Doctors Corner
EVERY one of us has moments during the day when their emotional state alters. Sadness and joy are part of everyday life.
An individual’s emotional state varies depending on many interactive factors which could be environmental, social, financial etc.
In other words the state of your emotion is a result of an interaction of several factors and is therefore dynamic.
However every individual usually has some control over their own emotional state.
There are many people however, who are not able to control their emotions or mood, and may have a persistent state of a particular emotion, exhibiting very exaggerated mood states such as major depression at one extreme or a high state of excitement, hyperactivity and elation of the mood on the other extreme.
When there is either one mood or the other, for example when there is either depression only or excitement only, the state is referred to as a unipolar condition.
There may be conditions in between these extreme unipolar states, called the bipolar disorders, when both features of depression and elation exist usually in an alternating fashion.
A patient with bipolar disorder may be found in a very euphoric state at one instance, and then found crying from depression in the next instance.
The emphasis when discussing mood disorders generally is on depression and elation as the core components of mood disorders.
However, anxiety and irritability are equally common, explaining the continued popularity of the broader rubric of “affective disorder”.
Depression or mania (another name for extreme elation) is diagnosed when sadness or excitement is overly intense and continues beyond the expected impact of a life stressor or arises in the absence of a stressor.
Signs and symptoms often cluster into a group of characteristics that typically recur or, less commonly, persist without stopping.
Significant depression and mania, unlike normal emotional reactions, cause marked impairment in physical function, social function, and work capacity.
Some type of mood disturbance, which may require a doctor’s attention, affects 20 percent of women and 12 percent of men during their lifetime.
Mood disorders are the most common psychiatric disorders, accounting for 25 percent of patients in public mental institutions.
These disorders also account for 65 percent of psychiatric outpatients, and as many as 10 percent of patients seen in non-psychiatric medical settings.
Depression affects twice as many women as men.
Bipolar disorders affect both sexes equally, but generally depression predominates in women while mania predominates in men.
Bipolar disorders usually begin in the teens, 20s, or 30s; unipolar disorders begin, on average, in the 20s, 30s, or 40s.
Social class, culture, and race have not been associated with depression.
However, bipolar disorder is somewhat more common in upper socio-economic classes.
Economic factors, such as unemployment and sudden financial reversals, have been linked to increased suicide rates in men.
Genetic inheritance is one of the most important predisposing factors.
This heredity mechanism may also increase the likelihood of depression by exposing children to the negative effects of their parent’s mood disorders.
Unipolar depression is more likely to develop in persons who are introverted and have anxious tendencies.
Such individuals often lack the requisite social skills to adjust to significant life pressures and often have difficulty recovering from any depressive episode.
Persons with bipolar disorders tend to be extroverted and achievement-oriented — they often use activity to combat depression.
Suicide, the most serious complication in patients with mood disorders, is the cause of death in 15 to 25 percent of untreated patients with mood disorders; unrecognised or inadequately treated depression contributes to 50 to 70 percent of all completed suicides.
Suicide, which is most common in young and elderly men who do not have good social support, tends to occur within four to five years of the first clinical episode.
Concurrent alcohol and substance abuse also increases the risk of suicide.
Specific mood disorders such as depression and mania itself and other psychiatric conditions will be discussed in forthcoming articles in more detail.
We shall also look at how we can recognise when someone is having significant depression to require medical attention as well as how to determine whether someone is likely to commit suicide, and what measures should be taken.
Anxiety disorders will also be looked at, including panic attacks, obsessive-compulsive disorders and acute stress disorder.
In future we will also look at general principles of child psychology and development.
