 1995;52:114–123.

    PubMed  CAS  Google Scholar 

  8. Akiskal HS, Benazzi F. DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. J Affect Disord 2006; 92: 45–54.

    Article  PubMed  Google Scholar 

  9. Angst J, Cassano G. The mood spectrum: improving the diagnosis of bipolar disorder. Bipolar Disord 2005;7(suppl 4): 4–12.

    Article  PubMed  Google Scholar 

  10. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well being of depressed patients: Results from the medical outcomes study. JAMA 1989;262:914–919.

    Article  PubMed  CAS  Google Scholar 

  11. Coryell W, Scheftner W, Keller M, Endicott J, Maser J, Klerman GL. The enduring psychosocial consequences of mania and depression. Am J Psychiatry 1993;150:720–727.

    PubMed  CAS  Google Scholar 

  12. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Leon AC, Solomon DA, Coryell W, Maser JD, Keller MB. Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry 2005;62:1322–1330.

    Article  PubMed  Google Scholar 

  13. Kessler RC, Akiskal HS, Ames M, Birnbaum H, Greenberg P, Hirschfeld RM, Jin R, Merikangas KR, Simon GE, Wang PS. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. Am J Psychiatry 2006;163:1561–1568.

    Article  PubMed  Google Scholar 

  14. Judd LL, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the U.S. population: Re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003;73:123–131.

    Article  PubMed  Google Scholar 

  15. Lewis A. Melancholia: A clinical survey of depressive states. J Merit Sci 1934;80:277–378.

    Google Scholar 

  16. Jackson SW. Melancholia and Depression: From Hippocratic Times to Modern Times. New Haven: Yale University Press, 1986.

    Google Scholar 

  17. Akiskal HS, McKinney WT Jr. Depressive disorders: Towards a unified hypothesis. Science 1973;182:20–28.

    Article  PubMed  CAS  Google Scholar 

  18. Robins E, Guze SB. Classification of affective disorders: The primary-secondary, the endogenous-reactive, and the neurotic-psychotic concepts. In: Williams TA, Katz DM, Shield JA, eds. Recent Advances in the Psychobiology of the Depressive Illnesses. Washington: Government Printing office, 1972: 283–292.

    Google Scholar 

  19. James W. The Varieties of Religious Experience (lectures). Edinburgh, Scotland: Reprint Services Corp, 1902.

    Google Scholar 

  20. Styron W. Darkness Visible: A Memoir of Madness. New York: Random House, 1990.

    Google Scholar 

  21. Dilsaver SC, Wu X, Akiskal HS, Manning JS. Pain complaints in adolescent patients with affective disorders versus adolescent psychiatric controls. Prim Care Companion J Clin Psychiatry 2005;7:150–154.

    PubMed  Google Scholar 

  22. Kielholz P, Poldinger W, Adams C, eds. Masked Depression. KöIn-Lövenich: Deutscher Arzte-Verlag Gmb, 1982.

    Google Scholar 

  23. Tolstoy L. Confessions. New York: Crowell, 1887.

    Google Scholar 

  24. Adams, F (ed). The Genuine Works of Hippocrates. Baltimore: Williams & Wilkins, 1939.

    Google Scholar 

  25. Perugi G, Toni C, Sanna Passino MC, Akiskal KK, Kaprinis S, Akiskal HS. Bulimia nervosa in atypical depression: the mediating role of cyclothymic temperament. J Affect Disord 2006;92:91–97.

    Article  PubMed  Google Scholar 

  26. Hamilton I. Robert Lowell—A biography. New York: Random House, 1982.

    Google Scholar 

  27. Kupfer DJ, Thase ME. The use of the sleep laboratory in the diagnosis of affective disorders. Psychiatr Clin North Am 1983;6:3–21.

    Google Scholar 

  28. Wehr TA, Rosenthal NE. Seasonality and affective illness. Am J Psychiatry 1989;146:829–839.

    PubMed  CAS  Google Scholar 

  29. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala A, Haskett RF, James NM, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E. A specific laboratory test for the diagnosis of melancholia. Arch Gen Psychiatry 1981;38:15–22.

    PubMed  CAS  Google Scholar 

  30. Nemeroff CB, Krishnan KR, Reed D, Leder R, Beam C, Dunnick NR. Adrenal gland enlargement in major depression. A computed tomographic study. Arch Gen Psychiatry. 1992;49:384–387.

    PubMed  CAS  Google Scholar 

  31. Widlöcher DJ. Psychomotor retardation: Clinical, theoretical, and psychometric aspects. Psychiatr Clin North Am 1983;6: 27–40.

    PubMed  Google Scholar 

  32. Roth M. The psychiatric disorders of later life. Psychiatr Ann 1976;6:417–444.

    Google Scholar 

  33. Beck AT. Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press, 1967.

    Google Scholar 

  34. Kraepelin E. Manic-Depressive Insanity and Paranoia. Edinburgh: E & S Livingstone, 1921.

    Google Scholar 

  35. Clayton PJ, Herjanic M, Murphy GE, Woodruff R Jr. Mourning and depression: Their similarities and differences. Can Psychiatr Assoc J 1974;19:309–312.

