Mood disorder is a term that refers to abnormal emotional states. The pathogenesis is related to genetic inheritance and neurotransmitter imbalance with the favorable factor being psychological damage. Currently, treatment is quite limited, but can basically control symptoms and manage disease progression.
What is a mood disorder?
Mood disorders are also known as affective disorders. This term refers to abnormal emotional states with the main manifestation of a single depressive disorder or alternating between depression and mania. Emotional disturbances and instability cause many influences on thinking and behavior, thereby reducing work and learning performance and increasing conflicts and conflicts in relationships.
Basically, mood disorders are divided into 2 groups: depression and bipolar disorder (including manic and depressive episodes). In particular, the depressive state is of more interest due to its complex pathogenesis, chronic progression and treatment limitations than mania. Mood disorders are seen mainly in women and are not associated with personality deficits like other mental disorders.
The rate of depression in the community is 6% and can affect anyone, but most are people aged 35-40 years old. Bipolar disorder is less common with a rate of only 1% of the population and the disease onset is quite early, most common in the age group of 20 – 30. Mood disorders are not influenced too much by economic factors. economy, culture, living area, etc.
Causes of mood disorders
Until now, experts have not determined the cause of mood disorders. However, the studies that have been done have partly identified the factors involved in the pathogenesis.
1. Pathogenesis of depression
Depression is a state of extreme low mood and lasts for a considerable time. Patients with depression often have lower than normal cortical serotonin synaptic clefts (only about 30% of that in healthy people).
As is known, serotonin is a neurotransmitter that has the effect of creating a feeling of relaxation, bringing joy, optimism, stimulating appetite and sleeping well. Therefore, a decrease in serotonin will lead to feelings of melancholy, sadness, pessimism, loss of interest along with some symptoms such as insomnia and loss of appetite.
According to experts, the decrease in serotonin levels at the synaptic cleft is related to genetics. The gene that carries the disease will cause a disorder in the production of serotonin and as a result, the concentration of the substance in the brain will decrease. In particular, psychological trauma is considered a favorable factor for the onset of the disease. That is why depression often occurs after facing traumatic events such as debt default, miscarriage, terminal illness, divorce, etc.
When faced with these events, the body responds to stress by increasing the hormones cortisol and norepinephrine. An increase in these hormones causes serotonin levels to drop, which is a direct factor in the onset of symptoms of depression.
2. Pathogenesis of mania
Mania is an emotional state that is the exact opposite of depression. In this state, emotions are heightened, making the patient feel happy, excited, and sometimes excessive, leading to anger, irritability, and difficulty controlling speech and behavior.
During manic episodes, experts notice an excess of dopamine in the synaptic cleft. Dopamine is a transmitter that creates feelings of joy, pleasure, and excitement. However, an excessive increase in dopamine causes emotions to rise uncontrollably. Similar to depression, the pathogenesis of mania is also related to genetics, and trauma is only a predisposing factor to increase the risk of disease.
In addition to the main role of genetics and psychological trauma, substance addiction, alcohol use, depression, hormonal changes, weak personality, sensitivity, … are also increasing factors. risks of diseases.
Manifestations of mood disorders
Mood disorders have varied manifestations depending on the specific emotional state. Patients with depression will only have a depressive state. Meanwhile, people with bipolar disorder will have both depression and mania. In addition, the symptoms of the disease will also depend on the age and severity of the disease.
1. Symptoms of depression
Depression is characterized by a decrease in emotion due to a decrease in serotonin levels at the synaptic cleft. Melancholy mood significantly influences behavior and thinking, which in the long run affects quality of life and physical health.
Symptoms of depression:
- Sad Mood: A depressed mood is a condition in which the patient is always sad, with a melancholy face, pessimism, and despair, and these emotions tend to become more severe over time. In children and adolescents, depression may not manifest as sad moods but rather mood swings and irritability.
- Loss of Interest: The sadness and pessimism caused by depression causes the person to lose interest in everything, including previous interests. However, there are also many cases where they still maintain 1-2 hobbies, but most of them are in unhealthy forms such as addiction to online games, drinking a lot of alcohol, etc.
- Sleep disorders: Patients with depression often sleep too much or have trouble sleeping, in which 95% of cases have insomnia due to a decrease in serotonin, which causes the hormone melatonin to decrease. The patient’s sleep time is usually only 2 hours per day. However, about 5% of patients also report sleeping more than 10 hours a day.
