Affective Disorders

Abstract

Affective disorders refer to extra paranormal, long-lasting and manifest emotional reaction, which features extensive affective disorder, psychomotor dysfunction and autonomic symptoms. When judging whether an affective reaction is normal, the doctor needs to consider three conditions: the intensity of affective reaction, the duration of it and its conformity to its surrounding. Normal affections, such as joy, anger, sadness and euphoria are parts of people’s daily life, and they should differ from abnormal affections of affective disorders which last longer.

Affective disorders refer to extra paranormal, long-lasting and manifest emotional reaction, which features extensive affective disorder, psychomotor dysfunction and autonomic symptoms. When judging whether an affective reaction is normal, the doctor needs to consider three conditions: the intensity of affective reaction, the duration of it and its conformity to its surrounding. Normal affections, such as joy, anger, sadness and euphoria are parts of people’s daily life, and they should differ from abnormal affections of affective disorders which last longer.

In psychiatry, “affection” and “emotion” are usually considered synonyms collectively known as “feeling”, including both the attitude towards objective things and the inner experience gained accordingly by an individual. The two terms differ in that an affection is usually closely related to sociality, featuring greater stability, persistence, implicitness and profundity; whereas an emotion is closely related to naturalness, featuring more situationality, instability, impulsiveness and explicit behavior. Emotions are the outward manifestations of affection, while affection is the intrinsic nature of emotions. A mood is a weak, calm, dispersed and persistent emotional status. An affective disorder is inevitably related to emotions and moods.

There are extensive inner associations between affective disorders and physical maladies. An affective disorder may be a direct or indirect cause to certain physical diseases; it may also be the direct manifestation of impacts of pathological damages on the neural system caused by certain physical diseases, or a reaction to some physical diseases.

1 Clinical Manifestations

Generally, affective disorders are presented in three forms, namely, changes in affective nature, changes in affective fluctuation and changes in affective coordination.

• 1. Disorders of an affective nature refer to the disproportionate intensity and duration of affective reactions to the stimulation of reality. It is true that under certain circumstances, normal people may also manifest affective reactions such as depression, mania, phobia and anxiety; however, only when such reactions have exceeded the normal degree of stress response to life events and thus cannot be interpreted according to the individual’s situation and moods, may they be deemed as psychiatric symptoms. Main changes of affective nature are as the following:

  • Elation: Affective activities see apparent enhancement, featuring morbid gladness, excessively positive self-perception, exorbitant exhilaration incompatible with the surrounding, loud speech, variant facial expressions and exultation, etc. Elation is manifested as a high-spiritedness that is understandable, appealing and easily resonant. It is commonly seen in patients with mania. The high-spiritedness that is not easily understood and features self-content is known as euphoria, which is commonly seen in patients with cerebral organic diseases or drunkenness.

  • Hypothymergasia: People with hypothymergasia show sad facial expressions and sorrow, and consider their future as bleak. Severe cases of hypothymergasia may experience despair and pessimism that often initiate suicidal thoughts and attempts. There are usually accompanying symptoms, such as retardation of thought, movement decrease, and certain inhibitions of physical functions such as anorexia and amenorrhea. Hypothymergasia is a major symptom of depression.

  • Anxiety: Anxiety refers to an expectant status accompanied with extreme restlessness in absence of corresponding objective factors. The patient has a number of manifestations, including excessive worries, a state of nervousness, uneasiness, a feeling of misfortune and constant panic, with a series of autonomic dysfunction symptoms such as palpitation, perspiration, cold hands and feet, quivers and frequent urination. Severe acute anxiety is also known as a panic attack, where the patient often has near-death and out-of-control experiences, accompanied with autonomic dysfunction symptoms such as difficulty in breathing and tachycardia. A panic attack usually lasts a few or tens of minutes.

  • Phobia: Phobia refers to the emotional reaction to adverse or dangerous situations. It manifests nervousness, fear and panic, along with evident autonomic dysfunction symptoms such as palpitation, tachypnea, perspiration, trembling limbs and even incontinence. Phobia usually leads to a desire to escape. The fears for certain specific matters are main symptoms of phobia.

• 2. An affection fluctuation disorder refers to an affective trigger dysfunction, which manifests dramatic affective fluctuations. Normally the disorder lasts a relatively short period of time. The main changes in affection fluctuation are as the following:

  • Labile affect: Patients with labile affect manifest extremely changeable affective responses, going from one extreme to another, which are totally unpredictable. While mild labile affect triggered by external surroundings may be a “character” thing, the labile affect irrelevant to external surroundings is a sign of mental illnesses. Labile affect is commonly seen in cerebral organic mental disorders.

  • Apathy: Apathy refers to the absence of affective responses to external stimulations, even to those the patients own a stake for. The patients are indifferent to what happens around them. They do not have much facial expression, have very few words and lack inner experiences. This manifestation is commonly seen in mental disorders and dementia that accompany schizophrenia and certain physical diseases.

  • Affective fragility: Manifestations of affective fragility include extreme liability to sadness. People who have affective fragility are very likely to be moved by and cry for very trivial matters. Although they may feel such sentiment unnecessary sometimes, they fail to exert self-control. This problem is commonly seen in depression, neurasthenia and dissociative disorders.

  • Emotional stupor: Emotional stupor refers to a status of brief and deep affective inhibition triggered by exceedingly strong mental stimuli. Overwhelmed by extreme grief or panic, the patients lack the corresponding affective experience or facial expressions as an appropriate reaction. This problem is commonly seen in acute stress disorder and dissociative disorder.

  • Irritability: Irritability is manifested as strong affective reactions triggered by mild stimulation. Its manifestations include agitation and anger that often lead to behaviors of bodily harm and/or vandalism. This state is usually transient and is commonly seen in fatigue, personality disorder, neurosis and paranoiac psychosis.

  • Pathological passion: Pathological passion refers to an intense but brief affective eruption. It is usually accompanied by impulsiveness and acts of sabotage, which the patient can only partially recall afterwards. The problem can be seen in cerebral organic mental disorders, mental disorders accompanying physical diseases, schizophrenia, reactive psychosis, and mental disorders accompanying mental retardation.

• 3. Affective coordination disorder refers to the discordance between affective experiences and environmental stimulation that trigger them, or the contradiction between inner experience and facial expressions. The main changes in affective coordination are as the following:

  • Parathymia: Parathymia refers to inappropriate affective manifestations to inner experience and the surroundings. For instance, the patient may appear sad in a joyous occasion but happy over misfortunes. It is commonly seen in schizophrenia.

  • Affective infantility: Affective infantility means a status in which an adult’s affective reaction resembles that of children. The adult becomes naïve, lacks rational control and reacts fast and intense without moderation or concealing. This problem is usually seen in hysteria and dementia.

  • Affective ambivalence: Affective ambivalence is manifested as two opposing affective reactions towards the same person or matter at the same time by the patient, who feels neither painful nor uneasy because he does not see any contradiction or contrast between these two opposing affective reactions. This problem is mostly seen in schizophrenia.

Key Points in History Taking

• 1. Age of onset, pre-morbid personality, acuteness and chronicity, characteristics of the surroundings and the scene, periodicity and seasonality, and time and location;

• 2. Exact symptoms and syndrome, the intensity of affective reaction and duration;

• 3. Inducing factors, pathogenesis, presence or absence of alarming symptoms, and factors for relief or exacerbation;

• 4. The process of affective disorder;

• 5. Presence or absence of accompanying symptoms, such as abnormal cognition and psychological state, psychotic symptoms, or psychomotor and autonomic dysfunctions, etc.;

• 6. Presence or absence of signs of fever, convulsions, coma, and allergic history; presence or absence of signs of infection, craniocerebral traumas, physical disease history, and history of poisoning and medication, etc.; presence or absence of family members with mental disorders, alcohol or drug dependency and history of consanguineous marriage, etc.

• 7. General conditions during the disease course.