    PubMed  CAS  Google Scholar 

  36. Akiskal HS, Lemmi HClinical,neuroendocrine, and sleep EEG diagnosis of “unusual” affective presentations. Psychiatr Clin North Am 1983;6:69–83.

    PubMed  CAS  Google Scholar 

  37. Zisook S, Shuchter SR, Pedrelli P, Sable J, Deaciuc SC. Bupropion sustained release for bereavement: results of an open trial. J Clin Psychiatry 2001;62:227–230.

    PubMed  CAS  Google Scholar 

  38. Roth M, Mountjoy Q. The distinction between anxiety states and depressive disorders. In: Paykel ES, ed. Handbook of Affective Disorders. New York: Guilford Press, 1982: 70–92.

    Google Scholar 

  39. Akiskal HS, Benazzi F. Family history validation of the bipolar nature of depressive mixed states. J Affect Disord 2003;73: 59–64.

    Article  PubMed  Google Scholar 

  40. Leckman JF, Weissman MM, Merikangas KR, Pauls DL, Prusoff BA. Panic disorder and major depression. Arch Gen Psychiatry 1983;40:1055–1060.

    PubMed  CAS  Google Scholar 

  41. Akiskal HS, Lemmi H, Dickson H, King D, Yerevanian BI, VanValkenburg C. Chronic depressions: Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions. J Affect Disord 1984;6:287–295.

    Article  PubMed  CAS  Google Scholar 

  42. Dubé S, Kumar N, Ettedgui E, Pohl R, Jones D, Sitaram N. Cholinergic REM-induction response: Separation of anxiety and depression. Biol Psychiatry 1985;20:408–418.

    Article  PubMed  Google Scholar 

  43. Curtis GC, Cameron OG, Nesse RM. The dexamethasone suppression test in panic disorder and agoraphobia. Am J Psychiatry 1982;139:1043–1046.

    PubMed  CAS  Google Scholar 

  44. Butler PD, Nemeroff CB. Corticotropin-releasing factor as a possible cause of comorbidity in anxiety and depressive disorders. In: Maser J, Cloninger R, eds. Comorbidity in Anxiety and Mood Disorders. Washington, DC: American Psychiatric Press, 1990: 413–435.

    Google Scholar 

  45. Kelly D, Walter CJS. A clinical and physiological relationship between anxiety and depression. Br J Psychiatry 1969;115: 401–406.

    Article  PubMed  CAS  Google Scholar 

  46. Ward NG, Doerr HO. Skin conductance: A potentially sensitive and specific marker for depression. J Nerv Ment Dis 1986;174:553–559.

    Article  PubMed  CAS  Google Scholar 

  47. Akiskal HS. Toward a clinical understanding of the relationship between anxiety and depressive disorders. In: Maser J, Cloninger R, eds. Comorbidity in Anxiety and Mood Disorders. Washington, DC: American Psychiatric Press, 1990:597–607.

    Google Scholar 

  48. Clayton PJ, Grove WM, Coryell W, Keller M, Hirschfeld R, Fawcett J. Follow-up and family study of anxious depression. Am J Psychiatry 1991;148:1512–1517.

    PubMed  CAS  Google Scholar 

  49. Davidson JR, Miller RD, Turnbull CD, Sullivan JL. Atypical depression. Arch Gen Psychiatry 1982;39:527–534.

    Google Scholar 

  50. Liebowitz MR, Quitkin FM, Stewart JW, McGrath PJ, Harrison W, Rabkin J, Tricamo E, Markowitz JS, Klein DF. Phenelzine vs imipramine in atypical depression. Arch Gen Psychiatry 1984;41:669–680.

    PubMed  CAS  Google Scholar 

  51. Akiskal HS Benazzi F. Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? J Affect Disord 2005;84:209–217.

    Article  Google Scholar 

  52. Akiskal HS. Dysthymic disorder: Psychopathology of proposed chronic depressive subtypes. Am J Psychiatry 1983b;140: 11–20.

    CAS  Google Scholar 

  53. Aretaeus of Cappadocia. The extant works of Aretaeus the Cappadocian. London: Sydenham Society, 1856.

    Google Scholar 

  54. Pauley J. Skywriting: A Life Out of the Blue. New York: Random House, 2004.

    Google Scholar 

  55. Bellow S. Herzog. New York: Viking Press, 1964.

    Google Scholar 

  56. Van Gogh V. The Letters of Van Gogh to His Brother 1872–1886: With a Memoir by His Sister-in-Law, J. van Gogh-Bonger. London: Constable & Co, Ltd; Boston and New York: Houghton-Mifflin, 1927.

    Google Scholar 

  57. Monroe RR. Creative Brainstorms: The Relationship Between Madness and Genius. New York: Irvington Publishers, Inc., 1992.