- Lose weight, eat less: Low Serotonin also reduces appetite and loss of appetite. Most patients do not feel like eating, eat poorly and as a result, lose weight suddenly (it can be from a few kg to 10 kg). In contrast, about 5% of patients have appetite, binge eating leads to obesity.
- Reduced energy: Sad mood causes certain fatigue. In addition, poor eating and sleep disorders also make the body exhausted, sluggish and reduce energy. Fatigue usually increases in the morning and decreases slightly in the afternoon.
- Psychomotor activity disorders: Agitation (cannot sit still, always walking) or slow movement (slow speech, lethargy, slow movement,…). Patients have low voices, incoherent speech, slow response to questions, poor content, and even many patients who do not communicate at all. Motor agitation is common in young people, while slow movements are common in people between 35 and 40 years old.
- Feelings of guilt and self-worth: People with depression often feel that they are worthless, have no value, and become a burden on their families. In addition, the patient always believes that the things that happen in life are all due to themselves and always has a feeling of torment and guilt.
- Difficulty concentrating: Patients have difficulty concentrating when studying or working and it takes a long time to make even very small decisions. The patient cannot watch all TV shows, short articles or listen to a song that they love.
- Suicidal thoughts and behaviors: Most people with depression have thoughts of death and some plan to commit suicide. Suicidal behavior comes from thinking that one’s own death will make life better.
2. Manic symptoms
Mania is characterized by an elevated mood, excitement, and joy. However, excessive emotional elevation leads to agitation and exaggeration. Compared with depression, mania is easier to treat and is less likely to lead to suicide. The greatest effect of mania is conflict in relationships and the consequences of thoughtless behavior.
Symptoms of a manic state:
- Elevated Mood: In contrast to depression, mania is characterized by elevated mood. The main manifestations are cheerfulness, excitement, and excessive excitement that occurs most of the day. The patient loses the ability to self-critical in all relationships.
Pride: During manic episodes, patients often overestimate themselves and do not realize their faults. In severe cases, patients may experience delusions of pride with illusory content and far from reality about their own bravery and special abilities.
- Sleep less: Most manic patients sleep only 1-2 hours a day but do not feel tired and sluggish. On the contrary, the patient always feels comfortable, excited and full of life. Some patients even stay awake for a few days without showing any signs of fatigue or exhaustion.
- Talk a lot, talk fast: Manic patients often talk a lot, talk continuously, and have a loud, clear voice. Patients can talk non-stop throughout the day and the content is diverse, covering all issues related to life. In particular, patients often change topics continuously and sometimes read poetry, sing, and act regardless of whether those around them want to enjoy it or not.
- Dispersion of attention and thoughts quickly: In a manic state, the person loses the ability to pay attention and is very susceptible to external stimuli. In contrast to depression, in mania the patient has rapid thoughts and these thoughts are related to each other.
- Increased risk-taking behaviors: Manic patients often shop a lot without thinking, and some engage in risky behaviors such as racing, using drugs, risky investments, and having unprotected sex. indiscriminate. The patient has a high need for sex and always shows provocative and provocative behaviors with others.
Diagnosis of mood disorders
Mood disorders cause many effects on health and quality of life. To avoid serious complications, early examination is essential. Diagnosing tangles mood disorders are mainly based on clinical symptoms and the doctor will compare symptoms with ICD-10 or DSM-5 diagnostic criteria.
In addition, symptoms must last for at least 2 weeks and must not be the result of traumatic brain injury, substance abuse, or alcohol abuse. In addition, the patient may have to perform some laboratory tests to rule out physical diseases.
Methods of treating mood disorders
Mood disorders are related to neurotransmitter imbalances, so chemotherapy is the mainstay of treatment. In addition, psychotherapy will also be applied to heal emotional trauma and help patients manage stress, which makes the disease worse.
The principle of treating mood disorders is to cut off manic and depressive states. Then, conduct consolidation treatment to prevent relapse and restore mental function.
1. Attack Treatment
Aggressive treatment is designed to quickly relieve manic and depressive episodes. As mentioned, chemotherapy is the preferred choice in the treatment of mood disorders. Depending on the emotional state, the patient will be prescribed the corresponding drug.
Medications used in manic episodes:
Sedative: Can choose Aminazin 300-450mg/day, divided into 2 oral doses (morning-evening), Olanzapine dose 10-20mg/day used once in the evening or Haloperidol 10-20mg/day, divided into 2 times Drink (morning – evening).
Mood-modifying drugs: Usually Carbamazepine dose is 800-1200mg/day, divided into 2 doses (morning – evening) or Valproate sodium is used 800-1200mg/day divided into 2 uses (morning – evening).
Some of the medications used for depression include:
Antidepressants: Usually use Amitriptyline 100mg/day in 2 divided doses (morning – evening) or Mirtazapine at a dose of 15-45mg/day orally once in the evening.
New antidepressant: Use Sertraline at a dose of 50-100mg/day orally once in the evening or Fluoxetine 20-40mg/day orally once a day after breakfast.
In case of psychotic symptoms, antipsychotic drugs will be used.
For treatment-resistant cases, the patient has committed suicide and self-destructive behavior, electroconvulsive therapy will be considered. In addition, patients allergic to antidepressants are also treated with this method. Electroconvulsive therapy is given from 8 to 12 times depending on the response and specific disease status.
2. Consolidation treatment
Consolidation treatment is carried out with the aim of preventing relapse. Basically, mood disorders are related to genetics and neurotransmitter imbalance, so the disease can recur after stopping treatment. In some cases, patients must have lifelong consolidation therapy to stabilize their lives and minimize the number of relapses.
Consolidation treatment for patients with bipolar disorder (including manic and depressive episodes):
Usually use mood-modifying drugs such as Carbamazepine 200mg x 4 tablets/day divided into 2 oral doses (morning – evening) or Valproate sodium 200mg x 4 tablets divided into 2 oral doses (morning – evening).
Patients must take medication for the rest of their lives to prolong the stabilization period and prevent relapses.
Consolidation treatment for people with depression:
Usually use antidepressants such as Fluoxetine 20mg x 1 tablet/day taken in the morning, Sertraline 100mg x 1 tablet/day taken in the evening or Amitriptylin 25mg x 4 tablets/day divided into 2 oral doses (morning – evening). .
Patients with depression require consolidation therapy for at least 1 year and may require lifelong treatment if 5 or more relapses occur.
To increase the effectiveness, patients should combine chemotherapy with psychotherapy. Psychotherapy helps patients stabilize their moods and know how to control their emotions. In addition, experts will also help patients adjust their perception in a more positive direction so that they can evaluate themselves and everything around in an objective and correct way.
Psychotherapy also helps patients have soft skills to serve life and easily integrate with people. Besides, patients are also equipped with stress relief skills because good stress management is an important step in preventing disease recurrence and stabilizing long-term life.
Rehabilitation measures for patients with mood disorders
In addition to aggressive and reinforcing treatment, patients need mental rehabilitation to adapt to the community, increase quality of life, and improve physical and mental well-being. This is an important step in helping patients manage their progression and minimize the impact of the disease.
Psychiatric rehabilitation measures for patients with mood disorders:
- The family needs to be there to encourage and encourage the patient to maintain treatment. In addition, patients should be encouraged to perform simple activities such as personal hygiene, house cleaning, cooking, etc.
- Encourage the patient to study, work and fulfill his/her family member duties.
- The family should remind the patient to use the medicine regularly and pay attention to any unusual symptoms to promptly notify the doctor.
- Instruct the patient to do more complex household chores. It is best to work together to help when needed and motivate the patient to build a sense of responsibility, bravery and more initiative in life.
- Educating the patient about social skills such as teamwork, study, working according to rules, etc. In addition to the support of members, the family should also allow the patient to participate in psychotherapy – especially is group therapy to improve social skills. Besides, music therapy, cultural therapy, labor, etc. also play a significant role in mental rehabilitation.
- Families should exercise with the patient daily to relieve stress and exercise. This measure also directs patients to a healthy, scientific lifestyle, away from alcohol, tobacco and stimulants.
- Encourage patients to go to supermarkets, parks, churches, etc. with their loved ones to increase their ability to adapt and integrate into the community.
- If they have difficulty in learning, the family should orient the patient to an apprenticeship to increase the chances of finding a job. In addition, inspiration should be given to motivate patients to study and strive to improve themselves.
Mood disorder is a common mental disorder today. Because the disease is related to inherited genes, the possibility of recurrence is high and treatment is limited. In order for the patient to manage the disease well, the family needs to work closely with the doctor in the process of treatment and care.