    Google Scholar 

  58. Krauthammer C, Klerman GL. Secondary mania: Manic syndromes associated with antecedent physical illness or drugs. Arch Gen Psychiatry 1978;35:1333–1339.

    PubMed  CAS  Google Scholar 

  59. Schou M. Artistic productivity and lithium prophylaxis in manic-depressive illness. Br J Psychiatry 1979;135:97–103.

    PubMed  CAS  Google Scholar 

  60. Carlson G, Goodwin F. The stages of mania. Arch Gen Psychiatry 1973;28:221–288.

    PubMed  CAS  Google Scholar 

  61. Cooper JE, Kendell RE, Gurland BJ, Sharpe L, Copeland JRM, Simon R. Psychiatric Diagnosis in New York and London. London: Oxford University Press, 1972.

    Google Scholar 

  62. Loosen PT, Prange AJ. Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: A review. Am J Psychiatry 1982;139:405–416.

    PubMed  CAS  Google Scholar 

  63. Perris C. A study of cycloid psychoses. Acta Psychiatr Scand SuppI 1974;253:1–77.

    CAS  Google Scholar 

  64. Akiskal HS, Puzantian VR. Psychotic forms of depression and mania. Psychiatr Clin North Am 1979;2:419–439.

    Google Scholar 

  65. Akiskal HS, Bourgeois ML, Angst J, Post R, Moller HJ, Hirschfeld RMA. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000;59(Suppl 1):5s–30s.

    Article  Google Scholar 

  66. Akiskal HS, Mallya G. Criteria for the “soft” bipolar spectrum: Treatment implications. Psychopharmacol Bull 1987;23: 68–73.

    PubMed  CAS  Google Scholar 

  67. Kukopulos A, Caliari B, Tundo A, Minnai G, Floris G, Reginaldi D, Tondo L. Rapid cyclers, temperament, and antidepressants. Compr Psychiatry 1983;24:249–258.

    Article  PubMed  CAS  Google Scholar 

  68. Dunner D. Rapid cycling bipolar manic depressive illness. Psychiatr Clin North Am 1979;2:461–467.

    Google Scholar 

  69. Akiskal HS, Djenderedjian AH, Rosenthal RH, Khani MK. Cyclothymic disorder: Validating criteria for inclusion in the bipolar affective group. Am J Psychiatry 1977;134:1227–1233.

    PubMed  CAS  Google Scholar 

  70. Akiskal H, Hantouche EG, Allilaire JF, Sechter D, Bourgeois M, Azorin JM, Chatenêt Duchêne L, Lancrenon S. Validating antidepressant-associated hypomania (bipolar III): a systematic comparison with spontaneous hypomania (bipolar II). J Affect Disord 2003;73:65–74.

    Article  PubMed  Google Scholar 

  71. Strober M, Carlson G. Clinical, genetic and psychopharmacologic predictors of bipolar illness in adolescents with major depression. Arch Gen Psychiatry 1982;39:549–555.

    PubMed  CAS  Google Scholar 

  72. Akiskal HS. Delineating irritable-choleric and hyperthymic temperaments as variants of cyclothymia. J Person Disord 1992;6:326–342.

    Google Scholar 

  73. Akiskal HS. Classification, Diagnosis and Boundaries of Bipolar Disorders, in Maj M, Akiskal HS, Lopez-Ibor JJ, Sartorius N, eds: Bipolar Disorder. London, John Wiley & Sons, 2002, pp. 1–52.

    Chapter  Google Scholar 

  74. Taylor MA, Fink M. Melancholia: The Diagnosis, Pathophysiology, and Treatment of Depressive Illness. Cambridge; Cambridge University Press, 2006.

    Google Scholar 

  75. Goodwin F, Jamison K. Manic-Depressive Illness. New York, Oxford University Press, 2006.

    Google Scholar 

  76. Marneros A, Akiskal H (eds). Overlap Of Affective And Schizophrenic Spectra. Cambridge: Cambridge University Press, 2006.

    Google Scholar 

  77. Akiskal HS, Akiskal KK (eds). TEMPS-A: Temperament evaluation of Memphis, Pisa, Paris and San Diego. Special issue monograph. J Affect Disord 2005;85:1–242.

    Article  PubMed  Google Scholar 

Download references

Authors
  1. Hagop S. Akiskal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry, University of Minnesota Medical School Medicine, 420 Delaware Street, SE Minneapolis, MN 55455, USA

    S. Hossein Fatemi PhD

  2. American Foundation for Suicide Prevention, 120 Wall Street, New York, NY 10005, USA

    Paula J. Clayton MD (Medical Director) (Medical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Akiskal, H.S. (2008). Mood Disturbances. In: Fatemi, S.H., Clayton, P.J. (eds) The Medical Basis of Psychiatry. Humana Press. https://doi.org/10.1007/978-1-59745-252-6_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-252-6_23

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-917-8

  • Online ISBN: 978-1-59745-252-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation